63-272 – Official 2006 COLLABORATIVE BACHELOR OF SCIENCE IN NURSING PROGRAM (University of Windsor, Lambton College, St. Clair College) Clinical Nursing Experience 63-272 (10 hours/week x 13 weeks) Site: Faculty of Nursing, University of Windsor Fall 2006 Lead Teacher: Maher M. El-Masri, PhD, RN University of Windsor ©Faculty of Nursing 2006 ALL RIGHTS RESERVED 63-272 – Official 2006F 63-272 CLINICAL NURSING EXPERIENCE I. Course Description This is the third of a sequence of 10 clinical practice courses. It is designed to provide the student with the opportunity to learn and practice professional and technical skills including assessment, goal-oriented planning, interventions and evaluation of clinical outcomes for young adults, adults and older adults experiencing acute and long-term health needs within the context of family and community. II. Program Competency Outcomes By the end of the program, graduating students will be able to: 1. Implement behaviours to promote personal and professional self-development. 2. Integrate the ethical, legal, professional and regulatory parameters into nursing practice. 3. Formulate clinical judgements that are based on critical inquiry and analytical reasoning. 4. Integrate nursing and multidisciplinary knowledge into nursing practice. 5. Integrate research findings into clinical practice, education and management. 6. Implement the nursing process to promote, maintain and restore the health of individuals, families, groups and communities. 7. Use the teaching/learning process to promote the health of individuals, families, groups and communities. 8. Collaborate with clients, their families, communities, members of the health team and other organizations for the promotion, achievement and restoration of optimal health. 9. Integrate leadership and management roles into the delivery of health care. 10. Engage in activities to promote the development of the profession of nursing. 63-272 Course Outline – F06 2 63-272 – Official 2006F III. Course Competency Outcomes 1. Implement behaviours to promote personal and professional self-development Analyze own philosophy/values about the care of adults and older adults experiencing episodic and long-term health alterations. Using reflective journal, analyze how own personal growth as a member of a family has influenced his/her nursing practice. Integrate feedback from individual client, families, peers, faculty and other health professionals to set goals to improve own practice. Analyze own learning needs, readiness, style and their impact on care of individuals and/or families experiencing episodic and long-term alterations. Evaluate own behaviours that document goal achievement against program competencies. 2. Integrate ethical, legal, professional and regulatory parameters into nursing practice Advocate for the rights of individual clients and/or families in provision of care during episodic and long-term health alterations. Use the College of Nurses of Ontario Standard of Practice in the care of adults experiencing health alterations. Adhere to the policies of the Collaborative Nursing Program and the participating agencies when caring for individual clients and/or families with episodic and long-term health alteration. Analyze with assistance ethical dilemmas encountered in the care of individual clients and/or families experiencing long-term health alterations. Document client care accurately. 3. Formulate clinical judgements that are based on critical inquiry and analytical reasoning Use inductive and deductive reasoning to assess and determine health needs. Use critical analysis skills to prioritize the needs of individual clients and/or families experiencing episodic and long-term alterations. Use analytical reasoning in collaboration with clients, to generate strategies to promote optimal health. Verify with clinical faculty and/or health care professionals evidenced based clinical judgements. Analyze own nursing actions that promote optimal health of individual clients and/or families experiencing episodic and long-term alterations. 63-272 Course Outline – F06 3 63-272 – Official 2006F 4. Integrate nursing and multidisciplinary knowledge into nursing practice Provide theoretical rationale for all actions taken to promote health of individual adult clients and/or families. Analyze the factors that contribute to the development of selected episodic and long-term health alterations. Apply relevant multidisciplinary theories to the care of individual adult clients and/or families. 5. Integrate research findings into clinical practice, education and management Analyze how research is applied in the care of individual clients and/or families experiencing health alterations. Use evidenced based practice in the care of individual clients and/or families experiencing health alterations. Formulate researchable questions to promote the health of individual clients and/or families. 6. Implement the nursing process to promote, maintain and restore the health of individuals, families, groups and communities Perform holistic health assessment for individual clients and/or families experiencing episodic and long-term health alterations. Perform preoperative and postoperative assessments for individual clients and/or families using selected tools Perform gerontological assessments for individual clients using selected tools. Perform pain assessment. Formulate nursing diagnoses in collaboration with clients and/or families. Collaborate within individual clients and/or families to formulate expected outcome criteria. Implement interventions that are relevant to the nursing diagnoses identified. Administer medications safely following the rights of medication administration. Evaluate client outcomes by comparing actual to anticipated outcomes, modifying the plan of care as required. 63-272 Course Outline – F06 4 63-272 – Official 2006F 7. Use the teaching/learning process to promote the health of individuals, families, groups and communities Collaborate with clients to determine learning needs. Determine learning needs of client in preparation for diagnostic procedures and preoperatively. Determine client readiness to learn. Mutually develop learning goals with individual clients and/or families. Implement learning plans based on teaching/learning principles to promote optimal health of clients and/or families with episodic and long-term health needs. Evaluate the effectiveness of teaching/learning strategies for clients and/or families by comparing actual to anticipated outcomes and modifying the plan as required. 8. Collaborate with clients, their families, communities, and members of the health team and other organizations for the promotion, achievement and restoration of optimal health. Use therapeutic and professional communication techniques. Respect clients/families and apply the principles of a helping relationship. Advocate for the rights of client and family. Collaborate with the members of the health team and related agencies to promote optimal health. 9. Integrate leadership and management roles into the delivery of health care Demonstrate time and resource management in the care of individual clients and/or families experiencing episodic and long-term health alterations. Analyze the leadership and management roles of nurses in the promotion of optimal health in clients and/or families experiencing episodic and long-term health alterations. 10. Engages in activities to promote the development of the profession of nursing. Participate in nursing and other professional discussions in promotion of optimal health of clients and/or families experiencing episodic and long-term health alterations. Explore the role of nursing in advocating for the rights of clients and/or families to quality care in a variety of settings. Identify factors that enhance or inhibit quality care of clients and/or families in a variety of settings. 63-272 Course Outline – F06 5 63-272 – Official 2006F Adapted Concepts of Bevis’ Curricular Framework Philosophical Foundation and Key Theoretical Concepts Introduction The University of Windsor, St. Clair and Lambton Colleges have adopted the key concepts from Em Bevis’ Curricular Framework (1973, 1983) as the theoretical basis for the collaborative nursing program. This brief outline provides the philosophical and theoretical underpinnings of the collaborative program. Philosophical Foundation The philosophical underpinnings of the curriculum are important in that they provide insight into nursing’s beliefs about persons, environment, health and nursing, as well as knowledge and ethics which underlie nursing practice. The theoretical foundation for Bevis’ concepts is based on a humanistic existentialism philosophy. Humanism Humanism emphasizes the value, beauty and importance of being human and a concerned action geared to human ideals, human existence and quality of life. Humanism is characterized by a value system that places great importance and high priority on caring about people. Existentialism Existentialism holds that each person is unique and inexplicable by science or philosophy. It is a natural part of holistic philosophy and proposes that the whole of a human being is different from his/her parts. Existentialism proposes that human are thinking beings who make choices. The tenet that a human is free (freedom to choose) is the most basic of all freedoms. Two other attributes spring from this freedom. Freedom of choice makes a human being a suffering individual and unpredictable. Freedom to choose and being a thinking being implies accountability. If one makes one’s own choices, then one is accountable to self and other human beings. Theoretical Basis The theoretical base for Bevis’ concepts is “General Systems Theory”. A system is anything that functions as a unit of “wholes” because its parts are interdependent. Persons have open systems in that energy and matter are imported from other systems and free exchange causes the system to achieve more complexity and heterogeneity. All open systems have subsystems and all but the largest have supra systems. Systems have inputs (energy and information going into the system) and outputs (energy and information going out of the system). 63-272 Course Outline – F06 6 63-272 – Official 2006F The key concepts for the collaborative nursing program are outlined below: Person: Individuals are unique holistic persons with inherent dignity and are worthy of respect and care. Individuals are capable of entering reciprocal relationships that foster health, growth and self-actualization. Environment: The milieu within which individuals, families and communities strive to achieve optimal health. As persons attempt to mature and adapt, there are dynamic interactions that can serve as a source of growth. Health: Is a dynamic process whereby the individual, family or community is able to realize aspirations, satisfy needs and change or cope with the environment. Health is a resource for everyday life. It is a positive concept emphasizing social and personal resources a well as physical capacity. Health is the goal of all nursing behaviours. Nursing: Is a process. Its purpose is to promote optimal health through nursing activities. These activities are carried out with three client systems-individuals, families and communities. Nursing’s role is to facilitate maturation and adaptation in these client systems. The tools with which nurses function are: communication, caring, problem-solving/decision-making, management/change and teaching/learning. Nurses are autonomous health professionals, who collaborate with other members of the health care team for the benefit of clients. They are accountable for their activities; they monitor and regulate the quality of nursing care given and prove each other with mutual protection, nurturing and facilitation of growth. The purpose of nursing is “the highest possible level of health or self-actualization for clients/patients”. (Bevis). LIFE PROCESSES: Bevis has identified two life processes: (maturation and adaptation) which are health-producing tasks. Maturation: Clients/patients are involved in maturational tasks that influence health. Individuals, families and communities have tasks to achieve to continue to grow. Clients, developing beings, move through life from one level to another, each level progressively differentiated from the other and integrated with the other at more advanced levels. Developmental status is one of the variables that influence nursing care because health and consequently nursing care impinge on, encourage or inhibit development as it moves from differentiation to integration. Adaptation: Is the outcome of the interaction of variables with the dynamics of stress as it influences persons, families and/or communities. Stress is a physical and emotional state always present in the person, one influenced by various environmental, psychological, and social factors but uniquely perceived by the person and intensified in response when environmental change or threat occurs internally or externally and the person must respond. The stress response is always an attempt at adaptation. For example, eustress is the stress that comes with successful adaptation and that is beneficial or promotes development and self-actualization. Distress is negative, noxious, unpleasant, damaging stress that results when adaptive capacity is decreased or exhausted. 63-272 Course Outline – F06 7 63-272 – Official 2006F FIVE TOOLS OF NURSING PRACTICE Problem-Solving/Decision Making: Problem solving, a process, is used to arrive at a place where decision can be made. Decision-making presupposes that problem solving has taken place and is the end product of problem solving. Problem solving involves all of the analytical processes including the nursing process and research. Decision-making is the acquiring, ordering and selecting of tools, resources, or alternatives for reaching goals or fulfilling needs. Problem solving is the system/process used to arrive at a place where decision can be made. Decision-making involves all of the analytical processes, including the nursing process and research process and utilizes critical thinking abilities of participants. Communication: Communication involves a series of processes such as becoming self-aware, sensitive and responsible to oneself and others. There are overt and covert signs and symbols as well as verbal and nonverbal cures to promote message-sending, an receiving activities plus processing, intuiting activities and the sending of feedback messages. Teaching/Learning: Learning is a change in behaviour, perception, insights, attitude, or a combination of these that can be repeated when the need is aroused. The change in behaviour may/may not be directly observable; however, the effects of learning are always observable. Teaching is a purposeful activity designated to facilitate learning and hence, becomes linked to learning. Caring: “Caring gives comprehensive meaning and order to one’s life (Mayeroff, 1971). Caring is one of the basic drives of life is to complete oneself. It is manifested in the drive to grow, to fulfill, to transcend one’s “prison of self”. The conditions of caring and the caring process enable mutual growth. Management/Planned Change: The process of management/planned change subsumes the processes of leadership, organizational structure and management. Planned change is the purposeful planned adaptation to a shift in the environment. “Planned” indicated collaborative and cooperative endeavours. The phrase “shift in the environment” means an increase in the number and complexity of variables as opposed to the stability of the environmental factors. 63-272 Course Outline – F06 8 63-272 – Official 2006F V. Course Requirements, Evaluation Methods and Grading System. 63-272 will be offered on a pass/non-pass basis. Each week students will have a laboratory experience during which there will be casestudies, technical skills, calculation skills and critical thinking exercises presented. Students are expected to read the assigned readings and have a good understanding of the theoretical basis of the skills prior to each lab. There will be skills evaluation session related to technical skills and theoretical knowledge as well as two written medication calculation quizzes in which the student must obtain 100%. The above evaluation methods will constitute the Competency Performance Evaluation (CPE) for the laboratory experience. All CPE’s and all of the critical elements must be passed. If unsuccessful in CPE skills, students must set aside time to practice and will be retested on one further opportunity to demonstrate progress from a “Non-Pass” to a “Pass”. If students are unsuccessful in calculation quizzes, they must set aside time to review and will be given two further opportunities to pass. Each week, students will also have the opportunity to care for clients in the clinical area. These clients will include young adults, adults, and older adults experiencing acute and long-term health needs. Students will be expected to practice both professional and technical skills. Students will be expected to demonstrate both UC’s and Course Competency Outcomes (CPE’s) and their critical elements at an acceptable level (see evaluation format). There will be a written mid-term performance evaluation. If a student obtains a non-pass, a written plan will be devised by the student and instructor in order to assist the student to obtain a “Pass” grade. There will also be a final written performance evaluation. Students are expected to pass all critical elements indicated in the CPE’s. All Universal Competencies must be passed. All Competency Outcome Elements (CPE’s) must be passed. A pass in BOTH the laboratory and the clinical experience must be obtained in order for the student to obtain a Pass in 63-272. The written assignments (CPAs) for the 63-272 clinical experience are as follows: CPA #1 – Learning Plan 1. A written learning plan is to be handed to the clinical instructor by Week 2. The plan should consist of an evaluation of the learning plan from first year as well as 2 new goals relevant to 63-272. Students are required to submit their revised learning plan and their portfolio for the instructor to assess. CPA #2 – OR Assignment 1. Pre and post-op assessment. Completion of Peri-operative Case Study assignment. 63-272 Course Outline – F06 9 63-272 – Official 2006F CPA #3 – Assessment Tool (Appendix A) & NCP (Appendix B) 1. Assessment tool: includes an assessment of the client and his family. Relevant nursing diagnoses must be included based on assessment findings. Due the week of November 6, 2006. 2. Care plan (one only), based on the clients for whom the assessment tools were completed. However, if the student’s writing of the care plan is deemed unsatisfactory, the instructor has the right to ask the student to rewrite or do more than one care plan until a satisfactory care plan is presented. Teaching activities, including assessment of learning needs and actual teaching must be included within the care plan or done separately. Due the week of November 6, 2006. CPA #4 – Research Article Research article related to some aspect of the clinical experience including a copy of the article and a one-page summary and its relevancy to the clinical area. Also include one researchable question relevant to the promotion of health of clients and/or families. Due the week of November 20, 2006. Weekly CPA’s VI. 1. Weekly reflective journal based on clinical experiences. 2. Complete the clinical worksheet for each clinical experience. Student Expectations/Class Preparation/Lab Expectations Students are expected to do readings and previewing of video content as outlined prior to labs. Students are expected to be familiar with all relevant materials listed and covered in labs as these materials will form the basis for testing. Students are also expected to carry forward what they learned in first year, from all semesters. It is up to students to continue to practice and review information they were responsible for in the first year. Missed lab time must be made up within 7 days of the missed lab by prearrangement with the lab instructor in conjunction with the Lab Coordinator. A written assignment as well as the weekly Preparatory Study Guide or videotape of the student practicing might be required. Arrangement for the AV equipment is the sole responsibility of the student. Valid photo ID with student number is required for all quizzes and skill testing. Calculators will not be allowed in quizzes, in keeping with the RN exam experience. Completed Preparatory Study Guides will be required weekly at the beginning of lab in order to attend that lab. The mandatory purchase of a Lab Kit is required by September 19th. Lab kits are paid for at the Cashier’s Office then the receipt presented to Nursing Lab to receive a kit. 63-272 Course Outline – F06 10 63-272 – Official 2006F Students are expected to practice weekly in lab, in addition to attending scheduled lab times. The only way lab groups can be switched is by one student trading with another, with the approval of both lab instructors. Lab group sizes must remain stable. The arrangements are the responsibility of the students initiating the switch. VII. Faculty of Nursing Policies After the end of the semester, no supplemental activities (CPEs, CPAs) will be offered in this course. Students of the Collaborative Nursing Program are required to demonstrate behaviours consistent with the “Professional Standards for Registered Nurses and Registered Practical Nurses” in Ontario and the “Ethical Framework for Nurses in Ontario”. Failure of any nursing student to conform to the principles of these documents may result in dismissal from any of the Faculty of Nursing programs at the University of Windsor. Students missing tests, laboratory or clinical may do so only with the clinical instructor’s written, e-mail or verbal permission supported with documentation of a valid reason. Late submission of assignments (CPAs) without the instructor’s consent will result in a nonpass. Anyone demonstrating dishonesty or cheating in relation to any aspect of this course will receive a non-pass. Preparation is expected for clinical and laboratory activities as stated in the course outline. Attendance is mandatory for both laboratory and clinical activities. VIII. Collaborative and Second Career Program Policies Professional Conduct and Appearance Nursing students are offered experiences in a variety of settings. As new members of the nursing profession, conduct and personal appearance must be congruent with the College of Nurses current Standards of Practice, principles of medical and surgical asepsis, legal contracts between the Faculty of Nursing and the agencies and policies of the Faculty and agencies. When attending lab professional, casual-business attire is expected (shoulders to mid-thigh covered) and the Dress Code Policy (below) followed. Dress should be conducive to moving, bending, stretching, lifting, lying and preventing contamination (no loose sleeves). A lab coat is recommended. Conduct Students of the Collaborative and Second Career Nursing programmes are required to demonstrate behaviours consistent with the following College of Nurses of Ontario documents: Professional Standards for Registered Nurses and Registered Practical Nurses The Standard for the Therapeutic Nurse - Client Relationship The Ethical Framework for Nurses in Ontario and Explanation of Professional Misconduct 63-272 Course Outline – F06 11 63-272 – Official 2006F The failure of any nursing student to conform to the principles of these documents and those of the Faculty of Nursing and may result in dismissal from the nursing programmes. Dress Code Policy A dress code policy is necessary for the purpose of infection control and the conveyance of a professional, well-groomed appearance. Hair must be neat, clean and worn above the collar; moustache and beards must be neatly groomed. Hands Nails must be short, clean and well manicured. Clear or pastel polish may be worn but must not be chipped. Make-up may be used conservatively, but must be scent-free. Proper hygienic practices are expected. Jewellery is restricted to a plain wedding band, watch and a small earring worn in one or both ears. Where possible, tattoos should be concealed. Uniform Policy Uniforms will not be needed until the second year of clinical. Students provide their own uniform, white lab coat, white duty shoes, white stockings or socks, watch with a second hand, bandage scissors, penlight, stethoscope and photo-identification name tag. Uniforms are to be clean and sized appropriately. They may be either white or a solid colour. Students must follow the uniform policies for speciality areas (Labour and Delivery, Renal Dialysis , NICU, Psychiatry and the Operating Room). Students’ name tags should be clearly visible. Solid white, closed, athletic shoes are acceptable in lieu of duty shoes. Students must follow medical asepsis practices to care for their equipment; i.e., bandage scissors and stethoscope. Students are to be dressed in casual-business attire (no jeans) when uniforms are not required, i.e. Psychiatry, community agencies, seminars or field trips. Refer to agency’s policy and professional guidelines. Lockers are generally not available. Areas for coat and boots will be identified. Keep valuables on your person or in designated areas. Uniforms should be worn only while on duty. Changing after duty, though recommended, may not be feasible; therefore, cover your uniform when it is necessary to wear it home to maintain infection control. When doing clinical research, students must wear appropriate professional attire, for example, a lab coat over street clothes and photo-identification badge. IX. Required Texts American Psychological Association. (2001). Publication manual of the American Psychological Association (5th ed.). Washington: Author. Craig, G. (2004). Clinical calculations made easy: Solving problems using multidimensional analysis (3rd ed.). Philadelphia: Lippincott Jarvis, C. (2000). Physical examination and health assessment. Philadelphia: W.B. Saunders. Ross-Kerr, J. C. & Wood, M. J. (ed.). (2006). Potter & Perry Canadian fundamentals of 63-272 Course Outline – F06 12 63-272 – Official 2006F nursing (3rd ed.). Toronto: Mosby. Wilson, B., Shanon, M., & Stang, C. (ed). (2007). Nurses drug guide. Upper Saddle River: Pearson Prentice Hall. (or any similar drug book) Recommended References/Resources Diagnostic Testing and findings reference book (or on-line resource) One medical dictionary of your choice Note: CD’s/videos will be available in the Learning Resource Centre (Lab) 63-272 Course Outline – F06 13 63-272 – Official 2006F Appendix A CPA - Client Assessment Biographical Data: Name: DOB: Sex: Date of Admission: Marital Status: Dependents: Religion: Birthplace: Ethnic Background: Source of information: (reliable/unreliable and why) Present Medical History: Medical Diagnoses: Past Medical History: Childhood Illnesses: Medical Illnesses: Surgeries: Injuries: Allergies: (drugs, food & environmental) Medications at home (prescription, over the counter, herbal supplements, vitamins): Immunizations: Last H&P or Problem Focused H & P: (on admission) Last Dental Exam & outcome: Last Hearing Exam & outcome: Last Eye Exam & outcome: Last Self Testicular/Breast Exam: Last Mammogram & outcome: Chief Complaint: (what is the patient’s chief complaint in their own words) History of Present Concern / Illness (HPI): (refer to Jarvis for PQRST; if pain use page 15 instead.) P: Q: R: S: T: 63-272 Course Outline – F06 14 63-272 – Official 2006F Associated Symptoms: Hospital Medications and Treatments: Relevant Lab Values: Diagnostic Tests & Results: Developmental Theorists: (use Erickson or Piaget and give a brief description of the appropriate stage of development. Discuss 3 tasks for the developmental stage and provide support as to whether the patient is meeting or not meeting the tasks) Systematic Physical Assessment Review of Systems (ROS): S (Subjective) 1. General: (don’t forget BMI) O (Objective) 2. Skin: 3. 4. 5. 6. 7. 8. Head: Eyes: Ears: Nose and sinuses: Mouth and throat Neck: 9. Breasts: 10. Respiratory: 11. Cardiac: 12. Peripheral-vascular: 63-272 Course Outline – F06 15 63-272 – Official 2006F 13. Haematological: 14. Gastrointestinal: 15. Endocrine: 16. Urinary 17. Genito reproductive 18. Musculoskeletal: 19. Neurological: (including sensory) 20. Psychiatric: 21. Psychosocial: a. Coping and stress: b. Developmental factors: c. Home, family, community and environmental factors: d. Social support: e. Spiritual, cultural and ethnic: Pain Assessment: a. PROVOKING/PALLIATING FACTORS: What brought (brings) it on? What makes it better? What makes it worse? b. QUALITY: What words best describe your pain? What other problems/symptoms occur with your pain? 63-272 Course Outline – F06 16 63-272 – Official 2006F c. REGION/RADIATION: Describe or point to the area of pain. Does the pain go anywhere? Describe where. d. SEVERITY Rate your pain on a scale of 0 (no pain) 10 (worst possible pain): At present: ________________________________ 1 hour after medication Worst it gets: ______________________________ Best it getse. TIMING When did it begin? How often does it occur? How long does it last? f. Visual Analogue Scale of Pain 0 No pain 10 Worst possible pain g. Symptoms associated with pain Nursing Diagnoses (in order of priority. Use ABC’s of CPR and Maslow’s Hierachy; Actual Problems, their Risks) (Minimum of 5) 63-272 Course Outline – F06 17 63-272 – Official 2006 Appendix B NCP Nursing Diagnosis #1: Goal Statements: Short-term (1) & Long-term (1) Interventions: Identify interventions using the 5 tools of Bevis Rationale & References Evaluation Strategies Goal Statements Interventions Rationale & References Evaluation Strategies Short-term(1) & Long-term(1) Identify interventions using the 5 tools of Bevis Nursing Diagnosis #2: 63-272 – Official 2006F Appendix C CLINICAL WORK SHEET Student : ___________________ Date: ___________Client initials:________ Rm.# ______ Age ______ Admission Date: Allergies:* DNR status* Medical Diagnosis: (inc. definition)* Hgb Hct RBC WBC PTT INR Platelets K+ Na+ ClCO2 Glucose BUN/Urea Creat Urinalysis Cultures/Others Diagnostic Tests & Results (eg.: XRay,CT, PFT, scopes) Lab values: (include norms) History of illness: Dose Time Action/Use Meds (add sheet if nec.) Drug Diet/Feeding Assistance* IV (type, rate, site)* Glucometer checks Hygiene Needs* Mobility Status* Treatments* Elimination Needs* Priority Assessments/Interventions* DATA COLLECTION & DOCUMENTATION 63-272 Course Outline – F06 19 Implications 63-272 – Official 2006F Assessments Vital Signs Nutrition & Fluid balance: Neurological, Cognitive & Pain: Skin: Activity & Rest: (include Safety) Elimination (GI & GU): Cardiovascular: Psychosocial/ Family Respiratory: PRIORITY NURSING DIAGNOSES: 1. 2. 3. 4. Goals/Interventions Communication, Caring, Critical thinking - problem-solving - decision-making, Management of change, Teaching / learning. [Bevis] Goals (long-term, short-term) Interventions 1. 2. 63-272 Course Outline – F06 20 63-272 – Official 2006