BETHEL COLLEGE SCHOOL OF NURSING Nursing Issues NUR 323 Spring 2017 with Christ at the Helm FACULTY Margarie Moses RN, MN, CNS, CNOR Office: 574-807-7407 Cell: 574-298-5007 E-mail: margarie.moses@bethelcollege.edu 1
BETHEL COLLEGE SCHOOL OF NURSING I. Course Number and Title: NUR 323 - Nursing Issues (3 credits) II. Course Description This course explores historical, legal, ethical, moral, spiritual, and current issues in nursing and the role of the professional nurse. This course has three hours of class each week. III. Prerequisites: NUR 312, 322 IV. Student Learning Outcomes Upon completion of this course, the student will be able to: 1. Discuss the role of the professional nurse as a participant in political and regulatory processes and in shaping the health care delivery system. 2. Identify past and present influences and future trends on the nursing profession. 3. Discuss differentiation of nursing practice among various levels of practice. 4. Relate moral concepts, professional ethics, and the law to nursing practice situations. 5. Discuss the legal implications of documentation. 6. Describe issues facing the professional nurse in various practice settings. 7. Apply a professional nursing code of ethics and professional guidelines to clinical practice situations. 8. Describe the advocacy role of the nurse within the health care delivery system in relation to legal and ethical guidelines. 9. Evaluate the nurse s role in spiritual aspects of nursing care. 10. Identify the significance of cultural competency in relation to ethical nursing practice. 11. Describe steps involved in recognizing and assisting an impaired nurse. V. Topical Outline A. Economic & Political Process 1. Access to health care providers: a. Economic factors b. Cultural factors 2. Health care costs 3. Health care financing/government 4. Political process/letter B. Nursing: Past, Present, and Future 1. Education: Where is it going? 2. Professional organizations and opportunities a. Preparing for a professional career b. Understanding organizational structure c. Utilizing cover letters and resumes 2
C. Historical Development of Nursing 1. Leaders 2. Roles of nurse 3. Educational issues 4. Professional nursing organizations 5. Societal/Cultural factors 6. Wars D. Legal Issues 1. The law a. Origins and sources b. Use in society c. Systems 2. Legal roles and responsibilities of the nurse a. Functions of law in nursing b. Legal roles and functions of the nurse c. The nurse as expert witness d. Liability insurance 3. Legal documents a. Informed consent b. Advanced directives c. Privileged communications d. Contracts 4. Issues resulting in loss of license a. Impaired nurse E. Ethics & Ethical Concerns in Nursing 1. Concept and applications a. Code for Nurses/patient(s) rights b. Spiritual/philosophical views 2. Moral Frameworks 3. Bioethical concerns a. Ethical principles 1. Ethical dilemma 2. End of life issues F. Influence of Spiritual Care in Health Care 1. Nurse's spirituality and effect on care 2. Patient's spirituality and effect on care G. Cultural Factors 1. Effect of culture on individual clients 2. Effect of culture on health provider's care H. Current Nursing Issues 1/ Managed care 2. Nursing shortage 3. Nursing quality of care 4. Overtime and staffing issues 5. Violence in workplace 3
VI. Course Outline with Class Days DAY/TIME: Monday 11:00 PM to 1:50 PM Spring 2017 Module Date Week Topic Chapters 1 & 15 January 9 1 Introduction to Course Module 1: Exploring the Growth of Nursing as a Profession - start Chapters 1 & 15 continued January 16 2 Module 1: Exploring the Growth of Nursing as a Profession finish Assigned: Political Issue Letter Martin Luther King Day: class dismissed at 1:00 Chapter 3 January 23 3 Module 2: Credentials for Healthcare Providers & Module 3: SLO #6 In Class Activity: Mandatory vs. Voluntary CEU to renew license; Mutual Recognition of Licensure (5 points) Chapters 2 January 30 4 Module 3: Educational Preparation for Nursing, SLO #1-5, 7-9 DUE: Political Issue Letter handed in @ start of class (10 points) Chapter 16 February 6 5 Module 3: Educational Preparation for Nursing, SLO #10-15 DUE: Discussion Teams Presentation: Entry Level for RN Practice (50 points) In Class Activity: Pro s/con s to Nursing Course of Study Plans (5 points) Chapter 4 February 13 6 Test #1 (chapters 1-3, 15/16) Module 4: Making Professional Goals a Reality In Class Activity: Short & Long Term Career Goals; & Roles in Nursing in Advanced Education (5 points) Assigned: Cover Letter, Resume, Resignation Letter (5, 20, 5 points) Chapter 5 February 20 7 Module 5: The World of Healthcare Employment DUE: Discussion Teams Presentation: Mandatory Nurse to Patient Ratio (50 points) 4
Module Date Week Topic February 27 8 SPRING BREAK Chapter 5 continued March 6 9 Module 5: continued DUE: Cover Letter, Resume, Resignation Letter (5, 20, 5 points) Reading TBD March 13 CLASS May NOT MEET Tentative Court house visit 10 Online Court Room Assignment & Writing Reflection/Response Due by midnight of March 20 th (30 points) Chapter 6 March 20 11 Module 6: Understanding the Healthcare Environment & Financing DUE: Discussion Teams Presentation: Mandatory Accreditation & Quality Standards of Nursing Schools and Hospital (50 points) Chapter 7 March 27 12 Test #2 (chapters 4-6) Module 7: Legal Responsibilities for Practice Chapters 8 & 9 April 3 13 Module 8: Ethical & Bioethical Issues Nursing Practice & Health Care DUE: Discussion Teams Presentation: Whistle Blowing (50 points) Chapters 8 & 9 continued Shelly & Miller Chapters 4-6; 13-15 review from previous classes April 10 14 Module 8: continued DUE: Discussion Teams Presentation: Nurse Work Hours (50 points) April 17 15 Module 9: Spiritual & Cultural Influences of Health Care DUE: Discussion Teams Presentation: Stem Cell Research (50 points) ---- Weds. April 26 16 Test #3 (chapters 7-9); 3:30-5:30pm 5
VII. Instructional Methods Teaching methods used in this course include power point lectures with class discussion and interaction, small group student lead debate type discussions and presentations, individual projects in class and outside of class both with report back to entire class with in class discussion, guest speakers and on-line assignments with writing reflection. VIII. Required Textbooks Ellis, J. R., & Hartley, C. L. (2012). Nursing in today's world: Trends, issues & management (10 th ed.). Philadelphia: Lippincott, Williams, & Wilkins. Ferrel, K.G. (2016). Nurse s legal handbook. (6 th ed.). Philadelphia, PA.: Wolters Kluwer/Lippincott, Williams, & Wilkins. Shelly, J. A., & Miller, A. B. (2000). Called to care: A Christian theology of nursing. Downer s Grove, IL: InterVarsity Press. American Psychological Association (2010). Publication manual of the American Psychological Association (6 th ed.). Washington, DC: Author. IX. Course Requirements A. Each student is expected to attend all classroom session. See attendance policy in the School of Nursing Student Handbook. B. Late Assignment Policy:Assignments (excluding discussion questions) will be accepted late, subject to a 10% deduction off the earned grade per day late (24 hour period), for up to 3 days. No assignments will be accepted after 3 days late. Assignments must follow APA (6 th ed.) format, be typed and grammatically correct to be considered for evaluation. C. Each student is expected to complete all required readings prior to class and assignments as specified in the syllabus, there will be unannounced quizzes from time to time to evaluate if the reading was completed prior to class. D. Tests and assignments: 1. Discussions Teams: Issues will be assigned along with assignments for class debate and discussion. Evidenced based practice articles will be researched and assignments completed based on those articles. 2. Tests: There are three (3) tests, no comprehensive final and per School of Nursing policy, all tests must be completed with a mean of 78% or higher. 3. Other assignments as outlined: various other assignments as described 4. Rubrics, grading guides, detailed instructions on various assignments will be handed out through-out the course E. Americans with Disabilities Act: ADA Statement: The Americans with Disabilities Act (ADA) is a law that provides civil rights protection for people with disabilities. Bethel College in compliance with equal access laws, requests students with disabilities seeking accommodations to make an appointment with the Center for Academic Success - Disability Services office at (574) 807-7460 for an appointment. Contact person is Rachel Kennedy. In accordance with the provision of the ADA, if a student requires any special assistance or adaptations in a course, the student is to contact the professor immediately. F. This syllabus is not a contract but is the planned outline for the class. Various items may be added or subtracted at the discretion of the professor. 6
X. Grading Methods A. The grading scale from the School of Nursing Student Handbook will be used. 1. The grading scale is consistent for each (NUR) course and is as follows: 95-100 A 78-80.9 C 93-94.9 A - 75-77.9 C - 90-92.9 B + 72-74.9 D + 86-89.9 B 69-71.9 D 84-85.9 B - 66-68.9 D - 81-83.9 C + 65.9 or below F 2. Grades are not rounded up to the next whole number. B. An average of 78% on examinations is required to pass the course. C. An overall course average of 78% (234 points) is required to pass this course. D. Grade breakdown: Total of 300 possible points. In Class Activity 20 In prompt quizzes 10 Political letter 10 Cover letter 5 Resume 20 Resignation letter 5 On line class assignment & writing reflection 30 Test 1 50 Test 2 50 Test 3 50 Discussion/Debate presentation (each 50 student assigned one) Total possible points 300 E. The grade assigned for any test, paper, or assignment where plagiarism or academic dishonesty occurs will be zero (0). Any act of deceit, falsehood or stealing by unethically copying or using someone else s work in an academic situation is strictly prohibited. A student found guilty of plagiarism or cheating will receive an F (zero) for that particular paper, assignment, or exam. Should this occur, the professor will have an interview with the student and will submit a written report of the incident to the academic Dean. If a second offense should occur, the student will be asked to appear before the professor, the academic dean and the vice president for student development. The student should realize that at this point continuation in a course and even his/her academic career may be in jeopardy. In the event of a recommendation for dismissal, the matter shall be referred to the Student Development Committee. 7
F. In order to maximize learning cell phones must be turned off and stowed in book bags during class and chapel. Any student using a cell phone for any reason (without permission) will be asked to leave class and an unexcused absence will be recorded. Student using cell phones during exams or graded activities and class may be cited for cheating (at the professor s discretion). In the case of an unexpected emergency, students may seek permission from the professor to leave their cell phones on during class, but the phone must remain in the book bag. Professors reserve the right to have optional cell phones in class. G. Bethel College School of Nursing reserves the right to use all student work generated in the course of academic work at Bethel College for non-profit, educational, or research purposes, (including reproduction, distribution, making of derivative works public performance and public display). This is subject to the student s privacy rights under federal law. H. Issues for Discussion/Debate Team Presentations Assigned Team Members and Presentation Dates DATE ISSUE 2/06/17 Entry Level for RN Practice 2/20/17 Mandatory Nurse to patient ration 3/20/17 Mandatory accreditation and Quality Standards 4/3/17 Whistle Blowing 4/10/17 Nurse Work hours: 8-hour vs. 12-hour shifts 4/17/17 Stem Cell Research Discussion/Debate Teams: Discussion/Debate issues will be assigned, along with members of the team for the class presentation and discussion. Teams will be assigned an issue, research the issue, present pro, con, nuances, current state, and future issues to the class and then serve as resource to the class for information as a class discussion occurs. Evidenced based practice (EBP) articles will be researched for accurate research data by team members to substantiate the information presented. Team members will be graded upon preparation, thoroughness, convincing argument and overall general knowledge about the assigned issue. A grading rubric will be provided. No late or substitute presentations will be accepted (unless approved by faculty). The presentation is worth 50 points, the value of a test to each student. The presentation is NOT counted as a test and will not be calculated in the test average. The presentation should include the following: A. Present foundational/basic information about the issue. Teach fellow students about the subject as if you were telling a professional who knows NOTHING about the issue. Never assume that the listener knows as much about this as you do. Tell them about all sides, pro s and con s, why it s an issue, what are the nuances, what is the future of the issue. B. Explain the data you gathered. Summarize (use parsimony) your EBP research articles. C. Describe opinions on the issue. D. Be prepared to debate, answer questions, and discuss your issue. 8
E. Finally, cultivate audience participation by having some questions for discussion and issues for debate. Be prepared to answer audience questions and facilitate exploration. F. Turn in EBP research articles and a summary of who did what on the project. MODULE 1 Exploring the Growth of Nursing as a Profession 1. Discuss early historical influences on the development of nursing. 2. Describe Florence Nightingale s contribution to nursing and to the development of nursing education. 3. Analyze the impact wars have had on the development of nursing and nursing education. 4. Discuss the development and characteristics of the early nursing schools. 5. Analyze the challenges of defining nursing and formulate a personal definition of nursing. 6. Explain the ways in which nursing differs from medicine. 7. Identify the seven characteristics against which social scientists have evaluated professions and how these have been applied to nursing. 8. Compare and contrast the terms profession and professional and relate the terms to the image others hold of nursing. 9. Describe some of the traditions in nursing and explain why they were adopted. 10. Discuss the history of the image of nursing in the United States and why it is important for nursing to have a positive image within society. 11. Analyze areas of nursing about which studies have been conducted and explain why each is important. 12. Explain how a universal language for nursing that included the North American Nursing Diagnosis Association International (NANDA-1), Nursing Outcomes Classification (NOC), Nursing Interventions Classification (NIC) systems of nursing classification support the growth of nursing as a profession. 13. Describe how specific documentation systems such as the OMAHA system affect nursing practice. Required Readings Ellis & Hartley (2012), Nursing in today s world (10 th ed). Chapter 1 & Chapter 15 9
MODULE 2 Credentials for Healthcare Providers 1. Define and discuss the concept of credentialing in the health professions. 2. Describe how each of the following types of credentials differ: Diploma, Certificate and License. 3. Outline the purposes of accreditation and the general process for seeking accreditation. 4. Identify and analyze the major elements addressed by nursing practice acts. 5. Outline the role of the state boards of nursing or other state regulatory authority. 6. Differentiate between licensure by examination, licensure by endorsement, and mutual recognition of licensure. 7. Discuss personal strategies to avoid violating the provisions of the nursing practice acts and encountering the disciplinary process. 8. Discuss issues in licensure, including ensuring continued competence, multistate licensure, and licensure for graduates of foreign nursing schools. 9. Explain the various uses of certification in nursing. 10. Discuss current trends in credentialing within the health care workforce. Required Readings Ellis & Hartley (2012), Nursing in today s world (10 th ed). Chapter 3 10
MODULE 3 Educational Preparation for Nursing 1. Compare the educational preparation of the nursing assistant, the licensed practical (vocational) nurse, and the graduates of the various types of programs preparing registered nurses (RNs), hospital-based programs, associate degree programs, genetic baccalaureate programs; and graduate degree entry programs. 2. Explain the purposes of other forms of nursing education, including external degree programs, RN baccalaureate programs, master s preparation, doctoral studies, non-degree programs, and articulated programs. 3. Discuss some of the innovative approaches to earning a higher degree in nursing. 4. Identify factors that have prompted changes in nursing education, including studies and sociopolitical events, and analyze the effect of each. 5. Analyze the effects the American Nurses Association (ANA) Position Paper on Nursing Education would have had on nursing licensure if adopted nationwide. 6. Critique the major points supporting both mandatory and voluntary continuing education, and explain the mechanisms for documenting and recording continuing education. 7. Discuss the concept of differentiated practice and provide a rationale for its development. 8. Discuss the impact of technology on nursing education. 9. Identify factors that have influenced changes in nursing education and analyze the effect of each. 10. Analyze the ways in which nursing theories serve to advance the profession. 11. Describe an effective strategy for evaluating information resources. 12. Discuss the value of the research in nursing. 13. Explain the role of the staff nurse in nursing research. 14. Explain the term evidenced-based practice (EBP) and its application to nursing. 15. List the types of evidence that may be used for EBP, moving from the most reliable to the least reliable. Required Readings Ellis & Hartley (2012), Nursing in today s world (10 th ed). Chapter 2. 11
MODULE 4 Making Professional Goals a Reality 1. Describe the various employment opportunities available to nurses today and discuss the educational requirements of each. 2. Describe the competencies needed by the new graduate as outlined by the job analysis study that is the basis for the National Council Licensure Examination (NCLEX). 3. Analyze the eight common expectations employers have of new graduates explaining why each is important and relate them to your own background and education. 4. Develop a list of your personal short-and long-term career goals. 5. Prepare a personal resume and sample letters of application, follow-up, and resignation. 6. Describe aspects to consider when preparing for an interview. 7. Formulate possible responses to an employment interview. Required Readings Ellis & Hartley: Chapter 4 12
MODULE 5 The World of Healthcare Employment 1. Discuss the purpose of organizational mission and vision statements and statements of philosophy and analyze how these differ. 2. Discuss the concept of organizational structure and explore the relationships among Organizational charts, chains of command, and channels of communication within the structure of organizations. 3. Delineate the characteristics of shared governance, and explain the advantages of a shared governance approach. 4. Discuss the development of the Magnet Recognition Program for hospitals and lists the characteristics required to achieve this status. 5. Describe various patterns of nursing care delivery and identify the major characteristics of each and a situation in which each would be employed appropriately. 6. Compare and contrast the characteristics of a grievance with those of a complaint. 7. Discuss the history of collective bargaining as it applies to nursing. 8. Analyze the processes through which resolution is achieved in collective bargaining issues. 9. Identify at least four professional concerns that should be addressed in a contract for nurses. 10. Discuss the concerns nurses have regarding membership in a collective bargaining group and the reasons for each of these concerns. 11. Outline the advantages and disadvantages of having the state nurses association serve as a bargaining agent for nurses. Required Reading Ellis & Hartley: Chapter 5 13
MODULE 6 Understanding the Healthcare Environment and Its Financing 1. Identify the various ways of classifying health care agencies and explain how these classification systems differ in their focus. 2. Compare the approach to the client/resident care between acute care hospitals and longterm care facilities.. 3. Describe the roles of the various health care providers and analyze how these roles affect the relationships between providers. 4. Analyze how issues related to education, credentialing, and scope of practice of health care occupations affect individual providers and clients within the health care system. 5. Discuss the various approaches to financing and managing cost in the health care delivery system and how the federal government has influenced this process. 6. Discuss the mechanisms being used to measure and ensure quality in organizations and agencies that are delivering health care. 7. Analyze the use of power by regulatory agencies, payers, providers, and consumers in the health care system. 8. Explain continuing concerns regarding the effective use of health care and concerns about changing the system. 9. Analyze how the nurse could use knowledge of the health care system and its financing when teaching clients and planning for continuity of care. Required Reading Ellis & Hartley: Chapter 6 14
MODULE 7 Legal Responsibilities for Practice 1. Differentiate the three general sources of law and explain how they apply to nursing. 2. Explain the role of institutional policies and protocols in legal decision making. 3. Describe situations in which inappropriate nursing actions may violate criminal law. 4. Discuss liability in relationship to nursing practice, including situations in which liability is shared by employers or supervisors. 5. Analyze how you can benefit as an individual nurse from purchasing professional liability insurance. 6. Explain the nurse s role in supporting patient rights through informed consent and advance directives. 7. Identify specific issues that can constitute malpractice and discuss the nurse s responsibilities in relationship to them. 8. Describe the most commonly recurring legal issues in nursing. 9. Identify factors that contribute to a suite being instituted against a health care professional, and explain how an individual nurse might prevent legal suits. 10. Explain the various aspects of a legal action. 11. Outline the role of the nurse when testifying for a legal proceeding. Required Reading Ellis & Hartley: Chapter 7 Nurse s Legal Handbook: Bring to Class 15
MODULE 8 Ethical Concerns in Nursing Practice Bioethical Issues in Health Care 1. Discuss the concepts of ethics and morality and their application in the health care arena. 2. Describe four ethical theories that may be used to guide ethical decision-making and give an example of each applied to a nursing situation.. 3. Explain how personal religious and philosophical viewpoints, the Code for Nurses, and the documents addressing patients rights are used as a basis for ethical discussion making. 4. Analyze ways in which sociocultural and occupational factors affect ethical decision making for nurses. 5. Outline a framework for ethical decision-making from a Christian perspective. 6. Discuss how ethics relate to commitment to the patient, commitment to personal excellence, and commitment to nursing as a profession. 7. Analyze how ethics effect specific work situations, such as your obligations related to a chemically impaired nursing colleague. 8. Discuss the importance of recognizing and adhering to boundaries with clients. 9. Evaluate bioethics and discuss reasons nurses need to understand bioethical concerns. 10. Outline the history of family planning in the U.S. and discuss how various value systems and beliefs have affected it. 11. List some of the ethical and legal problems associated with artificial insemination, surrogate motherhood, and in vitro fertilization. 12. Discuss the problem associated with determining when death has occurred and outline ways in which it impacts decisions regarding health care. 13. Analyze the multiple factors in right-to-die-issues including assisted suicide and the differences between active and passive euthanasia. 14. Analyze the various points of view related to withholding and withdrawing treatment. 15. Discuss the ethics that established the foundations for providing clients with informed consent and involving them in decisions regarding treatment. 16. Identify major nursing concerns associated with organ and tissue transplantation. 17. Discuss the purpose of the Human Genome Project and identify possible bioethical issues that could evolve from it. 18. Describe the arguments for and against gene therapy and identify related bioethical concerns. 19. Analyze the reasons that controversy surrounds stem cell research and outline the positive and negative outcomes that could result from that research. 20. Discuss the multiple concerns that affect decisions regarding the treatment of the mentally ill. 21. Outline concerns related to rationing of health care. Required Reading: Ellis and Hartley: Chapters 8 & 9 16
MODULE 9 Spiritual and Cultural Influences on Health Care 1. Describe how spirituality can influence wellness and illness. 2. Explain how the nurse's spirituality can affect or influence nursing care. 3. Discuss how the patient's spirituality can affect or influence nursing care. 4. Define spiritual need and apply it to professional nursing practice. 5. Select a Healthy People 2010 indicator to implement in a health care setting. Discuss plans for implementing the objective and evaluating the outcomes. What data did you use to develop a plan for implementing? 6. Identify factors related to communication, space, social organization, time, environmental control, and biological variations that health care providers should consider in providing culturally competent care. 7. Identify characteristics and factors unique to specific ethnic minority individuals and groups that may affect health care practices and/or responsiveness to use of health care services based on nursing research. 8. Relate important implications for providing competent nursing care to culturally diverse individuals and groups of differing ages and gender from a Christian perspective. Required Assignments Required Reading Shelly & Miller, Chapters 4, 5, 6, 13, 14, 15 17