The University of California, Irvine College of Health Sciences Program in Nursing Science Spring Quarter 2015 DRAFT – WILL HAVE UPDATED VERSION AVAILABLE BY START OF QTR Academic Year: 2014-2015 Course Title: Adult Health Care Nurs Sci 120 Units: 8 Faculty of Record: Maureen Movius CMSRN, MN, CNS Associate Clinical Professor Office: 288 Berk Hall Phone: (949) 824-0208 [email protected] Office hours: by appointment Open lab hours Berk Hall: by appointment Clinical Instructors: Haiyu Chen Feng RN, MSN [email protected] Tiffany Baleigh RN, MSN, NP [email protected] Amanda Firestone RN, MSN _________________________ Doug McCallum RN,MSN,NP [email protected] Bernie Milbury, RN,MSN,ANP-BC ONC; [email protected] Natalie Mlakar, RN,BSN [email protected] Course Description: This course focuses on the restorative, peri-operative, and supportive nursing management of adults with acute or chronic alterations in oxygenation, regulation, immune response, elimination, metabolism, mobility, cognition, and substance abuse. Diagnostics, pharmacology, pathophysiology, and therapeutics will be integrated. Emphasis will be placed on critical thinking, application of the nursing process, related research for evidence-based practice, sociocultural influences, and ethics. Concurrent practicum in adult health care hospital units. Course Objectives: Upon completion of the course, the student is able to: 1. Demonstrate understanding of the acute and chronic alterations in biologic functions that occur in adults. 2. Relate nursing assessment and management concepts to pathophysiologic processes. 3. Demonstrate understanding of the social and cultural influences on human responses to illness. 4. Discuss the process of implementing evidence-based practice. 5. Demonstrate understanding of developing a plan of care for patients. Prerequisites: Nur Sci 112LB, Nur Sci 114, Nur Sci 118, Nur Sci 125,Nur Sci 135 Class Times: Monday & Wednesday 12:00-2:00 pm Clinical: Tuesday, Thursday, Friday, Saturday 7:00am6:00pm Class location: PSCB 120 Clinical: UCIMC, OCMMC, Mission, Hoag, & Saddleback Course Requirements and Grading: 1. Attendance, preparation, and informed participation in class (10% ) a. Class attendance is an expectation. b. Students are expected to read assigned materials prior to class in order to contribute to informed class discussion. 2. Mid-course examination (30% ) 3. Education presentations (15%) 4. Final examination (30% of grade) 5. Clinical Assignments, attendance, completion of Kaplan tests (15%) Standard grading scale for all Nursing Science courses. A "C" minus (or a grade of 73.9 or below) is considered not passing. A+ A A_ B+ B B_ C+ C C_ D+ D D_ F 97 and up 94.0-96.9 90.0-93.9 87.0-89.9 84.0-86.9 80.0-83.9 77.0-79.9 74.0-76.9 70.0-73.9 67.0-69.9 64.0-66.9 60.1-63.9 60 and below Clinical grading: scores are assigned by the Clinical Instructor utilizing the Clinical Evaluation Tool (posted on EEE) as Pass/Fail. Student Responsibilities: In addition to reading class material and actively participating in class discussions, we expect the following: Arrive on time to class. When you arrive late to class, you may disrupt faculty and other students. Be responsible for all material presented in class-take notes and ask the faculty for assistance if there is something that you do not understand. Turn off beepers and cell phones while in class. Ask the permission of the instructor before you tape any lecture. Do not sleep in class. Avoid having conversations with others during lecture. It is disruptive to your peers. In addition, any form of academic dishonesty will not be tolerated. This includes plagiarism, cheating, or not doing your own work. Please discuss any issues that you have with us. We are here to help you learn this material so that you can have a successful career in nursing! ADA Accommodations: Any student seeking ADA Accommodations under the American with Disabilities Act should contact the UCI Disability Services Center to register for services. Student need to meet with faculty members within the first week of the quarter so that appropriate accommodations may be arranged. Required Texts: Ignatavicius, D Workman, L (2013). Medical-Surgical Nursing Patient- Centered Collaborative Care (7th ed.) St Louis: Elsevier, Saunders Ladwig, B. Ackley, (2011) Guide To Nursing Diagnosis (3rd ed.) Missouri: Mosby ,Elsevier. Recommended Texts: Pagana, K. D., Pagana, T. J. Mosby’s Diagnostic and Laboratory Test Reference, latest ed. St. Louis: Mosby. 2013/2014 Drug handbook of student’s choice Reading Assignments: Students are responsible for coming to class with knowledge of anatomy, physiology, and pathophysiology related to each topic. I highly recommend that you do the assigned readings prior to each class. Education Presentations: In small groups (3-4) choose one of the following topics to present during class time. 20 minutes per group. 1. Patient Safety Goals 2. Complementary/alternative treatments 3. Common problems of the older adult 4. Cultural aspects of health/illness 5. Evidenced based practice 6. Rehabilitation nursing 7. End-of-life 8. Environmental emergencies 9. Physician assisted suicide 10. Should you accept a Rolex from a patient 11. Other- you choose a topic related to med surg and have it approved by instructor. Web Sites for Health Literacy: http://www.nifl.gov http://www.healthgov/healthypeople http://www.chcs.org Date 3/30 4/1 4/6,4/8 Lecture Topics Introduction to Adult Health Nursing Discuss clinical preparation: PCO, skills check list, concept map, SBAR Patient safety, fluid & electrolytes, infusion therapy, pain Management of Perioperative Patients ( preop, intraop, post- op) Cardiac: heart failure, MI, HTN, arterial and venous peripheral vascular disease Nursing Care of Patients with Immune & hematological disorders: cancer, infection, sepsis, 4/13,4/15 HIV, arthritis, and other connective disorders: osteoarthritis, rheumatoid arthritis, lupus, Presentations: groups 1,2,3 Maintenance of skin integrity, pressure ulcer prevention, care. Case studies, review questions 4/20,4/22 Presentations: groups 4,5,6 Midterm 4/27,4/29 Oxygenation/respiratory problems: breathing patterns, COPD, Asthma, Pneumonia, TB, pneumothorax, chest tubes, oxygen tx Nutrition & elimination: sociocultural influences, common therapeutic disorders, diagnostics tests- blood tests, gastric aspirate, stool. Special procedures-UGI, endoscopy gastric analysis, 5/4,5/6 lower GI, enteral feedings, TPN, central lines, selected disorders: gastritis, cirrhosis, hepatitis, acute/chronic pancreatitis, pancreatic cancer Presentations:groups 7,8,9 Continue with GI: Crohn’s ostomies, intestinal obstruction, ulcerative colitis Endocrine: diabetes, insulin, orals, Addison, hyper/hypothyroidism, thyroidectomy, diagnostic tests Renal: acute/chronic renal failure Musculoskeletal: fractures/complications-fat embolism. Compartment syndrome, traction, hip 5/18,5/20 fracture/care, crutch walking, complications. Selected diseased: RA, gout, osteoporosis, osteomyelitis Presentations: groups 10,11,12 5/11, 5/13 5/25 HOLIDAY 5/27 6/1, 6/3 Sensory/neuro- Glasgow coma scale, stroke, (brain attack) herpes zoster, meningitis, migraines, Parkinsons, Multiple Sclerosis, detached retina, cataracts Case Studies June 8 @ 9:30 am Final Exam- Hitachi Lecture Hall - Do not follow the time/location listed in the schedule of classes Reading Assignments Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 10 Iggy Ch 1, 5,13,14, 15 Ch. 16,17,18,37,38 Ch. 20,21, 24,25 Ch 26, 27 Ch. 30, 31, 32, 33 Ch. 55,57,58, 59, 60 Ch. 61, 62, Ch. 66 , 67 Ch. 71,53, 54 Ch. 44,45,47,48,49,50 Overview of Clinical Experiences: Course Description: This course provides supervised clinical experience in the nursing management of adults requiring restorative, perioperative, and supportive care for acute or chronic alterations in oxygenation, regulation, immune response, elimination, metabolism, mobility, cognition, and/or substance abuse. Emphasis is placed on the synthesis of knowledge and skills, critical thinking, application of the nursing process, related research for evidence-based practice, socio-cultural influences, and ethics. Practicum experiences will be located in hospital inpatient medical, surgical and peri-operative units as well as in outpatient clinics. Patient care seminars follow each clinical session focusing on integration of experience with co-requisite lecture course content. Course Objectives: Upon completion of the course, the student is able to: 1. Integrate knowledge of the acute and chronic alterations in biologic functions in restorative, peri-operative, and supportive nursing management of adults with acute or chronic illness. 1.1 Demonstrate knowledge of alterations in biologic function for assigned patients and perform head to toe assessments on all assigned patients. 1.2 Relate therapeutic management to alterations in biologic function. 1.3 Make accurate observations related to physiological and psychosocial needs. 1.4 Perform therapeutic procedures correctly. 1.5 Administer medications safely and correctly, using the seven rights of safe medication administration. 1.6 Evaluate the effectiveness of treatments and medications based on knowledge of expected results. 1.7 Use health care technologies appropriately. 1.8 Maintain a safe environment for patients and families. 2. Demonstrate sensitivity to social and cultural influences on patient/family response to illness. 2.1 Identify socio-cultural values, beliefs, and attitudes influencing care. 2.2 Provide culturally competent and sensitive care to all patients/ families. 3. Eva!uate plans of care based on the scientific evidence to support actions. Students are responsible for submitting their weekly PCO’s to their clinical instructor. 3.l Obtain appropriate physiological and psychosocial data. 3.2 Develop an individualized and realistic plan of care using the nursing process. 3.3 Identify the scientific evidence for the plan of care. 3.4 Set appropriate priorities and patient goals/outcomes. 3.5 Evaluate the effectiveness of the plan of care and makes modifications accordingly. 4. Document patient care activities appropriately and with accuracy. 4.1 Document accurately, clearly, concisely, and promptly 4.2 Use appropriate terminology 5. Communicate effectively with other members of the health team. 5.1 Interact appropriately with other members of the health team. 5.2 Provide accurate, meaningful and complete verbal reports. 5.3 Communicates deviations promptly. 5.4 Appropriately seek assistance from instructor. 5.5 Actively participate in post clinical discussions. Patient Care Seminars: Clinical seminars will be scheduled each day by the clinical instructor. Seminars will focus on integrating the theoretical material presented in class with the clinical objectives presented below. These objectives are the guidelines for what students should strive to achieve during each week of the clinical experience. Both the Human Behavior and Mental Health and the Adult Health Nursing courses will follow the same format using these clinical objectives. This structure is intended to facilitate student learning by providing thematic consistency during each week of clinical. Students are expected to apply knowledge learned cumulatively so that by Week 3 the student will show an early understanding of the RN role and start developing communication skills appropriate for the clinical setting while focusing on conducting a complete assessment. Cutting across all weeks of clinical experience students are expected to approach patient care from a holistic perspective that is sensitive to the patient's biological, psychological, social, cultural, spiritual being. Student clinical conduct is expected to follow ethical principles of care. Students will be asked to complete a weekly journal following their clinical experience. It is expected that students develop and show insight into their interactions with patients, families, and other staff. It is our hope that this insight will encourage students to generate empirical questions that they would be interested in addressing in future scholarly endeavors. Week Clinical focus 1 Observe and consider the RN role, RN-patient, RNhealth professional staff interactions; Complete a PCO Become familiar with the paperwork (e.g. c o m p u t e r d o c s - admission assessment, physical assessment, care plan, med sheet-supplies Assist in care of one pt. How does the RN organize day his/her dayday 2 3 4 5 Week 6 7 8 9 care of one ptroomProvide/assist of one Communication: Building rapport with care patient,family; pt.( assessment, documentation)boundaries in payVS, attention to interpersonal ( V S , p h y sobserve i c a l RN-health professional interactions; communication; attend rounds. Discuss SBAR ,Care for one patient Assessment: conduct complete assessment & focused exam; identify challenges to doing full assessment and resources to guide exam; assist with admission to hospital , care for one patient a s s e s s diagnoses m e n t , d o&c med u m admin. Identify 2-3 Nursing nursing diagnoses and provide supportive evidence for diagnoses; know patient's medication basic comfortuse, needs, assessment for one indications, side physical effects, administration, drugpt. patient interactions. Care for one patient Medication administration administer patient's medications under direct supervision of RN or instructor-must know patient's medication indications, use, side effects, administration route, drug interactions, the 7 rights. Care for 1 pt. P P A T IE N T patient Clinical focus Goals of patient care: identify 2-3 goals for patient care based on assessment and diagnoses; focus on short- and long-term goal setting; distinguish your goals from your patient's goals. Care for 1-2 patients Interventions: Identify 2 nursing interventions to achieve patient care goals; develop the rationale and patient-specific considerations for implementing each intervention 1-2 patients Evaluation of interventions: explain how you can evaluate the effectiveness of each intervention; describe/evaluate patient's progress toward meeting patient care goals. 1-2 patients Long-term treatment planning & patient education: develop a patient education plan for guiding the patient towards meeting 2-3 long-term treatment goals at discharge; assist with discharge, 1 -2 p t s pts.2222ptsddddd case 1-2 patients O Theory/Post Conference focus Intro to Medical–Surgical Nursing Pt. safety, fluid & electrolytes, infusion therapy, pain Preop, intraop. postop Management of patients with problems of immune & hematological disorders: cancer, infection, HIV, arthritis, other connective diseases Maintenance of skin integrity, pressure ulcer prevention, care Cardiovascular system: ECG basics: brady, tach, sinus, PVC’s, fibrillation, V tach. Ht failure, HTN, peripheral vascular disorders-arterial & venous, anticoagulants (side effects and labs) Theory focus Oxygenation/respiratory problems: breathing patterns, COPD, Asthma, pneumonia, TB, pneumothorax, chest tubes, oxygen therapy Nutrition & elimination: sociocultural influences, common therapeutic diets, diagnostic tests-blood tests, gastric aspirate, stool. Special procedures-UGI, endoscopy, gastric analysis, lower GI,enteral feedings TPN, central lines, selected disorders Endocrine:diabetes, insulin, oral, Addisons, Cushings, hyper/hypothyroidism, thyroidectomy diagnostic tests Renal: diagnostic studies cultures, creat clearance Enteral feeding, central lines, conduit, selected cystoscopy, biopsy,TPN, US, diversions-ileal disorders care of catheters,suprapubic, nephrostomy, incontinence/interventions, selected disordershernia,pgastritis,peptic ulcer acute/chronic renal failure, peritoneal dialysis 10 Integrating holistic nursing in practice: identify elements of patient's care plan that specifically address biopsychosocial, spiritual, cultural concerns; barriers to providing holistic care in clinical setting, 1-2 patients Oral Case Presentation (can begin week 9) Musculoskeltal-fractures/ complications- fat embolism, compartment syndrome, traction, hip fracture/care/ crutch walking ,complications selected diseases,RA, gout, osteoporosis,osteomyelitis Sensory/neuro-glasgow coma scale,stroke(brain attack)herpes zoster, meningitis, migraine headaches,Parkinsons, Multiple Sclerosis, detached retina, cataracts Expectations: Ethical behavior. Nursing students are expected to follow professional code of ethics when caring for patients. Your primary responsibility is to those requiring nursing care. It is important to recognize and use your authority as a health professional ethically. The ethical charge of nursing is to promote good, and prevent and remove harm from our patients. It is your responsibility as a caring health professional to promote and respect your patients' autonomy, which means respecting your patient's role in setting goals, making plans, deciding upon treatments, and freely choosing to act on these decisions. You must also respect your patients' individual, family, and community rights, customs, values, and beliefs. In your role as patient advocate you are obliged to maintain a non-judgmental, nondiscriminatory attitude towards all patients. The nurse-patient relationship is a therapeutic relationship. Communication is the cornerstone of providing excellent, compassionate care. Building a relationship that engenders trust, faith in one another, truthfulness, and open communication is important for building a strong, healing relationship with your patients. Confidentiality and privacy are critical to maintaining your patient's dignity and autonomy. Information about your patient should only be shared with your clinical instructor and other professionals in private settings (e.g., the clinical seminar). Do not discuss your patients in public places in the hospital. You must take responsibility for your actions, and report to your clinical instructor any doubts, concerns or issues that you have in delivering care to your assigned patients. This also means that you are held accountable in educating yourself about how to best care for patients. Unethical behavior (e.g., omission of informed consent, breach of confidentiality, undue coercion, failure to maintain professional boundaries) render our patients more vulnerable and will not be tolerated. Attendance. Clinical rotation hours are dictated by course units and approved by the Board of Registered Nursing (BRN). Missing clinical time m a y place you in jeopardy of failing the course and makes you ineligible to take the Board exam for nursing. In case of illness, the instructor and the unit to which the student is assigned must be notified prior to the beginning of the clinical experience. Students are expected to arrive 15 minutes early for their clinical experiences so they can receive their assignments and get ready for report. Lateness will not be tolerated-it is critical that you be present for morning report on your patients. Please call your clinical instructor if you have an emergency which may make you late or absent for clinical. Professionalism. Students must be appropriately and professionally attired in the required uniform. Students are expected to take initiative and express thoughts, feelings, learning needs, and concerns directly with clinical instructor and staff as appropriate. Active collaboration with clinical staff is important-do not just wait for the staff members to tell you what to do. Show initiative by making suggestions and asserting your professional development needs. Treat all staff and other health professionals with respect and deference for their experience. Remember you are a novice-be humble and learn from their experience. Safe Clinical Practice. The UC Irvine Program in Nursing Science maintains that patient and student safety are essential. If a student's clinical performance is unsafe, the student will be withdrawn from the clinical arena, counseled, and sent home. Examples of behaviors that will be deemed unsafe are: medication errors as a result of the student's performance, negligent misconduct, and professional misconduct. Faculty and clinical partners will clearly detail on a clinical evaluation or an Anecdotal Note form what is deemed "unsafe clinical practice". Clinical partners will discuss the behavior with the faculty member. Concise written guidelines will be given to the student. In the event that the student's performance remains clinically unsafe, another Anecdotal Note will be completed and the student will be referred to their student advisor who, with the Director and Chair of the Program, will decide on a course of action. If the student is sent home for what is deemed unsafe clinical practice, this will be considered an unexcused clinical absence. Oral Presentation: Evidenced-Based Nursing Practice. Evidenced-based nursing practice refers to the use of evidence to guide nursing practice.Using the sources of knowledge used as evidence for practice, for example, theory, knowledge from medical record data, quality improvement reports, infection control reports, health professionals’ clinical expertise and judgment and patient preferences based on culture and values, discuss a change in clinical practice within the last several years as a result of the ‘evidence.’ Students can work in small groups. CLINICAL JOURNAL THE USE OF JOURNALING IN CLINICAL NURSING EDUCATION Journals are used in nursing education to stimulate thought and reflection (Billing and Kowalski, 2006). During your first clinical experience you will be exposed to a variety of encounters that will be new and thought provoking. We are asking you to document some of these experiences so that you can gain an appreciation of underlying values, and behaviors. What you say in your journal entries will not be shared with anyone other than your clinical instructor. Occasionally, there may be experiences that challenge, excite, or upset you. You may wish to describe these events in detail in your journals. Feel free to add more information about how clinical was each week. Also, add specific learning needs that you have as well as issues that you would like to communicate to your clinical instructor. Choose any format you like; you may wish to buy a journal, or use plain paper or type these into an electronic log. You must hand these in to your clinical instructor weekly Guide for Clinical Supervision In the clinical area, you are expected to be actively involved with your own learning. You are to have written daily goals that you are to share with your assigned RN and instructor. Your clinical instructor acts as a facilitator and will coach, prompt, mediate and help you in the process of integrating knowledge. If there is any doubt about anything that is happening in clinical, it is your responsibility to inform your clinical instructor. Below are some brief guidelines to reinforce the need for supervision as you perform some of the clinical skills in the Adult Health Practicum course. Again, this is only a guide. Safe practice is the rule, so if you are unsure about a procedure, you must seek assistance from your clinical instructor before doing anything. Minimal Supervision Skills Taking vital signs Bathing/hygiene needs Bed making Patient positioning Use of bedpan, urinal Assessment (inspection, auscultation, palpation and percussion) Patient/family teaching Interviewing Assessment of Intake & Output Blood Glucose Testing Maximum Supervision Skills (Instructor or RN must be present) Medication Administration IV Therapy, including IV insertion Drawing blood Wound management Tube feeding Dressing changes Tracheal suctioning Weekly Skills Worksheet: Keep this up to date and have your clinical instructor review this throughout the quarter.