COURSE SYLLABUS
RNSG 1513 (5:4:4)
FOUNDATION FOR NURSING PRACTICE
**********
ASSOCIATE DEGREE NURSING PROGRAM
DEPARTMENT OF NURSING
HEALTH OCCUPATION DIVISION
LEVELLAND CAMPUS
SOUTH PLAINS COLLEGE
SPRING 2013
SCANS COMPETENCIES
RESOURCES: Identifies, organizes, plans and allocates resources.
C-1
TIME--Selects goal--relevant activities, ranks them, allocates time, and prepares and follows schedules.
C-2
MONEY--Uses or prepares budgets, makes forecasts, keeps records, and makes adjustments to meet objectives
C-3
MATERIALS & FACILITIES-Acquires, stores, allocates, and uses materials or space efficiently.
C-4
HUMAN RESOURCES--Assesses skills and distributes work accordingly, evaluates performances and provides
feedback.
INFORMATION--Acquires and Uses Information
C-5
Acquires and evaluates information.
C-6
Organizes and maintains information.
C-7
Interprets and communicates information.
C-8
Uses computers to Process information.
INTERPERSONAL--Works With Others
C-9
Participates as members of a team and contributes to group effort.
C-10
Teaches others new skills.
C-11
Serves clients/customers--works to satisfy customer's expectations.
C-12
Exercises leadership--communicates ideas to justify position, persuades and convinces others, responsibly challenges
existing procedures and policies.
C-13
Negotiates-Works toward agreements involving exchanges of resources resolves divergent interests.
C-14
Works with Diversity-Works well with men and women from diverse backgrounds.
SYSTEMS--Understands Complex Interrelationships
C-15
Understands Systems--Knows how social, organizational, and technological systems work and operates effectively with
them
C-16
Monitors and Correct Performance-Distinguishes trends, predicts impacts on system operations, diagnoses systems'
performance and corrects malfunctions.
C-17
Improves or Designs Systems-Suggests modifications to existing systems and develops new or alternative systems to
improve performance.
TECHNOLOGY--Works with a variety of technologies
C-18
Selects Technology--Chooses procedures, tools, or equipment including computers and related technologies.
C-19
Applies Technology to Task-Understands overall intent and proper procedures for setup and operation of equipment.
C-20
Maintains and Troubleshoots Equipment-Prevents, identifies, or solves problems with equipment, including computers
and other technologies.
FOUNDATION SKILLS
BASIC SKILLS--Reads, writes, performs arithmetic and mathematical operations, listens and speaks
F-1
Reading--locates, understands, and interprets written information in prose and in documents such as manuals, graphs,
and schedules.
F-2
Writing-Communicates thoughts, ideas, information and messages in writing, and creates documents such as letters,
directions, manuals, reports, graphs, and flow charts.
F-3
Arithmetic--Performs basic computations; uses basic numerical concepts such as whole numbers, etc.
F-4
Mathematics--Approaches practical problems by choosing appropriately from a variety of mathematical techniques.
F-5
Listening--Receives, attends to, interprets, and responds to verbal messages and other cues.
F-6
Speaking--Organizes ideas and communicates orally.
THINKING SKILLS--Thinks creatively, makes decisions, solves problems, visualizes, and knows how to learn and
reason
F-7
Creative Thinking--Generates new ideas.
F-8
Decision-Making--Specifies goals and constraints, generates alternatives, considers risks, and evaluates and chooses
best alternative.
F-9
Problem Solving--Recognizes problems and devises and implements plan of action.
F-10
Seeing Things in the Mind's Eye--Organizes and processes symbols, pictures, graphs, objects, and other information.
F-11
Knowing How to Learn--Uses efficient learning techniques to acquire and apply new knowledge and skills.
F-12
Reasoning--Discovers a rule or principle underlying the relationship between two or more objects and applies it when
solving a problem.
PERSONAL QUALITIES--Displays responsibility, self-esteem, sociability, self-management, integrity and honesty
F-13
Responsibility--Exerts a high level of effort and preservers towards goal attainment.
F-14
Self-Esteem--Believes in own self-worth and maintains a positive view of self.
F-15
Sociability--Demonstrates understanding, friendliness, adaptability, empathy, and politeness in group settings.
F-16
Self-Management--Assesses self accurately, sets personal goals, monitors progress, and exhibits self-control.
F-17
Integrity/Honesty--Chooses ethical courses of action.
SOUTH PLAINS COLLEGE
ASSOCIATE DEGREE NURSING PROGRAM
FOUNDATION FOR NURSING PRACTICE
TABLE OF CONTENT
Page
COURSE SYLLABUS ...................................................................................................................4
Course Description......................................................................................................................4
Course Learning Outcomes.........................................................................................................5
Course Competencies..................................................................................................................5
Academic Integrity......................................................................................................................5
Verification of Workforce Competencies ...................................................................................6
SPECIFIC COURSE/INSTRUCTOR REQUIREMENTS .......................................................6
Attendance Policy .......................................................................................................................6
Assignment Policy ......................................................................................................................6
Grading Policy ............................................................................................................................7
Course Grade Worksheet ............................................................................................................8
Grievance Policy .........................................................................................................................9
Course Requirements ..................................................................................................................9
COURSE OUTLINE .....................................................................................................................9
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
XVI.
XVII.
Nursing Today, Theoretical Foundations of Nursing Practice, Caring in Nursing 11
Nursing Process ....................................................................................................12
Older Adult ............................................................................................................24
Health Maintenance, Promotion, & Wellness........................................................24
Communication ......................................................................................................25
Health Care Delivery System.................................................................................34
Stress and Coping ..................................................................................................35
Self Concept ...........................................................................................................36
Complimentary & Alternative Therapies...............................................................36
Ethics & Values, Legal Implications In Nursing Practice .....................................37
Sensory Alterations ................................................................................................38
Spiritual Health ......................................................................................................39
Cultural and Ethnicity ..........................................................................................39
Sleep .......................................................................................................................41
Patient Safety .........................................................................................................42
The Experience of Loss, Death, & Grief ...............................................................43
Pain Management…………………………………………………………………45
2
ACCOMODATIONS ...................................................................................................................10
APPENDIX………………………………………………………………………………………46
3
Campuses: Levelland
COURSE SYLLABUS
COURSE TITLE:
RNSG 1513 Foundations for Nursing Practice
INSTRUCTORS:
Reva Lynn Baldwin, MSN, RN-Level I Semester I Coordinator
Emily Rider, MS, RN-RNSG 1513 Course Leader
Korbi Berryhill MSN, RN CRRN - Instructor
OFFICE LOCATION, PHONE/ E-MAIL:
Reva Lynn Baldwin 716-2392, lbaldwin@southplainscollege.edu
Emily Rider
716-2194, erider@southplainscollege.edu
Korbi Berryhill
716-2393, kberryhill@southplainscollege.edu
OFFICE HOURS:
Posted on each instructor’s door.
SOUTH PLAINS COLLEGE IMPROVES EACH STUDENT’S LIFE
******************************************************************************
I.
GENERAL COURSE INFORMATION:
A.
COURSE DESCRIPTION:
Introduction to the role of the professional nurse as provider of patient-centered care, patient
safety advocate, member of health care team, and member of the profession. Content includes
fundamental concepts of nursing practice, history of professional nursing, a systematic
framework for decision-making and critical thinking. The mechanisms of disease and the needs
and problems that can arise are discussed and how the nursing process helps manage the patient
through these issues. Emphasis on knowledge, judgment, skills and professional values within a
legal/ethical framework.
RNSG 1513 involves the development of basic nursing principles essential in caring for the
individual who is influenced by genetic inheritance, life experiences and cultural background and
is part of a larger community. The student will develop observational, and communication skills.
Emphasis is placed on the unifying concepts of basic human needs, roles of the nurse and
nursing practice. The focus is on the client in a state of homeostasis with attention to
interruptions, caused by common stressors that prevent need attainment.
College laboratory and clinical agency experiences offer opportunities for beginning nursing
practice and application of classroom learning applied to the adult client experiencing stressors
of illness. Through classroom and laboratory/clinical experiences the student explores basic
concepts and skills related to nursing process, communication, safety, problem solving, critical
thinking, collaboration, delegating, referrals, cost effectiveness, quality care, ethical/legal
practice, self awareness/self monitoring and client advocacy.
4
1.
Placement:
Level I Semester I
2.
Time Allotment:
Sixteen (16) weeks. The course allows five (5) semester hours credit including didactic
and laboratory.
3.
Teaching Strategies:
Team teaching, demonstrations, independent assignments, Nursing Resource Learning
Laboratory, Center for Clinical Excellence, audiovisual media, group presentations, and
discussions.
4.
Teaching Personnel:
Associate Degree Nursing faculty and guest speakers.
B.
COURSE LEARNING OUTCOMES
1. Upon satisfactory completion of RNSG 1513, the student will meet the following:
a. The SCANs (Secretary’s Commission on Attaining Necessary Skills) Competencies
Foundations Skills found within this course are: C1,C3, C4, C5, C6, C7, C9, C11, C12,
C13, C14, C15, C16, C17, F1, F2, F3, F4, F5, F6, F7, F8, F9, F11, F12, F13, F14, F15 &
F17.
b. SPC ADNP Graduate Outcomes: 1, 2, 3, 4, & 5.
c. DECs (Differentiated Essential Competencies) are listed in each unit.
C.
COURSE COMPETENCIES
Successful completion of this course requires:
a. A minimal average grade of “77” on examinations
b. Satisfactory achievement of unit and course outcomes
c. Regular classroom attendance
D.
ACADEMIC INTEGRITY
1. Refer to the SPC Catalog and the SPC ADNP Nursing Student Handbook for policies related
to academic integrity.
2. Specific examples related to this course of academic integrity violations may include, but are
not limited to, the following:
a. Presenting work as your own when you have worked in pairs or groups to complete it.
All work in this course is intended to be completed on your own unless it is specified
by the instructor as group work.
5
E.
VERIFICATION OF WORKPLACE COMPETENCIES:
No external learning experiences are provided in this course but learning experiences in the lab
provides the setting in which the student applies workplace competencies. Successful
completion of the designated Level 1 Semester 1 course outcomes will allow the student to
continue to advance within the program. Successful completion of RNSG 1513 meets the
requirements as stated in the Differentiated Essential Competencies of Graduates of Texas
Nursing Program.
II.
SPECIFIC COURSE/INSTRUCTOR REQUIREMENTS:
A.
ATTENDANCE POLICY
1. The SPC ADNP policy must be followed. Refer to the SPC ADNP Nursing
Student Handbook to review this policy. In addition, refer to the attendance
policy found in the South Plains College Catalog.
2. Punctual and regular class and lab attendance, as stated in the SPC Student Handbook, is
required of all students attending South Plains College. According to the SPC Student
Handbook there are no excused absences. The instructor/course leader has the prerogative
of dropping the student from the course for any absences.
3.
E.
Lecture attendance is mandatory. The instructor may initiate a student’s withdrawal if
a student misses 5 hours or more of class. Reinstatement is handled on an individual basis
by the course leader. *Do not be tardy for lecture. If lecture has began before you enter the
classroom, you must wait until the break period to enter the classroom. Pagers and cellular
phones must be turned off during the lecture period or while in the NLRL will be
confiscated and given to the Health Occupation Dean.
ASSIGNMENT POLICY:
1. All required work must be in on time in order that the student may benefit
from the corrections and study for future examinations. Assigned outside
work is due on the dates specified by the instructor. Assignments turned in
later than the due date may not be accepted unless the student clears the
circumstances with the instructor. Late work may be assessed penalty points by the
instructor. The assignment may be docked five (5) points per day for each late day. Students
should keep a copy of all assignments turned in, to avoid having to redo an assignment if it
should be lost.
2. Examination Policy:
a) Exams will not be retained by the student. After all students have
taken an exam, feedback will be provided at a scheduled time. Exams
may be reviewed by students upon request, under direct supervision.
6
b) A student must communicate with the course leader if unable to take an exam on a
scheduled day. If there is no communication prior to the time the exam is
administered, a “0” will be given.
c) Alternate exams may be given as make up exams.
d) Name badge must be worn when testing in the computer lab.
C.
GRADING POLICY:
1.
Refer to SPC ADNP Nursing Student Handbook Grading System
2.
There will be three preliminary tests, and a comprehensive final examination to
determine the course grade.
3.
The final exam will be administered at the end of the semester.
4.
A student course grade worksheet can be found on the following page.
5.
A student must receive a minimum course grade of “C” to progress to the next nursing
course.
6.
Grading Scale:
7.
A Personal Belief paper must be turned in as assigned, meeting all stated criteria found.
The paper has a pass/fail graded: but, is required for completion of the course.
8.
A minimal of 5 hours on practice tests of the ATI Assessment System must be
documented and submitted prior to taking the final exam of RNSG 1513.
9.
Failure of RNSG 1513, 1160, 1144, 1105, and/or 1115 and/or will necessitate repeating
Level I Semester I courses. When repeating any course, the student is required to
complete all aspects of the course including the required written work.
A = 90% - 100%
B = 80% - 89%
C = 77% - 79.99%
D = 60% - 76.99%
F = below 60%
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SOUTH PLAINS COLLEGE
ASSOCIATE DEGREE NURSING PROGRAM
COURSE GRADE WORKSHEET
FOR
NURSING FOUNDATIONS
Student’s Name:_______________________________________________________________
1.
Prelims:
1.
2.
3.
_________ X 0.24 = ________
_________ X 0.24 = ________
_________ X 0.24 = ________
3.
Final Exam Grade X 0.28 = __________
4.
Final Grade (add all the above) = __________
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E.
GRIEVANCE POLICY:
The student is responsible for scheduling an appointment with the instructor/course leader to
discuss the final grade or discipline action. If the student is not satisfied, he/she should schedule
an appointment with the Level I Semester I Coordinator. The next chain of command is to make
an appointment with the Health Occupation Dean. The procedure will follow the same as found
in the student handbook.
E.
III.
COURSE REQUIREMENTS:
1.
Prerequisites: Chemistry 1406, Psychology 2301, Biology 2401,
and English 1301.
2.
Meet all requirements for admission into the Associate Degree Nursing Program.
3.
Concurrent enrollment in RNSG 1105, RNSG 1144, RNSG 1160, and RNSG
1115. If RNSG 1115 has been successfully completed, concurrent enrollment is
not required.
4.
Completion of student contract Level I Semester I.
5.
Regular classroom attendance.
6.
Completion of cultural beliefs paper and all assigned student presentations,
charting exercises, and assigned computer programs.
7.
Satisfactory grade average on written examinations (77 or above).
8.
Satisfactory achievement of behavioral course outcomes (see unit outcomes).
COURSE OUTLINE
Unit I
Unit II
Unit III
Unit IV
Unit V
Unit VI
Unit VII
Unit VIII
Unit IX
Unit X
Unit XI
Unit XII
Unit XIII
Unit XIV
Unit XV
Unit XVI
Nursing Today, Theoretical Foundations of Nursing Practice
Nursing Process
Older Adult
Health Maintenance, Promotion & Wellness
Communication
Health Care Delivery System
Stress & Coping
Self Concept
Complimentary & Alternative Therapies
Ethics & Values, Legal Implications in Nursing Practice
Sensory
Spiritual Health
Culture and Ethnicity
Sleep
Patient Safety
The Experience of Loss, Death & Grief
9
Unit XVII
IV.
Pain Management
ACCOMMODATIONS
Diversity Statement:
In this class, the instructor will establish and support an environment that values and nurtures individual
and group differences and encourages engagement and interaction. Understanding and respecting
multiple experiences and perspectives will serve to challenge and stimulate all of us to learn about
others, about the larger world and about ourselves. By promoting diversity and intellectual exchange,
we will not only mirror society as it is, but also model society as it should and can be.
Disabilities Statement:
Students with disabilities, including but not limited to physical, psychiatric, or learning disabilities, who
wish to request accommodations in this class should notify the Special Services Office early in the
semester so that the appropriate arrangements may be made.
In accordance with the federal law, a student requesting accommodations must provide acceptable
documentation of his/her disability to the Special Services Coordinator. For more information, call or
visit the Special Services Office in the Student Services building, 716-2529.
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11
RNSG 1513
TYPOLOGY OF ELEVEN FUNCTIONAL HEALTH PATTERN*
Health-perception-health-management pattern. Describes client's perceived pattern of health and
well being and how health is managed
Nutritional-metabolic pattern. Describes pattern of food and fluid consumption relative to
metabolic need and pattern indicators of local nutrient supply
Elimination pattern. Describes patterns of excretory function (bowel, bladder, and skin)
Activity-exercise pattern. Describes patterns of exercise, activity, leisure, and recreation
Cognitive-perceptual pattern. Describes sensory perceptual and cognitive pattern
Sleep-rest pattern. Describes patterns of sleep, rest, and relaxation
Self-perception self concept pattern. Describes self concept pattern and perceptions of self (e.g.,
body comfort, body image, feeling state)
Role-relationship patten. Describes pattern of role-engagements and relationships
Sexuality-reproductive pattern. Describes client's pattern of satisfaction and dissatisfaction with sexuality
pattern; describes reproductive pattern
Coping-stress tolerance pattern. Describes general coping pattern and effectiveness of the pattern in terms of
stress tolerance
Value-belief patten. Describes patterns of values, beliefs (including spiritual), or goals that guide choices or
decisions
*Gordon, Marjory (1982). Nursing Diagnosis: Process and Application. N.Y.: McGraw-Hill
16
RNSG 1513
DATA COLLECTION FORM
Now that you have accomplished the skill of determining a nursing problem or diagnosis you will use only the
data collection form for history and assessment. The Data Collection Form is contained in this section along
with a Nursing Process Form. Use the following directions to compile the data you collect.
DIRECTIONS FOR USE OF DATA COLLECTION FORM
1. Fill in the blanks at the top of the data form. Remember to use only one of the client’s initial to maintain
privacy.
2. Complete status categories by filling in the subjective and objective information specified. Data may be
repeated in some categories due to the inter-relatedness of the body’s systems.
3. Review each area for actual or potential problems. Determine the nursing diagnosis from the data collected
in each category if appropriate. Write the nursing diagnosis in the category, You will also list your nursing
diagnosis in the Problem, Etiology, Signs and Symptoms (PES) format at the end of the database.
NURSING DIAGNOSIS
Priority
High (H)
Medium (M)
Low (L)
P. Problem/Nursing Diagnosis
E. Etiology or Cause
S. Subjective and Objective
Data to Support Diagnosis
a. Determine nursing diagnosis from status categories. Review each area for risk or actual problems.
b. Write your nursing diagnosis using the PES format.
c. List the nursing diagnosis in order of priority according to Maslow’s Hierarchy of Needs, i.e.,
oxygenation--------self-esteem.
High
P. Alteration in respiratory function related to
impaired gas exchange
E. Smoking
S. Smoking Hx. 1-2 pks/day X 20 years;
freq. prod. cough
past hx. bronchitis, chest x-ray atelectasis
cough p smoking, lethargy and fatigue pursed-lip
breathing
17
RNSG 1513
Medium
P. Alteration in Nutrition: less than body
requirement
E. Loss of appetite due to stress of illness and
smoking
S. Wt. Loss 20 lbs./past mo.
Hgb 11 gm, Hct 35%, Ht 5’10”
eats small amounts
Medium
P. Noncompliance
E. Previous unsuccessful experience with advised
regimen
S. Personal behavior deviates from health related
advice.
4. Determine priority of each of your nursing diagnoses; in other words, establish the degree of urgency of
each actual or potential problem. It is possible to have more than one diagnosis at each level, i.e., High (H),
Medium (M), Low (L).
5. List the client’s strengths/assets, those factors that the client possesses, which can be utilized by the nurse to
assist in meeting his/her needs, and/or preventing and solving problems.
EXAMPLES OF STRENGTHS/ASSETS
Intact family
Able to read/write
Available support system
Financially independent
6. After you have become proficient at this stage; you will transfer the nursing diagnosis to the assessment
column of the Nursing Process Sheet. You will then continue with the planning (Step III) and complete this
step as directed by your instructor.
PLANNING
The nursing assessment and the formulation of nursing diagnoses initiate the individualization, coordination,
and the continuity of nursing care that is planned during the third component of the nursing process. Planning is
a category of nursing behaviors in which the goals of care are set for an individual client and a strategy is
designed to achieve goals. During planning, the client’s goals are determined, priorities are established,
outcomes of nursing care and are projected, and a nursing care plan is written. The planning of nursing care
includes consulting other health professionals, modifying care, and recording information relevant to client
management (Potter & Perry, 2008).
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RNSG 1513
DETERMINING GOALS OF CARE
Goal Statement – specific aim planned by the nurse to assist the client in achieving
his/her maximal level of wellness.
Ultimately the goal is the intended outcome of the nursing intervention. Goal statements assist caregivers in
focusing on exactly what you hope to accomplish with the client. The first step in determining a goal statement
is to ask yourself, “What can or should be done about the problem identified in the nursing diagnosis?” For the
client with a diagnosis of Alteration in Respiratory Function/Impaired Gas Exchange, a specific goal planned by
the nurse would be to improve the client’s gas exchange. This goal is individualized to this client and sets the
framework for planning care. Goals include prevention and rehabilitation as well as emergency need. Goal
setting should include the client and/or family and significant others.
The current trend in setting goals is to develop a statement (goal) that is client centered and specifies
measurable evaluative outcome criteria (EOC). When projected outcomes are clearly specified in the planning
stage, evaluation becomes a much easier task.
Utilize the following suggestions when writing goal statements:
1. The statement should designate a client outcome which shows reduction or alleviation of the identified
problem (nursing diagnosis). This suggestion will make the goal client centered and measurable.
2. A realistic time span should be set within the goal statement.
3. The goal should be realistic for the nurse’s level of skill and experience.
4. The goal should be congruent with and supportive of the client’s medical regime.
5. If possible, the goal should be important and valued by the client, the nurses, and the physician.
6. The goal should be very specific.
A goal may be achieved quickly, such as during a period of hospitalization, or at a clinic visit. A goal may
focus on rehabilitation, prevention, or education.
Alteration in respiratory
function related to impaired
gas exchange.
Client will demonstrate  respiratory
effort by _______________________
as evidenced by:
a.
b.
c.
d.
e.
resp. rate of 20-24/min
lack of nasal flaring
lack of sternal retractions
ability to speak without gasping
expectoration of secretions and
following treatments as ordered.
Client will maintain
optimal ventilation after
discharge as evident by
resp. rate of 12-20. No
evidence of cyanosis.
No SOB
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RNSG 1513
Alteration in nutrition, less
than body requirement.
Client will  present weight of 98 lbs
By 1 lb weekly.
Client will maintain 15
lb. Gain for a period of 6
months.
99 lbs by _______________.
Date
100 lbs by ______________.
Date
101 lbs by ______________.
Date
Having established the goals and EOC’s are the specific aims planned by the nurse to assist the client in
achieving his maximal level of wellness, the specific actions by the nurse are planned. Nursing actions are
those things the nurse plans to do to help the client achieve a goal. Nursing actions are instructions for the care
of the client. Although nursing actions are considered as part of the planning phase of care for our purposes,
these actions will be written in the implementation column of the NCP. This brings us to the fourth step of the
nursing process, Intervention or Implementation.
IMPLEMENTATION
Adequate planning of nursing care results in the individualization, coordination, and continuity of nursing care.
Planning established the framework of nursing care to be delivered during the fourth step of the nursing process,
implementation. This step of the nursing process delineates the actions necessary for accomplishing the health
care plan. A nursing action/intervention may be any act by a nurse that implements the nursing care plan/goals.
Intervention may be in the form of support, medication, treatment for the current condition or treatment to
prevent future health problems.
Implementation of interventions may include the nurse’s performing or assisting in the performance of the
clients ADL’s counseling and teaching, giving care to achieve therapeutic goals and facilitate the achievement
of the client’s health goals, supervising, delegating, and evaluating the work of staff members involved in the
client’s care, and recording and exchanging information relevant to the client’s continued health care (Potter &
Perry, 2000).
NURSING INTERVENTIONS
Nursing intervention is what the nurse does for, with, and to a client to achieve client goals.
Nursing interventions are based on scientific principles.
Nursing interventions should answer the following questions:
a.
b.
c.
d.
What is the intervention?
When should each intervention be implemented?
How should the intervention be performed?
Who should be involved in each aspect of intervention?
20
RNSG 1513
Nursing interventions may be dependent, independent, or interdependent.
a. Dependent-interventions by the nurse are based on instruction or written orders of professional, i.e.
physician’s orders.
b. Independent interventions are designed and carried out by the nurse without a specific doctor’s order.
These interventions involve aspects of nursing encompassed by licensure and law.
c. Interdependent interventions are carried out by the nurse in collaboration with another health care
professional. These interventions require nursing judgment within the framework of standard protocols
and/or standing orders.
In the following situation: The client is anxious about going to surgery.
Goal Statement
The client will demonstrate decreased anxiety
level by end of the evening shift.
EOC
a. Pulse rate 60-80/min
b. Ability to communicate pre and post-op
instructions.
c. Lack of observable signs of agitation such
as restlessness and wringing of hands.
d. Verbalize feelings of less anxiety.
Nursing Interventions
The nurse will:
1. Visit with the client at the beginning of the
shift.
2. Explain preoperative preparations at 0800.
3. Allow client to ventilate fears prior to
going to surgery.
Situation II: The client is developing a pressure area on the sacral region.
Goal Statement
Client’s skin integrity will be maintained while
on complete bed rest as evidenced by:
EOC
a. Lack of reddened areas in the sacral region.
b. No disruption of skin integrity.
c. Maintenance of proper positioning to
prevent skin breakdown.
d. Lack of signs and symptoms of infection.
Nursing Interventions
The Nurse will:
1.
2.
3.
Did you think of some? Check the interventions listed below with your answers.
Answers to Interventions:
Nursing Interventions-Situation II:
1. Egg crate mattress to bed
2. Turn and reposition q. 2
3. Assess area after turning
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RNSG 1513
As a final thought concerning the process of implementation, remember that this step is more than just the
giving of nursing care. Implementation involves reviewing your plan of care with other professionals to
validate that it is based on proper scientific principles and is individualized for your client.
Implementation also includes proper documentation of the plan in the client record as well as continual data
collection to be utilized in revising and updating the plan.
Professional nursing care is based on scientific principles. The body of scientific knowledge, which is the
foundation of nursing, is constantly enlarging and, therefore, principles are continuously being revised. It is
impossible for the nurse to depend on a learned repertoire. She/he must, instead, base her/his practice on
relatively unchanging principles to guide her/him in modifying techniques.
A principle can be defined as a proven scientific fact, a law of science, or a generally accepted theory. The
scientific basis of nursing is drawn from many areas, including the biophysical sciences, medical sciences,
nutrition, and the psychosocial sciences.
For example, the nurse will orient a client to the nursing unit as a means of meeting his/her security needs,
based on Maslow’s Hierarchy of Needs derived from psychosocial theory.
When planning care for a client, the nurse’s interventions must be guided by scientific principles. A scientific
or psychosocial principle for each nursing intervention should be included in the appropriate column on the care
plan. Each principle should reflect the nursing intervention as it relates to the problem. Each principle must be
documented with the information source.
Example:
PLANNING/IMPLEMENTATION
SCIENTIFIC PRINCIPLES
Observe client for disorientation.
Because nervous tissue is very
sensitive to oxygen deficiency,
the client with respiratory
problems may show signs of
impaired brain functioning
(Dugas: 590).
When writing nursing interventions that assist the client in goal achievement, state a scientific rationale for each
action, or for each group of similar actions, that answers the following questions.
1. Why is this action effective?
2. What is the intent of this action?
For all scientific rationales, document with a source, e.g. Potter & Perry, Fundamentals of Nursing, page 132, or
Smeltzer & Baer, Essentials of Medical Surgical Nursing, page 140.
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EVALUATION
Evaluation is the final step of the nursing process. We learned that evaluation determines the extent to which
goals have been achieved. Evaluation is the process used to reassess the client to determine whether the
problems identified in the nursing diagnosis have been resolved. Without evaluation it is impossible to
determine if the care given to the client has been effective in reducing or alleviating the problem. Nursing
assessment skills are used to evaluate the need for continued care.
Evaluation of nursing care includes four steps:
1.
2.
3.
4.
establishment of evaluation criteria
comparison of client response to the criteria
analysis of variables affecting outcomes and conclusions
modifications in the nursing care plan (Potter & Perry, 2008)
Evaluation criteria are based on the projected outcomes developed during the planning step of the nursing
process. EOC’s (evaluation outcome criteria) are also based on scientific principles, the quality of care in
relation to accepted standards of care and internal nursing audits. A properly stated nursing goal will make the
task of evaluating how well nursing interventions met the goals much easier.
To determine whether the goal was accomplished, the nurse must observe what happened to the client during
the intervention and describe his response. The nurse evaluates client response to each nursing intervention and
this evaluation should include any additional data relating to the problem. Therefore, we can see that problems
identified in the nursing diagnosis in conjunction with the nursing goals, serve as the criteria against which
nursing care is evaluated. Remember, the nurse evaluates goal achievement specifically whether or not the
client was able to perform the outcome designated in the goal statement. The evaluative statement is not an
evaluation of nursing actions. The appropriateness of nursing actions is reviewed during the reassessment
phase.
The evaluative statement should state whether the goal was met, partially met, or not met. The statement should
also contain the client behaviors which support the conclusion drawn. If the goal is met and the problem
identified in the nursing diagnosis is completely resolved, the nurse should state that no further nursing actions
or follow up is necessary and sign and date this statement. At times, a goal may be met but the problem is not
resolved. Reassessment of the plan at this point will determine if the plan needs modification or can remain
unchanged for a while. If the plan is not changed include a date for reevaluation following the evaluative
statement. Whenever a goal is partially met, the plan must be reassessed.
Through analysis of variables affecting outcomes, the nurse determines the degree, which a plan was effective
and draws conclusions about factors that led to the success or failure of the plan of care. Behavioral responses
allow the nurse to determine the outcome of the evaluation. Responses may be any one or a combination of the
following:
1. The client responded with behavior that indicates the problem has been reduced or alleviated.
2. The client’s responses (signs and symptoms) indicate his problem has not been resolved.
3. The client’s responses indicate new problems.
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4. The client’s responses indicate the need for more data or that the data collected was incorrectly
interpreted resulting in incorrect problem.
Analysis of outcomes and conclusions allow the nurse to determine the success of the care plan or whether the
plan must be reassessed and modified. Reassessment is the process of changing or eliminating previous nursing
diagnoses, goals, and actions based on new client information. If changes are necessary (based on evaluation of
client responses), discontinue the plan by stating “plan not effective; see revision.” Date and sign this
statement. Following modifications, the plan must be re-implemented and reevaluated. Therefore, the
evaluation of nursing care is an ongoing process, which assists the nurse in maintaining care suitable to the
client’s problems.
Let’s think back to the previous situation in the planning section. The example referred to a client anxious
about impending surgery.
After nursing intervention was the client less anxious? What observations would you make to determine if you
decreased the client’s anxiety about surgery?
Example:
1. When questioned, the client stated that the information given to
her had “relieved her fears.”
Example:
2. The client was smiling and appeared calm and relaxed.
What is your conclusion? Was the client’s anxiety alleviated?
Conclusion:
Goal met – Smiling, the client stated “her fears had been relieved.”
Care plan related to this problem is discontinued.
N. Nurse –9/1/11
Now, you evaluate Situation II.
After your nursing interventions did you prevent scores on the client’s sacral area?
List what observations you would make.
1.
2.
3.
4.
5.
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Now what is your conclusion? Were you successful in meeting your nursing goal?
If your nursing intervention were not effective, how would you revise it?
Good Work! Completion and periodic review of this supplement should assist you in
preparing your nursing care plan, as assigned, to meet clinical outcomes.
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THERAPEUTIC COMMUNICATION
Summary of Basic Techniques & Blocks
Therapeutic Techniques
1.
Use Broad Opening Statements (Universal Openers)
Communicates Interest
Allows client to set the direction
Eg. – “Is there something bothering you?”
“Is there something you would like to talk about?”
2.
Use General Leads (Minimal Encouraging or Encouraging Verbalization)
Leave direction of conversation to client
Encourages client to continue
Eg. – “Yes”, “Oh?”, “Um hmm”, “Go on”, “I see”
3.
Reflecting (Restatement)
Repeat all or part of client’s statement
May be verbatim or slightly rephrased
Encourages client to continue
Be careful not to over use this technique
Eg. – Client: “Everyone here ignores me.” Nurse: “Ignores you?”
4.
Sharing Observations (Observational Openers)
Shares with client the nurses observations regarding his behavior, physical or emotional
Nurses may share what she actually perceives through her senses or her interpretations of her
perceptions
Eg. – “You are trembling” or “You seem upset”
5.
Acknowledging Client’s Feelings (Expressing Acceptance & Focusing on Feelings)
Demonstrates acceptance and understanding on the nurse’s part
Encourages continued expression
Eg. – Client: “I hate this town. I have no friends here.” Nurse: “It must be difficult for you to live in a
place where you feel you have no friends.”
6.
Selective Reflecting
Nurse selects most important idea contained in a client’s statement and directs this back to him
Eg. – Client: “I feel so tired; I don’t like it here.” Nurse: “Tired?” or “You don’t like it here?”
May also reflect feelings – “It sounds as if….” or “perhaps you feel….”
7.
Using Silence
Slows pace of conversation. Gives client opportunity to reflect upon what has been said
Be attentive and expectant during silences
8.
Giving Information (Offering Information)
Nurse gives specific information to help answer questions or dispel misconceptions
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9.
Clarifying (Clarifying)
Prevent misunderstanding and ambiguity on nurse’s part
Allows for clear interpretation of meaning
Eg. – “I’m not sure I follow…” or “Did I understand you correctly?” or
“Do you mean…?”
10.
Verbalizing Implied Thoughts and Feelings
Nurse voices what client seems to have implied rather than what he actually said
Helps client to become more fully aware of his feelings
Eg. – Client: “These exercises are a waste of time.” Nurse: “You feel they are not benefiting you?”
11.
Validating
Nurse checks her impressions with client in regards to whether or not a need has been met
Eg. – “Do you feel more relaxed” or “Are you feeling better now?”
12.
Offering Self
Blocking Therapeutic Communication
1.
Using Reassuring Clichés (False Reassurance – Textbook)
Conveys to client that nurse feels he is worrying needlessly or that she is not interested or does not
understand his/her problems
Eg. “Everything will be all right”, or “You don’t need to worry” or “You are doing fine”
Exception – When there are reassuring facts it is okay to give genuine reassurance by communicating
the facts to the client
2.
Giving Advice (Giving Opinions – Textbook)
Imposes nurse’s own opinions and solutions rather than helping client to explore and arrive at own
decisions
Can backfire or force dependency
Eg. – “What you should do is…” or “Why don’t you…”.
3.
Giving Approval (Showing Approval – Textbook)
Shifts focus of discussion to nurse’s values or feelings and implies standards of what is and what is not
acceptable
Implies that nurse’s concept of right and wrong will be used in judging client’s behavior
Eg. – “That’s the right attitude” or “That’s the thing to do.”
Exception – Sometimes useful when nurse wishes to motivate or encourages a client
4.
Requesting an Explanation (Asking “Why” – Textbook)
Asks client to immediately analyze and explain his feelings or actions
This can be intimidating
Avoid “Why” questions
Eg. – “Why are you upset?” or “Why did you do that?”
Instead ask open ended questions using “who”, “what’, “when”, and “where”
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5.
Agreeing with the Client
Introduces nurse’s own opinions or values into conversation making it difficult for client to express self
freely
Makes it difficult for client to later change or modify opinion already stated
Eg. – “I agree with you.” or “You must be right”
Nurse should accept client’s statements and encourage elaboration by using general leads or reflecting.
6.
Expressing Disapproval (Showing Disapproval – Textbook)
Imposes nurse’s own value rather than accepting the client’s values
Implies that client should conform to nurse’s standards
Eg. – “You should stop worrying like this” or “You shouldn’t do that.”
7.
Belittling the Client’s Feelings
Implies that client’s feelings are not unusual and thereby denies their importance
Eg. – “I know just how you feel” or “Everyone gets depressed at times.”
8.
Disagreeing with the Client
Contradicting client indicates to him that nurse cannot accept what he has said
Nurse shows value judgment by disagreeing and demonstrates non-accepting attitude
Eg. – “You’re wrong” or “That’s not true” ir “Not it isn’t”.
9.
Defending
Tells client his/her negative comments are unfounded and implies he/she has no right to express such
opinions or feelings.
Eg. – “She’s a very good nurse” or “Your doctor is quite capable”.
Nurse should instead, acknowledge client’s feelings and encourage elaboration
10.
Making Stereotyped Comments
Social clichés or trite phrases keep conversation at a superficial level
Eg. – “Isn’t it a beautiful day?” or “How are you feeling?”
11.
Changing the Subject (Changing the Subject – Textbook)
Nurse directs course of conversation rather than letting client discuss what he wishes
This usually occurs when nurse is uncomfortable with the topic
Eg. – “Oh, by the way…” or “That reminds me…”
These are the basic blocks. The information in parenthesis corresponds to phrasing used by your textbook
(Potter & Perry).
Note: One additional technique that may be considered a facilitator or blocker is the
technique of confrontation. This technique may inhibit or enhance
communication depending on how it is used. The nurse uses this technique to
point out q discrepancy. Eg. – Client: “I have been taking my blood pressure
today is 220/120 Mr. James
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TECHNIQUES THAT PROMOTE THERAPEUTIC COMMUNICATON
CLARIFYING: Helps to make meaning clear and to avoid misunderstanding.
BROAD OPENING STATEMENTS: Allows the patient to set direction of the conversation. Gives the patient
an opportunity to begin to express himself.
GIVING INFORMATION: May dispel misconception and help the patient to better evaluate his situation.
REFLECTING: Leads the patient to more fully consider and expand upon his remark.
VALIDATING: checks if the patient’s need has or has not been met.
ACKNOWLEDGING THE PATIENT’S THOUGHTS AND FEELINGS: Helps the patient know his feelings
are understood and accepted.
USING SILENCE: Slows the pace of conversation. Gives the patient time to reflect upon, then speak further
about his feelings. Allows the nurse time to observe the patient for non-verbal cues.
SHARING OBSERVATIONS – Focuses on either the patient’s physical or apparent emotional state.
VERBALING IMPLIED THOUGHTS AND FEELINGS – Helps the nurse verify her/his impressions. Helps
the patient become more fully aware of his feeling.
USING GENERAL LEADS: Encourages further exploration of a part of the patient’s statement.
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TECHNIQUES THAT BLOCK THERAPEUTIC COMMUNICATON
DISAGREEING WITH THE PATIENT: May anger the patient and put him on the defensive, or cause the
patient to refrain from further expression of thoughts and feelings.
REQUESTING AN EXPLANATION: Requires the patient to analyze or explain his feelings, and thereby
threaten the patient.
BELITTING THE PATIENT’S FEELINGS: Implies that the patient’s feelings are not unusual, thus denying
the importance they have for him.
MAKING STEROTYPED COMMENTS: Leads the patient to respond in like manner, thus keeping
conversation at a superficial level.
GIVING APPROVAL: Tends to focus conversation on the nurse’s values rather than the patient’s, and implies
that the nurse’s concept of right and wrong will be used in judging the patient behavior.
DEFENDING: Suggests that the patient’s criticisms are unfounded, and that he has no right to express his
thoughts and feelings.
USING REASSURING CLICHES: Tends to minimize the significance of the patient’s feelings, and conveys a
lack of understanding or interest.
EXPRESSING DISAPPROVAL: Indicates that the patient’s feelings and actions have not been accepted.
GIVING ADVICE: Indicates that the nurse is imposing her/his judgments rather than accepting the patient’s
feelings and actions.
AGREEING WITH THE PATIENT: Makes it difficult for the patient to later change or modify his opinions.
CHANGING THE SUBJECT: Takes the lead in the conversation away from the patient, thereby blocking what
the patient wishes to discuss.
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SOUTH PLAINS COLLEGE
ASSOCIATE DEGREE NURSING PROGRAM
THE ELDERLY: COMMUNICATION GUIDELINES
I. General Interactions:
A. Obtaining the Person’s Attention
Begin each conversation by identifying
yourself and calling the person by name.
Stand in front of the person or directly
in his/her line of vision.
B. Maintaining the Person’s
Attention
Use nonverbal gestures and touch to
supplement verbal messages.
Use short words and simple sentences; say
individual words clearly and slowly.
Maintain eye contact; if the person moves
away, move alongside and continue talking.
Use distinct or exaggerated facial expressions for added
emphasis.
C. Obtaining Answers to
Questions
Ask one question at a time; wait for
a response; repeat exactly, if necessary.
Summarize back to the person what you
understood from their reply; ask if what
you said is correct: “Have I got it right?”
Take note of particular phrases or ways of
asking questions which succeed in eliciting
responses; convey and exchange these with
the other family caregivers.
D. Responding to Loss
of Memory
Establish customary locations for items of
use or interest to the person.
Provide a consistent schedule of daily
activities and routines.
Expect to repeat the same instructions daily,
perhaps several times in succession.
Provide memory aids such as signs, color
coded instructions, lists, and schedules or
calendar.
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Break complex tasks into simple steps;
instruct the person through one step at a
time; write out steps on a piece of paper.
Be prepared for changes in the person’s
environment to affect his/her ability to
perform routine tasks, i.e., a different color
bedspread, rearranged furniture.
E. Establishing Trust, Providing
the Person with a sense of
Being Cared About
Take time to listen to the person even if
rambling content of his/her speech makes
little sense to you.
Repeat key words and especially clear or
understandable portions of the person’s
conversation so that she/he feels understood
Use touch, smiles, and gestures of understanding while the person attempts to
communicate.
Expect fluctuations in the person’s ability
to recognize family members; try not to
exhibit hurt when the person does not seem
to know who you are.
Be careful to avoid assuming that the person
will forget promises you have made; do
what you say you are going to do.
II. Frequent or Unpredictable Mood Changes:
A. Responding to Occasional
Displays of Assaultive
Behavior
Approach slowly; avoid startling the person.
Be aware of your own nonverbal messages
through tone of voice, body posture, and
facial expressions.
Separate yourself from the person when
your own stress level could act as a
trigger.
Learn to recognize over-stimulation in the
person’s environment; make an attempt to
reduce stimulation when stress is evident.
B. Assisting the Person with a
Loss of Control over
Emotional Expression
Discern which responses are due to actual
influences and which are due to
“organic affective lability,” a common
symptom of the disease process.
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If there appears to be no relationship
between the start of an emotional
expression and what is going on around
the person, and if the emotional behavior
is easily interrupted by diverting his/her
attention, assume that it is a symptom of
the dementia.
Rumination, crying, flares of anger, unexpected laughter, or moaning can be
diverted in these instances by snapping your
fingers, changing the subject, asking the
person a question, or calling his/her name
sharply.
Realize that interrupting such expression
serves to help the person gain control over
his/her behavior and relieves the potential
fatigue from such outpouring.
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Cultural Beliefs
SOUTH PLAINS COLLEGE
ASSOCIATE DEGREE NURSING PROGRAM
RATIONALE AND GUIDELINES FOR PERSONAL BELIEFS PAPER
If a nurse is to respond to and meet clients' needs, then he/she must learn that the evaluation of one's
actions and behaviors is part of becoming a nurse. This means that the nurse must first grow in self-knowledge
thereby, establishing a base on which to apply this knowledge in a helping relationship. Self-awareness is a
process of becoming conscious of one's values and goals. Knowledge of one's self enhances the effect of the
therapeutic relationship.
Everyone has values, needs, and feelings--many of which are not consciously recognized and may
diminish our effectiveness within the therapeutic nurse--client relationship. These values, needs, and feelings
are never static. Just as our life experiences change, person's attributes also change. We enter nursing with
different experiences and values. The nurse is expected to understand the values, needs, and feeling of the
client without attaching any right or wrong, in order to establish empathy.
The faculty appreciates and understands that people sometimes feel threatened when asked to share
values, needs, and feelings. When risk is involved, an atmosphere of trust and safety must exist in order for
students to comfortably express themselves without being rejected or ridiculed. Vulnerability is inevitable with
self-disclosure but disclosure will enhance the process of increased self awareness.
Criteria
Examine your beliefs and attitudes toward people who are different from yourself physically,
culturally, racially, religiously, socio-economically, and in life-style.
State any known intolerance you may have toward others who are different from yourself.
Identify those life experiences that have contributed to the formation of your beliefs and
attitudes.
Discuss you feelings regarding providing personal care for persons of the opposite sex and
persons of different ethnic/cultural groups.
Discuss your attitudes about spiritualism and witchcraft practices as means of treatment for
health problems.
Discuss how these beliefs and attitudes may enhance and/or inhibit your effectiveness as a
nurse.
The paper should be three to five pages in length and typewritten.
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