Nursing 271 (2012) Page 1

NURS 271, Advanced Clinical Nursing is a 90 hour course for the student in the third semester of the nursing curriculum
NUR 271, Advanced Clinical Nursing, provides the student with a 13 hour Intravenous
Infusion (IV) simulated clinical laboratory experience using the nursing process and critical intraveneous skills. Intraveneous therapy sills will be taught, demonstrated followed by student demonstrations of the skill set. Additional skill sets will be demonstrated with student return demonstrations including, but not limited to; IV push medications, IV secondary/piggy back medications, blood administration, and central line care.
Each student is observed by a faculty member during a 1 hour lab assessment and must successfully demonstrate an “IV Therapy check-off.” This performance includes; accurate completion of a physician order, evidence-based elements of initiating an IV using aseptic techniques, completing a medication calculation and delivering this medication via IV push technique, calculation of a gravity flow rate, and establishing a primary and secondary IV using current electronic devices. After the student has successfully performed these procedures in a graded check-off the student will be allowed to perform intraveneous therapy on a hospitalized patient.
NUR 271, Advanced Clinical Nursing, provides the student with seven 11 hour clinical experiences in a medical surgical environment where the student will provide total
(primary) care for one, or more, acute or complex patient(s) .
I. COURSE DESCRIPTION:
Requires students to use the nursing process to identify and prioritize health care needs in the provision of care for patients experiencing complex/acute alterations in health.
Expands upon previous clinical learning to include the teaching/learning process and administration of intravenous fluids and medications in the acute care setting.
II. STUDENT LEARNING OUTCOMES:
At the successful conclusion of the course the student will:
1.
Demonstrate professional accountability through identification of self-learning needs and on-going professional development.
2.
Apply principles of aseptic technique when initiating an Intravenous line/site.
3.
Demonstrate psychomotor skills in the initiation of IV therapy, regulation of IV flow rate and changing of IV solution.
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4.
Demonstrate the cognitive and psychomotor competencies of accurate IV medication administration and fluid calculations.
5.
Adhere to current safety/infection control standards and demonstrate psychomotor competencies when administering blood and blood components.
6.
Discuss and demonstrate understanding of legal parameters and application of institutional policies regarding administration of blood and blood products.
7.
Provide understanding and application of intravenous skill sets including: a.
client preparation b.
aseptic venipuncture technique c.
use of manual flow rate and electronic devices d.
detection of complications of IV therapy e.
safe administration of intravenous medications, hyperalimentation and fat emulsion therapy. f.
use of special techniques related to IV therapy
8.
Explain and return demonstrate the following methods of IV medication administration – a.
Bolus (push) b. Piggy-back or partial fill infusion
c. Maintenance fluid infusion
8.
Display current safety/infection standards, and demonstrate psychomotor competencies when caring for the patient with a PICC line or administration of Total
Parenteral Nutrition (TPN).
9.
Apply therapeutic communication skills to meet the needs of patients related to IV infusion.
10.
Communicate and document accurate and concise IV data and administration
11.
Apply principles of teaching and learning to empower patients and families to effectively participate in intraveneous healthcare decisions.
12.
Utilize the nursing process throughout all aspects of the IV concepts
13.
Modify plans of care based on patient outcomes.:
III. REQUIRED TEXTS:
Required Textbooks:
Fluids and Electrolytes Made Incredibly Easy (2005) 3 rd Ed. Philedelphia: Lippencott
Williams and Wilkins.
Gahart, B. & Nazareno, A. (2006) Intravenous medications. 23 rd edition. St. Louis,
Mosby.
Lewis, S., Heitkemper, M., & Dirksen, S., (2011). Medical-Surgical Nursing:
Assessment and Management of Clinical Problems (8 th ed.). St. Lewis: Mosby.
Lynn, P. (2008 or latest edition).
Taylors’s Clinical Nursing Skills: a Nursing Process
Approach ( 2 nd ed.). Lippincott & Wilkins, Philadelphia. (pp. 833-877)
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Taylor, C., Lillis, C., LeMone,P. (2008 or latest edition). Fundamentals of Nursing: The
Art & Science of Nursing Care (6 th ed.). Lippincott & Wilkins, Philadelphia.
IV. TEACHING-LEARNING STRATEGIES:
Student-focused learning opportunities include:

Student participation in discussions

Student participation in simulated clinical experiences

Completion of assigned reading of weekly topics

Research focused inquiry into evidence based intravenous practice outcomes
Weekly Lab Content:
1. Math Calculations and content quiz documentation of skill
20 min.
(5 reading content and 5 math calculations )
2. Didactic review of topic 30 min.
3. Weekly skill demonstration/return demonstration and instruction and
60 min.
***** Week 1 and week 5 has an additional 60 min of lab time for a total of 3 hours.
V. GRADING:
Pass-Fail Simulation-Lab grading:
To successfully complete this simulation lab each student must:

Attend each clinical simulated laboratory

Earn a 90% average on all quizzes. (Students who achieve less than 90% will be required to perform remediation.)

Successfully complete each weekly IV start demonstration

Successfully return demonstrate each weekly assigned skill set

Successfully complete the IV start return demonstration, the IV medication administration, and discontinuation of IV. Faculty will conduct a formal student assessment in which the student apply critical skill sets using formal check-off tools.
Skills must be completed prior to the end of the semester. Competencies are graded on a pass/fail basis ; students must meet the critical skill sets.
Once the student has demonstrated a passing grade for the required Clinical simulated Skill, he/she may perform IV start on a hospitalized patient in the presence of faculty or RN preceptor.
The clinical skill demonstration will be completed with WNC faculty. Faculty will initial the student’s clinical skill set when the student has demonstrated a successful IV
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procedure in the clinical setting in the acute care clinical (NUR 271) or in maternalchild clinical (NUR 265) at faculty discretion.
In the acute care clinical environment (NUR 271) or in maternal-child clinical (NUR
265) and at faculty discretion the student’s clinical RN preceptor may then observe/coach the student when there is an opportunity to start or terminate an IV.
VI. STUDENT RESPONSIBILITIES:
Clinical Simulation-lab attendance for the entire scheduled lab period is mandatory per nursing program policy.
Life happens, so if you are unable to attend a lab, you must make arrangements to schedule and complete a make-up lab within the week after the missed lab.
Dress code: Lab coat or student uniform with WNC ID badge
Cell phones will be turned off: Please speak with faculty PRN if there is an emergent need.
Lab etiquette must be maintained
No food/drink in lab
Lab housekeeping @ end of class
Students are expected to come prepared by reading the required assigned readings and participating in skill practice throughout the week. It is the students responsibility to come prepared to successfully complete the return demonstration each week.
Academic Integrity per WNC policies R/T cheating and plagiarism per WNC’s Nursing Student
Handbook, Professional Standards and http://www.wnc.edu/policymanual/3-4-5.htm
LOCATION of IV LAB:
Groups DEF – Wednesday – Room Cedar Lab 221
August 29 – September 26
Groups ABC
– Thursday – Room Cedar 325
August 30- September 27
VII. WEEKLY COURSE CONTENT OUTLINE:
Each week each student will start an IV with IV fluids along with the application of new learned skill for that week
Week 1:
1. Starting an Intravenous Infusion with solution administration & Saline Lock
2. Terminating an Intravenous Infusion or Saline Lock (review from 2 nd semester)
Week 2:
1.
Administering IV Push Medications Through Intravenous Infusion or Saline Lock
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2.
Administering IV Medication via Piggy Back Through Intravenous Infusion
3.
Administering IV Medication via primary Intravenous Infusion
Return Demonstartion Check-Off:
After week 2 instruction and practice:
Initiating an IV and administration of a IV push OR IV piggy back and documentation
Week 3:
1.
Administering Intravenous solutions via Central Line and Implantable ports
2.
Administering Intravenous solutions via Peripheral Inserted Central Catheter (PICC)
3.
Central Line dressing changes
4.
Administering Total Parenteral Nutrition (TPN) via central Intravenous catheter
5.
Administering Lipids via central Intravenous catheter
6.
Discontinuation of a Central Line
Week 4:
Administering Blood products via intravenous line with an emphasis on safety
Week 5:
Random Student Skill Simulation: Individual return demonstration of skills learned throughout weeks 1-4.
______________________________________________________________
Week 1: August 29, 1pm-4pm - Groups DEF
August 30, 1pm-4pm - Groups ABC
1. Starting an Intravenous Infusion with solution administration & Saline Lock
-
Read Taylor’s Fundamentals of Nursing pgs. 1414-1448, 1451-1458,
1460-1479
- Read Taylor’s Clinical Nursing Skill 15- 1 ‘Initiating a Peripheral
Venous Access IV Infusion’ pgs.784-792
- Skill 153 ‘Monitoring an IV Site and Infusion’ pg 798-801
- Read & Review Taylor’s clinical Nursing Skill 15-2 ‘Changing an IV
Solution Container and Administration Set. Pg 794-797.
2. Terminating an Intravenous Infusion or Saline Lock
Review Hand-Out
Week 2: September 5 1pm-3pm - Groups DEF
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September 6 1pm-3pm - Groups ABC
1.
Administering IV Push Medications Through Intravenous Infusion or Saline Lock
- Read Taylor’s Skill 5-10 ‘Administering Medications by Intravenous bolus or Push Through an Intravenous Infusion’ pgs.204-207
-
Read Taylor’s Skill 5-14 ‘Introducing Drugs through a Medication or drug-Infusion Lock (Intermittent Peripheral Venous Access Device)
Using the Saline Flush’ pgs. 224-227
2.
Administering IV Medication via Piggy Back Through Intravenous Infusion
- Read Taylor’s Skill 5-11 ‘Administering a Piggyback Intermittent
Intravenous Infusion of Medication’ pgs. 207-212
3.
Administering IV Medication via primary Intravenous Infusion Bag
- Read hand-out
IV SKILL CHECK-OFF
September 7, 2012 8am-5pm Skill check-off (self schedule)
September 14, 2012 8am-5pm Skill ckeck-off (self schedule)
Week 3: September 12, 1pm-3pm - Groups DEF
September 13, 1pm-3pm - Groups ABC
1.
Administering Intravenous solutions via Central Line and Implantable ports
-
Review Taylor’s Fundamentals of Nursing pgs. 1448-1451
2.
Administering Intravenous solutions via Peripheral Inserted Central Catheter
(PICC)
3.
Central Line dressing changes
-
Read Taylor’s Skill 15-7 ‘Changing the Dressing and Flushing Central
Venous Access Devices’
4.
Administering Total Parenteral Nutrition (TPN) via central Intravenous catheter
5.
Administering Lipids via central Intravenous catheter
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6.
Discontinuation of a Central Line
- Hand-Out
Week 4: September 19, 1pm-3pm - Groups DEF
September 20, 1pm-3pm - Groups ABD
1.
Administering Blood Products via Intravenous Line
- Read Taylor’s Fundamentals of Nursing pgs 1458-1460
- Read Taylor’s Skill 15-6 ‘Administering a Blood Transfusion’ pg 807-
812.
Student pair will accurately check “blood “ product and administer 1 unit of
“blood” via newly started peripheral IV and will provide appropriate documentation.
Week 5: September 26, 1pm-3pm - Groups DEF
September 27, 1pm-3pm - Groups ABD
Random Student Skill Simulation:
Individual explanation and discussion of critical elements with return demonstration of skills learned throughout IV Sim lab weeks 1-4.
Starting a peripheral IV
Setting up IV solution/pump tubing
Setting IV pump
Setting IV gravity flow rate
Delivering IV medication via push administration
Hanging a secondary piggy back medication
Administration of blood product
Changing central line dressing
Administering medication/flush via central line
Discontinuing and IV
Simulated activity with random draw of one of the above skills;
Accurate documentation of skill content.
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I. Course Objectives :
At the successful conclusion of the course the student will be able to:
1. Accept responsibility and accountability for own nursing practice and professional development.
2.
Establish a collaborative relationship with the patient, the patient’s family, staff and instructor to provide safe, effective nursing care.
3.
Use effective therapeutic communication while working with patients, families, staff and faculty.
4.
Assess, monitor, and provide appropriate nursing interventions and follow-up evaluation for patients experiencing complex/acute health care conditions.
5.
Use effective communication and relevant teaching-learning theories to provide patient teaching to optimize recovery, health maintenance and illness prevention.
6.
Modify plans of care based on patient outcomes.
7.
Accurately perform medication, intravenous fluid and nutritional fluid rate calculations for clients receiving such medications and nutritional support.
8.
Provide discharge planning using appropriate acute care facility resources in collaboration with the health care team and community resources.
9.
Implement a cost effective, patient-centered, holistic and multidisciplinary plan of care on each day of your clinical rotation.
10.
Employ ethical and legal guidelines when working with patients and their
families who are experiencing acute and complex alterations in their health.
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Prior to the first day you will have completed your clinical orientation, your HIPPA, your
OSHA and whatever other (computer) trainings which are required by your clinical site.
The First Clinical Day
Arrival: On day ONE - arrive absolutely no latter than 0600 in the hospital cafeteria. On your first day, faculty will escort each of you to the appropriate unit and make introductions. Each student will select a patient for whom they will provide care. From
6:00-6:45, when report starts, yo u will look through your patient’s chart. You will always start your day by stopping in to the cafeteria where you check in with your clinical faculty. When faculty make rounds you will be expected to be informed on all aspects of care and treatment for your patient. Faculty will be listening to your patient report when they make rounds. PLEASE HAVE YOUR DAILY REPORT READY TO
GIVE BY 10:30 EACH MORNING. Exceptions will be made if you are extremely busy and/or have two patients. You must inform the instructor of this. This must be the exception not the rule. These daily reports are vital to your success. Make them a high priority!
Orientation: Please spend time on your first clinical day orienting yourself to the physical unit, as well as, the specifics of equipment, patient care, and unit routines.
Remember that you are guests on each unit and representatives of nursing students in general and Western Nevada College specifically. Your helpfulness, willingness to be involved in with the unit, and collegiality are important steps in making a positive first impression.
Facility Preparation: Each unit manager has been sent letters regarding our clinical visit. The letters contain information regarding the specifics of your clinical placement, the course objectives, and a list of skills you are seeking.
Faculty Supervision: During clinical please contact your clinical instructor by his/her cell phone number. Please do NOT hesitate to contact your clinical faculty if you are in need of any assistance. Faculty must be present to supervise when you are performing skills, or medications for the first time . After your clinical instructor has witnessed your “firsts“ you may have another RN or your clinical instructor supervise your practice. When you are in need of assistance please have as much of the procedure or skill prepared prior to your clinical instructor’s arrival. An example would be IV drug administration. Faculty expect you to have the appropriate equipment available and setup along with the appropriate dose calculations performed. Faculty expect you to have researched the medication you are going to administer. Faculty expect that you will have checked the order against the chart - etc. In other words, prep for each skill as much as possible prior to calling your faculty to your location. In addition to the prep, please allow adequate time when treatments or medications are time sensitive. Do not wait until the last minute to administer a medication or perform a treatment.
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After your faculty has witnessed the administration of oral and other types of medications, the student may administer medications with the RN resource nurse.
Never administer a medication or perform a procedure without faculty or your resource nurse present . You may perform all ADLs independently. The student will document medication administration using their own sign-in and verification will be done by your clinical instructor or your resource RN.
Leaving the Unit: You should be at clinical post conference by 16:00 each day. The location of post conference will vary and your faculty will make you aware of the location on a day-by-day basis. Remember that you are responsible for giving report to your primary RN (and unit charge nurse if s/he desires) prior to leaving the floor for ANY reason (including lunch and post-conference). If there is an especially meaningful learning opportunity occurring during post-conference please speak with your faculty and you may be released from conference. You are encouraged to follow your patients to diagnostics and other departments if it is appropriate - please always let your faculty know if you are going to be somewhere other than your unit.
You are responsible for assuring you receive appropriate breaks and lunch.
Breaks should be limited both in number (1) fifteen minute morning break and one 30 minute lunch break. It is not acceptable to leave the hospital building during a clinical day.
If you are going to be absent please contact your clinical instructor by phone.
Student Preparation: Each clinical morning your clinical instructor will go over your written materials and take report on your patient using the daily report form provided.
Please review the chapter(s) in the Lewis, Heitkemper, and Dirkesen text regarding health problems associated with your unit prior to arriving to clinical. Neuro - Telemetry -
Oncology – Medical, etc.
The minimum knowledge set for safe practice in the student role includes:
• Knowing the pertinent medical and nursing diagnosis of each client.
• Exhibiting a working understanding of the patho-physiology of each of the patients’ medical diagnoses.
• Knowing the patient’s plan of care.
• Knowing the patient's medications, dosages, time schedules, side effects, and nursing interventions necessary to safely deliver/administer the medications
• Knowing the nursing considerations for any special procedures the
patient is undergoing.
• Knowing pertinent laboratory values.
 Utilizing all steps in the nursing process to deliver safe and effective
nursing care.

Employing time management techniques to assure all care is delivered
in a safe and effective manner.
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Additional clinical work may be assigned during post-conference and may vary from experience to experience. This may include (but is not limited to): clinical research on medications, or laboratory research, patho-physiology reports, and nursing diagnosis.
Please contact your faculty with questions, or concerns regarding your clinical experience. BRING YOUR MED BOOKS: LEWIS & HEITKEMPER, YOUR DRUG
BOOK, AND YOUR LAB BOOK each clinical day. You may also utilize the facility elearning and computerized resources.
YOU MUST ALSO BRING YOUR PATHOPHYSIOLOGY PAPERS for use with your orange daily report sheets to clinical to be read and evaluated by your clinical instructor.
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