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
mmovius@uci.edu
Office hours: by appointment
Open lab hours Berk Hall: by appointment
Clinical Instructors:
Haiyu Chen Feng RN, MSN h3chen@uci.edu
Tiffany Baleigh RN, MSN, NP tball@uci.edu
Amanda Firestone RN, MSN _________________________
Doug McCallum RN,MSN,NP mccallum@uci.edu
Bernie Milbury, RN,MSN,ANP-BC ONC; bmilbury@uci.edu
Natalie Mlakar, RN,BSN nmlakar@uci.edu
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.