SEATTLE UNIVERSITY COLLEGE OF NURSING

1 SEATTLE UNIVERSITY COLLEGE OF NURSING SYLLABUS, NURS333 PROMOTING WELLNESS IN FAMILIES CLINICAL FALL, 2009 CLINICAL FACULTY: Toni M. Vezeau, PhD, RNC, IBCLC (Overlake) Lydia McAllister, RN, MN, PhD (Overlake) Terri Clark, PhD, CNM, ARNP, RN, FACNM (Valley) Bonnie Bowie, PhD, MBA, RN (Valley and Group Health) Brenda Broussard, PhD, RN, IBCLC (Swedish) Suzan Watanabe, MN, ARNP, CNM (Group Health) Catherine Santi, MN, RN-C (Swedish)

SEATTLE UNIVERSITY COLLEGE OF NURSING 2 SYLLABUS FOR NURS 333: PROMOTING WELLNESS IN FAMILIES- CLINICAL Childbearing and Childrearing Credits: 4 Clinical Hours: 80 Prerequisites: PSYC 322, NURS 304, and 308 Co-requisites: NURS 305, 312, 332 Placement: Course Description: Quarter 2 of Nursing Sequence Experiences in nursing care of childbearing women and childrearing families and groups. Clinical practice in a variety of acute care and community-based settings. Application of theories, principles, and nursing strategies to promote wellness and reduce illness in families and groups. Course Objectives: Upon completion of this course, the learner will: 1. Apply knowledge from liberal arts, nursing science and related disciplines to promote well being within families. 2. Use the process of assessment, diagnosis, outcome identification, planning, intervention and evaluation to promote health, prevent illness and provide basic care for individuals, families, and groups, in a developmentally effective manner. 3. Demonstrate beginning critical thinking attitudes, skills and abilities in clinical decision making and in evaluating nursing practice. 4. Employ technological and relationship-centered nursing interventions in providing health promotion and direct care to individuals and families. 5. Utilize communication and collaboration skills to work in teams and partnerships with individuals, families, and health care providers to facilitate healthy communities. 6. Demonstrate commitment to self-evaluation, life-long learning, service, professional behaviors, diversity, and social justice in the care of families. Course texts: same as Nurs332, see syllabus

3 SEE COURSE POLICIES IN NURS332 SYLLABUS Policy on Absences, Assignments, and Progression to Clinicals: NURS 333 is co-requisite with NURS 312 and NURS 305. In addition, NURS 332 and 333 are paired theory and clinical courses in which the theory portion provides the content for the practice portion. While the content and objectives for each of these courses are slightly different, the courses are nevertheless very interdependent and each relies on the other to provide knowledge for safe and effective client care. For this reason, missing time in theory classes may jeopardize your success in clinical. Attendance at classes, workshops and labs for the first two weeks is mandatory. Students who are absent during the first two weeks, may result in a student not progressing to clinical experiences and the student may need to repeat the course. The intensive classes, labs and workshops during the first two weeks are carefully designed to help a student succeed in a condensed clinical experience. Students must get checked off on various skills in NURS312 labs prior to performing them in this clinical. Plagiarism on any assignment may result in dismissal from the course. When working on worksheets or assignments, use quotation marks and cite where appropriate. Faculty encourages students to translate especially pharmacology and pathophysiology text content into their own language as much as possible to increase their comprehension of the information. See Appendix in Nurs332 syllabus for the SU Academic Honesty Policy. All papers and assignments are due by a specific time and date and are to be turned in on time. Paper copies of your work are to be turned into faculty. That is, you may not email attach your assignment unless your faculty gives permission. If you are not able to turn in an assignment on time, you must request in advance of the due date an extension by using the Request for Exception in the BSN Handbook. Late unexcused assignments are not accepted. Assignments in Nurs332 specifically mean the weekly clinical writeup. Please follow your faculty s directions. It is expected there will be some slight variation from faculty to faculty. Students are required to turn in one comprehensive write-up each clinical week, but no more. Faculty can vary this in some situations to include verbal case presentations in lieu of written work in the last two weeks of clinical, based on individualized assessment. Concerns about this should be directed, first, to the clinical instructor, then, if necessary, to the course coordinator. As part of professional accountability and integrity, students are expected 1) to not attend clinical if ill or infectious, and 2) to notify the faculty prior to the start of the clinical of their absence. Missing clinical, whether due to an excused or unexcused absence, may seriously impair a student s ability to demonstrate satisfactory performance in meeting course objectives. Student progression, when affected by absences, is decided on an individual basis by the instructor and the course coordinator, in light of the student s prior progress in meeting course objectives. Additional time in most clinical sites is not possible. Appropriate special experiences arranged in the CPL, or additional written or verbal work may be required of the student. However, if the student is not passing at the time of the missed clinical(s), faculty reserve the right to not pass the student. Student will demonstrate professional behavior at all times in all classroom, group, community, clinical, conference, lab, or other learning experiences. Unprofessional behavior, as consistent with the BSN Handbook, is grounds for dismissal from the course. See Nurs332 syllabus for further discussion of this. Additional, but not an exhaustive listing, of professional behaviors in clinical and all settings in which the student represents SUCON include: Following HIPAA requirements Professional appearance (having all necessary equipment, uniform, and hygiene each day) Professional communication and interactions with faculty, staff, families, peers Ethical behavior consistent with AACN practice values and the SU Academic Honesty Policy

Clinical Hours: Nurs333 is 4 credit hours = 80 clinical hours (7 clinical days = 56; conference=10;orientation=4;validation labs = 10 [4 practice, 6 demo]) 4 Note: Clinical conference generally follows each clinical day: see clinical faculty for times, rooms, and expectations. This is to be an active learning time for students, for students to share their day, integrating previous and current course theory to their experiences of the day. Students need to plan their transportation and family needs accordingly. Orientation to Facilities:. Details will be shared by clinical faculty by email. Evaluation Process Evaluation is ongoing in a clinical course. Faculty collect and document data weekly from a variety of sources to get the fullest picture of the student s knowledge and skills. Examples of data sources can include (not an exhaustive list): performance in workshop and validation labs direct observation of clinical performance verbal discussion of client care or healthcare elements written work by student feedback from staff at the healthcare facility feedback from clients and their families conference participation interaction with faculty and peers It is incumbent upon the student to clearly demonstrate to the faculty the knowledge and skills required to pass the course. Both students and faculty use Nurs333 Clinical Evaluation Form to evaluate student clinical performance. Faculty score each course objective on a 1-4 scale. These grades are averaged to obtain the grade for this rotation. Faculty convert this mean to a letter course grade using the SUCON scale below. Final grade distribution (minimum pass grade is C or 2.0) College of Nursing Scale University Scale 94-100 A 4.0 Superior 90-93 A- 3.7 87-89 B+ 3.3 83-86 B 3.0 Good 80-82 B- 2.7 76-79 C+ 2.3 * 73-75 C 2.0 Adequate 70-72 C- 1.7 66-69 D+ 1.3 63-65 D 1.0 Poor 60-62 D- 0.7 Below 60 F 0.0 Failing * Minimum passing grade for nursing courses

Clinical Experiences in Nurs333 Childbearing Sites 5 Students will receive a schedule for their 7-week clinical experience. Occasionally, due to student or staff absences or client needs, this schedule may be altered during the clinical experience. For example, a student may prepare for labor and birth, but there are no laboring families on the unit. Another example is if a student is having difficulty meeting course objectives, he/she may be re-assigned to areas in which support and supervision are more available, such as the mother-baby unit. Students will have comparable, but not the same clinical experiences. Assignments are made by faculty and staff to meet the needs of client families, learning needs of the students, and the resources available on each unit. Families have the right to state if they want a student nurse or not. Consistent with AACN values, staff and faculty encourage families to exercise that right. Students will then be re-assigned to new family or learning experience. There are a variety of childbearing experiences available to students. They may be assigned to observe labor and birth, be assigned a specific client family for postpartum care, shadow a lactation consultant, or work with a staff nurse in a postpartum follow-up clinic. Not all clinical sites have nursery (often Special Care Nursery or NICU) experiences for students. If students are placed in the nursery, faculty should try to place students with a resource nurse caring for grower, gainers, not the most acute newborns. Students should then identify with the resource nurse appropriate hands-on activities (temperature, VS, diapering) and appropriate observational experiences (medications, IVs, X-rays). Students arrive at the start of the shift, prepared for the experience indicated on their schedule. Students will be knowledgeable about the care expected in that area, as well as medications and lab test preparation related to that area. The students will speak often with faculty during the day, and are encouraged to contact faculty on their pager when they have time to discuss their clients or for their learning needs. If the student needs help with skills, planning, or organization, they are to contact their faculty for this assistance in a timely manner. If a student is bored or has nothing to do, the student will contact faculty in a timely manner. It is incumbent upon the student to clearly demonstrate to the faculty the knowledge and skills required to pass the course. Intrapartum Experiences The intrapartum (labor and birth) experience will be primarily an observation experience with limited participation in direct care by the student. At the discretion of the resource RN the student will assist with vital signs, direct care, and supportive measures for the laboring woman and her family. At all times, the student is to act as if they were the RN performing the client s care. That is, the student s brain should always be working and engaged to identify what care is being performed, the rationale for the care, and to identify changes in condition or plan of care. The student is to work closely with the RN, and to use their faculty in understanding the assessments and interventions they are observing. The student is to be an active, prepared, and informed observer, and a partial participant (e.g., VS). To be an informed observer of the childbearing process, the student should: 1. Demonstrate knowledge of the normal onset and stages of labor and birth, including what the experience might be both physically and emotionally for the laboring woman. 2. Be familiar with measures used to provide comfort and support for the woman and her family during various stages of the labor/birth process. 3. Demonstrate knowledge regarding the procedures and the basic equipment used in the inpatient setting, including aseptic technique, universal precautions and monitoring equipment for mother and fetus. 4. Be aware of the variety of members of the team and their basic roles in supporting the family and providing safe care. 5. Demonstrate knowledge of how cultural differences may impact the family s experience of labor and birth. 6. Demonstrate knowledge of common interventions that might be used in the intrapartum period, such as external and internal electronic fetal monitoring, artificial rupture of membranes, induction or augmentation of labor,

6 epidural anesthesia, vacuum extraction, forceps and surgical birth. 7. Demonstrate knowledge of emergency situations that might occur during the intrapartum, including bleeding, umbilical cord prolapse, fetal distress, and maternal hyper- or hypotension. 8. Demonstrate knowledge of common interventions that might be used in the postpartum period including: fundal massage and expression of clots, catheterization, perineal care, assistance with breastfeeding and teaching for the mother; diapering, dressing and bathing, newborn metabolic screening, circumcision, and glucose screening for the infant. 9. Use universal precautions at all times. There is the potential for exposure to blood, amniotic fluid, urine, feces, and vernix. Splashing of these fluids is not unusual. Eye protection is mandatory for students who are in the OR during a C-section. The student may be involved in changing amniotic fluid-and/or blood-soaked pads and providing perineal care to the laboring and postpartum woman. It is the student s responsibility to know and implement universal precautions, as taught at SUSON. If there are any questions or concerns about this, contact your faculty immediately. Your safety and that of your clients are of highest priority to the faculty. POSTPARTUM EXPERIENCE The postpartum experience is a hands-on (that is, not observational) experience in which the student is assigned to a client family and works with a staff nurse, who is either an RN or an LPN. The student actively assesses, documents, and intervenes, always in communication with the staff nurse and their faculty. The workshop outlines what the expectations are in terms of assessment, provision of comfort and support, and client teaching. If the student is caught up their work with their assigned family and with the permission of their staff nurse, the student may observe or participate in the care of other clients. The student must self-assess well regarding this situation. To be an effective participant learner in care of the childbearing family in postpartum experiences, the beginning student will be expected to: 1. Introduce herself or himself to the nurse, client, and family and explain the role of the student. Introduce the faculty as appropriate. 2. Review the mother and newborn charts after report, and begin to gather data on the client family. 3. Take and document accurate vital signs. If you get a measure out of the normal range retake it and use critical thinking. Document the most normal measure. (Example: Newborn temperature left axilla is 36.2, and right axilla is 36.6. Document 36.6 as the temperature.) Temperature or VS measurements out of the expected range, on retake, should be communicated to the resource nurse in a timely manner. 4. Carry out complete assessments and document in a timely manner. It may take a couple of weeks to be effective at this. Variances from normal or difficulties in assessment should be communicated with the staff nurse and the faculty immediately. 5. If a student has difficulty or requires support in assessment, he/she should communicate this in a timely manner. 6. Assist with non-pharmacological comfort measures for the postpartum family (example: ice bag to the perineum). 7. Provide basic teaching to families in an ongoing manner. Again, it may take a few weeks to be effective at this. 8. Use universal precautions at all times. There is the potential for exposure to blood, urine, feces, and vernix. The student may be involved in changing blood-soaked pads and providing perineal care to postpartum woman. It is the student s responsibility to know and implement universal precautions, as taught at SUCON. If there are any questions or concerns about this, contact your faculty immediately. Your safety and that of your clients are of highest priority to the faculty. The student may only perform those assessments and interventions that they have practiced and been successfully validated on in their labs or in NURS312. Any questions about this should be referred to the faculty. For example, the lab does not teach how to remove staples on a non-complicated cesarean section client, but this may be good learning opportunity for a student. After conferring with the faculty, the student can read the facility s procedure, observe the nurse, and then with supervision, practice this skill.

7 Written Work Clinical Write-ups (form follows in this syllabus). Students will complete this worksheet related to each of their seven clinical days (unless instructed otherwise by clinical faculty). The form is to be turned in to faculty the next day unless instructed otherwise by the clinical faculty. Only if faculty have stated it is acceptable, students may email to faculty by attachment. Be sure that it is a.doc file, not a.docx, which is a newer Word version. Not all faculty have the newest Word program installed. You can save all Word documents from the newest program in the compatibility mode which is a.doc file. See your Word help files, peers, faculty, or SU helpdesk, 206-296-5571 (hours 8-5). Review the worksheet. Be a critical thinker. All the data should be collected but not necessarily in the order indicated on the form. The form is organized by the childbearing continuum and nursing process. Again, Do not gather your data in this sequence necessarily critically identify what information you need to know, first, to do what must be done for the client. Refer to workshop content. By the end of the day, the form should be complete. Students are to, first, use all data sources (review of the chart, information given in change of shift report, staff nurse assigned to client, other providers) before asking for information from the client. If in doubt about how to ask for this information or if it should be asked, contact your faculty to role model questioning the client on difficult content or finding this information in the chart. If the student sees a number of families during the clinical day (for example, when shadowing a lactation nurse), the student will pick one of the families they interacted with during the clinical day for the write-up; faculty may also suggest an alternative style to the write-up. If some parts of the form do not apply (e.g., the client is antepartum, therefore, has no data for newborn), then leave those areas blank. Faculty encourage you to get help from your staff RN, peers, or the faculty if you are having difficulty reading charts or finding data on your clients. Students are responsible for photocopying or downloading the form for each of the four clinical weeks. STUDENTS ARE NOT TO PHOTOCOPY CLIENT CHART INFORMATION to take home; this is a HIPAA violation. Write-ups are evaluated by faculty and they will give useful feedback to you. Read your feedback carefully and clarify it as needed so that you make improvements on the next write-up. Faculty will use write-ups to track student learning needs and progress. Clinical faculty may make some reasonable adjustments to the worksheets to be congruent with their facility. Students should review the final clinical evaluation each week and self-assess to what degree and depth they are meeting each of the objectives; this is part of the write-up.

NURS333 Entering and Exiting Behaviors 8 Entering Behaviors Familiarity with the history of the nursing profession. Basic understanding of systems theory Ability to perform physical and psychosocial health assessment of an adult Basic understanding of pathophysiology, including chromosomal and genetic disorders, human reproduction, and sexually transmissible diseases. Basic understanding of child growth and development. Students must pass the growth and development review test at 73% (15 items). If you do not meet the expectations for entering the course as listed above, see course coordinator. Exiting Behaviors Ability to carry out individual and family health assessment, including evaluation of structure and function, strengths, health promotion needs, and risk factors. As a direct care provider, complete a focused assessment and provide basic nursing care for mothers and newborns. Recognize normal and abnormal physical assessments Ability to plan and carry out developmentally and culturally appropriate health teaching to family members. Ability to plan and carry out appropriate nursing interventions of teaching and/or referral based on above assessments and screenings. Document care in a variety of settings using appropriate medical and nursing terminology. Appreciate the unique, complementary, and sometimes overlapping roles of various disciplines involved in family and individual health care. Develop a professional relationship with clients and health care professionals Seek supervision appropriately for clarification and/or validation

9 BSN and AACN Competencies and Nurs333 The following tables describe for you how this course is planned to address the competencies set forth in the CON undergraduate curriculum, the competencies described by the Association of American Colleges of Nursing (AACN), and what faculty view as the skills and knowledge students should have before and after this course. Similar tables will be found in the syllabi of all clinical nursing courses. The tables in each syllabus differ because they are written to be specific to each course. Students should read these tables to get an idea of what they are going to gain from the course. BSN 2000 Competencies Critical Thinking Relationships/ Communication Provider Skills Care Management Community Students will utilize critical thinking skills in the classroom, in conference and in clinical settings as they practice interviewing, assessment and intervention skills for health promotion and disease prevention, and utilize clinical experiences to apply learning. Students will practice communication skills with individuals from infants through adults, and with peers, faculty and other health care providers in the clinical settings. They will establish therapeutic relationships with children, adults and families and practice teaching skills with individuals and families. Basic provider skills will be applied to the practice setting. These will include assessments across the life span from newborn to adults, bed making, bathing, mobility and transfers, and aseptic techniques. Observe supervision and delegation aspects of RN role in agencies. Students will learn about safety issues, assessment issues, confidentiality, and therapeutic relationships of the nurse in the community. AACN Essential Knowledge Health Promotion Risk Reduction, Disease Prevention Illness/Disease Management Information/ Technology Ethics Diversity Global Health Care Systems and Policy Principles of health promotion and specific assessment and intervention measures for the family, from infants through adults. Taught in theory classes and implemented in related clinical situations. Students will be doing direct health teaching. Principles of risk reduction and disease prevention through screening, teaching and immunization across the lifespan. Applied in inpatient childbearing settings and longterm care settings. Identification of common health problems. Basic illness management incorporated with health promotion and disease prevention in childbearing and childrearing family settings. Students will utilize computers as a learning tool by accessing the internet website for this class, the SU library website for health sciences search engines, and websites for various other health related organizations. Ethics will be integrated in theory classes, clinical conferences and clinical settings. Issues of privacy, confidentiality, client choice, respect and honesty will be addressed. Socio-cultural issues that relate to family and health promotion will be addressed in theory classes and through case studies that include diverse family situations. The clinical settings provide students the opportunity to provide care to people from a variety of cultural and ethnic backgrounds. U.S. childbearing outcomes and governmental support of parenting is compared to other countries. Systems theory will be reviewed in class and utilized throughout the course as an approach to families and health care settings.