Nursing Care of Complex, High Acuity, or Critically Ill Patients - NURS400 (NURS400L)
Spring 2015
Schedule Number 22288 (22289, 22290, 22291, 22292, 22293, 22294, 22295, 22296, 22297)
COURSE INFORMATION
Class Days: Friday
Class Times: 0800-1110
Class Location: HT 2108
Professor: Dr. Beverly Carlson, PhD, RN, CNS, CCRN
Contact Information: bcarlson@mail.sdsu.edu
Office Hours Days: Mondays and by appointment
Office Hours Times (and by appointment): 2-4pm
Office Hours Location: AH 3175
Course Overview
COURSE CATALOG DESCRIPTION: Theory and selected laboratory experience in care of patients with complex, high acuity and
life-threatening health problems.
This senior level course is designed to provide the professional nursing student with the opportunity to acquire and apply
knowledge related to the practice of caring for complex, high acuity, and critically ill patients. As the capstone course in the
nursing curriculum, students synthesize previously acquired knowledge with more complex content to plan and provide
comprehensive nursing care for complex, high acuity, and critically ill patients. Theoretical application, critical thinking and
appropriate priority setting are stressed.
COURSE OUTCOMES: Upon completion of this course the student will be able to:
1. Synthesize previously learned and new knowledge in the application of the nursing process with complex, high acuity, and
critically ill patients.
1.1 Apply current evidence-based knowledge/theory/concepts to select pathophysiologic states.
1.2 Conduct a biopsychosocial assessment of complex, high acuity, and critically ill patients.
1.3 Generate definitive nursing diagnoses or problem list based on data collected.
1.4 Formulate realistic, applicable, measurable and specific patient outcomes.
1.5 Formulate planned evidence-based nursing interventions that reflect current patient status and needs.
1.6 Demonstrate nursing judgment in prioritizing care.
1.7 Demonstrate ability to implement the plan of care.
1.8 Select nursing actions that promote physical, environmental and psychosocial safety.
1.9 Evaluate the effectiveness of nursing actions by noting the change in patient status and progress toward outcome
achievement.
1.10 Modify the plan of care based on evaluation findings.
1.11 Maintain accurate, concise and current nursing records.
2. Analyze the effects of select pathophysiologic stressors that produce complex and critical illness.
2.1 Examine select cardiovascular stressors.
2.2 Examine select pulmonary stressors.
2.3 Examine select neurologic stressors.
2.4 Examine select metabolic stressors.
2.5 Examine the multisystem effects of critical illness.
3. Integrate appropriate and specialized evidenced-based nursing interventions for complex, high acuity, and critically ill
patients.
3.1 Use available specialized monitoring and therapeutic equipment for assessing and caring for complex, high acuity, and
critically ill patients.
3.2 Demonstrate evidence-based and safe use of equipment/technology/techniques and incorporate nursing actions to
prevent/minimize hazards to patients.
3.3 Demonstrate ability to implement appropriate and specialized evidence-based techniques & nursing interventions for
complex, high acuity, and critically ill patients.
4. Utilize appropriate interventions for psychosocial stressors impacting patients, families and nurses during complex, high
acuity and critical illness.
4.1 Incorporate into the plan of care, nursing actions to prevent or minimize emergent and complicating psychosocial
stressors.
4.2 Recognize patient/family situations requiring stress management interventions.
4.3 Utilize effective communication skills with patient and family.
4.4 Recognize and utilize opportunities for patient/family teaching and counseling.
4.5 Facilitate patient/family examination and decision-making of quality of life and end-of-life issues.
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5. Incorporate current research findings in the application of the nursing process with complex, high acuity, and critically ill
patients.
5.1 Incorporate research based nursing interventions into planned care.
5.2 Recognize opportunities for research based practice changes to improve care.
6. Practice within a professional framework according to the essential value of caring.
6.1 Negotiate roles/responsibilities for shared patient care.
6.2 Recognize and communicate limitations, abilities, personal objectives and learning needs to preceptor or assigned staff
mentor.
6.3 Deliver compassionate, appropriate and culturally sensitive care.
6.4 Incorporate professional values of altruism, autonomy, human dignity, integrity and social justice as the foundation for
professional practice
6.5 Fulfill professional obligations re responsibility for nursing care & communication with other professionals.
6.6 Demonstrate accountability for one’s own practice and seek appropriate resources for assistance.
6.7 Seek experiences to progressively expand knowledge and skills.
NURS400 and NURS400L must be registered for concurrently.
Enrollment Information
Prerequisites: Nursing 358, 410, 414 and 416
Course Materials
Required for ALL students:
 Textbook: Urden, et al. (2014) Critical Care Nursing: Diagnosis and Management, 7th ed. St. Louis: Mosby Elsevier.
 iClicker
 3 small red and white ParSCORE Test Forms
 All necessary clinical equipment: stethoscope, calipers, etc.
Recommended Material:
 N400 Course Reader available from book store
Course Structure and Conduct
This course involves both traditional lecture and lecture-discussion as well as a supervised clinical experience. The iClicker
response system is used for in-class quizzes and to promote class discussion. The SDSU Blackboard system is used for
supplementary course materials, all course communication and grade
Clinical experiences take place in acute & critical care units (adult and pediatric intensive care & progressive care units) at acute
care sites throughout San Diego County. All students will participate in one group activity within their clinical laboratory group,
a Clinical Research Critique Presentation, described below.
Clinical Laboratory Experience: The method of patient assignments will be specific to the clinical setting and will be
determined and communicated by your Clinical Instructor.
 While caring for complex, high acuity, or critically ill patients, students will work under the supervision of the Clinical
Instructor or the assigned RN. The assigned RN will retain overall responsibility for the nursing care of the patient.
 Students may perform all assessments and interventions routinely provided by the nursing staff under the direction of the
assigned RN or Clinical Instructor. Do not perform procedures or administer medications without first reviewing the action
with your Clinical Instructor or the assigned RN.
 Each student will retain responsibility for the nursing care that he/she provides and must exercise judgment regarding
personal ability to perform specific skills. In order to insure patient safety, communication with the assigned RN and the
Clinical Instructor regarding skill ability is imperative. Students are encouraged to provide as much of the direct nursing care
as possible. Documentation in the medical record is expected.
 Students are responsible for following all administrative policies, rules, and regulations of the hospital.
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Course Assessment and Grading
Students earn a letter grade for the course based on satisfactory attainment of the course and clinical objectives and classroom
and clinical requirements. The grading criteria listed below are dependent upon successful completion of the clinical
component of the course.1 Unsatisfactory performance in the clinical setting will result in a failing grade for Nursing 400.
The student's letter grade for the course will be derived as follows:
Class Participation/In-class quizzes
20 pts
Exam #1
100 pts2
Exam #2
100 pts2
Exam #3
100 pts2
Clinical Worksheets
75 pts3
Clinical Research Critique Presentation
15 pts3
Clinical Professionalism & Preparedness
10 pts3
420 pts
Grades will be assigned as follows if the specified criteria1, 2, 3 are met:
A 93 - 100% (389-420 points)
A- 90 - 92% (377-388 points)
B+ 87 - 89% (364-376 points)
B 83 - 86% (347-363 points)
B- 80 - 82% (335-346 points)
C+ 77 - 79% (322-334 points)
C 73 - 76% (305-321 points)
C- 70 - 72% (293-304 points)
D 67 - 69% (280-292 points)
F Less than 67% (279 points or less)
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Students must earn at least 210 points of the 300
possible on the written exams (an average score of >
70%). Students who fail to do so will receive the lowest of
either their computed score or a grade of D.
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Students must earn at least 70 points of the 100 possible
on the listed clinical assignments (an average score of >
70%). Students who fail to do so will receive the lowest of
either their computed score or a grade of D.
Clickers
A classroom response system (aka clickers) is used in this course. Clickers are small handheld devices used to foster interaction,
active learning, and quick feedback for faculty and students. You are required to obtain a clicker as a learning resource (just like
a required text). Use of your clicker is part of the course participation requirement. Students may not use other students'
clickers; doing so is a violation of academic integrity. You must purchase and register your clicker prior to the 1st class
meeting, and bring your clicker to class on that day prepared to participate. Assistance is available at the SDSU clicker website:
http://clicker.sdsu.edu/
In-Class Quizzes
In-class quizzes will be conducted sporadically during class sessions using the Clicker response system. Full credit will be
awarded for correct responses, half-credit for incorrect responses, and no credit for non-responses. Quizzes will be based on
required reading and material previously covered during the course and the nursing curriculum.
Exams
Each exam may include questions pertaining to material covered in the required reading, class sessions, presented earlier in the
nursing curriculum, as well as drug calculation exercises. Any student unable to take an exam due to illness/injury or
extraordinary circumstances must notify the course coordinator PRIOR to the exam to be considered for a full-credit make-up
exam prior to Finals Week. Such approval will be at the discretion of the course coordinator and validation of
illness/injury/circumstances may be required. Any student who misses an exam without prior authorization will be allowed to
take a make-up exam (which may differ from the original exam & may differ in format) during Finals Week only, at a time to be
specified by the course coordinator. In this instance, only fifty percent (50%) of the score earned will be granted towards the
course grade. Any student who arrives for an exam more than 15 minutes late will not be admitted and will have missed the
exam without prior authorization. Students need 3 small red and white ParSCORE Test Forms for the exams.
During exams, students must leave all parcels, phones, pagers, PDAs, etc. at the front of the room. Students are allowed to
have pencils, erasers, a calculator and one par score form at their desks. Once a test has begun, any student who leaves the
room will not be allowed to continue the test (so please make arrangements to use the bathroom before each exam begins so
that you do not need to leave the classroom during exams). Any student who, in the judgment of the faculty, is cheating during
an exam will receive a zero for that test and will be reported to the University Judiciary Committee for further action. It is the
responsibility of the student to avoid any behavior which could give rise to a suspicion of cheating. During test reviews, neither
writing nor recording are allowed.
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Clinical Worksheets
The Clinical Worksheets provide a means for practical application of theoretical information to the clinical setting and foster
your critical thinking skills and ability to prioritize care based on patient status and care needs. You are required to complete a
total of 5 clinical worksheets. The due dates for these are dependent on your lab section and are posted on the Course
Calendar.
 Each worksheet will be worth a possible 15 points toward the course grade (75 total points). The worksheet forms are areaspecific (Adult or Pediatric, ICU or PCU) and are posted, along with the grading criteria, on the BB website. Your Clinical
Instructor will direct you as to which form(s) to use.

Worksheets are to be submitted to your clinical instructor by 2 methods:
1. Final versions must be submitted by email within 6 days after the clinical experience by 5 pm and
2. Hard copies complete with all necessary ECG/Pressure strips are to be hand-delivered to your clinical instructor the
following morning at the beginning of your next clinical day (e.g., if you have clinical on Monday, your worksheet is
due by email the following Sunday by 5pm with a hard copy delivered to your instructor the next morning (Monday)
at the beginning of your clinical shift).
NOTE: NOTHING on the worksheet is to be changed after it is emailed to the clinical instructor. Any modification will
be considered academic dishonesty.

Late worksheets (emailed after 5pm or not turned in at the beginning of the next shift) will not be accepted. There are no
exceptions to this requirement. Zero points will be recorded for any and all late worksheets

Worksheet scores are final and will not be re-graded.

A plagiarism detection service will be used to evaluate portions of the clinical worksheets for evidence of academic
dishonesty. Students agree that by taking this course all required papers may be subject to submission for textual similarity
review to Turnitin.com for the detection of plagiarism. All submitted papers will be included as source documents in the
Turnitin.com reference database solely for the purpose of detecting plagiarism of such papers. No identifying information
about you will be included.

Academic dishonesty related to the worksheets will have the following consequences: 1) a score of zero for the worksheet;
2) a score of zero for Clinical Professionalism and Preparedness; 3) institution of a student clinical performance plan for
Unsatisfactory Professional Conduct related to not communicating truthfully with faculty and Written Work Deficit; and 4)
report of the incident to the University Judiciary Committee for further action.

NOTE: Your clinical hours are to be used to care for patients. It is your responsibility to gather the information needed
from the medical record without taking time away from patient care. This may mean planning for time before or after your
clinical shift to gather the necessary information for the worksheet.

Do not under any circumstances remove from the hospital a copy or printout of any portion of the patient medical record
or electronically transmit any portion of the patient record to use for your worksheets. This would be a violation of HIPAA
laws and a Federal crime and may result in immediate course failure. ECG and pressure wave tracings without any
identifiable information are acceptable.
Research Critique
All students are required to complete a group assignment that involves presenting a professional critique of a current (within 5
years) research article applicable to nursing care of complex, high acuity, or critically ill patients and the assigned clinical
placement. This assignment accounts for 15 points of your overall grade. Your Clinical Instructor will make the group
assignments. The research article must be pre-approved by the Clinical Instructor at least 3 weeks prior to the presentation
and distributed to the entire clinical group at least 1 week prior to the presentation. Additional guidelines for this assignment
and grading criteria are provided in the appendix of this syllabus. Individual scores will be assigned to each student.
Clinical Professionalism and Preparedness
Students are expected to demonstrate professionalism and preparedness at all times in the clinical setting. Clinical
professionalism and preparedness account for 10 points of your overall grade. Guidelines for this expectation are provided in
the clinical section of this syllabus.
Clinical Performance
The expected clinical performance outcomes are clearly stated in the Clinical Performance Evaluation Form. It is your
responsibility to review and focus on these expected outcomes to facilitate a successful clinical experience.
Compliance Requirement
It is the policy of the SDSU SON (as stated on the SON website) that “in order to attend clinical practica, each nursing student
must present a Compliance Permission Slip to the clinical instructor at the start of each semester. Faculty will not allow any
student who does not present a permission slip to attend clinical. Faculty may allow students to attend orientation sessions so
long as there is no contact with patients.” See the SON website for all necessary and updated information. All students will be
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held to the SON policy. One point will be deducted from the Clinical Professional & Preparedness score if the compliance slip
is not brought to the first clinical lab day (orientation day).
Medication Competency Requirement
For the purpose of patient safety, all students are required to complete a drug-dose calculation competency quiz on their
assigned orientation date or before their first clinical experience. Items will include calculating divided doses, dosage
conversions, and weight- and time-based dosing intravenous flow rates. Practice items are available on the Blackboard
website. Calculators are allowed for this exam. A score of 100% must be achieved before you may give medications in the
clinical setting. You may repeat the test once during the 3rd week of the semester at a date & time specified by the Clinical
Instructor. One point will be deducted from the Clinical Professional & Preparedness score if this 2 nd attempt is necessary.
Failure to achieve a perfect score of 100% in these 2 attempts will result in immediate course failure.
Basic ECG Competency
Accurate basic ECG rhythm interpretation is an expected level of skill for the student in N400. All students who completed N358
in a prior semester are required to complete a Basic Rhythm Interpretation Competency quiz on their assigned orientation date
or before their first clinical experience. Please refer to your N358 materials for any necessary review. You are expected to
correctly identify 5-6 common or life-threatening ECG rhythms. You may repeat the test once. One point will be deducted
from the Clinical Professional & Preparedness score if this 2nd attempt is necessary. Failure to correctly identify all rhythms in
these 2 attempts will result in institution of a Student Clinical Performance Plan as continued performance deficiency may
result in course failure. Students currently enrolled in the N358 course must successfully complete the N358 final examination.
Simulation Experience
All students are required to participate in a clinical lab day in the Sharp Simulation Lab. Attendance is mandatory without
excuse or make-up. Your simulation lab dates are dependent on your lab section and posted on the Course Calendar.
Preparation for the simulation lab is mandatory - you are expected to come prepared to care for the “patient” as you would in
the clinical setting. A scenario will be provided in advance. Clinical Instructors may require that you submit answers to the
“Questions to Prepare for the Simulated Experience” prior to the assigned simulation appointment. Be prepared to perform
urgent drug calculations and to implement life-support measures in a timely manner.
Clinical Professionalism and Preparedness
Clinical professionalism and preparedness account for 10 points of your overall course grade. Your clinical instructor will assign
this grade based on the 10 Clinical Performance Objectives related to Professionalism found in the clinical evaluation. One
point will be deducted from the Clinical Professional & Preparedness score for each incident of tardy arrival for the clinical
laboratory experience. Note that failure to meet other expectations as listed in this syllabus may also result in loss of points.
Clinical Attendance
Attendance is mandatory for all clinical laboratory hours unless illness or serious extenuating circumstances exist. However, it
is unacceptable for a student to come to the clinical setting when ill because doing so may jeopardize the health or safety of
your patients and classmates. When a clinical day is missed for appropriate reasons, students will be required to complete one
additional clinical worksheet that is worthy of at least 11 out of 15 possible points as graded by the Clinical Instructor. A second
missed clinical day may result in the student being put on a learning contract (Student Clinical Performance Plan) because
absences may jeopardize achievement of the course objectives and place the student at risk for course failure. Missing a
clinical day for unacceptable reasons or without timely and appropriate notification of the clinical instructor is a breach of
professional responsibility and behavior and the student will be placed on a Student Clinical Performance Plan and be subject to
failing the clinical experience. If you will be absent, call your clinical instructor at least 30 minutes before the shift is to begin.
Other Course Policies
Classroom Participation and Student Behavior
All students are expected to participate in classroom activities and behave in a professional manner. Tardiness is disruptive to
other students and will not be tolerated. Any behavior during class time that may be disruptive to other students, such as
talking or leaving the room unexcused, is unprofessional and will not be tolerated. Cell phones and all other electronic devices
should be turned off or on vibrate mode during class and are not to be used when class is in session. Following a single
warning, grade points may be deducted for any student behavior deemed inappropriate by the course coordinator.
Professional Standards
All students are expected to know and adhere to all standards contained within the School of Nursing Undergraduate Student
Handbook. As students in the final semester of the SDSU nursing program, all N400 students are expected to conduct
themselves in an ethical and professional manner at all times. The American Nurses Association Code of Ethics for Nurses and
the American Association of Critical Care Nurses (AACN) Standards for Acute and Critical Care Nursing Practice provide specific
guidelines for the professional nurse. The ANA code is included in this syllabus. The AACN standards can be found at
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http://www.aacn.org/WD/Practice/Docs/130300-Standards_for_Acute_and_Critical_Care_Nursing.pdf. All students are
expected to comply with these standards at all times. Failure to do so may result in course failure.
Academic Dishonesty
As stated in the SON Undergraduate Handbook: “The School of Nursing follows the University policy on academic
dishonesty/student discipline as identified in the San Diego State University General Catalog which states that any student may
be expelled, suspended, placed on probation, or given a lesser sanction for several campus related causes. Such sanction shall
include cheating or plagiarism in connection with an academic program at a campus. The above policy applies to both oncampus and off-campus activities. It includes such off-campus activities as falsifying clinical records or public documents.” See
the SON Undergraduate Handbook for further information and definitions of cheating, plagiarism, and disruptive behavior.
Referral to the Center for Student Rights and Responsibilities will be made as appropriate.
Information Regarding Off-Campus Course Work
This course requires students to participate in field trips, research or studies that include course work that will be performed
off-campus. Participation in such activities may result in accidents or personal injury. Students participating in the event are
aware of these risks, and agree to hold harmless San Diego State University, the State of California, the Trustees of the
California State University and Colleges and its officers, employees and agents against all claims, demands, suits, judgments,
expenses and costs of any kind on account of their participation in the activities. Students using their own vehicles to transport
other students to such activities should have current automobile insurance.
Disability Accommodations
If you are a student with a disability and believe you will need accommodations for this class, it is your responsibility to contact
Student Disability Services at (619) 594-6473. To avoid any delay in the receipt of your accommodations, you should contact
Student Disability Services as soon as possible. Please note that accommodations are not retroactive, and that accommodations
based upon disability cannot be provided until you have presented your instructor with an accommodation letter from Student
Disability Services. After accommodations have been authorized by SDS, students are responsible for notifying faculty in
advance of the need for accommodation. This can best be accomplished by making an appointment to meet privately with the
faculty member early in the semester, or as soon as possible in the event that a disability is diagnosed during the course of the
semester. Your cooperation is appreciated.
Attire and Equipment
All students are to adhere to the school of nursing policies regarding clinical attire and hygiene without exception - please refer
to the School of Nursing “CLINICAL ATTIRE AND HYGIENE GUIDELINES” outlined in the student handbook (the official school
uniform is required). Any student considered unprofessional in appearance will be asked to leave the clinical setting. This will
result in an unexcused absence and will affect the student’s clinical evaluation. Be sure to bring all necessary equipment to
clinical: stethoscope, calipers, etc. Cell phones must be turned to off or vibrate (depending on the requirements of the specific
clinical setting) and are not to be used for personal business during clinical hours.
Patient Safety
Each Clinical Instructor has the authority and responsibility to remove students from clinical practice if their activities or
behaviors are deemed UNSAFE or UNPROFESSIONAL by faculty or clinical staff. Examples of unsafe performance include
dangerous, hazardous, risky, unsound, unstable, unreliable, untrustworthy, undependable, unsure, or unprepared. If at any
time, a student demonstrates behavior jeopardizing patient safety or practices nursing in a grossly negligent or incompetent
manner, the student will be removed from the clinical setting and be subject to faculty review. This circumstance may result in
dismissal from the program.
Patient Confidentiality
In accordance with ethical and legal regulations, patient confidentiality must be maintained at all times. Students are expected
to adhere to all HIPAA privacy laws. No patient name or identifying information will be used on the clinical worksheets or
reference material prepared by the student. Patients will be identified by initials only.
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