Academic Year: F2014-S2015

Academic Year: F2014-S2015 Nursing N323: Nursing Process and Practice in the Care of the Adult Patient I

Catalog Course Description: Care of the medical-surgical patient with problems of the cardiovascular, peripheral vascular, endocrine, immune and hematological system, and oncological problems is emphasized. Nursing process based on the Roy Adaptation Model is continued. Communication and teaching are practiced. This course may have a practicum. Program Student Learning Outcomes: PATIENT-CENTERED CARE Integrate the nursing process using the Roy Adaptation Model for all individuals and groups Adapt patient-centered care based on respect, compassion, and consideration of the patient s developmental stage, preference, values, and or culture TEAMWORK AND COLLABORATION Collaborate within nursing to foster open communication, mutual respect for disciplines, and shared decision making in order to deliver patient-centered care to individuals and groups EVIDENCE-BASED PRACTICE Integrate best current evidence collected electronically or through other means, to support clinical decision making for delivery of optimal health care QUALITY IMPROVEMENT Internalize the knowledge, skills, and attitudes necessary to continuously improve quality, and safety within professional nursing practice Utilize data to monitor outcomes of care processes and use improvement methods for continuous improvement in the quality and safety of health care systems SAFETY Determine teaching and learning needs to promote health and clinical prevention to patients and health care providers INFORMATICS Use information and technology to communicate, manage knowledge, mitigate error, and support decision making Student Learning Outcomes 2 nd Level At the 2 nd level, students are expected to apply nursing concepts and recognize abnormal physical attributes in clinical settings to an identified adult patient population, develop a plan of care and make decisions on the basis of general guidelines or principles derived from their experiences, use appropriate resources to assist in solving patient problems, and develop an awareness and skill in utilizing resources to achieve planed outcomes of care. The student at this level will: 1. Utilize the nursing process & Roy Adaptation Model in caring for adult Medical-Surgical patients. 2. Display professional behaviors or nursing practice. 3. Interpret rationales for clinical decisions. 4. Provide safe, patient-centered care. 5. Practice as a member of the nursing team utilizing effective communication strategies. 6. Incorporate evidence-based practices which support clinical reasoning. 7. Utilize a variety of sources to review outcomes of care. 8. Utilize technology to research patient information and communicate with inter-professional teams. 2

Course Student Learning Outcomes: 1. Utilize the nursing process & Roy Adaptation Model in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. a. Completes a nursing history and assessment that categorize ineffective behaviors that affect adaptation in the four modes: Physiological, self-concept, role function, and interdependence. b. Incorporate sufficient and appropriate pathophysiology and pharmacotherapy based on relevant sources. c. Uses the mode boxes to prioritize actual and potential nursing diagnoses and formulates expected outcomes. d. Plans and employs nursing interventions individualized to patient(s). e. Evaluates patient responses to therapeutic nursing and medical interventions, treatments, medications, teaching, and reports. f. Develops a nursing care plan that includes a physiological, psychosocial, and teaching component. 2. Display professional behaviors or nursing practice in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. a. Demonstrate core professional values (compassionate, independence, honesty, human dignity, social justice, and philanthropy). b. Complies with agency and school policies, state laws and regulations, and practices within the legal and ethical frameworks of nursing. c. Treats all individuals with dignity and respect, and maintains patient confidentiality. d. Uses constructive criticism to improve performance, behaviors, actions, outcomes of actions, and making appropriate changes. 3. Interpret rationales for clinical decisions in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. a. Uses accurate information regarding patient s medical history, assessment, diagnostic tests, laboratory values, and medications to develop an individualized plan of care. b. Interprets and validates stimuli of effective and ineffective behaviors. c. Identifies and documents relevant information for clinical decision-making; recognizes inconsistency. 4. Provide safe, patient-centered care in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. a. Perform the following nursing skills safely: Administration of Heparin, Lovenox, insulin; Monitoring Blood transfusions; Administration of TPN; Central line dressing change. b. Demonstrates active involvement in patient values, preferences and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. c. Considers learning needs of patient and family, and community resources in developing teaching plan. d. Demonstrates patient advocacy, protecting from injury, infection, & harm; maintains a safe care environment. e. Performs nursing procedures according to college and agency policy and procedure guidelines. f. Follows 8 rights in medication administrations. 3

g. Adheres to National Patient Safety Guidelines. h. Provides accurate information to patients and families to make informed decisions. i. Describe the process of pain assessment and implement therapeutic nursing interventions for the patient with pain. j. Perform basic nursing skills learned in previous nursing courses with minimal assistance/cues from experts. 5. Practice as a member of the nursing team utilizing effective communication strategies in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. a. Distinguish between effective and ineffective teaching and communication skills when collaborating with patients and other members of the health care team. b. Utilizes communication techniques that assist patient and family to achieve health goals. c. Interacts effectively with patient/family, staff, and instructor and participates actively in clinical conferences. d. Utilizes communication practices that minimize risks associated with handoffs among the interpersonal team. e. Reports and documents responses to nursing and medical interventions. Follows agency documentation policies. f. Uses appropriate and respectful words and tone in communications while working with patients & team members. g. Adapts communication strategies based on patient s age, developmental level, disability, and/or culture. h. Reports ineffective behaviors, pertinent info, and patient concerns in a timely manner to staff, and/or instructor. i. Uses SBAR communication within the interpersonal team members. 6. Incorporate evidence-based practices which support clinical reasoning in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. a. Apply principles of peri-operative care. b. Identify and prepare patients for various diagnostic tests for patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. 7. Utilize a variety of sources to review outcomes of care in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. a. Adapts plan of care in response to patient needs. b. Completes care safely, cost effectively, organized and timely to improve the quality of care. c. Evaluates patient response to nursing and medical interventions, including medication response, therapeutic treatments and interventions, patient teaching, lab and diagnostic reports. d. Uses measurable outcomes on care plans to evaluate care and modifies accordingly. 8. Utilize technology to research patient information and communicate with inter-professional teams in caring for adult Medical-Surgical patients with selected diseases of the cardiovascular, hematologic, endocrine systems, as well as patients with selected ineffective immune responses, and dysfunctional cellular proliferation. 4

a. Uses appropriate resources, collected electronically or other means to assist in solving patient problems. b. Documents patient data accurately on computerized system established by clinical agency. c. Uses EMAR to effectively pass medications as appropriate for each clinical agency. The General Education Student Learning Outcomes ensure that students who complete programs in occupational areas are expected to demonstrate that they: Have college-level skills in reading, writing, and speech appropriate to the selected degree Utilize appropriate informatics: computer skills & Internet Apply previously learned knowledge to the current area of study Are able to acquire the skills and perform the tasks necessary for their employment or career enhancement Have adequate college level mathematical skills Required Textbooks and Supplies: S.L. Lewis, M.M. Heitkemper, S. R. Dirksen, L. Bucher, & M. M. Harding (2014). Medical-Surgical Nursing (9 th Ed.) Mosby, Elsevier, St. Louis Missouri. Roy, C. (2009). The Roy Adaptation Model (3rd Ed). Appleton & Lange. Cho, S. J. (1999). The nursing process manual: Assessment tool for the Roy Adaptation Model. Polaris Publishing Company, Glendale, California Reference books: Latest edition of Davis Drug Guide for Nurses, Philadelphia PA, F.A. Davis or equivalent, Perry, A.G. & Potter, Clinical Nursing Skills and Techniques. Perry, A.G. & Potter, Fundamentals of Nursing Concepts, Process, and Practice, St. Louis MO: Mosby. Diagnostic/Laboratory Tests Textbook of choice, Nursing Diagnoses Handbook of choice/care Plan book of choice Scantron: #882 will be required for 2 exams; F-289-PAR-L will be required for 3 exams Current academic year LAHC Nursing Student Handbook National Patient Safety Goals - http://www.jointcommission.org/assets/1/6/2014_hap_npsg_e.pdf Quality Safety Education in Nursing (QSEN) - http://qsen.org/competencies/pre-licensure-ksas/ National Council of State Boards of Nursing (NCSBN) 2013 NCLEX Test Blueprint https://www.ncsbn.org/2013_nclex_rn_test_plan.pdf Student Nurse Uniform: Refer to current student handbook on appropriate attire Lecture Monday 0800-1005; 1400-1405 Wednesday 1310-1630 Clinical Laboratory Days Harbor UCLA Tuesday 0630-1530; Wednesday 0630-1230 Thursday 0630-1530; Friday 0630-1230 Saturday 0630-1930 Little Company of Mary: Tuesday 0630-1530; Wednesday 0630-1230 Torrance Memorial Medical Center: Tuesday 0630-1930 + 6 to 18 hours of simulation TBA for each clinical group Lecture and Clinical hours may vary slightly depending on semester holidays to meet required lecture and clinical required hours. 5

Faculty Contact Information: Instructor Doris Webster Kathy Vo Office Location N141 N113 Contact Number 310-233-4385 (310) 233-4387 E-mail Address webstedf@lahc.edu vokt@lahc.edu Office Hours Posted outside office door Posted outside office door Credit/Contact Hours: This is a 5 unit course with 54 hours of lecture and 108 hours of clinical over an 8 week period. Transferability: Conditional Prerequisites: The prerequisites for this course includes: Algebra, chemistry, English 101, Anatomy, Physiology, psychology, and psychology 41 or equivalent. The student must past all pervious nursing courses with a grade of "C" or better. The prerequisites for this course includes: Algebra, chemistry, English 101, Anatomy, Physiology, psychology, and psychology 41 or equivalent. The student must past all pervious nursing courses with a grade of "C" or better, N 311, N321, N313, N315. LVNs may enter course after completion of N311, 321, and N329A and B, with a grade of C or better, and completion of all current admission criteria. Course Policies Clinical Eligibility: To be eligible for clinical attendance all students are required to have the following: American Heart Professional CPR and First Aid certification, background check clearance, current TB test or chest x-ray, positive rubella, varicella, rubeola, and hepatitis B titers, current flu shot, physical examination within the past two years, OSHA certification, FIT testing, and current personal liability insurance for the period of time of course participation. All laboratory, x-ray, and TB skin test official results must be present in clinical health packet as defined by current student nursing handbook. In addition, all agencies required tests must be completed and submitted to clinical instructor. Any student will be terminated from the course with a failing grade if the student s behavior(s) puts the patient in physiological or psychological jeopardy or is considered life threatening. Plagiarism: Any form of academic dishonesty is not tolerated within the Los Angeles Community College District and will result in a zero for the assignment in question and a possible one to two day suspension from the class (in most cases this will result in a course failure). Attendance Policy: Class absences are not to exceed one 2 hour lecture or 6 hours of clinical. If the student is ill or has an emergency, please contact lead instructor as soon as possible. Clinical hours cannot be missed. Nursing students are urged NOT to be absent, and are reminded that the student is responsible for ALL information given during class time. Three tardies will be counted as one absence (8-week courses). Absence that exceeds specified maximum 5 hours for clinical and 2 hours for lecture may result in exclusion from the course or receiving an F grade. Clinical absence may NOT be made-up in other Nursing clinical unless the 6

circumstances for absence are extraordinary: such as a major illness. The possibility of clinical make-up will be determined by the availability of a 2nd semester clinic or at the discretion of the clinic instructor. Lecture absences will require a makeup assignment at the discretion of the instructor. Math Test Policy: The student must pass a basic math test with 90% accuracy. The student will have 2 opportunities to pass the exam. If the student is unable to pass the math exam at 90% accuracy after 2 attempts; therefore, the student will not be able to meet the course objectives and need to withdraw from the course. Subsequently, the student is required to remediate prior to readmission to the course. Clinical Written Assignments Policy: All students are required to review their patient's medical record the day before clinic. If a student is NOT prepared to take care of the assigned patients, the instructor reserves the right to send the student home for that day resulting in an absence. All clinical assignments are due in accordance to the clinical instructor. Each student is required to write 4 completed sets of nursing care plans and 1 team leading assignment. Students who are assigned to procedural sites (GI Lab, Cath Lab, OR) are required to submit a minimum of a 3-page paper in APA format describing experience (Refer to clinical objectives for procedural sites). Clinical Paperwork: Nursing History & Physical Assessment Form: Is required for 1 of 2 patients being cared for each week. Pathophysiology Forms: Is required for all assigned patients being cared for each week. There is no maximum amount of pathophysiology; the amount is dependent on your patient assignment/week. Nursing Care Plans: A total of 4 nursing care plan sets are due for the entire clinical rotation. All re-dos must be completed and submitted before the end of the class according to the instructor. Each set of NCPs include: Physiological, Psychosocial, and a Teaching Care Plan with flow sheet. The objectives for the teaching care plan include: Practice specific principles of learning and teaching to the patient/family using necessary visual, audio, written, verbal methods as necessary. Customize teaching to each patient/family, keeping in mind the patient/family s reading level, cultural, and cognitive and language abilities. Develop teaching plans consistent with patient and family learning needs. Involve patient, family, and other members of the healthcare team. Include teaching flow sheet. Medical Administration Record: Is required for all assigned patients being cared for each week. It is due the day of patient care. You must include: Dosages, mechanism of action, usual dose, frequency, generic/trade names, side effects/adverse effects, nursing management, indication for your patient, and time. *Black box warning and High-alert medications must be noted 7

Remediation Readmission Policy: If a student fails to complete this course with a passing grade, including exiting the course before completion by exclusion or a Withdrawal, the student is required to complete an Exit Interview with the clinical instructor or lead instructor and the nursing remediation counselor. To be readmitted to the program, the student must complete a Readmission-Remediation-Transfer-Committee (RRT&C) request form and submit the form to the department s administrative secretary. The student request will be considered by the RRT&C Committee and readmission will be determined by eligibility, having met the admission requirements in force at the time of reapplication, completion of any required remediation, and available space. *Consideration for readmission the RN program is based on the student s ability to participate in and provide documented evidence(s) of advised activities and skills by indicated due date. Please refer to the Student Handbook for the RRT&C Policy and Procedure for this course. Course Credit Challenging Policy: The student who satisfies the Los Angeles Harbor College and Nursing Division requirements for receiving Credit by Examination is eligible to challenge Nursing 323 course and clinical requirements by Achieving 90% on a math test that includes IV calculations (on the first attempt) Achieving a minimal score of 75% for each of the course units and final examination (on the first attempt) Achieving a satisfactory performance rating for units procedures Achieving a 75% or greater competency level for a Practicum examination (Criteria and the procedure for the practicum examination will be provided to the applicant in advance of the exam and will be based on the Nursing 323 Clinical objectives). *All testing must be completed on the Los Angeles Harbor College campus, in a test-secured room within the nursing building. No more than 1.5 minutes are allotted for the completion of each exam question. The student is allowed 40 minutes to complete the practicum exam, allowing 20 minutes for each procedure. The student is expected to have completed the Course Syllabus materials as preparation for the challenge exam, including assigned readings designated in the course units. College and Department Policies: See College Catalog and Current Nursing Student Handbook. Board Policies/Accommodations 1. Nursing students requiring special accommodations in a course must present official documentation of the type of accommodations required to the nursing faculty. 2. Board Rule 9803.12. Dishonesty, such as cheating, or knowingly furnishing false information to the college. Examples of academic dishonesty: A student copies from another student, to help an academically weaker student by providing answers to a test or using "crib" notes. 3. Board Rule 9803.14. Obstruction or disruption of classes, administration, disciplinary procedures, or authorized College activities. 4. Board Rule 9803.19. Alcohol and Drugs. Any possession of controlled substances which would constitute a violation of Health and Safety Code section 11350 or Business and Professional Code section 4230, any use of controlled substance the possession of which are prohibited by the same, or any possession or use of alcoholic beverages. 8

Please see college catalog for a listing of all District Board Rules. Also, refer to the Student Discipline Procedure for due process for disciplinary issues, grievances and the student appeal process. All students are required to read the Student Nurse Handbook. If you do not have a copy, you may obtain a copy from the Nursing Learning Lab desk. Course Grading: Nursing 323 is a combined course. Failure of either the theory or clinical portion results is a failure of the entire course. To successfully pass the clinical portion of this course, the student must pass all critical clinical criteria with a 3 or 4 rating. Weekly clinical evaluation performance will be graded on a scale of 1 to 4 (4=Exceeds level expectations, 3=Moving toward independent level. Performance as expected for this level, 2=Concerns regarding performance level, 1=Dependent level, significant concerns for safety). Exam scores and classroom performance will determine the final course grade if student performance in clinical is passing. If the final clinical grade is below a passing score (1 or 2), the highest course grade that can be earned is a D. Note: A D is not a passing grade in the nursing program. The course has 1000 points. Grades are earned from four (4) Unit tests, a final exam, and ATI proficiency level achieved. Students will receive an additional two (2) points for scoring at Proficiency level (1), on the ATI Medical Surgical Exam, and three (3) points for scoring at Proficiency level (2). All written tests with the exception of the ATI test are based on units objectives. EACH STUDENT MUST RECEIVE A SATISFACTORY GRADE (75%), IN THEORY IN ORDER TO PASS THE COURSE. ALL STUDENTS MUST ALSO RECEIVE A SATISFACTORY GRADE IN CLINIC IN ORDER TO PASS THE COURSE. POINTS GRADE PERCENTAGE 900-1000 A 90-100% 810-899 B 81-89.9% 750-809 C 75-80.9% 749-600 D 60-74.9% Below 600 F Less than 60% There are no scheduled make up exams. Students are urged to contact instructor if major illness requires missing an exam. The grade obtainable for an exam taken after the scheduled testing day is 75%. All make-up tests must be scheduled within 5 days; otherwise the student will receive a zero for missed test. Make-up exams may be multiple choice, fill-in, essay, or assessment &/or nursing care plans, or a combination of all the above. To receive a grade of W (withdrawal) for the class, the student must officially drop the course in admissions by the end of the sixth (6) week of the course. 9

Critical Outcomes A student must receive a Pass (3 or 4) criteria rating on all critical outcomes identified for the current course in order to Pass the clinical component by the end of the term. Clinical performance identified as a 1 or 2 at the midterm, must improve to a criteria performance rating of 3 or 4 to successfully pass the course. Students are responsible for all procedures learned and practiced in all previous nursing courses at a satisfactory level. Student Learning Resources Textbook Assignment Evolve Website College Library Computer Lab Simulation Lab Nursing Learning Lab Learning Resource Center (Main Library) Hospital Libraries Case Studies Videotapes, DVDs, CDs Library Databases/ Nursing Learning Lab Health Databases for Nursing Students - http://www.lahc.edu/library Method of Instruction Textbook Assignment Lectures Discussion Demonstrations/Skills Videotapes, DVDs, CDs Case Studies Internet Simulations Computer-Assisted Instruction Clinical Patient Care Experiences Critical Thinking Exercises Nursing Care Plans (Physiological, Psychosocial, & Teaching with flow sheet) Study Time: The College expects a minimum of two hours of study/preparation by the student for each hour of lecture and one hour of preparation for each hour of clinical laboratory. Evaluation Method: NCLEX blueprinted exams designed to measure comprehension, application-based, nursing judgment, clinical reasoning, and critical thinking based on the nursing process. o All exams include multiple multiples, principles of delegation, prioritization, and patient care needs in accordance with the student learning outcomes o Overall score of 750 points or 75% must be achieved. Written assignment for procedural sites must meet specified criteria - See clinical grading criteria. Clinical Performance of Competences at level II Compliance with College, Nursing Program, and Course Policies 10