Module description Module 10 Nursing Acute and Critically Ill Patients/Citizens August 2015 1
Contents 1. Nursing Acute and Critically Ill Patients/Citizens... 3 Learning objective... 3 2. Themes and transverse subject areas... 4 Theme 1: Nursing problems related to acute and critically ill patients undergoing surgery.... 4 Theme 2: Nursing problems related to acute and critically ill patients with medical heart conditions.... 4 Theme 3: Nursing problems related to patients with critical life-threatening cancers... 4 3. Organisation of the teaching... 5 The study-activity model for module 10... 5 4. The module s fixed and planned study activity... 6 Study activity C... 6 Planned study activity in general pharmacology and calculating dosages of medicine... 6 Other study activities... 7 Theme day: Acute and critical nursing in clinical practice... 7 5. Exam... 7 Exam form... 7 Frameworks... 7 Guidelines for external exams... 7 Oral exam... 8 Assessment criteria... 8 6. Resits and make-up exams due to illness... 8 Illness... 8 Resits... 9 7. Overview of the module... 9 8. Literature... 10 2
1. Nursing Acute and Critically Ill Patients/Citizens This module centres on how patients/citizens experience and react to acute and critical illness, suffering and impending death. It also focuses on organisation and collaborative work, including nursing management. Learning objective On successful completion of the module, students will have achieved the following learning objective: the ability to search for, categorise and apply practice-, development- and research-based knowledge of acute and critical nursing situations the ability to search for, categorise and evaluate knowledge about quality development in nursing the ability to explain key methods and models for quality enhancement the ability to analyse and discuss patients perspectives in conjunction with critical illness, suffering and impending death the ability to identify, analyse and evaluate selected complex nursing phenomena in the event of life-threatening conditions, and justify selected interventions the ability to identify, analyse and evaluate selected interventions in the event of life-threatening conditions the ability to explain selected forms of pharmacological treatment the ability to calculate dosages and administer medication the ability to explain pathological conditions in relation to selected acute and critical illnesses the ability to reflect upon the importance of co-operation with critically ill patients, their relatives and other professionals the ability to explain the importance of prioritisation, co-ordination, delegation and the allocation of resources in nursing the ability to account for selected forms of organisation and management of patient care in the health and social services the ability to apply the legal framework for professional practice, and to reflect upon the consequences of legislation for professional practice. The module s core subject areas (nursing, pathology, pharmacology and organisation, administration and management) are addressed through the teaching of complex nursing problems. 1 Core subject areas Theoretical ECTS credits Clinical ECTS credits Nursing care 8 0 Pharmacology 2 0 Pathology, including radiology Organisation, administration and management 3 0 2 0 1 A nursing problem is defined as a problem that the patient/citizen already has, or risks contracting, and which the nurse addresses on the basis of a professional evaluation in his or her sphere of activity. (Karoliussen, M & Smebye, KL 1986. Sygepleje fag og proces (Nursing: Profession and Process), Munksgaard Copenhagen). 3
2. Themes and transverse subject areas The module starts with instruction in key, recurring concepts used in different ways in all of the module s themes. Students acquire knowledge on acute and critical nursing practice from the perspective both of the patient and of the nurse. The module consists of three themes defined by complex nursing scenarios associated with: acute and critically ill patients with medical illnesses, patients who undergo emergency surgery, and patients with life-threatening cancers. The themes arise from complex nursing problems. The module s four subject areas are integrated into the teaching and learning for each theme. Organisation, Management and Administration permeates all three themes. Organisation and Management provides students with knowledge of the delivery of patient care in Region H (The Capital Region of Denmark) at hospital and ward level as well as of available packages and programmes, and a knowledge of the competencies required to provide professional nursing care based on the nurse s duties and the patient s rights. This includes the competencies to evaluate how quality development is integrated into nursing practice. Students acquire knowledge of different forms of health care delivery and how nursing is organised. They also acquire competencies to evaluate the nurse's role in prioritisation and delegation, as well as knowledge of the contact person scheme. Determining dosages and administering medicine is also an interdisciplinary subject, where students learn dose calculating skills, as well as acquiring knowledge of the nurse's responsibility when preparing and administering medicine. Theme 1: Nursing problems related to acute and critically ill patients undergoing surgery. Students acquire knowledge and competencies to observe and provide nursing care to patients undergoing emergency surgery, including patients involved in accelerated/optimised care programmes. They acquire knowledge of diagnosis and treatment of patients with acute and deteriorating abdominal problems accelerating into hypovolemic shock. The students learn skills to identify, evaluate and analyse complex nursing problems such as pain and nausea, and to make suggestions for appropriate interventions. They acquire knowledge of anaesthesia, analgesia and thromboprophylaxis, and skills needed to provide nursing care to patients requiring oxygen therapy, blood transfusions and fluid therapy. Theme 2: Nursing problems related to acute and critically ill patients with medical heart conditions. Students acquire knowledge of and competencies to observe and provide nursing care to patients with acute heart disease, including patients who have a care package. They acquire knowledge of diagnosing and treating patients with acute coronary syndrome (ACS), deteriorating into acute left ventricular heart failure leading to pulmonary oedema, cardiogenic shock and acute kidney failure. The students acquire skills to identify, evaluate, analyse and intervene when caring for patients experiencing pain. They also acquire knowledge of heart medicines and diuretics. Theme 3: Nursing problems related to patients with critical life-threatening cancers Students acquire knowledge of and competencies to observe and care for patients with cancer. The students acquire skills to identify, evaluate and analyse complex nursing care conditions such as fatigue, nausea and chronic malignant pain. They acquire knowledge of diagnosing and treating patients with cancer, including the progression of the disease and side effects of the treatment. 4
They acquire knowledge of palliative care, and competencies and skills to identify, evaluate, analyse and intervene effectively during end-of-life care. They acquire knowledge of cytotoxic agents, anti-emetics, glucocorticoids and hormone therapy in the treatment of cancer. 3. Organisation of the teaching The Department of Nursing expects a high level of participation from students. Preparation for and active participation in classes are important prerequisites for the quality of both teaching and learning. The figure below shows the different types of study activities covered by the module, and the expectations and requirements given to the students. The study-activity model for module 10 The module involves classroom teaching and study activities. It also includes a planned study activity. This means that some of the teaching will be initiated and guided by teachers, some of it will be initiated by groups of students working on nursing problems, and some of it will be based on study questions. 5
For the study activities, classes are divided into two study groups. The study groups use a variety of teaching methods that incorporate and support different learning styles. There are three different types: study activity A: simulation-based teaching study activity B: workshops study activity C: analysis and processing of cases. 4. The module s fixed and planned study activity Participation in both the fixed and planned study activity is a prerequisite for sitting the external exam. Students must be able to document participation. The fixed study activity consists of Study activity C: Study activity C The purpose of this study activity is for the students to integrate the module's core subjects and overall learning objective into the work on a nursing problem that focuses on pharmacology, clinical assessments and intervention in life-threatening conditions. This activity also provides students with the opportunity to develop the skills required to complete the assignment for the external exam. This study activity is organised in two inter-related components. In the first component, the whole group meets to discuss and identify nursing problems based on a particular, recurring case. The group then divides up into smaller sub-groups, each of which selects a nursing problem on which to work. The sub-groups draw up a synopsis that covers the module's four subject areas for the analysis of their selected nursing problem from the case study. At the second meeting of the whole group, the sub-groups present their synopses and analyses of the nursing problem from the case study. In the event of illness or other absences In the event of illness or other absences a predefined essay is produced and submitted instead. The assignment is approved by the teacher. The procedure for the submission of the predefined essay is published on Intrapol. Documentation requirement Attendance is documented at the end of both the first and second meetings of the whole group, by the teacher. Planned study activity in general pharmacology and calculating dosages of medicine The planned study activity for module 10 consists of an e-learning-based test called the Pharmacology test. The test is compulsory and must be taken during the first four weeks of the module. Danish students at the international module receive an e-mail with a link and login details for the test. The test can also be found via IntraPol. New login details are provided if originals are forgotten or lost. Any student who encounters problems logging in is responsible for contacting the named contacts listed on Intrapol via the link above. International students will take a different test on the subject. Introduction will be given by the beginning of the module. Documentation requirement Student Services is automatically informed that you have completed the Pharmacology Test by the deadline so students do not need to do anything else. After completing the test, students can print a diploma proving that they took part. 6
Other study activities Study activity A The objective is for the students to acquire knowledge of and practice in nursing tasks associated with patients receiving blood transfusions. The activity takes place in two parts: The first part consists of work and reflection on the study question. The second part is a practical exercise in SIMLAB: control, setup and registration for blood transfusion. Study activity B Three workshops with exercises related to patient safety, contributing of adverse events, triage and sage communication practises. Theme day: Acute and critical nursing in clinical practice Objectives: To provide students with insight into development and research in acute and critical patient care in different areas of clinical practice, as well as into the nurse's duties and responsibilities associated with them. The focus for the day is on research and development related to acute and critical nursing in clinical practice. 5. Exam The module culminates in an external exam. The exam is designed to demonstrate the degree to which students have achieved the learning outcomes for the module. It is assessed according to the 7-point grading scale. The module s core subject areas (nursing, pathology and radiology, pharmacology and organisation, administration and management) are all covered. Exam form The external exam is an individual oral exam. Frameworks Students are automatically registered for the exams associated with the programme's modules. Therefore as soon as the module starts, registered students have used one exam attempt. (Section 5 of Ministerial Order no. 1519 of 16.12.2013) The only exemptions to this rule are cases of documented illness or parental leave. Students who fail to complete the fixed or planned study activity by the deadline are not eligible to sit the exam, and will be registered as having failed it. The external exam is held during the last two weeks of the module. Students are given access to the exam material two days before the oral exam. The procedure for access to the exam material is published on Intrapol. Guidelines for external exams The exam material forms the basis for the external exam: 7
The student analyses the exam material using practice-, development- and research-based literature and, based on this, selects a clinical nursing problem for further analysis. The student prepares a synopsis with literature references The synopsis should include a brief explanation of the selected clinical nursing problem The synopsis must include a summary of content from the four subject areas that provides insight into the clinical nursing problem The synopsis must be max. one standard page, i.e. max. 2,400 keystrokes with spaces The synopsis may be written in bullet points, or as a mind map The students should draw up a bibliography listing the literature used for the synopsis. The bibliography must comply with technical guidelines Students must bring the synopsis and bibliography with them to the exam. Oral exam The oral exam is designed to assess the student in regards to the learning objective for the module and the subject areas. Students must bring two copies of their synopsis and bibliography and submit one each to the internal and external examiners. The exam is individual and lasts 35 minutes 10-minute presentation by the student 15-minute oral exam The exam concludes with 10-minutes voting and feedback to the student In the oral presentation, the students must present the selected clinical nursing problem, and identify and justify proposals for selected interventions. The oral exam is based on the student s synopsis and oral presentation. The oral exam must cover the module's learning outcomes and subject areas. Knowledge from previous modules that underpins the oral presentation can be incorporated into the exam. Assessment criteria Based on the oral exam, the examiners assess the extent to which the learning outcomes for the module have been achieved. The exam is assessed according to the 7-point grading scale. (Ministerial Order no. 262 of 20.03.2007). 6. Resits and make-up exams due to illness Illness In case of illness, the student must submit a medical certificate to Student Services in accordance with Metropolitan University College s rules no later than three working days after the exam was held ( Intrapol>Information and Guides>Study tools>exam ) Students who miss an exam due to illness are automatically registered for it the next time it is held. (Ministerial Order no. 1519 of 16.12.2013). 8
The programme secretary for the module, can be contacted for details on make-up exams. Makeup exams are held in the following weeks: For November January modules between week 11 and week 16 For April-June modules, week 34 Resits If your external exam is assessed Failed, you are automatically registered for it the next time it is held. Contact the programme secretary for your module for details of resits. Exams are scheduled as follows; For November January modules between week 11 and week 16 For April-June modules, week 34 To resit in week 11-16, you must have completed the Pharmacology test by Monday in week 9 at 12:00 at the latest. To resit in week 34, you must have completed the Pharmacology test by Monday in week 33 at 12:00 at the latest. Please contact the module co-ordinator if you have any questions concerning make-up exams and resits. 7. Overview of the module 9
Teaching recurring concepts and nursing theory Module 10 Overview Week ½ week 2½ weeks 2½ weeks 2½ weeks 2 weeks Nursing theme 1 Nursing theme 2 Nursing theme 3 External exam Topics: Nursing problems related to acute and critically ill pre-op patients Nursing problems related to acute and critically ill medical patients Nursing problems related to patients with life-threatening cancers Introduction Individual Nursing care Complex nursing issues: Observation, identification, evaluation and interventions Complex nursing issues: Observation, identification, assessment and interventions Complex nursing issues: Observation, identification, assessment and interventions Oral Pre-, peri- and postoperative nursing Nursing care for acute heart patients Nursing care for cancer patients Receiving the patient and information ABCDE with focus on A and B observations Respiration, CPAP, O2 Assessment and treatment of acute pain Probes, drains, sutures Hypovolemic shock Fluid therapy Accelerated patient care Emergency hospitalisation and receiving ABCDE with focusing on C observations Early Warning Score Triage Managing cardiac pain Cardiogenic shock Acute kidney failure Nursing care for patients with ACS The experience of the patient with cancer The experience of relatives of patients with cancer Effects/side effects of the medical treatment and the cancer The troublesome symptoms: fatigue, nausea, weakened immune system, effects on mucous membranes, pain, weight loss, hair loss Sepsis Psychosocial effects Palliative care Death and dying including a social and societal perspective 8. Literature - See lessonplan on Intrapol 10
Pathology Acute abdominal pain Etiology Pathophysiology Radiological diagnostics Blood tests Operation Fluid balance Complications: Infection, leakage, rupture O2. treatment Acute Coronary Syndrome Etiology Pathophysiology Diagnosis and treatment UAP, non-stemi and STEMI Acute left ventricular heart failure Acute kidney failure Cancer Etiology Pathophysiology Tumour biology Diagnostics Examples of cancers progression and treatment Blood transfusion Pharmacology Anticoagulants, e.g. low molecular weight heparin (main group B) Acute pain treatment with primary analgesics, including opioid analgesics, paracetamol and NSAIDs (main group N) The respiratory organs (main group R) The autonomous nervous system Anaesthetics Heart medicine, e.g. ACE inhibitors and beta-blockers, digoxin (main group C) Anti-platelet agents ADP receptor inhibitors (main group B) Diuretics, nitrates and statins (main group C) Cytotoxic agents (main group L) Anti-emetics (main group A) Hormones (main group L) Glucocorticoids (main group H) Calculating medicine dosage The nurse's responsibility for administering medication Calculating dosage Organisation and management Organisation of patient care in Region H at hospital and ward level Care packages and programmes, Accelerated/optimised patient care The Health Care Act involving patients in decisions and informed consent The Authorisation Act Quality enhancement, the Danish Quality Model (DDKM), Clinical guidelines Forms of care and the named-person scheme The nurse's duties in connection with prioritisation and delegation 11