School of Health Sciences
Philosophy of Nursing Programs (MSN)
Master Degree of Sciences in Nursing with Specialty in Family Nurse Practitioner (MSN FNP)
The Dimensions of Nursing
The dimensions of nursing include the cognitive, interpersonal, ethical, skill, process, and reflective dimensions. The cognitive dimension of nursing practice encompasses the knowledge needed for the nurse to identify client health needs and to plan and implement care to meet those needs. The interpersonal dimension includes affective elements and interaction skills. Affective elements consist of the attitudes and values of the nurse that influence his/her ability to practice effectively. Interaction skills and the abilities to collaborate and communicate effectively with others are important elements of the interpersonal dimension.
The ethical dimension includes moral and ethical principles which are essential elements in nursing. Nurses must be able to make ethical decisions targeted to always decide what is best for the client and to be his/her advocate. The skills dimension encompasses manipulative and intellectual skills. These are common to all aspects of nursing practice. Manipulative require performance of different procedures and intellectual skills include capacities for critical thinking.
The process dimension refer to several specific processes utilized in the provision of care: nursing process, epidemiologic process, health education, home visits, case management, change process, leadership process, group process, and political process. The most fundamental process, according to this model, is the nursing process. Nursing actions occur in the context of the nursing process. The dimensions of health are used to guide assessment of the client’s health status and to derive nursing diagnosis. The dimensions of health care direct the planning, implementation, and evaluation of nursing interventions.
The faculty believes that nursing is an art and a science; a discipline oriented towards the diagnosis and treatment of actual or potential health problems. Nursing involves observations, interactions, and analysis of interventions with families, groups and communities. These interventions take place in a variety of scenarios and at primary, secondary, and tertiary prevention levels.
The nursing professional assumes different roles according to the time and situation. Therefore, the necessary knowledge, skills and competencies are essential, according to the role assumed. All nurses must demonstrate excellent decision-making, problem-solving and critical thinking skills in order to be able to impact the health care delivery systems.
An essential domain in the education of nursing professionals is the concept of the client being in constant interaction with the environment. The client is continuously evolving, and the behavior is a manifestation of interaction with the environment. Each person is responsible to make decisions that affect their health. Health is viewed, as a dynamic state where individuals take responsibility for their quality of life by meeting different needs. Nursing interactions are focused on health promotion and disease prevention. When the person is not able to maintain health the nursing professional uses therapeutic interventions with the purpose of assisting the individual in the process of health restoration.
Theoretical frameworks, research, and scientific knowledge are important processes in which nurses develop, validate, and communicate problems. Practice, education, and administration/leadership are the bases for nursing care, which is performed in collaboration with other members of an interdisciplinary health care team. The nurse’s role is that of a health care provider who both, independently and in collaboration with others, assesses, plans, implements, and evaluates nursing care.
The client includes biophysical, psychological, physical-environmental, behavioral and health system dimensions. Illness is the loss of balance between these dimensions as a product of the relationship between the client, and the environment. The health of individuals, families, and communities is affected by this imbalance. Because of this constant interaction of individuals with the environment, three levels of therapeutic interventions through the different dimensions of nursing are directed toward the satisfaction of human needs to reach the goal of optimum health.
With the current gaps in health care services, Puerto Rico needs well-trained advanced practice nurses with increased knowledge and skills to provide primary care to those lacking high quality accessible health care. The students in the graduate program are encouraged to maintain a holistic perspective in the health care they provide with a multidisciplinary and collaborative focus throughout the individuals life span. The establishment of FNP program will increase the access to health promotion, health prevention and primary care services, yet furthermore decrease morbidity and mortality in medically underserved low-income populations of Puerto Rico and globally.
The graduate program is oriented towards a greater depth and breadth of knowledge and a greater degree of complexity of skills and interventions in primary care. Currently, the American Nurse Association identifies the following four advanced practiced nursing roles: nurse anesthetist (CRNA), midwifery (CNM), clinical nurse specialist (CNS), and nurse practitioner (NP). As such, the School of Health Sciences has selected the role of nurse practitioner, specifically Family Nurse Practitioner.
The Master of Science in Nursing degree program prepares advanced practice nurses to contribute in specialized areas with the first specialty being Family Nurse Practitioner. Specialty in Family Nurse Practitioner in the academic program of Master of Science in Nursing is the first nurse practitioner program in Puerto Rico. For over 30 years nurse practitioners have demonstrated to be an asset to the increased demand for primary health care services. Locally and globally there are increasing opportunities for nurse practitioners to provide primary care to underserved communities. Family Nurse Practitioners provide health care services to individuals, families, groups of clients and communities, with an emphasis on health promotion, disease prevention and diagnosis and management of common and acute illnesses/injury and stable chronic diseases. Within their scope of practice they may order, conduct and interpret diagnostic and laboratory tests and prescribe pharmacologic and non-pharmacologic treatments. Educating and counseling individuals and their families regarding healthy lifestyle behaviors are also within their scope of practice.
The students in the Family Nurse Practitioner Academic Program are encouraged to maintain a holistic perspective in the health care they provide with a multidisciplinary and collaborative focus throughout the individuals life span of the patient.
In addition to the Dimensions Model of Community Health Nursing the Specialty in Family Nurse Practitioner in the academic program of Master of Science in Nursing is embedded in the empowerment theory. Zerwekh describes empowerment as a helping process that enables a person to take charge of his/her life and make choices and believe that the future may be influenced. Empowerment is fostered through mutual participation where the patient and provider have equal power. Participation in community activities creates change through critical thinking and dialogue that can lead to outcomes such as economic ventures, educational opportunities, political action, and access to health care services. Through the dialogue process, the oppressed become self-reliant, self-assertive, self-determinative, and self-sufficient, while the academics must relinquish some of their own power and control.
The conceptual model (See Figure 2) is represented by three concentric circles with four arrows on the superior side of the outer circle pointing upwards and three arrows from the inferior side of the outer circle pointing downwards. The circle at the core of the model represents increased access to primary health care through the utilization of Nurse Practitioners. The intermediate circle symbolizes the interventions of health promotion and health prevention through education provided to clients. The outer circle depicts the empowerment of clients superiorly and the empowerment of communities inferiorly. From this outer circle, emerge the arrows that point the outcomes of the interaction of the NP with individuals and communities. Consequently, the four superior external circles reflect increased client satisfaction, increased positive healthcare outcomes, increased quality of life and increased number of clients receiving primary care through the empowerment of clients with the practice of Nurse Practitioners.
Additionally, the three inferior external circles illustrate the increase of quality of life, increase of healthy communities and decrease of gaps in community services with the empowerment of communities through the utilization of Nurse Practitioners. The conceptual framework for the Master of Science in Nursing Program with Specialty in Family Nurse Practitioner is consistent with the goals of the undergraduate nursing program and the School of Health Sciences. The establishment of this program will not only increase the access to health promotion, health prevention and primary care services, yet furthermore will decrease morbidity and mortality in medically underserved low-income populations of Puerto Rico and globally.
Figure 2 Adaptation of Zerwekh’s Empowerment Model