TRENT/FLEMING SCHOOL OF NURSING TRENT UNIVERSITY NURS 3021H: Clinical Practice Focused on Chronic Disease Management Spring 2015 Peterborough Course Lead: Kim English, RN Office: Life and Health Sciences C158 Office Hours: By appointment Clinical Faculty: PRHC: • D2-1 Jennifer Bested • D2-2 Maureen Robinson • A2 Ashley Finnegan • C2 Janet Scott NHH: • Telephone: (705) 748-1011 ext 7059 Email: kimenglish@trentu.ca Rehabilitation Rebecca Rutherford RMH: • CCP1 Cathy Copeland • CCP2 Diane Short Lakeridge Health Oshawa: • 6F Anne Vongprachanh Rowsham Lakeridge Health Whitby: • CCC Sarah Jackman Lakeridge Health Bowmanville: • CCC Lindsay Green Course Description The focus of this course is caring for adults experiencing a chronic disease or palliative treatment. Learners will be assigned, in groups, to one of the following care settings: complex continuing care medicine, mental health, rehabilitation, hospice palliative or high acuity long term care unit. Clinical practicum is supported by Learning Centre activities related to caring for people with chronic illness including: medication administration, VAC treatments, feeding pumps, patient-controlled administration pumps and assessment of consciousness, orientation, and pain. A total of 180 hours of practice are provided in the various elements of this course. Course Pre-requisites: A minimum of 60% in all required NURS 2000 level courses and BIOL 2550H. Co or pre-requisite: NURS 3001H Co or pre-requisite: BIOL 3550H 1 Recommended Texts Medical-Surgical Nursing Lewis, S., Dirkson, S., Heitkemper, M., Bucher, L., & Camera, I. (2014). Medical-surgical nursing in Canada: Assessment and management of clinical problems. Toronto: Elsevier. Nursing Fundamentals Kozier, B., Erb, G., Berman, A., Snyder, S., Bouchal, S., Yiu, L., Stamler,L., & Buck, M. (2010). Fundamentals of Canadian nursing: Concepts, process and practice. (2nd ed.). Toronto, ON: Pearson. OR Potter, P., Perry, A., Ross-Kerr, J. & Wood, M. (2010). Canadian Fundamentals of Nursing. (4th ed). Toronto: Mosby. Health Assessment Weber, J. & Kelley, J. (2009). Health Assessment in nursing: North American Edition. (4th ed.). Philidelphia: Lippincott, Williams & Wilkins. OR D’Amico, D., Barbarito, C. (2012). Health & Physical Assessment in Nursing: Canadian Edition. Toronto: Pearson 2 Course Format: Type Orientation Days of Week April 27th online panopto Clinical practice Mondays-Saturdays Clinical learning centre practice Mondays-Fridays Times A lecture will be provided on the course website for compulsory viewing before the beginning of the first clinical shift. As assigned: 2 x 12 hour shifts per week for 6 weeks plus one 12 hour shift (including two hours of post-conference seminar per week) and four hours for individual preparation for a total of 160 hours As assigned: 2 x 2 hour sessions; each 2 hour session on a separate day Location Online Start date: The week of April 27th Start date: The week of April 27th CLC L&HS C141 & C142 Course Objectives: By participating in the required period of supervised CLC laboratory practice, clinical practice and post clinical conferences, and completing reflective journals, portfolio entries and clinical evaluations, the learner will: 1. Demonstrate accountability and responsibility in the teaching-learning relationship 2. Explain the experience of chronic illness in individuals in chronic care settings 3. Interpret critical aspects of the person’s experience of chronic illness in relation to common signs and symptoms, responses to treatment, patterns of coping, and impact on individual and family relationships. 4. Identify common medical treatments of selected chronic illnesses 5. Demonstrate selected nursing and collaborative interventions related to caring for the person with chronic illness, such as medication administration, physical and chemical restraints, enteral feedings, residual volumes, NG tube insertion, wound care, colorectal screening, patient-controlled administration pumps, neurological assessment 6. Identify potential consequences/complications of selected chronic illnesses 7. Under the supervision of a Registered Nurse, demonstrate safe, competent, evidence-based, holistic nursing practice with clients with chronic illness a. Use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship b. Demonstrate accountable, responsible and ethical practice c. Engage in respectful, collaborative, therapeutic and professional relationships d. e. f. g. h. i. Demonstrate therapeutic use of self ii. Create a culturally safe environment Apply nursing models and theories Demonstrate health promotion and illness prevention practices Demonstrate patient advocacy Predict outcomes of nursing care Evaluate client response to nursing care 3 i. Critically appraise own practice in relation to nurse-client/family interactions and as a member of the health care team j. Participate in professional development based on reflective practice and critical inquiry Learner Evaluation: All assignments are to be completed as individual work unless explicitly stated otherwise in the course outline. The learner will be awarded either a pass or fail. The learner must pass all components in order to pass the course. Item Learning centre activities Description Active participation in all components of Clinical Learning Centre (CLC) activities is mandatory. Students must demonstrate satisfactory completion of all CLC activities, including quizzes. Evidence of completion of CLC activities will be submitted to the CLC instructor as required. Students must have a satisfactory record of attendance. Date 2 x Weekly for 6 weeks If students do not demonstrate satisfactory completion of CLC requirements or satisfactory attendance and remediation or coaching is not successful, students will fail the course. Please refer to your timetable for your assigned lab days and time. Beginning: Apr 28th (Tue/Wed) or Apr30th (Thu/Fri) What is satisfactory completion of requirements? Completion of all CLC preparation activities, attentive listening, active collaboration with lab partners, and completion a return demonstration of newly acquired practice skills will merit a “satisfactory” rating by the CLC instructor. Within each lab, the CLC instructor may designate certain skill demonstrations or learning activities as critical; that is, students must complete these demonstrations or activities in order for their performance to be considered satisfactory. Students should expect to receive formative feedback from the CLC instructor during most practice sessions. What is satisfactory attendance? Students who attend and participate in all required CLC practice hours will be considered to have satisfactory attendance. Any absence, brief or extended, no matter how reasonable or acceptable (e.g. serious illness, lengthy illness, bereavement, or injury) may result in an inability to meet CLC requirements and/or course objectives and a grade of “Fail”, unless the student is given permission to withdraw from the course. Students should note that there are no scheduled “make-up” lab sessions. When individual students require remediation due to learning challenges, then the CLC instructor and course professor will work with the student to develop an individual learning plan, which may or may not involve additional CLC practice time. Unwarranted or unexplained absence from CLC does not necessarily qualify a student for 4 remediation with additional practice time. Students who choose to miss a CLC activity for unwarranted reasons do so at their own risk. Reflective journal Seminar Twice during the semester, students will submit an example of reflective writing. This reflective writing must provide evidence of knowledge synthesis and critical reflection. Each learner as a member of a pair will lead a one-hour post-conference seminar in which the learner will review a case example and • Synthesize related nursing evidence • Complete a comprehensive plan of care designed to support the patient living with a chronic disease The care plan is based on an identified nursing theory and includes principles of chronic disease management. The learner will demonstrate knowledge of adult learning principles in the presentation. The leaner will engage other students in a scholarly and productive discussion. The learner will create entries to his/her portfolio that demonstrate progress and evidence of learning • learning plan evaluations- self, peer, individual and faculty • reflections, • articles related to the learner’s clinical practice in Nursing 3021 • feedback from patients, VCEs, labs, online skills documents and other material that demonstrate developing practice competency First journal: May 11th Second journal: June 1st As assigned by clinical instructor clinical weeks 2-6 Assignment Guidelines 1. All assignments will be completed as individual work unless otherwise stated. 2. Individual written assignments will be graded as “Satisfactory” or st “Unsatisfactory”. Portfolio Friday June 1 3. All required written submissions (learning plans, reflections, preand post-clinical assignments, portfolios, selfevaluations) must be submitted in the appropriate Clinical Week of May 11th Instructor. Evaluation of student performance is an st Blackboard drop practice Week of June 1 ongoing part of the clinical experience. Mid-term and box or by email to performance final evaluations will be completed by clinical instructors. the clinical Evaluations must contain specific evidence that the instructor by the student has been successful in meeting the learning due dates objectives as set out in the learning plan, as well as 4. Handing in evidence that the student has met course objectives. An assignments on the important component of a satisfactory clinical evaluation due date and time is a satisfactory record of attendance. demonstrates Self. Evaluation of one’s own performance is an ongoing “professional part of the clinical experience. Students will complete responsibility and mid-term and final self-evaluations. Evaluations must accountability”, contain specific evidence that the student has been which is one of the successful in meeting the learning objectives as set out in course outcomes. the learning plan, as well as evidence that the student has Failure to do so met course objectives. jeopardizes the student’s ability to be successful in the clinical course and may lead to grade of “Unsatisfactory” or “Fail”. 5. Instructors will not ask students to resubmit written work more than once. 6. There will be no opportunity for students to redo or complete supplementary, make-up assignments. 5 Trent/Fleming School of Nursing Academic Integrity Statement Integrity in practice is essential for nurses. The Ethical Framework (CNO, 2009) specifies that Registered Nurses: “have an obligation to maintain the commitments they assumed as regulated health professionals.Maintainingcommitmentsmeanskeepingpromises,beinghonest and meeting implicit or explicit obligations toward their clients, themselves, each other, the nursing profession, other members of the health care team and quality practice settings” Ethical Framework, p. 9 Faculty in the School of Nursing is expected to meet this obligation and, in turn, expect students as future members of the profession to do the same. For the purpose of interpreting and applying the University’s Academic Integrity policy, the Nursing Program has adopted the following: When a student submits a piece of written work in fulfillment of an assignment, she/he implicitly acknowledges the following: a) that she/he is the sole author of the work; b) that the wording and organization of the work, apart from acknowledged quotations, paraphrasing or adaptation, is her/his own; and c) that she/he has not and will not submit this work, either as a whole or in part, to satisfy another course requirement. These basic assumptions will be reasonably interpreted. They do not preclude collaboration between students upon a single project, by prior arrangement with the instructor (such as a group assignment), for shared academic credit (either for written or oral presentation). APA 6th edition is required. Failure to use this standard consistently will result in a deduction of at least 10% of the total grade for the paper. Clinical and Laboratory Practice Policies Department and/or Course Policies: The Student Handbook (2014-2016), posted on the School of Nursing Intranet, contains substantial information related to clinical practice settings. All students are accountable for reviewing that material. Students are required to understand and adhere to all of the policies in the School of Nursing Handbook (2014-2015), including, but not limited to the following: • Gift policy • Incident reporting policy • Dress code • Instructions for Reporting a Student Injury During an Unpaid Student Placement • Ethical and Professional Guidelines for Students • The Nursing Student and Conflict of Interest Forms and instructions for reporting an actual or potential injury are posted on the TFSON Intranet site. Failure to comply with the uniform policy will result in being sent home to change into appropriate attire and may result in lost clinical practice hours. Starting times for clinical placements vary. Students should be aware that practicum placements are scheduled from approximately 0700-1900. Travel time is not included in practice time. If students participate in the taxi program, it is their responsibility to meet at the assigned pick-up site. Drivers will not wait for students who arrive late at the pick-up site. Absence from Clinical Placement 6 If you are ill or unable to attend due to family emergency, you must: • Notify the clinical instructor and the unit where you are working at least 30 minutes prior to the commencement of the shift. You must notify the unit by telephone. You may use other means (text message, email) to notify your instructor and/or travel colleagues when necessary as long as each participant agrees. • If you are taking a taxi to a clinical setting, inform a student with whom you normally travel at least 30 minutes prior to the scheduled departure, so that the driver knows that you will not be travelling that day. • Communicate in a timely fashion with the clinical instructor about your estimated return to clinical practice • Upon your return, meet with the clinical instructor and supply suitable documentation supporting the reason for your absence. Any absence, brief or extended, no matter how reasonable or acceptable (e.g. serious illness, lengthy illness, bereavement, or injury) may result in an inability to meet the course objectives and a grade of “Fail” unless the student is given permission to withdraw from the course. Absence from Lab If absent from a lab without prior notification and reasonable cause, the learner will fail the course. If you are ill or unable to attend due to a family emergency you must: • Notify the lab instructor and course coordinator at least 30 minutes prior to the commencement of the lab. You may use text message, or email to notify your instructor. • Upon your return, meet with the lab instructor and supply suitable documentation supporting the reason for your absence In the case of a missed lab, the student will be required to develop a detailed learning plan in which the student outlines his/her plan to acquire the skills that were the focus of the lab session. Such a learning plan must be submitted to the course coordinator no later than two weeks after the missed lab. If a learning plan is not submitted, the student will receive an incomplete in the course until the learning plan is submitted. Any absence, brief or extended, no matter how reasonable or acceptable (e.g. serious illness, lengthy illness, bereavement, or injury) may result in an inability to meet the course objectives and a grade of “Fail” unless the student is given permission to withdraw from the course. University Policies Academic Integrity Academic dishonesty, which includes plagiarism and cheating, is an extremely serious academic offense and carries penalties varying from failure in an assignment to suspension from the University. Definitions, penalties and procedures for dealing with plagiarism and cheating are set out in Trent University’s Academic Integrity Policy which is printed in the University Calendar. See also www.trentu.ca/academicintegrity. Plagiarism . Plagiarism will result in a charge of academic misconduct as outlined in the University policy. Please read the note below pulled from the University policy on plagiarism to ensure knowledge about the full extent of ways that plagiarism can occur. Ignorance of this policy is not reason to prevent charges of academic dishonesty. Plagiarism is knowingly presenting words, ideas, images, data, or any other form of work of another person (including essays, theses, lab reports, projects, assignments, presentations and posters) in a way that represents or could be reasonably seen to represent the work as one’s own. (The School of Nursing has determined that these sources also include slides and other course specific materials designed and presented by course instructors). “Knowingly” includes ought reasonably to have known. Plagiarism includes failure to acknowledge sources correctly and submitting materials copied from the internet without proper 7 acknowledgement of the source. Draft work submitted for evaluation is subject to the same standard as final work. Adapting and paraphrasing requires citation. Direct quoting requires quotes and citations per APA, 6th edition. Trent/Fleming School of Nursing Academic Integrity Statement . Integrity in practice is essential for nurses. The Ethical Framework 1specifies that Registered Nurses: Have an obligation to maintain the commitments they assumed as regulated health professionals. Maintaining commitments means keeping promises, being honest and meeting implicit or explicit obligations toward their clients, themselves, each other, the nursing profession, other members of the health care team and quality practice settings.2 Faculty members in the School of Nursing are expected to meet this obligation and, in turn, expect students as future members of the profession to do the same. For the purpose of interpreting and applying the University’s Academic Integrity policy, the School of Nursing has adopted the following: When a student submits a piece of written work in fulfillment of an assignment, she/he implicitly acknowledges the following: a) that she/he is the sole author of the work; b) that the wording and organization of the work, apart from acknowledged quotations, paraphrasing or adaptation, is her/his own; and c) that she/he has not and will not submit this work, either as a whole or in part, to satisfy another course requirement. These basic assumptions will be reasonably interpreted. They do not preclude collaboration between students in a single project by prior arrangement with the instructor (such as a group assignment) for shared academic credit (either for written or oral presentation). Written assignments. The format for all written assignments is that set out by APA 6th edition. School of Nursing policies The School of Nursing web page (www.trentu.ca/nursing) is a valuable source for information about policies, department events, the program, the faculty and staff. The current student handbook can be found on the BScN Intranet site. The handbook contains substantial information related to clinical practice settings including the Professional Conduct Policy of the School of Nursing. All students are accountable for reviewing and abiding by the policies included in the student handbook. Access to Instruction It is Trent University's intent to create an inclusive learning environment. If a student has a disability and/or health consideration and feels that he/she may need accommodations to succeed in this course, the student should contact the Disability Services Office (Blackburn Hall Suite 132, 7481281, disabilityservices@trentu.ca) as soon as possible. Complete text can be found under Access to Instruction in the Academic Calendar. Other Please see the Trent University academic calendar for University Diary dates, Academic Information and Regulations, and University and departmental degree requirements. 1 2 CNO Ethical Framework, 2009 CNO Ethical Framework, 2009 8 Required Readings • • • • Week I April 27th-May 3rd • • RNAO BPG o Prevention of Falls (Revised, 2011) http://www.rnao.org/Page.asp?PageID=924&ContentID=810 • RNAO BPG o Nursing Care of Dyspnea: The 6th vital sign in individuals with chronic obstructive pulmonary disease (revised 2010). http://www.rnao.org/Storage/67/6135_REVISED_BPG_COPD.pdf RNAO BPG o Assessment and Management of Venous Leg Ulcers (2007) http://www.rnao.org/Page.asp?PageID==924&ContentID=722 Week 2 May 4th-May 10th Week3 May 11th-May 17th Week 4 May 18th-May 24th Course Syllabus Trent University Academic Integrity Policy Professional Conduct Policy (TFSON Handbook) CNO Clinical Practice Guidelines (www.cno.org) o Professional Standards of Practice (2002) o Medication Standards (2008) o Ethics (2009) o Therapeutic Nurse-Client Relationship (2006) o Documentation (2008) RNAO BPG • Strategies to Support Self-Management in Chronic Conditions-Collaboration with Clients (2010) http://www.rnao.org/Storage/72/6710_SMS_Brochure .pdf • • RNAO BPG o Risk Assessment and Prevention of Pressure Ulcers (2005) http://www.rnao.org/Storage/12/638_BPG__ressure_Ulcers_v2.pdf RNAO BPG o Decision Support for Adults Living with Chronic Kidney Disease (2009) http://rnao.ca/bpg/guidelines/decision-support-adults-living-chronic-kidneydisease • Week V May 25th-May 31st • Week 6 June 1st-June 7th RNAO BPG o Screening for Delirium, Dementia and Depression in the Older Adult http://www.rnao.org/Page.asp?PageID=924&ContentID=818 In addition to these readings, learners are accountable to review these and other topics as presented in the required text for this course, as they relate to their assigned clients. Prior reading and review of related material are a necessary component of clinical practice learning. Clinical instructors may ask learners to discuss material from their preparatory readings. 9 Preparation for Clinical Practice Students are required to complete a pre-post clinical practice tool weekly for each assigned patient. The pre-clinical portion of the tool must be presented to the clinical instructor prior to the start of shift on the first clinical day of the week. Pre-post clinical practice tool with collected assessment information must be submitted electronically to your clinical instructor by the following Monday at 1700h. Please note: Students who do not submit a comprehensive, completed pre-clinical practice tool are not eligible to enter clinical practice and will be excused until they are prepared. A student excused under these circumstances is at risk of failing the course. Courses are not extended to provide make-up time for students who are excused from clinical due to inadequate preparation. Suggested post conference topics: chronic illness and depression, the family and the dying person, chronic renal failure, wound care, hospice care, rehabilitation, nutritional care in chronic illness Suggested student clinical conference topics: care of the person with glaucoma, diabetes, deep vein thrombosis and pulmonary embolus 10 Pre-Clinical Preparation Student Name ___________________________________ Client Initials Date _____________________ ________Gender _________Age______ Medical Diagnosis (Dx) _________________________________ Explain the Dx in your own words: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Surgery (Sx) or Treatment (Tx) or Diagnostic Test __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Explain the Sx or Tx or Test in your own words: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Priority Assessments: 1. __________________________________ 2. __________________________________ 3. __________________________________ 4. ____________________________________ 5. ____________________________________ 6. ____________________________________ Identify two possible nursing diagnoses for this patient. Identify special care needs or approaches for this client: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ What will you need assistance or supervision with? __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Discuss this information with your clinical instructor prior to starting your shift to develop a plan for success Post Clinical 11 1. Application of theory to practice: Discuss one idea from nursing theory that relates to your client. Reflect on how you integrated this theory into practice. Alternatively, discuss a theoretical framework that assisted you in decision-making in your practice. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 2. Identify four laboratory/diagnostic tests that have been completed for your client: 1. ____________________________________ 3 . ____________________________________ 2. ____________________________________ 4. _____________________________________ Select two of the test results above and explain the rational for conducting the test; note the test result; compare the result with the normal range or findings; and interpret the reason for any abnormal values as it relates to the client’s condition. 1._________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 2._________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 3. Choose two prescribed medications for this client and include: 1. Generic & Trade Name: ____________________________________________________________________________ Classification: ______________________________________________________________________________________ Reason for Medication: ______________________________________________________________________________ Nursing Implications: ________________________________________________________________________________ __________________________________________________________________________________________________ 2. Generic & Trade Name: ____________________________________________________________________________ Classification: ______________________________________________________________________________________ Reason for Medication: ______________________________________________________________________________ __________________________________________________________________________________________________ Nursing Implications: __________________________________________________________________________________________________ ________________________________________________________________________________ Trent/Fleming School of Nursing 12 BScN Year Three Preliminary Expectations of Performance in the Clinical Area Every Shift Assessment: In the first hour of shift • TPR, BP, (if indicated) SaO2 , Pain • Daily weight if applicable • LOC • Chest, abdomen, circulation and skin • In depth assessments relative to patient condition • Immediate self-care needs Assessment: ongoing • As above and related to client’s condition • General mood • Situational stressors and coping pattern Medications: Basic knowledge of the medications prescribed • Classification • Purpose • Possible side effects • Implications for nursing care Health Teaching • Identify client’s learning needs • Collaborate with team to develop plan to meet client’s learning needs • Implement aspects of plan within scope of practice as a learner Psychosocial/Relational Practice • Fully engage with client and family • Recognize and acknowledge client distress as it arises, and help patient manage distress • Offer support and solution finding • Engage in problem-solving as required, in collaboration with others as needed Communication • Discuss any abnormal findings related to the patient assessment with staff nurse/instructor • Seek assistance/ask questions before doing procedures for the first time, or for anything that you are uncertain about. • Report to staff nurse when you are leaving the floor and arrange for coverage of your patients with another student or staff member Activities of Daily Living • Consistently perform hand hygiene • Assist patients as required with o Bed baths, oral hygiene and hair care o Toileting o Meals • Turn and position bedridden patients on a regular basis, assessing skin with each turn • Assist with transfers to chairs and with ambulation of those patients who are able. 13 • The patient’s bed and bedside must be kept clean and clear of clutter. Dispose of all garbage in the appropriate receptacle. No urinals on the over bed table. Nursing and Collaborative Interventions • Determine which interventions are required, what resources, including support and supervision are required, and schedule interventions in consultation with the client • Complete interventions as appropriate and within scope of learner practice Relationships • Work with the staff to learn and deliver excellent patient care • Maintain a professional manner in dress, behaviour and conversation • Assist other students and staff with patient care as time and scope of practice permit • Welcome all opportunities to learn and practice new skills Evaluation and Documentation • Document vital signs and physical assessments in the appropriate areas of the chart for assigned patients, accurately and concisely, ASAP after assessment • Use institution’s system of documentation for nursing process and patient progress • Reflect on own performance independently during and after each shift • Reflect on and seek clarification of any feedback from the instructor, who may receive feedback from the staff. 14
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