REGISTERED NURSING PROGRAM. Nursing Education 140 L

Transcription

1 REGISTERED NURSING PROGRAM Nursing Education 140 L

2 Clinical Agency Manual Spring

3 NE 140 L: Course Outline Department: Nursing Education Course Number: NE 140L Course: Nursing II Clinical Laboratory. No Prerequisites Units: 2.5 units. The course is evaluated as credit or no-credit. Corequisites: NE 102 and NE 140. Fifteen laboratory hours weekly for 8 weeks Catalog Description: This course is the clinical laboratory for NE 140. Students apply the nursing process to the care of pediatric and adult clients with non-critical /moderately complex medical-surgical conditions, involving alterations in fluid/ electrolyte and acid/base balance, oxygenation, nutrition, elimination and endocrine regulation. Students learn to conduct a comprehensive nursing assessment and to intervene to prevent health problems and reduce complications. Students learn to manage care for two moderately complex clients and to apply risk reduction strategies to protect the client and maintain legal and ethical nursing practice. Schedule Description: This course is the clinical laboratory for NE 140. Students learn to apply the nursing process to the care of pediatric and adult clients with non-critical /moderately complex medical-surgical conditions, involving alterations in fluid/electrolyte and acid/base balance, oxygenation, nutrition, elimination and endocrine regulation. Assignments/Expectations: Deliver nursing care to clients in acute care facilities. Attend pre clinical conferences to discuss preparation for client care. Attend post clinical conferences to discuss client care, client outcomes, and clinical decision-making. Observe client care in various units in the acute care settings (e.g., operating room, recovery room, intensive care unit) and in community agencies. Expected Outcomes for Students Upon completion of this course, the student will be able to: 1. Conduct a comprehensive nursing assessment, including a health history, focused physical examination, and diagnostic studies, and analyze assessment data in order to formulate actual and potential nursing diagnoses. 2. Plan and implement nursing interventions to maintain physiological and psychological integrity related to oxygenation, fluid/electrolyte and acid/base balance, nutrition, elimination and endocrine regulation. Use knowledge of pathophysiology, age and culture, and evidence-based practice for selection of nursing interventions. 3. Demonstrate an understanding of how to identify and examine several alternatives to a clinical problem and begin to analyze each solution for benefits and risks before making a final clinical judgment or decision. 3

4 4. Demonstrate safe performance of nursing skills and knowledge of underlying principles associated with moderately complex needs of clients with a focus on pharmacological and parenteral therapies. 5. Convey caring & communicate therapeutically with clients and families coping with acute or chronic illness. 6. Communicate effectively with members of the health care team when seeking information, discussing client care, and reporting and documenting assessments and the provision of nursing care. 7. Educate client and family with select health education needs as the client transitions from acute care to the community. 8. Apply basic principles of organization with an emphasis on time management, priority setting and delegation when managing care for two moderately complex clients. 9. Identify potential legal liability in the clinical setting and risk reduction strategies to protect the client and maintain legal and ethical nursing practice. 10. Apply a problem solving method to an ethical problem or dilemma in the clinical area and identify resources available for resolving it. Misc Author s Notes College Terms Syllabus: A course syllabus is a summary of the course. It usually contains specific information about: the course; how to contact the instructor; the instructor s office location and office hours and specific classroom rules. Withdrawal: Student may withdraw from courses during a semester however, there are established deadlines and procedures for doing so. The Class Schedule lists the deadline and procedures. College of Marin Student Handbook 4

5 NE 140 L: Instructor Information and Expectations Instructor Information (student to fill in, depending on assigned PT instructor) Instructor: Phone: Pager: Instructor Expectations Methods of instruction: Post conferences include lecture/discussion/case studies, questions & answers, and/or guest speakers. Instructor will mentor and perform skills as needed in clinical. Methods of evaluation: All asterisk items in the clinical evaluation tool must be passed at expected level or above in order to pass clinical. Attendance policy: Refer to the current regulation in the R.N. Student Handbook. Any student missing any clinical day will be required to meet with the clinical nursing faculty member to make arrangements for a make-up assignment. Tardy policy: Students are expected to be on time for clinical. Please allow time for bad weather and parking. Students who are excessively tardy will be required to complete a written assignment, or may be advised by the instructor. Learning Disabilities: If you have a verified need for an academic accommodation or materials in alternate media (i.e.: Braille, large print, electronic text, etc.), per the Americans with Disabilities Act (ADA) or Section 504 of the Rehabilitation Act, please contact the instructor as soon as possible. Behavior: Students are expected to cooperate and to participate meaningfully in post conference and clinical. No audible pagers or cell phones are allowed in clinical. Students who are repeatedly not prepared, i.e. unable to answer questions on client care or no written care plan, will be removed from patient care. The student will be verbally and formally warned and an Advisement note may be initiated at that time. Clinical Assignment: If the student is uncomfortable with the clinical assignment, it is the student s responsibility to notify the instructor. Every attempt will be made by the instructor to change the assignment. Legal & Ethical Responsibilities & Regulations: According to the R.N. Student Handbook, Students are to accept direction and guidance only from the instructor, except in a life threatening emergency... Nursing care plans- Expected to be thorough and complete prior to clinical. If unprepared for more than one time, the student will be warned and an Advisement note may be initiated. 5

6 NE 140L Course Outline: I. Health Assessments, including health history, physical examination, diagnostic tests, and medication therapy, to determine Nursing Diagnoses and Therapeutic Nursing Interventions for geriatric, adult, and pediatric clients with non-critical/moderately complex medical-surgical conditions. These conditions involve alterations in fluid/electrolyte and acid/base balance, oxygenation, nutrition, elimination, and endocrine regulation. II. Intravenous Management, Including Infusion of Fluids, Electrolytes, Medications, and Blood Products, by the Peripheral and/or Central routes in clients across the lifespan. III. Nursing and Collaborative Management of clients across the lifespan with Problems of Oxygenation: Ventilation A. Nursing Assessment of the Respiratory System B. Nursing Management of Clients with Upper Respiratory Problems; e.g. Upper Airway Infections, Tonsillectomy/Adenoidectomy, Influenza, Airway Obstruction C. Nursing Measures to Protect the Airway; e.g. Suctioning, Oral Airway/Bite Block, Nasal CPAP, Tracheotomy Tubes D. Nursing Management of Clients with Lower Respiratory Problems; e.g. Bronchitis, Pneumonia, Tuberculosis, COPD, ARD (Asthma), Cystic Fibrosis E. Nursing Measures to Maintain Adequate an Adequate Oxygenation Status; e.g. Pharmacological Therapy, Oxygen Administration, Suctioning, Respiratory tx, Chest Physical Therapy, Postural Drainage, Tracheotomy Care, Hydration, Conservation of Energy, Pain Relief, Rest, Nutrition F. Identify Clients with Respiratory Alkalosis or Respiratory Acidosis IV. Nursing and Collaborative Management of clients across the lifespan with Problems of Nutrition and Elimination (Ingestion, Digestion, Absorption, and Elimination) A. Nursing Assessment of the Gastrointestinal System and Nutritional Status B. Nursing Management of Clients with Nutritional Problems; e.g. Malnutrition C. Nursing Measures to Meet the Needs or Maintain an Adequate Nutrition Status; e.g. Oral Feeding, Enteral Nutrition with various Tube Feedings, Total Parenteral Nutrition, Collaborative Surgical Care, Client Teaching Medication/Drug Interaction, Pharmacological Therapy D. Nursing Management of Clients with Upper Gastrointestinal Problems; e.g. Peptic/Gastric Ulcer Disease, GI Bleed, Gastric Surgery, Gastroesophageal Reflux Disease (GERD), Pyloric Stenosis, Cleft Lip or Cleft Palate, Esophageal Fistula, Nausea, Vomiting, Gastritis E. Nursing Management of Clients with Lower Gastrointestinal Problems; e.g. Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis), Irritable, Bowel Syndrome, Colorectal Cancer, Celiac Disease, Appendectomy, Small or Large Bowel Obstruction 6

7 F. Nursing Management of Clients with Liver, Biliary Tract, and Pancreas Problems; e.g.cholelithiasis/cholecystectomy, Cirrhosis of the Liver, Acute Pancreatitis G. Nursing Measures to Meet the Needs or Maintain Bowel Elimination; e.g. Pharmacological Therapy, Collaborative Surgical Care or Invasive Interventions, Head of Bed Elevation, Nutritional Therapy, Nasogastric Tube Management, Fluid Volume and Blood Product Replacement, Rest/Sleep, Pain Management, Ostomy Care H. Identify Clients with Metabolic Alkalosis V. Nursing and Collaborative Management of clients across the lifespan with problems of Endocrine Regulation A. Nursing Assessment of the Endocrine System B. Nursing Management of Clients with Endocrine Problems; e.g. Hypothyroidism Hyperthyroidism, Adrenal Insufficiency, Hypercortisolism (Cushing syndrome and Steroid Administration) C. Nursing Management of Clients with Diabetes Mellitus; Type I, Type II, and Acquired D. Nursing Measures to Meet or Maintain an Adequate Glycemic Control; e.g. Pharmacological Therapy, Nutrition Therapy, Blood Glucose Monitoring, Client Education for Self Care, Hypoglycemia and Hyperglycemia Measures E. Identify Clients with Metabolic Acidosis VI. Application of Critical Thinking to the Nursing Process A. Conduct a Comprehensive Nursing Assessment to determine causalities and establish a database for clients with non-critical/moderately complex medical-surgical conditions. B. Apply Critical Thinking to each step of the Nursing Process 1. Assessment- Utilize critical thinking skills in assessing client, validating and interpreting data, and identifying client's actual and potential problems 2. Analysis- analyze and interpret data based on physiological and psychosocial responses 3. Planning- Describe the process of priority setting to sequence nursing diagnoses and nursing actions 4. Implementation- Utilize knowledge of pathophysiology in order to apply rationales and evidence-based practice for selection of nursing interventions 5. Evaluation- Discuss evaluation measures used to determine a client's progress toward goals of care and outcome criteria 6. Utilize the nursing process to develop nursing care plans or concept maps for client care C. Identify and examine several alternatives to a clinical problem and begin to analyze each solution for benefits and risks before making a final decision VII. Management of Care for the Clients with Non-Critical/Moderately Complex Medical-Surgical Problems 7

8 A. Principles of effectively communicating with members of the health care team B. Principles of caring and communicating therapeutically with clients and families coping with acute or chronic illness C. Principle of Delegation, Time Management, and Priority Setting when managing care for two moderately complex clients 8

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10 VIII. Client Education A. Analyze assessment data to identify and prioritize the learning needs for a client, and family member or caregiver, with a medical-surgical condition B. Provide informal teaching to the client, and family member or caregiver, with a medical-surgical condition that has specific learning needs or content areas for teaching to transition from the acute care to the community C. Application of multiple teaching/learning principles and use various teaching resources, and documentation of the teaching provided IX. Ethical and Legal Scope of Nursing Practice and Lifelong Learning A. Problem solving method for ethical dilemmas in the clinical setting; and resources and appropriate strategies for seeking resolution of ethical problems B. Note the ethical and legal considerations of Ethical Dilemmas e.g. Genetic Testing, Pain Management, Patient Adherence, and Withholding or Withdrawing Treatment C. Legal Liability in the client setting and risk reduction strategies to protect the client and maintain legal and ethical nursing practice D. Evidence-based research to clinical practice e.g. Asthma Education for Self- Management, Diet and Mortality Risk in Women, Enteral Feeding for Patients with COPD, Follow-up for Patients with Colorectal Cancer 10

11 Excerpt from NE 140L course outline approved by COM Curriculum committee 11

12 Excerpt from NE 140L course outline approved by COM Curriculum committee Learning Objectives 12

13 1. Recall anatomy and physiology of the gastrointestinal system, including liver, biliary tract, and pancreas. 2. Apply normal and variant findings from physical examination, history and physical, assessment, to pathologies of Gastric/Peptic Ulcer Disease, GI Bleed, and Gastric Surgery. 3. Explain in-depth knowledge of pathophysiological processes, disease management and health promotion in adults with acute and/or chronic illness, such as Inflammatory Bowel Disease, Crohn's Disease, Ulcerative Colitis, Irritable Bowel Syndrome, and Colorectal Cancer. 4. Compare and contrast the two major malabsorption disorders in children. Describe cystic fibrosis, including pathophysiology, signs and symptoms, dietary adjustments, medical treatment, and effects on the child s growth and development. Consider the nursing care for the Child with Vomiting and Dehydration, including the assessment and management of metabolic alkalosis. 5. Outline the dietary changes on individuals diagnosed with alterations in the GI tract, in the following age groups: infants, toddler, adolescent. Implement nursing care throughout the lifespan: children with Upper GI Problems, resulting from Cleft Lip or Cleft Palate, Hypertrophic Pyloric Stenosis, Gastroesophageal Reflux, or Esophageal Atresia and Tracheoesophageal Fistula, Appendectomy, Bowel Obstruction, Intusscusption. Toddler Hospitalized for Repair of Pyloric Stenosis. Adolescent Hospitalized with Ulcerative Colitis. 6. Using diagnostic reasoning, formulate a nursing diagnosis and apply high priority nursing interventions for each nursing diagnosis: such as Alteration in nutrition: Less than body requirements, Potential for injury related to weakness, Change in loss of consciousness, Activity intolerance related to weakness due to muscle wasting, Swallowing impaired related to dysphagia, Aspiration related to dysphagia due to cerebral vascular accident, Alteration in comfort related to abdominal cramps, nausea, vomiting, Ineffective coping related to anxiety, alteration of body image. 7. Formulate a treatment plan based on appropriate treatment decisions, including appropriate laboratory tests, health maintenance recommendations, consultation and referral sources. 8. Utilize evidence-based recommendations to develop interdisciplinary health care plans including pharmacologic and nonpharmacologic treatments. 9. Critique evaluation measures to determine the client s progress toward goals of care and outcome criteria. 10. Describe the Clinical Nurse Specialist role, ostomy RN in partnership with other health care providers. Examine core professional values and ethical/legal standards of the Clinical Nurse Specialist role. 11. Demonstrate the ability to teach effectively by communicating effectively and efficiently with peers, colleagues, health care professionals, clients and their families. 13

14 12.Based on evidence-based practice, apply current practice issues, research, and technological advances that impact patients health in acute and chronic disease management, adult with cholelithiasis and cholecystitis, acute pancreatitis, and cirrhosis of the liver, nursing care of the adult and child with viral hepatitis and awareness of liver transplant. 14

15 Problems with Liver, Biliary Tract, and Pancreatic Problems Learning Objectives 1. Recall anatomy and physiology of the liver, pancreas and biliary tract. 2. Interpret findings from physical examination, history and physical, assessment, including normal variants and pathological findings of hepatic, biliary tract disorders, compare and contrast the adult and child with cholelithiasis & cholecstitis, acute pancreatitis, and cirrhoisis of the liver. 3. Develop a nursing care plan for a patient with viral hepatitis, cholelithiasis & cholecstitis, acute pancreatitis, and cirrhoisis of the liver. 4. Based on evidence-based practice, apply current practice issues, research, and technological advances that impact patients health in acute and chronic disease management, adult with cholelithiasis and cholecystitis, acute pancreatitis, and cirrhosis of the liver, nursing Care of the Adult and Child with viral hepatitis. 5. Demonstrate beginning awareness of some of the nursing care involved in liver transplant for the pediatric patient. 15

16 Fluid & Electrolyte imbalance Learning Objectives 1. Recall anatomy and physiology of fluid and electrolytes, including mechanisms that maintain fluid and electrolyte balance including key terms. Describe complex physiologic processes related to fluids and electrolyte across the lifespan: fluid differences by proportion, percent of body weight composed of fluid, approximate urine output in a 24 hour period, average fluid requirements in a 24 hour period, routes of body fluid loss, average fluid loss. 2. Describe the management of patients with a fluid or electrolyte imbalance. Compare the mechanisms and effects of fluid deficit and fluid volume excess. Describe and apply the pathophysiology of fluid volume deficit (hypovolemia, dehydration) and fluid volume excess (hypervolemia, edema) to case studies. 3. Compare the mechanisms and effects of deficits and excesses of sodium, potassium, calcium, and magnesium. Describe and apply to case scenarios, the following electrolyte imbalances, ie hyper/hyponatremia, hyper/hypokalemia, hypo/hypercalcemia, hyper/hypomagnesemia, hyper/hypomagnesemia, hyper/hypophosphatemia. 4. Arrive at high priority nursing diagnoses by applying assessment findings, ie fluid volume deficit related to abnormal fluid loss and/or inadequate oral intake, fluid volume excess related to improper diet, dependent venous pooling, immobility, venous pressure points, alteration in skin integrity related to edema or poor turgor, constipation related to decreased fluid intake, diarrhea due to malnutrition, altered body image related to childhood obesity. 5. Develop a nursing care plan which prioritizes the nursing diagnosis, highlights the therapeutic nursing interventions, and the expected outcomes are evaluated to determine the effectiveness of an individualized nursing care plan. 6. Discuss evaluation measures used to determine a client s progress toward goals of care and outcome criteria. 16

17 Problems with Endocrine Regulation Learning Objectives 1. Recall anatomy and physiology of the endocrine system. Explain the functions of the hormones secreted by the pituitary, thyroid, parathyroid, adrenal cortex, adrenal medulla, and pancreas. Compare the biologic effects of deficit and excess of each major hormone. 2. Interpret findings from physical examination, history and physical, assessment, including normal variants and pathological findings of thyroid, adrenal disorders; endocrine, pancreas problems, compare and contrast the adult and child with hypothyroidism & hyperthyroidism, including care of the adult following a thyroidectomy, hypocortisolism (adrenal insufficiency), hypercortisolism (Cushing Syndrome and Steroid Administration). Develop a nursing care plan for a patient with hypersecretion or hyposecretion of the anterior or posterior pituitary, thyroid, parathyroid, or adrenal gland. Explain reasons for surgery of the pituitary, thyroid, parathyroid, or adrenal gland. 3. Differentiate the pathophysiologic bases for type 1 and type 2 Diabetes Mellitus. Contrast the epidemiologic and etiologic factors of type 1 and type 2 DM. Describe the common manifestations of uncontrolled type 1 and type 2 DM. 4. Differentiate the pathophysiology, clinical manifestations, and management of persons with diabetic ketoacidosis from those of persons with hyperglycemic hyperosmolar nonketotic coma. 5. Describe the chronic complications of DM, the relationship between metabolic control and the chronic complications, and the management of the complications. 6. Compare the comprehensive care of patients, including School-Age Child Hospitalized with type 1 and type 2 DM, including the roles of dietary management, education, and exercise. 7. Recall anatomy and physiology of the endocrine system. Explain the functions of the hormones secreted by the pituitary, thyroid, parathyroid, adrenal cortex, adrenal medulla, and pancreas. Compare the biologic effects of deficit and excess of each major hormone. 8. Interpret findings from physical examination, history and physical, assessment, including normal variants and pathological findings of thyroid, adrenal disorders; endocrine, pancreas problems, compare and contrast the adult and child with hypothyroidism & hyperthyroidism, including care of the adult following a thyroidectomy, hypocortisolism (adrenal insufficiency), hypercortisolism (Cushing Syndrome and Steroid Administration). Develop a nursing care plan for a patient with hypersecretion or hyposecretion of the anterior or posterior pituitary, thyroid, parathyroid, or adrenal gland. Explain reasons for surgery of the pituitary, thyroid, parathyroid, or adrenal gland. 17

18 9. Differentiate the pathophysiologic bases for type 1 and type 2 Diabetes Mellitus. Contrast the epidemiologic and etiologic factors of type 1 and type 2 DM. Describe the common manifestations of uncontrolled type 1 and type 2 DM. 10. Differentiate the pathophysiology, clinical manifestations, and management of persons with diabetic ketoacidosis from those of persons with hyperglycemic hyperosmolar nonketotic coma. 11. Describe the chronic complications of DM, the relationship between metabolic control and the chronic complications, and the management of the complications. 12. Compare the comprehensive care of patients, including School-Age Child Hospitalized with type 1 and type 2 DM, including the roles of dietary management, education, and exercise. 18

19 Problems of Pulmonary, Oxygenation, Ventilation Learning Objectives 1. Recall anatomy, physiology of pulmonary system, including terms, such as: cyanosis, hypoxemia, hypoxia, oxygen dissociation curve, Kussmaul, eupnea, dyspnea, tachypnea, apnea, bradypnea, Cheyne-Stokes, hyperventilation, hypoventilation, nebulization, aerosol, vital capacity, tidal volume, crackle, rhonchi, wheeze, stridor breath sounds. 2. Interpret findings from physical examination, history and physical, assessment, including normal variants and pathological findings of pulmonary conditions in the adult, ie upper respiratory tract infections, influenza, the child with upper airway infections, including strep. pharyngitis & croup syndrome, Epiglotittis, Laryngotracheobronchitis, Preschooler Hospitalized for Tonsillectomy/ Adenoidectomy. 3. Describe the signs and symptoms of: 1) upper respiratory infection, 2) lower respiratory tract problems, such as, Adult with Acute Bronchitis, Adult and Child with Pneumonia, including Respiratory Alkalosis, Tuberculosis, Chronic Obstructive Pulmonary Disease, Emphysema, Pediatric Client with Chronic Inflammatory Disease - Asthma, 3) Chronic Obstructive Disease - Cystic Fibrosis, including Assessment and Management of Respiratory Acidosis, infant hospitalized with bronchiolitis/rsv. 4. Anticipate which diagnostic interventions will be ordered, such as arterial blood gases, chest x-ray, skin tests, pulse oximetry, pulmonary function test. 5. Develop nursing interventions and scientific principles for the following therapies: coughing exercises, breathing exercises, positioning, fluid intake, humidification therapy, chest physiotherapy, environmental control, suctioning, oxygenation therapies: ie nasal catheter, nasal cannula, oxygen mask, tent, partial rebreathing mask, non rebreathing mask, croupette, humidification therapy, aerosol, medication therapy, chest physiotherapy, intermittent positive pressure breathing, pressure cycled and volume cycled ventilation. 6. Apply select and applicable nursing diagnosis and collaborative problems to real life case scenarios. ie ineffective breathing/airway clearance, altered breathing pattern, inadequate gas exchange, anxiety, activity intolerance, aspiration, knowledge deficit, PC atelectasis, hypoxia, hypoxemia, respiratory acidosis/alkalosis, respiratory arrest. 7. Discuss the following pathophysiology including signs and symptoms, diagnostics, treatment and key nursing interventions for: respiratory and metabolic acidosis, respiratory and metabolic alkalosis, chronic obstructive lung disease (emphysema, chronic bronchitis, asthma), restrictive lung disease, inflammatory, respiratory syntial virus in children. 8. Discuss evaluation measures used to determine a client s progress toward goals of care and outcome criteria. 19

20 Acid-Base Disturbance Learning Objectives 1. Compare and contrast the pathophysiology of acid base imbalances, such as respiratory acidosis (hypoventilation, COPD, cigarette smoking, sleep apnea) and respiratory alkalosis (hyperventilation, CHF, hypoxia, pneumonia, asthma, pulmonary edema, drowning, high altitudes), metabolic acidosis (DKA 2 IDDM, ARF, septic shock, lactic acidosis, diarrhea, ETOH poisoning), and metabolic alkalosis (severe K depletion: vomiting, postop NGT LWS). 2. Describe and apply the principles of acid-base balance to the interpretation of arterial blood gas (ABG) measurements. 20

21 RECOMMENDED POST CONFERENCE SCHEDULE Week 1 Overview of clinical expectations. Presentation of case studies. Week 2 Nutritional Case studies Week 3 Gastrointestinal: Conditions & nursing care Week 4 Fluid & Electrolyte: Case studies Week 5 Endocrine: Nursing care plan Week 6 Pulmonary: Disorders & medical treatment Week 7 Arterial blood gases: Interpretation Week 8 Putting it all together 21

22 CLINICAL NOTES 22

23 NE 140L Clinical Evaluation Tool Student Name: Instructor Name: Clinical Agency: Date: Semester: Year: Absences: Tardies: Pediatric Hours: Practical: Observed: Grade (Pass/Fail): Comments: Students Comments: Student s Signature Date Instructor s Signature Date Rating Scale S = Satisfactory: Meets clinical performance objectives at a level commensurate with theory and experience in the program. Functions adequately with moderate direction and guidance. Consistently meets all clinical performance objectives. Seeks assistance when needed and benefits from constructive criticism. N = Needs Improvement: Is displaying difficulty in meeting clinical performance objectives at a level commensurate with theory and experience in the program. Needs guidance and detailed instruction. Is unable to consistently apply theory to practice. U = Unsatisfactory: Exhibits behavior which endangers self, the patient or others. Is deficient in meeting clinical objectives at a level that is commensurate with theory and experience in the program. Is unable to demonstrate improvement with constant guidance and detailed instruction. Is unable to consistently apply theory to clinical practice. N/R = Not Rated In order to receive a grade of Credit for this course, all ratings must be Satisfactory or Needs Improvement. Any rating of Unsatisfactory will result in a grade of Fail of the course.

24 BEHAVIORS RATING S N U Responsibility and Accountability A. Demonstrates behavior which reflects responsibility. 1. Arrives on time in the clinical area. 2. Notifies instructor prior to clinical assignment when unable to attend. 3. Dress and grooming are in compliance with College of Marin uniform dress code and agency standards, and are appropriate to the clinical setting. 4. Attends and participates in the clinical conference 5. Arrives to clinical having completed pre-lab data collection and written care plan. B. Demonstrates behavior which reflects accountability. 1. Reports to and introduces self to appropriate person upon arrival and departure from the clinical unit. 2. Informs the instructor and appropriate staff member when unable to complete care. 3. Recognizes limitations in knowledge and skills by seeking appropriate guidance from RN/or instructor. 4. Seeks learning experiences to meet course objectives utilizing instructor, staff, and other resources. 5. Evaluates own performance using the clinical objectives and clinical evaluation tool. 6. Demonstrates truthfulness and honesty in all dealings. Legal and Ethical Scope of Practice S N U 1. Follows code of student conduct for the College of Marin. 2. Follows the policies and procedures of the College of Marin RN Program. 3. References and works within the policies and procedures of the clinical agency. 4. Follows HIPPA guidelines and maintains patient confidentiality and privacy. 5. Exhibits honesty and truthfulness in dealings with staff, clients, instructor, and peers. 6. Demonstrates concern and respect for patients and families whose culture, values and/or behaviors differ from those of the student. 7. Recognizes and discusses instances of ethical conflict. 8. Recognizes and reports to instructor quality care client issues/problems and unsafe practices. Communication S N U A. Communicates clearly and professionally with members of the health care team. 1. Introduces self to staff RN and other members of the health care team. 2. Clarifies received communications and ensures that sent communications are received and understood. 5. Follows direction Demonstrates courtesy, friendliness, and helpfulness 3. Communicates ideas and information precisely, using appropriate medical terminology. 4. Seeks assistance from the instructor to resolve conflicts in constructive and mutually beneficial ways. B. Receives and reports necessary information related to assigned patients. 1. Meets with appropriate staff to share plan of care and get pertinent information at beginning of the shift. 2. Reports changes in patient s condition promptly to assigned RN. 3. Updates instructor periodically regarding patient assignment. 4. Gives complete report to appropriate staff member prior to end of shift. C. Patient Therapeutic Communication 1. Utilizes therapeutic communication purposefully and spontaneously with patients and families. 2. Applies therapeutic communication techniques in interactions with clients, who may be challenging e.g., suffering grief or loss, uncooperative/demanding, aggressive, agitated, psychotic &/or self-destructive (suicidal, substance abusers). D. Documentation 1. Documents according to agency s and instructor s guidelines 2. Charts vital signs and nursing care within prescribed time frame 3. Updates and/or completes all charting before leaving unit. 4. Documents all administered medications on the MAR. 24

25 5. Documents initial patient assessment and significant changes in patient condition during shift. 6. Evaluates patient s progress toward outcomes/goals. Caring S N U 1. Establishes and maintains therapeutic relationships with client and families. 2. Offers appropriate emotional support based on developmental level of client and is inclusive of family and significant others. 3. Demonstrates caring by providing comfort measures that are age appropriate and culturally sensitive. 4. Demonstrates team work and caring by offering to share information and to help to staff and classmates. Patient Teaching S N U 1. Provides informal health teaching to patient and family while providing care (e.g., while doing vital signs, assessments, administering medications, or performing treatments) 2. Applies teaching/learning principles in teaching and evaluating learning with clients and families. 3. Accurately explains interventions (medications, treatments, and procedures) to clients at a level they can understand prior to administering them 3. Seeks answers to patient s and family s questions from appropriate resources. 4. Participates or assists in pre-op teaching 5. Participates or assists in discharge teaching Nursing Care Planning A. Assessment and Data Base 1. Locates specific patient data in the medical record, Kardex, and medication administration record. 2. References medical terminology in order to build vocabulary and understand the medical record. 3. Obtains relevant information from the health care team, chart, computerized medical record, MAR and Kardex to develop an initial patient database that includes the physiological, psychological, psychosocial, cultural, and spiritual needs of the individual. 4. References textbooks in order to understand and explain the client s medical diagnosis, usual signs and symptoms, diagnostic tests, and usual medical and/or surgical treatment. 5. Updates database and the patient s care plan in response to new data obtained from patient assessments, diagnostic tests, and the patient s changing condition and needs. B. Nursing Diagnoses 1. Identifies and prioritizes appropriate nursing diagnoses (responses to health problems), PCs/CPs (Potential Complications and Collaborative Problems) based on the client s assessment data base. 2. Identifies possible causalities of each nursing diagnosis. 3. Is able to describe the signs and symptoms by which the nursing diagnosis is manifested. C. Expected Outcomes 1. Identifies realistic, individualized client goals and expected outcomes of care for each nursing diagnoses. 2. Discusses evaluation measures that will be used to determine a client s progress toward goals of care and outcome criteria. D. Nursing Interventions 1. Utilizes theory and evidence-based research in selecting appropriate nursing interventions. 2. Selects nursing interventions that address problems with multiple causalities. E. Evaluates the Client s Progress Toward Goals and Expected Outcomes 1. Evaluates the effectiveness of specific nursing interventions. 2. Evaluates the client s progress toward expected outcomes S N U F. Completes a written care plan 1. Completes a written care plan assignment according to syllabus and instructor guidelines. 2. Submits care plans and written assignments on time. 25

26 Therapeutic Nursing Interventions and Comprehensive Nursing Care S N U A. Knowledge Base and Preparation 1. Arrives for clinical assignment with a written nursing care plan 2. Can explain client s medical diagnosis and treatment plan. 3. Identifies priorities in the care of the client. 4. Discusses relevant patient data and plan of care with RN and/or instructor prior to beginning care. 5. Explains relationship of client s medications to medical and nursing diagnoses. B. Provision of Nursing Care 1. Maintains universal precautions and infection control standards 2. Maintains asepsis in all sterile procedures. 3. Ensures safety of patient and environment, including observing fall precautions, seizure precautions, aspiration precautions, and bleeding precautions. 4. Accurately assesses, reports, and documents VS, including pain and O2 sat, at appropriate times, and initiates appropriate follow-up in consultation with RN or instructor. 5. Performs and documents basic head to toe physical assessment. 6. Ensures that treatments, procedures, and equipment that are ordered and/or needed for patient are being provided. 7. Accurately performs FSBS, documents/reports findings, and initiates follow-up. 8. Provides appropriate patient hygiene and toileting. 9. Ensures that patients receive correct diet and required assistance with feeding 10. Utilizes correct ambulating/transferring techniques, and observes prescribed activity precautions. 11. Monitors, reports, and documents intake and output 12. Implements measures to protect skin. 13. With guidance, performs dressing changes and prescribed wound care utilizing appropriate clean or sterile technique. D. With guidance, prepares and administers pharmacological agents in a knowledgeable, methodical, competent manner. 1. States the indications for, actions, routes of administration, dosages, common side effects of, toxicity, and nursing considerations for patient s medications that will be administered. 2. Performs patient assessments and reports to patient s RN and/or nursing instructor prior to administering medications. 3. Follows the facility policy and procedure for administering and documenting medications. 4. Prepares medications utilizing precautions for infection control and maintenance of sterility. 5. Accurately calculates medication dosages in the clinical setting. 6. Utilizes the 5 Rights. 7. Prepares and administers medications in presence of instructor or RN. 8. Administers PO, inhaled, topical, and SQ/IM medications using appropriate medication administration techniques. 9. Identifies clinical situations which can lead to medication or other medical errors and works with instructor and staff to correct them. 10. Explains the patient s medications to him/her prior to administration in language that is appropriate and understandable. E. IV Therapy 1. Demonstrates ability to aseptically spike and prime IV tubing 2. Demonstrates ability to calculate and regulate correct rate for IV infusions via gravity, controller, or pump 3. Safely administers an IV piggyback, back-priming, determining and setting the prescribed/recommended infusion rate 4. Demonstrates ability to aseptically flush a saline or heparin lock. 5. Assesses and monitors patients receiving the IV therapy for local and systemic complications and notifies instructor or RN for problems. 6. Assesses that the ordered IV fluid is hanging and infusing at the prescribe rate, is on time, and properly labeled 7. Documents the IV infusion on the correct forms and according to hospital policy 8. Documents the condition of the IV site on the correct forms and according to hospital policy 26

27 9. Safely D/Cs an IV 10. Participates in quality assurance by ensuring that IV sites and tubing are labeled correctly and changed according to hospital policy/cdc guidelines. Leadership /Management S N U 1. Develops and follows a schedule for providing nursing care within the timeframe allowed. 2. Recognizes and responds to shifting client care priorities. 3. Demonstrates planning and organization by obtaining needed supplies prior to beginning care. 4. Demonstrates patient advocacy by conferring with health care team in unsafe situations when patients needs are not being satisfactorily met 5. Adapts to changes in clinical assignment, demonstrating self-direction in seeking information and find learning opportunities. 6. Seeks out additional information and learning opportunities, going above minimal requirements. 27