Community College of
Philadelphia
Department of Nursing
N101
ACE
FALL, 2006
Introduction to Problem-Solving,
Therapeutic Communication, Pharmacology, and
Teaching/Learning
Classes meet Thursdays and Fridays, Weeks I-IV
in the Business and Technology Center, C2-28
or in the Winnet Building, S2-3.
(Announcement will be made weekly)
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
NURSING 101
ALTERNATE CLINICAL EXPERIENCE (ACE)
FALL 2006
PACKET CONTENTS
Reading Assignments
Contained under each topic
Read for general concepts before class
Read for more detail after class
ACE Schedule
Group assignments will be posted on the bulletin board outside of W2-15.
There are eight groups (Groups A, B, C, D, E, F, G, F) and students will stay in one group
throughout the ACE Weeks (Weeks I, II, III and IV). These groups are NOT your clinical groups.
Clinical groups will be posted by Week III.
During Week #1 you will attend two daily sessions on Thursday (9/7) and Friday (9/8) in S2-3;
these sessions will introduce you to concepts important to development of thinking skills relevant
to nursing (On-line learning, nursing process and therapeutic communication).
During weeks II, III, and IV you will attend a total of four ACE sessions:
two classes from this packet (see attached schedule) and one hands-on practice
session in the skills lab (Rooms W2-15, W2-16, W2-22 or W2-17) related to physical assessment.
During weeks II, III and IV, one of the physical assessment assignments will be on line
and must be completed prior to attendance at the hands on physical assessment session
in the skills lab.
Topics:
Orientation, ACE Packet, 8
Problem Solving and The Nursing Process, 13-19
Therapeutic Communication Skills, 38-42
Growth and Development, 9-12
Introduction to Pharmacology, 32-34
Health Promotion and Disease Prevention; Introduction to CT Paper, 20-26 and articles
The Nursing Process: Constipation, 27-31
Client Education/Health Teaching (Knowledge Deficit), 35-37
History of Nursing and Math Test, 43
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3
4
Department of Nursing
Alternate Clinical Experience (ACE)
Week 1
Thursday, September 7, 2006 Day Section
ORIENTATION AND INTRODUCTION TO ON-LINE LEARNING IN THE
DEPARTMENT OF NURSING
Introduction of Full and Part-Time Faculty.
Data Collection/Forms
Curriculum Overview
Student Handbook Review.
Greetings:
Dr. Mary Anne Celenza
Dean, Division of Mathematics, Science and Health Careers
Dr. Andrea Mengel
Head, Department of Nursing
Ms. Carmen Colon/Judy Davidson/Jon Brown
Counselors
Ms. Gail Chaskas
Math Specialist
Introduction to On-line Learning in N101
Faculty will orient students to seminar and classroom assignments to be completed online throughout the semester.
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Week #1
Friday, September 8, 2006
TOPIC: CRITICAL THINKING AND PROBLEM SOLVING IN NURSING PRACTICE:
THE NURSING PROCESS AND THERAPEUTIC COMMUNICATION SKILLS
Objectives: At the end of the class the student will:
1.
Identify essential characteristics of the problem-solving process used for nursing practice.
2.
Explain the relationship between critical thinking and the nursing process.
3.
Identify strategies used to assist the nurse with problem-solving.
4.
Discuss the Community College of Philadelphia Nursing Department's Philosophy of
Nursing.
Required Readings:
Craven and Hirnle:
(Read for General Understanding)
Chapter 9,
The Nursing Process, p. 143-147
Chapter 10, Types of Assessment: p. 157-159
Assessment Activities: pp. 163-167
Chapter 11, Components of a Nursing Diagnosis: pp. 182-191
Chapter 12, Establishing Client Outcomes: pp. 195-205
Chapter 13, Types of Nursing Interventions: pp. 210-212
Evaluation: pp. 212-216
Chapter 14, How to Develop Critical Thinking: pp. 226-227
How to Develop Nursing Judgment: pp. 228-230
Lipe and Beasley: Chapter 2, Problem Solving, p. 19-26
Scenario 1 and 2, p. 31
Scenario4 and 5, p. 32-33
Chapter 5, p. 89-95
Sample Care Plan, Box 5-3
Scenario 1, p. 110-111, Scenario 2, p. 111-113.
Assignment:
Prior to class, do Fun Exercise on page 34 of Lipe and Beasley, Chapter 2.
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COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
N101
Nursing process - a systematic, rational method of planning and providing nursing care.
The nursing process includes these five steps:
1.
2.
3.
4.
5.
1.
Assessing
Diagnosing
Planning
Implementing
Evaluating
Assessing - data collection. Systematic, comprehensive gathering and analysis of
relevant information. Establishment of data base, sometimes using a nursing
history:
a.
Defining characteristics/behaviors include:
(1)
(2)
subjective data - what client says; e.g. "I didn't sleep well."
objective data - obtained through physical exam, observation, review
of laboratory data, x-ray, etc; what nurse observes, e.g. pulse of 92;
rales in bases; lab data, for example, Na-140 meq/liter.
Please note: These data (subjective and objective) relate to the nursing
diagnosis; you will not be listing all data for the client in the
behavior column of the care plan, only data that provide
information about the nursing diagnosis.
b.
Contributing factors - (sometimes called etiology, causes or related factors)
(1)
(2)
(3)
(4)
Physiological Integrity (physiology, pathophysiology)
Growth and Development (norms for age groups; Erickson’s tasks)
Care Environment (eg. New environment, immobility, previous
patterns, medical/nursing treatments, medications (pharmacology),
diagnostic tests, cultural influences)
Psychosocial Integrity (eg. stressors, coping mechanisms, support
systems)
Please note: Contributing factors are significant because they
individualize the care plan and subsequently drive the
interventions. All care plans will include the four categories of
contributing factors and all contributing factors need rationales.
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2.
Diagnosing - diagnostic reasoning to determine the client’s problem, in the form of
a nursing diagnosis, e.g. Health Maintenance, Altered. A nursing diagnosis is a two
part statement. The first part reflects defining characteristics/behavior and is taken
from a list of nursing diagnosis and the second part consists of one or more of the
most important contributing factors, for example, Constipation related to inadequate
toileting and lack of exercise. Part one RT (relate to) part two.
3.
Planning - expected outcomes. Describe the desired or favorable client condition
that can be achieved through nursing interventions. Stated in terms of expected or
desired client behavior:
ie. 1) "Client's respiratory rate will remain within 16-20 per minute during
hospitalization"
2) “Client will walk for 20 minutes three times today”.
3) "Client will maintain self esteem today as evidenced by participating
in self care."
4.
Implementing - nursing interventions. Very often interventions are derived from
significant contributing factors. This step is the process of putting the nursing care
plan into action to attain the desired client outcomes. Interventions are justified by
a rationale which explains the theoretical basis for a nursing action on all care
plans. Nursing interventions address the following categories: (note the relationship
to influencing factors)
(a)
(b)
(c)
(d)
5.
safe, effective care environment
physiologic integrity
psychosocial integrity
health maintenance/promotion
Evaluating - on-going comparison or appraisal of the degree to which expected
outcomes have been accomplished.
Revised/08/05/ET
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Psychosocial Behavioral Stressors in the Hospitalized Client
The following list of stressors that affect the hospitalized client may be helpful in
developing care plans. Stress reduction is a significant nursing activity. As you review the
interventions listed in the next section please observe that the interventions are similar in
that they assist the client by:
1.
eliminating the stressor or reducing its intensity.
2.
reducing the number of stressors to be coped with simultaneously.
3.
reducing the duration of exposure to the stressor.
4.
developing the client's coping mechanisms, i.e., assisting the client to identify his
stressors and select a coping mechanism to manage his stress, educating the client so
that he is well-informed, remaining accessible so that the client has sufficient
opportunity to discuss his hospital experience.
Stressors Affecting the
Hospitalized Client
Interventions:
1.
Loss of familiar surroundings-placement
in an alien environment.
1.
When admitting client, orient him to his
physical environment.
2.
Disruption of daily routines and
preferences.
2.
Modify care plan so that daily routines can
be preserved (when possible)
3.
Deprivation of pleasure stimuli-over-load
of noxious stimuli.
3.
Assist client to recognize positive
environmental factor rather than
permitting him to focus exclusive on the
negative factors.
4.
Being uniformed regarding the daily
schedule of activities, diagnostic tests,
treatments, etc.
4.
Inform client regarding time parameters so
that he can anticipate and plan for
activities.
5.
Being uniformed regarding how to get a
need satisfied.
5.
Identify what the client, perceives as his
needs and inform him re: activities for
need satisfaction.
6.
Delay in getting an expressed need
satisfied.
6.
Validate with the client whether his needs
are being met, and if not, identify alternate
methods.
7.
Being exposed to unfamiliar language.
7.
Use terminology familiar to the client and
repeat information when the patient seems
to have difficulty comprehending or
remembering.
8.
Loss of personal autonomy loss of control
of decision-making.
8.
Provide an environment which encourages
client independence to his maximum
ability. Encourage client so that he is an
active participant in his care plan.
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9.
Loss of privacy (defined as the individual's
right to exclude others from certain
knowledge about himself).
9.
Maintain physical privacy by avoiding
unnecessary exposure of a body part.
Maintain psychosocial privacy by not
requiring disclosure of information
whichthe client prefers not to share.
10.
Loss of territory (defined as desire to
occupy portions of space, and when
necessary, to defend it against intrusion by
others; it involves identification with the
space symbolized by attitudes of
possessiveness and arrangement of objects
in the area.
10.
Maintain sense of territoriality by
arranging objectives in the client's room to
his preference (if possible); opening
bedside stand with his permission; knock
prior to entering room when door is
closed.
Loss of personal space: (defined as the
space compassed by the body; the invisible
boundary which exists around the client; it
moves with the client and expands and
contracts in varying situations) 4 zones:
11.
Enter client's personal space only when the
care plan requires it; inform him of what
activity you're carrying out; encourage his
sharing any feelings of distress regarding
his loss of personal space.
11.
Intimate 0-1 1/2 ft.
Social 4-12
Personal 1 1/2-4
Public 12-beyond
12.
Loss of significant other or change in their
interactional style.
12.
Arrange nursing care activities that privacy
can be provided during visiting hours
(when possible); support the family in
interacting with the client.
13.
Forced interaction with multiple strangers.
13.
Assign the same nurses to care for client
daily. When admitting the client, orient
him to the personnel he will be meeting.
Request the personnel entering room
introduce themselves and explain the
reason for their entry.
14.
Unfamiliar diagnostic and treatment
procedures.
14.
Describe the procedures and what the
client may experience: correct any
misinformation the client may have about
his care.
15.
Uncertain diagnosis and prognosis.
15.
Assist client to accurately appraise his
health status and correct any
misconceptions. Encourage client to share
feelings of distress and then encourage
problem-solving behaviors.
16.
Loss of financial security.
16.
Refer client to support services available
in hospital.
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Week #1
Friday, September 8, 2005
TOPIC: INTRODUCTION TO THERAPEUTIC COMMUNICATION SKILLS
OBJECTIVES: At the end of the class, the student will:
1.
Identify the purpose of therapeutic communication.
2.
Describe characteristics of therapeutic communication.
3.
Give examples of the following therapeutic communication techniques:
paraphrasing
clarifying
summarizing
open-ended questions
using silence
focusing
4.
Give examples of the following non-therapeutic responses:
failing to listen
unwarranted reassurance
judgmental responses
5.
Discuss the importance of professional behavior, including confidentiality and
appearance.
6.
Discuss data which is essential to be communicated to hospital staff and/or the
clinical instructor during the clinical day and at end of shift report.
Required Reading:
Craven and Hirnle,
Chapter 15,
Chapter 22,
Oral Communication: p. 253-256;
Types of communication: p. 366-368
Ingredients of Therapeutic Communication: p. 371380
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Characteristics of Effective Communication
- confidentiality
- sharing empathy and hope
- simple clear and specific
- appropriate time and setting
- responds to clues and cues from other party
- credible, warm, and caring
- respects personal space
- informative
- nonjudgmental
Inhibiting Effective Communication
- giving personal opinions
- offering false reassurance (“Don’t worry”)
- automatic response using stereotypic responses) and parroting
- being defensive and asking for explanations (use of “Why”)
- changing the subject inappropriately
- asking personal questions
- giving approval or disapproval
- arguing
Therapeutic Communication Techniques
- open-ended question
- sharing observations
- providing information
- closed-ended question for focusing
- paraphrasing and reflection of feelings (reflection)
- silence
- clarification (verifying the implied, using paraphrase, expressing concern)
- summarizing
Note: These techniques should be illustrated in a process recording to be handed as a
clinical assignment (Time to be determined by the clinical instructor). See
attached sample.
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COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
SAMPLE PROCESSING RECORDING
N101
PATIENT:
Mr. B
MEDICAL DIAGNOSIS: Coronary Insufficiency
AGE: 62
SETTING:
Client sitting in chair. Nursing sitting next to him. Client is to be OOB for 15 to 20'.
TIME:
10:00 AM
GOAL OF COMMUNICATION: (1) Client will verbalize feelings and concerns about being in the hospital to the
nurse this A.M.
NURSE/CLIENT INTERACTION
(INCLUDING VERBAL AND NON-VERBAL)
NURSE: MR. JONES, TELL ME WHAT IT IS LIKE FOR YOU BEING IN
THE HOSPITAL.
CLIENT:
I'VE NEVER BEEN IN THE HOSPITAL BEFORE. (N.V. client grimaces)
NURSE:
THIS IS A WHOLE NEW EXPERIENCE FOR YOU.
CLIENT:
YES, IT'S NOT WHAT I EXPECTED..... EVERYONE
RUNNING AROUND AND ASKING ME ALL THESE
QUESTIONS..... AND SO MANY TESTS. (N.V. client
wringing his hands)
NURSE: MR. JONES, ARE YOU SAYING THAT ALL THE TESTS AND
DIFFERENT PEOPLE ARE CONFUSING TO YOU?
CLIENT:
INTERPERSONAL
COMMUNICATION SKILLS
OPEN-ENDED QUESTION
PARAPHRASING
CLARIFICATION (VERIFYING THE
IMPLIED)
YES, AND I AM NOT USED TO IT. I MEAN, I RUN MY
OWN BUSINESS..... HAVE FOR YEARS.
NURSE: TELL ME WHAT IT IS LIKE FOR YOU, BEING HERE FEELING
CONFUSED.
CLIENT:
I'M NOT SLEEPING WELL. I WISH I COULD RELAX BUT
I FEEL NERVOUS ALL THE TIME.
NURSE:
WHEN YOU ARE FEELING NERVOUS AT HOME OR
WORK, WHAT DO YOU DO TO FEEL BETTER?
CLIENT:
I TALK WITH MY WIFE OR CALL MY DAUGHTER. SHE
LIVES IN TEXAS.
NURSE:
SO TALKING TO YOUR WIFE AND OTHER SUPPORT
PERSONS HELPS YOU COPE.
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OPEN-ENDED QUESTION
(FOCUSING)
FOCUSING
PARAPHRASING (HELPING
CLIENT TO IDENTIFY COPING
MECHANISMS)
EXERCISES IN COMMUNICATION SKILLS
I.
OPEN-ENED QUESTIONS
EXERCISE: For each of the statements listed think of a more open-ended way to phrase
the request.
NURSE’S
QUESTION: “Where is the pain, when does it hurt, how bad is it?”
“Have you been ill this week?”
II.
PARAPHRASING
EXERCISE: For each of the following statements, think of how you would paraphrase it.
How would you say it in your own words without changing the meaning?
CLIENT’S
STATEMENT: “My child has a 100-degree temperature and has been coughing. What
should I do?”
“I haven’t been sleeping well. I get up every mornign at 3 A.M. and stay
awake looking at the ceiling.”
“I can’t leave him alone even for a few hours because I’m afraid of what he
will get in to and I never get any time for myself.”
III.
CLARIFYING
EXERCISE: There are various ways to use clarification as a technique, for example:
a. Confess confusions and ask the client to repeat or restate the message.
“I’m not sure I understood that completely. Can you tell me again?”
b. “Verify the implied.
“Are you saying that the test results are confusing to you?”
c. Perception checking or consensual validation.
“You say you are fine but your body appears tense.”
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FOR EACH OF THE SITUATIONS LISTED, USE A CLAFIFYING RESPONSE TO
MAKE THE CLIENT’S MESSAGE MORE UNDERSTANDABLE.
A client relates one symptom after another to the nurse. “I felt faint…I called my
sister…I fell down…My leg hurts.”
“A mother complains about her child’s behavior with a slight grin on her face.”
“The doctor was just in here and said they found something on my lungs. I feel so
bad. I just wish I didn’t have to go through all this.”
IV.
SUMMARIZATION
EXERCISE: decide how you would summarize the “interview” in one or two sentences.
a. A postoperative phlebitis client feels tired but hopeful of fast recovery. Her
husband has not been in to see her, and she expresses worry over where he is.
V.
CRITICAL THINKING EXERCISES
THINK ABOUT A BRIEF RESPONSE TO EACH OF THE FOLLOWING QUESTIONS:
1. When a patient’s spouse says to you: “I don’t need nurses to help me when we go
home”, what are the possible explanations regarding the meaning of this
communication?
2. Mr. Hess, a client with Parkinson’s disease living in a life-care community, has a stiff,
expressionless face. He sits slumped in a recliner chair all day and seems lost in his own
world, rarely looking at or interacting with others. When he does talk, he mumbles in a
soft voice and his words are difficult to understand. What kinds of things could the
nurse do to establish a helping-healing relationship with Mr. Hess?
3. Mrs. Peterson, a client who has been recently admitted to a hospice program, confides to
the nurse that she feels overwhelmed with the number of things she must attend to now
that she is facing death. She says, “My thoughts are all over the place. I don’t know
where to start”. What communication techniques could the nurse use to help Mrs.
Peterson at this point? What communication techniques are not helpful?
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Week #2
Thursday, September 14, 2006
TOPIC: INTRODUCTION TO PHARMACOLOGY
Objectives: At the end of the content presentation, the student will:
1. Define the pharmaceutical, pharmacokinetic and pharmacodynamic phases of
drug action.
2. Describe the pharmacokinetic phase of drug action, i.e., absorption, distribution,
metabolism, and excretion.
3. Identify factors that influence the pharmacokinetic phase of drugs across the life
span.
4. Relate drug action to drug classification.
5. Define the terms: side, effect, toxic effect, idiosyncratic effect, cumulative effect,
drug allergy, drug tolerance, drug interaction, and half-life.
6. Develop a beginning understanding of the role of the nurse in safe drug
administration.
Required Reading:
Lilley: Chapter 2, p. 16-34 (Pharmacologic Principles)
Do NCLEX Review Questions, p. 34
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INTRODUCTION TO PHARMACOLOGY
STUDY QUESTIONS
1. Of tablets, enteric-coated pills, and suspensions, which drug form is most rapidly
absorbed from the gastrointestinal tract? What is the rationale for this?
2. Does the presence of food enhance or interfere with dissolution and absorption of
medications?
3. List the four processes of pharmacokinetics and define each.
4. Explain four factors that affect drug action.
5. Define bioavailability.
6. Why is adequate renal function vital for therapeutic responses to medications?
7. What are the nursing implications related to the half-life of a medication?
8. Explain the receptor theory of drug action.
9. What is the difference between a side effect and an adverse reaction to a
medication?
10. Compose two questions a nurse might ask a client or significant other that will
elicit unique information to help the nurse to enhance adherence to a drug therapy
regimen.
11. List four factors that might influence a client’s ability to comply with a
medication regimen.
12. Differentiate between an additive and a synergistic effect of medications.
13. Describe three ways to involve parents or caregivers in the administration of
medications to pediatric clients.
14. What is meant by first pass elimination? How can it be avoided?
15. How does the nurse use information about onset, peak and duration of action of a
medication when giving prn medications?
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INTRODUCTION TO PHARMACOLOGY: Group Activity:
Each group will be assigned a commonly prescribed medication. As a
group, create a drug card to include the following information:
Brand Name & Generic Name
Pharmacokinetics (See ACE outline)
Absorption (Route, Factors influencing absorption, etc.)
Distribution
Metabolism
Excretion
Pharmacodynamics
Action
Onset
Peak
Duration
Therapeutic Window
Indications
Precautions
Interactions (Only include a few major interactions)
Side Effects
Adverse Reactions/Toxic Effects
Nursing Implications
Group A - Tylenol
Group B - Ambien
Group C - Motrin
Group D – Aspirin
Group E - Tylenol
Group F - Ambien
Group G - Motrin
Group H – Aspirin
Group I - Tylenol
Group J - Ambien
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Week #2
Friday, September 15, 2006
TOPIC: GROWTH AND DEVELOPMENT-Erickson’s Psychosocial Development
Theory
Infancy to the Middle Years
Older Adult
Objectives: At the end of the class the student will:
1. Identify characteristic tasks at each stage of development during the life cycle,
utilizing Erickson’s Theory.
2. Discuss issues related to psychosocial changes of aging.
Assignment: Prior to attending the class please read the growth and development
readings and answer the questions on the study guide below which are marked by * (The
additional study guide questions will be answered during class time).
(Note: The emphasis for this class is psychosocial development. Content on physical
changes for older adults will be covered weekly in lecture throughout the semester.)
Methodology: Students will view the video “Everyone Rides the Carousel” during class
time and discuss each developmental stage based on the movie.
Required Readings:
Craven and Hirnle,
Chapter 10, Life Span Development: p. 284-311
(Focus on Psychosocial Changes only)
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Growth and Development (Answer the questions marked with * from your readings
prior to class).
1.
2.
Infancy: Trust vs. Mistrust
*a.
Describe the most essential developmental tasks of the infant.
b.
How did the baby in the movie demonstrate the conflict of trust vs. mistrust?
Toddlerhood: Autonomy vs. Doubt
*a.
Describe the most essential developmental tasks of the toddler.
b.
Discuss the toddler in the movie. How did he evidence autonomy? doubt?
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3.
4.
5.
Pre-school Child: Initiative vs. Guilt
*a.
Describe the developmental tasks of the pre-school child.
b.
How did the pre-school child in the movie demonstrate initiative? Guilt?
School age years: Industry vs. Inferiority
*a:
Describe the developmental tasks of the school age child.
b.
What activity in the movie most accurately described the conflict of the
school-age child?
Adolescence and Young Adult:
Isolation.
*a.
Identity vs. Role confusion and Intimacy vs.
Describe the developmental tasks of the adolescent and young adult? How
are they alike?
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6.
Middle Years: Generativity vs. Stagnation
*a.
b.
7.
Describe the developmental tasks of the middle years.
What events in the movie most accurately describe the conflict experienced
by the generative adult? How does this relate to you now?
Late Adulthood: Integrity vs. Despair
*a.
Describe the essential development tasks of late adulthood.
b.
Describe conflicts portrayed in the movie by the older adults. How did they
reach resolution?
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Week #3
Thursday, September 21, 2006
TOPIC: INTRODUCTION TO HEALTH PROMOTION/DISEASE PREVENTION
DEVELOPING THE CRITICAL THINKING PAPER
Objectives: At the end of the class, the student will:
1. Compare and contrast definitions of health and illness.
2. Explain the purpose of Healthy People 2010.
3. Describe factors that influence health promotion and disease prevention.
4. Describe levels of disease prevention and give examples using diabetes and heart
disease as the prototypes.
5. Begin to formulate ideas for the development of the critical thinking paper.
6. Demonstrate the use of APA format in citing references.
7. Give examples of health promotion/disease prevention behaviors that are
appropriate for use in the critical thinking paper.
Required Readings:
Burke, L. (2003). Primary prevention in patients with a strong family history of coronary
artery disease. Journal of Cardiovascular Nursing, 18 (2) p 139-143. (attached)
Craven and Hirnle,
Chapter 16: Health and Wellness: p. 261-264
Chapter 33, Normal Health Maintenance Patterns: p. 705-708
Factors Affecting Health Maintenance: p. 708-710
Implementation: 718-722
Mark’s Story (Please read before coming to class; the class will begin with a discussion
of this story) (attached, p. 21-22)
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Mark’s Story
Mark, a forty-two-year-old man with cerebral palsy, first came to the support group for
the disabled somewhat unwillingly. He had been admitted to the hospital with
pneumonia secondary to a viral infection. He was severely spastic, and his speech was
readily understood only by close family members. He was ADL-dependent and lived
with his widowed father in a new condominium. He could toilet himself but could not
walk to the toilet unaided. In emergencies, he could crawl. He could feed himself if his
food were cut for him. He could partly dress himself if his clothes were laid out in a
certain way. Buttons were beyond him, but he could manage some zippers. He had
moved into the area two years previously but had not visited a doctor. I first met Mark
when he came to the support group. The physician who took on his care in the hospital
called in the physical therapist for an assessment of Mark’s condition so that he would
know what follow-up care would be appropriate.
The physical therapist was upset by Mark’s general condition. She saw that he was in
many ways born too soon, because current approaches to physical “habilitation” would
have allowed less severe contractures, greater strength, and greater range of movement
and control. She was certain that the pneumonia was an inevitable result of general lack
of physical movement and shallow breathing. She was amazed that he hadn’t been sick
sooner. After her assessment, she remarked to him.
“You know, we have a support group for disabled people that meet here at the hospital.
You might be interested in joining after your discharge.”
Mark’s reply (which she could not understand until his father interpreted) was: “But I’m
not disabled.” We both came to understand how he could have this self-understanding
after we learned his story.
Mark was born into a Midwestern family of Scandinavian extraction. His father and
mother still could speak their parents’ native tongue. His father was a blue-collar worker.
His mother was a housewife. He had one younger sister. The family moved to the
Southeast to get special schooling and medical care for him when he was a child. In his
teenage years, they moved back to their Midwestern hometown. Cerebral palsy was
associated with great stigma at that time. Because his speech was comprehensible only to
his mother and his sister, strangers assumed he was mentally retarded. So as to appear
“normal,” he never used a wheelchair around the house. He usually sat in the living room
and read. His favorite topic was cars, especially racing cars.
His mother was his support, mainstay, and advocate. She recognized his need and desire
to have some independence and had her husband adapt a three-wheel motorcycle for his
use. He drove it around the country roads near their home. One evening the motorcycle
slipped into a ditch and overturned. Mark was unhurt, but could not right the cycle. He
crawled a mile to a farmhouse and finally convinced the family there he was not crazy
and had them call his parents. His father wanted to declare the motorcycle off-limits as
too dangerous. But his mother said, “No, he has to have it.”
26
His sister was his closest friend. But she went to college, married, and moved abroad for
awhile. When he was thirty-eight, his mother died. His father was devastated by the
loss. In addition, he and his wife had had a traditional division of roles in the family, and
he was entirely undomestic. He had to take on the full-time care of Mark, and he
couldn’t even understand what Mark was saying. After two very unhappy years for both
of them, they moved to the West Coast, where Mark’s sister and her young family had
settled.
In the new surroundings, life improved for both Mark and his father. Their condo was
new and comfortable. They visited Mark’s sister once a week for a day plus dinner. And
most special for Mark, they lived one block away from a racing car garage. His father
took him by at first to look at the cars. The mechanics, owners, and drivers soon found
out that this very disabled man, who because of his garbled speech and twitchiness
appeared retarded, knew almost as much about cars as they. He could discuss
knowledgeably all the internal workings of the various racing car engines. He knew the
speeds they could be expected to attain in certain brief spans of time. He could predict
what would most likely go wrong with the car first. He became a sort of mascot of the
garage. He drove there often on his three-wheeler. And he and his father would travel to
some of the big races. The rest of the time, he sat in the living room reading as he always
had.
Mark did not think of himself as disabled because being disabled meant being mentally
retarded. His mother had tried to protect him from stigma. She helped him develop his
undoubted intelligence, and she enabled him to achieve a small measure of freedom and
independence at great cost to her own peach of mind.
When he did finally start to attend the disabled support group he found what he had never
had: friends. He was dear to his family. His father, sister, brother-in-law, and nephews
all loved him, but they were not the same as friends. The men at the garage regarded him
with fond tolerance. They liked him and admired his amazing knowledge of cars, but
they would never invite him out for a beer after work.
With this group of people, Mark went to movies, day trips, and even week-long vacations
to Hawaii and Mexico. They called each other on the phone. And as a group they shared
the pain and frustrations of their lives with others who understood.
One day at support group they decided they would each tell the others their impossible
dreams, the one thing they always longed to do but knew they would never be able to do.
This was painful and yet somehow warming because of the complete understanding that
flowed through the group. Then came Mark’s turn. “Drive a car,” he said. “But that’s
not impossible,” one member of the group protested, “You’re supposed to tell us the
really impossible thing you want to be able to do.” I won’t detail the ensuring argument
or even the later difficulties, hassles, and red tape. One year later, Mark had his license
and a new car specially adapted for his use.
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Mark enrolled in special classes for disabled people at a nearby junior college designed to
improve strength, flexibility, breathing, and motor control. He began to prepare to take a
series of computer classes that would qualify him for reemployment producing
specifications for machinery parts manufacture. Four months before the classes were
slated to begin, Mark died of ventricular fibrillation brought on by coughing. The funeral
was well attended. All his friends were there.
Reflect on this story: What have you learned about Mark and his family, about your
own values, about your initial impression of the client and his situation?
What barriers prevented Mark from achieving wellness?
What factors most influenced Mark’s ability to achieve his optimal level of function
and health?
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DEVELOPING THE CRITICAL THINKING PAPER
The purpose of the Critical Thinking Paper is to afford the student the opportunity
to assess a selected client's behavior and analyze and articulate their findings in an
organized fashion.
TOPIC AND CLIENT SELECTION
The topic of this paper is Health Promotion/Disease Prevention. The student is
asked to assess client behaviors that promote health and/or prevent disease. You may
also elect to assess high risk factors or behaviors that put a client at risk for the
development of a disease.
After interviewing the client you should select the risk factor that you assess to be
the highest priority and use that as the topic for your paper.
SUGGESTED TOPICS (Based on Healthy People 2010; this list is not inclusive):
Physical Activity and Fitness
Overweight and Obesity
Tobacco Use
Responsible Sexual Behavior; Sexual Health and Prevention of STD’s
Safety Issues
Immunizations
Access to Health Care
Cardiovascular Health, including nutrition and exercise
GUIDELINES:
There are 3 major parts to this paper
1. ASSESSMENT
This section includes a brief description of client, including health status; topic
chosen for the paper and why the topic was selected; and risk factors which influence
the client's ability to participate in health promotion/disease prevention activities.
Consider all contributing factor categories: physiological integrity, care environment,
growth and development and psychosocial integrity.
Remember that the focus of the paper is Health Promotion/Disease Prevention.
Your client may be healthy and working to stay that way or have a strong family
history of a disease that he or she is trying to prevent. Clients with chronic problems
may be trying to prevent the onset of complications.
2. EXPECTED OUTCOMES
Outcomes represent the expected result of nursing interventions or health
teaching. Outcomes must be logical and consistent. A minimum of two outcomes is
required for the paper. Both outcomes must relate to the same topic and must be
directed toward Health Promotion/Disease Prevention.
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3. NURSING INTERVENTIONS
Nursing interventions are activities for the client that will assist the client in
meeting the stated outcomes. Nursing interventions should be written as
recommendations for your client. They should be realistic for the client you have
chosen and achievable if put into use. Three interventions are required for each
outcome. Each intervention requires a rationale.
INSTRUCTIONS FOR WRITING THE PAPER
The paper should be 3-4 pages in length. It must be typed, double-spaced. APA
format must be used in citing references in the body of the paper and on the reference
sheet. In addition, please use the following guidelines:
White paper only
1" margins top and bottom and both sides
Font no less than 10 and no larger than 12
Paragraph form for the entire paper
Running head is optional
No folders
REFERENCES
You are required to provide a list of references in the completed paper. Include at
least one (1) article from a nursing journal. Please use articles from referred nursing
journals that describe current nursing practice, i.e. American Journal of Nursing, Nursing
2005 (or Nursing 2004, 2003, 2002, 2001, 2000 etc), RN, Journal of Public Health
Nursing, Perspectives in Health Care etc. No journal article should be more than 5 years
old. Additionally, you must utilize information from the article in the body of the paper
to substantiate or validate concepts discussed in the paper.
A minimum of 3 references is required for this paper. In addition to the journal
article you may use textbooks and popular literature. One-half point will be deducted for
papers that do not have a minimum of three references.
GRADING FORMAT
You will receive a grade between 0-10 on this assignment. This grade is
computed as 10% of the final grade for Nursing 101. Please review the Grading Criteria
Sheet for point distribution. Keep in mind the following:
Proofread your paper and follow the directions. Up to 0.5 points may be deducted
for multiple spelling or grammar errors or failure to adhere to the format.
Points are deducted for papers that are handed in late, one point for each normal
working day beginning 12:01 PM on the due date.
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DATE PAPER IS DUE
The Critical Thinking Paper is due Tuesday, October 31, 2006 by 12 Noon.
Papers should be handed in to Sue Orehowsky, W3-47. Be sure to make a copy
of your paper on a disk or copier before handing it in to Sue.
Lateness, failure to follow the format and multiple grammatical errors may result
in the deduction of points. Papers submitted after the deadline will have one point
deducted for each 24 hour period that the paper is late. For example, if the paper is
handed in by 12 noon on Wednesday, November 1, 2006 one point will be deducted for
lateness but if the paper is handed in to a faculty member at 3:00 PM on Wednesday,
November 1, 2006, two points will be deducted since the paper is two days late. Late
papers should not be slipped under faculty office door or sent to a faculty member
via email. If no faculty members are present on campus, hand the paper in to W2-5
where it will be dated and timed. Each paper will be dated and timed by the person who
receives the paper and the student will be asked to sign the paper in order to validate the
date and time.
PLEASE NOTE: The last day to seek faculty assistance with this paper will
be Tuesday, October 24, 2006. Faculty will not review work after this date.
FACULTY ADVISEMENT
Students are expected to utilize faculty as resource persons when organizing and
writing the critical thinking paper. You will be assigned a faculty critical thinking paper
mentor who will assist you in development of the paper and who will grade the paper.
You are expected to make an appointment to see your critical thinking paper faculty
mentor during posted office hours or ask for an appointment at a mutually agreeable time.
The following schedule will apply to faculty advisement for the paper. Drafts of
papers received after the following due dates will not be reviewed by the faculty mentor.
No papers will be reviewed after October 24, 2006.
Task
Approval of Paper Topic
Draft of Assessment Section and Expected
Outcome Section of Paper Completed to
Show to Faculty Mentor
Draft of Nursing Intervention Section and
Reference Page to show to Faculty Mentor
Due Date
By Monday, October 2, 2006
By Tuesday, October 10, 2006
By Tuesday, October 24, 2006
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NAME
SCORE
COMMUNITY COLLEGE OF PHILADELPHIA
DEPARTMENT OF NURSING
NURSING 101, FALL 2005
CRITICAL THINKING PAPER
GRADING CRITERIA
PROCESS
Assessment
Expected
Outcomes
Interventions or
Teaching
Strategies
CRITERIA
POINTS
To receive full credit for this section (4 points)
include a brief description of client, including
health status; topic chosen for the paper and
why the topic was selected; and risk factors
which influence the client's ability to participate
in health promotion/disease prevention
activities. Full credit also includes
consideration of all contributing factor
categories: physiological integrity, care
environment, growth and development and
psychosocial integrity.
To receive full credit for this section (2 points)
identify two expected outcomes that relate to
the same topic and are directed toward health
promotion / disease prevention outcomes.
Outcomes must be logical and consistent and
relate to one topic (ie. obesity prevention).
To receive full credit for this section (4 points)
include three interventions for each outcome.
These will be written as recommendations for
your client. They must be achievable if put
into use. To receive full credit for this section
(4 points) rationales for each intervention must
be included.
Reference
Use major nursing nutrition, maternity texts
and journals. One must be from a nursing
journal. Format of APA guide-lines, spelling,
grammar and conclusive ending will be judged
here. A minimum of 3 references is required
and must be referred to in the paper.
Grading: Deductions will be made as follows:
0.25 APA format; 0.25 spelling, grammar and
conclusive ending; 0.5 references.
Graders
C. Bartsch, T. Curry, B. McLaughlin
S. Orehowsky, E. Tagliareni,
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4
2
4
SCORE
COMMENTS
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34
35
36
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Week #3
Friday, September 22, 2006
TOPIC: THE NURSING PROCESS: DEVELOPMENT OF A CARE PLAN:
AT RISK FOR CONSTIPATION
Objectives: At the end of the class, the student will:
1. Review the essential components of the nursing process.
2. Utilize the nursing process to write a Care Plan: At Risk for Constipation for a client
in a case study presented in class (See attached).
3. Describe physiological and psychosocial factors that influence bowel elimination.
4. Identify common types of laxatives and cathartics.
Required Readings:
Craven and Hirnle:
Chapter 43
Bowel Elimination, p.1115-1121
Objective Data: p. 1125-1126
Outcome Identification/Implementation: p.1132-1134
Gulanick,
p. 42-45 (Constipation Care Plan)
Lilley,
Chapter 50, p. 862-870
Class Activity: Develop a care plan for Josephine Pinella (case study attached) for the
nursing diagnosis: Constipation
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CASE STUDY:
Josephine Pinella is 83 years old. She has lived alone with her sister Angelina (age
72) for all of her adult life.
Josephine and Angelina share a row home in South
Philadelphia; Josephine worked as an administrative assistant in a perfume company for 50
years, retiring when she was 68. Angelina worked on an assembly line for 35 years; she has
been retired for 5 years now.
Their lives have always been highly structured and
predictable. Josephine handles all financial matters (the sisters have adequate pensions to
live quite comfortably); she makes all major decisions. Angelina is the social butterfly of
their South Philadelphia neighborhood; she knows everyone, talks for hours on the phone
and loves to invite neighbors in for coffee. Angelina rarely makes decisions about the
household or about daily routines.
The sisters' routine is the same each day. They rise between 7 and 8 each day; eat a
breakfast of cereal, a fruit and a glass of milk, "one cup of coffee only." Josephine often
relates that the most important thing to her is a proper diet. "You must take a multi-vitamin
each day." She tells anyone who will listen that she weighs the same (121 lbs. 5'3") now as
when she was 20 (she's wearing the same skirts she bought in 1960!) and that she watches
her salt and cholesterol intake. The sisters have their "big meal" at lunch (minimum of one
protein, two vegetables and one fruit) and eat lightly at dinner time because as Josephine
says, "The second most important thing in life is adequate rest and you can't sleep well after
a hearty meal." They both sleep 8-9 hours a night. About once a week they have a nip of
dry vermouth "just to relax."
Josephine and Angelina consider themselves to be in excellent health. For the past
ten years, each day they walk for one hour; they see the doctor regularly. Josephine has
moderate hypertension and was prescribed a diuretic (Diuril) but stopped taking it due to
dizziness. Her BP is usually about 150-160/90-100. Angelina has arthritis which is fairly
well controlled with Aleve BID.
The sisters have a structured weekly schedule: Monday is cleaning; Tuesday is
shopping; Wednesday is visiting their sister whose husband has Alzheimer's Disease;
Thursday is weekly chores and Friday is the day to get their hair done. They rarely watch
TV and keep themselves very busy each day. They come from a large Italian family who
are continually inviting them to dinner and family parties: They always attend (weather
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permitting) but leave well before dark. Their nephew sees them weekly to check the house
and inquire about things they may need (i.e., cleaning windows, oil heater, etc.) They are
most generous with their nieces and nephew and value highly the support the family gives
them. Josephine often says, "We love our privacy but it's good to know our family is always
there, if we need them."
Last week, while Angelina was out visiting neighbors, Josephine felt faint and fell as
she attempted to sit down. Her left arm became "numb and tingling." When Angelina
returned, Josephine was on the floor conscious and very scared. Angelina called her
neighbor who came over and contacted paramedics. Josephine suffered a stroke and her left
side was involved.
Josephine is now in the hospital (it is day #3); she is receiving Heparin via IV and
will be started on Coumadin therapy when she returns home. Josephine is also taking an
NSAID (Toradol 10 mg q6 hrs) for discomfort and Iron for chronic anemia. You are the
nurse assigned to Josephine. As you assist Josephine with her bath, she states, “I want to go
home and do the things I have always done. I want to be able to go back to my routines”.
She expresses concern that she will be able to manage at home and wonders if there are
services available to help her and Angie “be able to stay in our little home together”.
Josephine tells you that the most important thing to her is being in control of her daily life,
being able to walk and cook, “being able to take care of myself, with Angie”.
While in the hospital Josephine is able to be out of bed to the chair three or four
times a day. At home she was on her feet all day, doing “chores”. This change in activity is
different for Josephine and causes her great concern. Also, Josephine is not eating her meals
at the same time that she was accustomed to eating meals. She states, “I am not eating fruits
and vegetables like I usually do; everything here is pasta and bread. Don’t the hospital staff
know about fiber?” Josephine has an IV running at the rate of 100 cc per hour and she is
drinking about 500 cc every eight hours.
Josephine is worried about her bowel routine. She tells the nurse that she had a
bowel movement on day #2 (yesterday) but that today she is not able to have a bowel
movement. “It is hard because I am used to eating breakfast at 6 AM and I usually go to the
bathroom by 8:30 AM. But here I have to ask someone to help me get out of bed and one
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nurse told me that I had to use the bedpan. I just can’t go in the bedpan”. “I have the urge to
go and then I need to call you and the urge just goes away”.
The nurse decides to discuss Josephine’s bowel pattern while the nurse is giving
Josephine her bath. The nurse asks Josephine about her bowel movement yesterday.
Josephine states that her stool was formed and dark brown in color but hard, and that she
had to strain with defecation. The odor was normal and the amount was slightly less than
usual. The nurse notes that Josephine has bowel sounds in all four quadrants and that the
sounds are normal and not hypoactive. The stool was negative for occult blood.
No
palpable abdominal mass or distention was noted.
During class we will develop a health promotion care plan for Josephine while
she is hospitalized, using the NANDA diagnosis: At Risk for Constipation. We will
consider the most essential contributing factors and expected outcomes.
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Week #4
Thursday, September 28, 2006
TOPIC: CLIENT EDUCATION/HEALTH TEACHING
Objectives: At the end of the class, the student will:
1.
Using vignettes distributed in class, describe factors that influence client learning
across the life span.
2.
Identify nursing interventions utilizing a variety of teaching modalities.
3.
Develop cognitive, affective and psychomotor goals appropriate to client learning
needs, utilizing a case study.
Required Reading:
Craven and Hirnle: Chapter 24:
Domains of Learning: p. 400-401
Assessment for Learning: p. 404-406
Teaching Methods: p. 413-414
Lifespan Considerations: 415-418
Gulanick & Myers, pp.103-106 (Deficient Knowledge)
Lipe and Beasley: Chapter 8: Scenario: Lesson Plan, p. 190
Topical Outline:
A. Developmental factors that influence learning across the life-span.
B. Cognitive, Affective and Psychomotor Expected Outcomes
1. Cognitive: i.e.
The client will list…
The client will identify foods…
The client will describe…
(Do Not Use: The client will learn.)
2. Affective: i.e.
The client will verbalize concerns…
The client will talk about…
3. Psychomotor: i.e.
The client will demonstrate injection technique…
The client will perform…
C. Discussion of Teaching Strategies
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TEACHING-LEARNING CASE STUDY
Assignment: Read the case study prior to coming to class and practice utilizing the
information to formulate the nursing diagnosis Health Promotion: Knowledge Deficit:
Maintenance of Optimal Functional Ability. The case study will be processed during classtime.
CASE STUDY
Josephine Pinella has been hospitalized for six days.
She experienced partial
paralysis of her left arm and left leg. She is to be discharged in two days to her home.
Twice a day Josephine attends OT to work on exercises to maintain joint mobility in
her left arm and left leg. She has learned to use her right arm to raise and lower her left arm
through full range of joint motion. She attempts to manipulate a soft ball in her left hand
and actively tries to comb her hair, left handed, with assistance. She has practiced rsing to a
standing position using a walker for balance. The occupational therapist has asked you to
reinforce these psychomotor skills and to continue to explain the rationale for the exercises.
Angelina visits Josephine every day. Since the stroke, Angelina has taken on more
responsibility; paying the bills, initiating the placement of safety bars in the bathroom at
home; arranging for a homemaker to assist with Josephine's personal hygiene when she
returns home.
When you enter the room to initiate teaching, Josephine asks, "Will I every be
cured? Will my hand and leg be like they were before?"
She begins to talk about her previous life at home, how she cooked and cleaned and
managed the finances. She asks, "Will I ever be able to do those things again?" She
continues, "It is very important to me to be independent. My idea of being healthy is being
able to take care of myself. I don't want to be a burden to Angie." As you begin to direct
Josephine through her exercises, she states, "Sometimes it is hard for me to remember what
comes first; I used to remember everything but since I've been in the hospital, sometimes I
don't even know the date. Sometimes I forget if Angie has been here or when she left. I
was never like that before." Josephine also expresses concern about "doing it right" at home
because "all of you won't be there." As you and Josephine talk, Josephine's roommate,
Dorothy calls out and asks you to dial her daughter's phone number. Ten minutes later
43
Dorothy asks you to take her to the bathroom. Angelina continually interrupts, asking for
more specific directions, questioning Josephine's ability to do the exercises two to three
times a day. "She'll be exhausted and rest is so important."
Josephine is currently taking Toradol for pain control, and Diuril, a diuretic, to
control hypertension. As you leave her room, Josephine calls out, "Please keep telling me
how to do the exercises; I want to learn how to do it right and don't mind Angie; she is just
worried about going home and getting back to our usual routine."
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Week #4
Friday, September 29, 2006
TOPIC: MATH TEST; HISTORY OF NURSING
OBJECTIVES: At the end of this content presentation, the student will:
1. Identify historical movements and forces that influenced American nursing from the
beginning to the present.
2. Discuss the emerging role of the nurse.
3. Identify issues that have led to the development of a community based health care
system.
REQUIRED READINGS:
Film: Sentimental Women Need Not Apply. (Film will be shown in class).
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