Nursing Advanced Clinical Practice

Course Calendar

Fall 2008

Week 1

Clinical Focus

Assignment

Week 1

Wednesday August 27

10-12 Orientation to course

Syllabus

Pharmacology Review

Week 1

Thursday, Aug. 28

Skills Lab-Monroe Campus

Math Quiz

Start LP-1

Orientation to clinical sites

Complete Math Quiz

Review & Practice Skills

Week 1

Friday, Aug. 29

Central Campus-Sim/ADN

Lab

Finish LP-1

Scenarios and case studies

Simulated patient care experience

Math Quiz retake (if needed)

Week 2

Sept 4, 5

Start LP-2

Start Team Leading

Assigned written work

Week 3

Sept. 11, 12

Team Lead

Assigned written work

Week 4

Sept. 18, 19

Team Lead

Mid-term Evals

Assigned written work

Week 5

Sept. 25, 26

Team Lead

Assigned written work

Week 6

October 2, 3

Team Lead

Assigned written work

NCP due if not turned in before

Week 7

Oct. 9, 10

Team Lead

Assigned written work

Week 8

Oct. 16, 17

Team Lead

Staff Inservice/Project due

Assigned written work

Final Course Evaluations due

Final clinical self evaluations

Due

Nursing Advanced Clinical Practice

Course Outcome Summary

WTCS – Wisconsin Technical College System

Information

Course Number 543-115

Credits 3

Contact Hours 144 for 16 week semester

Instructional Area Nursing

Instructional Level Associate Degree

Developers WTCS Nursing Alignment Team

Revised A. Hart 07/08

Description

This advanced clinical course requires the student to integrate concepts from all previous courses in the management of groups of clients facing complex health alterations. Students will have the opportunity to further develop critical thinking skills using the nursing process in making clinical decisions. Continuity of care through interdisciplinary collaboration is emphasized.

Prerequisites

Pre/Co: Nursing Complex Health Alterations II

Textbooks

ADN Faculty. ADN Handbook: Blackhawk Technical College. Required

Cox et al., Clinical Applications of Nsg Dx, 4^th ed. Publisher: David. Required

Lewis, Medical-Surgical Nursing. 7^th Ed. Publisher: Mosby. Required

Marsden. Pharmacology Math: Notes and Practice Tests. Required (See Learning Center)

Mosby. Mosby’s Medical, Nursing, and Allied Health Dictionary. Required

Pagano & Pagano. Mosby’s Manual of Diagnostic and Laboratory Tests. Required

Perry & Potter. Clinical Nursing Skills and Techniques. 5^th Ed. Publisher: Mosby. Required.

Potter & Perry. Fundamentals of Nursing. 6^th Ed. Required

Skidmore-Roth, L. Mosby’s Drug Guide for Nurses (2004) 6^th Ed. Required.

Stuart, G. Principles and Practice of Psychiatric Nursing. 8^th Ed. Required.

Whitehead, Weiss, and Tappen, Essentials of Nursing Leadership and Management. 4^th edition, F.A. Davis. Required.

Core Ability must be met within each course competency

1. Communicate Professionally

● Demonstrate communication standards specific to occupational area

● Write professionally

● Speak professionally

● Interpret professional documents

● Demonstrate critical listening skills

● Communicate using professional non-verbal behavior

2. Use Appropriate Technology

● Select equipment, tools, and resources to produce desired results

● Demonstrate proper and safe usage of equipment

● Demonstrate occupational specific computer skills

● Adapt to new technology

● Use security measures to protect confidentiality

3. Work Effectively In Teams

● Participate in identifying team goals

● Respect the contributions and perspectives of all members

● Work with others

● Complete assigned tasks

● Motivate team members

● Resolve conflicts

● Assess team outcomes

4. Demonstrate Professional Work Behavior

● Follow policies and procedures

● Meet attendance expectations

● Manage time effectively

● Dress appropriately

● Accept constructive feedback

● Take initiative

● Work productively

● Be accountable

● Demonstrate organization/prioritization skills

● Transfer learning from one context to another

● Adapt to change

5. Show Respect For Diversity

● Interact with diverse groups respectfully

● Treat everyone without bias

● Seek information when necessary to interact effectively with others

● Adapt to diverse situations

● Demonstrate respect and common courtesy

6. Solve Problems Efficiently

● Identify a problem to be solved

● Select an appropriate problem-solving methodology

● Recognize and gather relevant information

● Apply mathematical reasoning

● Utilize appropriate resources

● Recognize when to change direction if needed

● Recognize when the process is complete

7. Lead By Example

● Recognize leadership qualities in others

● Demonstrate legal and ethical standards of practice

● Create and share a vision

● Develop and implement a plan to accomplish a goal

● Manage conflict, pressure, and change with constructive strategies

● Be a colleague/peer others can depend on

● Acquire the knowledge needed for success

● Bring passion and energy to your work/project

● Take risks when necessary or appropriate

Supplies

Uniforms as described in BTC ADN Handbook

Watch with second hand

Stethoscope

Eyeglass shields and/or safety glasses

CPR mask

Scissors, recommended

Penlight

Competancies

1. Demonstrate professional behaviors.

2. Communicate effectively with clients, families, and groups.

3. Document effectively.

4. Analyze comprehensive client assessment data.

5. Make complex clinical decisions.

6. Apply knowledge relevant to client care.

7. Adhere to principles of safety and infection control.

8. Provide individualized client care.

9. Administer medications safely.

10. Provide individualized client/family education.

11. Ensure collaborative client care.

12. Manage care using principles of organization, prioritization, delegation and supervision.

COURSE POLICIES AND GUIDELINES

Attendance

Orientation to Course

This will take place in week 1. If you are unable to attend, you are responsible for all information. Attendance will be recorded as the number hours you are present when course grade is submitted. If you arrive late for any class, exam or lab and door is closed, wait until break time to enter.

Nursing Skills Lab (Weeks 1)

Sixteen hours will be spent in scheduled lab time. If a student is unable to attend scheduled Nursing Skills Lab, they should notify instructor or lab assistant and must arrange make-up time with Lab Assistant. Time must be made up before clinical and the student must discuss absences with instructor. If no effort is made by student to arrange make-up time, student will receive a failure and not be allowed to attend clinical. If you are 15 or more minutes late for a lab session, this time must be made up.

Scheduled Appointments

The student is expected to come to all scheduled appointments. This includes appointments to make up lab time. If the student is a no-show, no-call for such an appointment, two points will be deducted from the student’s total points at the end of the course for each occurrence.

Safety

At any time in the clinical course the instructor, based upon evaluation of the student’s competence and actions, may conclude whether or not the student is safe to continue in the clinical course.

Emergency Closing of BTC

Decisions regarding school closing will be made prior to 5:45 a.m. for day classes and prior to 3:00 p.m. for evening classes. See ADN Handbook for a list of radio stations which BTC will contact in the event of a closing.

Cell Phones

Cell phones and pagers are to be turned off when attending any class, clinical or lab session.

Taping of Presentations

If you wish to tape record any portion of a presentation, you must obtain permission from the speaker.

Student Folders

Communications from faculty may be placed in folders located in the Nursing Skills Lab. Be sure to check regularly

Portfolio

Course assignments should be placed in student portfolio.

ADDITIONAL LEARNING SUPPORT

1. Learning Center – math skills, editing papers, etc. – Lori Rodefeld

2. Student Services – Program Counselor

SUPPORT TO STUDENTS AT RISK OF FAILURE

If the student fails a test, or is struggling with satisfactory completion of assignments, the student is encouraged to make an appointment to discuss concerns with the faculty and/or the BTC counselor in Student Services. The Learning Center may be able to offer assistance as well. The student is responsible for knowing their own academic status. It is also their responsibility to contact their instructor, the ADN Coordinator or Program Counselor if in jeopardy of failing the course.

ADA STATEMENT

The faculty is committed to providing each student with the opportunity to successfully complete the course. If there is any reason that would interfere with your ability to complete the requirements of this course or to participate in the activities described in this syllabus, please contact the Nursing Coordinator. Reasonable requests for appropriate academic adjustments and reasonable modifications to policies and practices will be granted. Requests must be received prior to the third class session.

Instructors/Staff

Amy Hart	329-8249	Office hours for faculty are posted at the information desk. Voice mail is also available.
Crystal Hansen, Lab Assistant	329-8255

The lead instructor reserves the right to make any changes in the syllabus at any time.

Evaluation of Student Performance

It is expected that all students will adhere to the policies of Blackhawk Technical College and the Associate Degree Nursing Program in addition to the guidelines set forth in this course syllabus.

In order to receive a passing grade in Nursing Advanced Clinical Practice 543-115, the student must pass each of the following components of the course.

* Final Course grade of “C” or better (see below).

* Math test at 100% according to guidelines.

* Nursing Skills Lab review with 100% attendance and completion of skills scenario.

* Each assignment with score > 80%.

* Pharmacology Review Test.

* Clinical Evaluation Tool – all competancies met satisfactorily with an “S”.

* Clinical Evaluation Tool Professional Behaviors passed with > 80% (no more than 4 ‘U’s)

Total Course Points = 470

A = 94-100%

B+ = 91-93%

B = 87-90%

C+ = 84-86%

C = 80-83%

D = 73-79%

F = 72% or less

Clinical Evaluation Tool Professional Behaviors = 235

Assignments:

Comprehensive Physical Assessment with Nursing

Care Plan and Teaching Plan 75

Analysis of Management Experience 100

Math test passed after 1^st attempt 10

Pharmacology Review Test 50

Total Points 235

Students are expected to make an appointment with their clinical instructor to discuss any scores below 80%. Late assignments or tests will have 5 percent deducted for each calendar day late.

Assignments

All written assignments must meet the 80% passing grade. If this is not met, the student will receive a “U” for Communication in the Professional Behaviors for each assignment below 80%. The student will discuss grade with the CI. The student will be given one opportunity to redo the assignment in order to meet the 80% passing grade. Student cannot attain a grade greater than 80%.

Each “U” equals 11 points. Therefore, 11 points will be deducted for each “U” received for an assignment below 80%.

DESCRIPTION OF LEARNING ACTIVITIES

Nursing Skills Lab

Your first week of clinical will be spent on campus. Time will be spent reviewing the course syllabus and getting oriented to the course, taking the math test, reviewing designated skills at ‘stations’, using material and critical elements from previous skills courses, take the Pharmacology exam and finishing by getting oriented to the clinical site. One full day will be spent on Central Campus. During this day we will review any unanswered questions or concerns regarding skills, spend the rest of the day in patient simulations and begin discussing and group analysis of prioritization and decision making exercises. (See Learning Plan 1 for guidelines.)

Mathematic Calculation Test

You must pass the test with a score of 100%. You may repeat the test 2 times. If you have not passed at 100% after the 3^rd test and within a two-week time frame, you have failed the course. Tests must be completed within 30 minutes. The first test will be given during course orientation. Retakes will be scheduled in the Learning Center. You may not pass meds in clinical until requirements are met. A referral will be made to Learning Center if test is not passed after one retake. Referral must be completed before a retake.

Pharmacology Review Test

A 50 point multiple test will be given over previously learned material. The following classifications will be included on test: The test must be passed at > 80% before you pass meds in clinical. The grade from the first attempt will be recorded for final grade.

The test questions address the following drug categories:

Beta blockers

Calcium channel blockers

Opioids

NSAIDS

Insulins

Nebulizer meds

Inhalers

Cardiac Glycosides

Oral hypoglycemics

PPD skin test

IV rate calculation – using a pump or gtt factor

Diuretics

Anti-depressants

Eye drops

Nasal sprays

Antiarrhythmics

PROFESSIONAL BEHAVIORS

SCORING GUIDE:

Performance of these “Professional Behaviors” will be scored weekly by the student and validated by the instructor. Three unsatisfactories in any one category or a total of four unsatisfactories will result in a course failure. The instructors reserve the right to fail a student immediately if a major safety issue arises that deems the student unsafe to continue in the course. The instructor may require the student to write a plan of action for any unsatisfactory received. Each “U” will result in a 5% reduction of the “Professional Behaviors” points.

ATTENDANCE	The student arrives on time for ATL and Clinical sessions. If absent, the student contacts the clinical agency and the clinical instructor or the ATL instructor as stated in syllabus and A.D.N. handbook.
TIMELINESS	The student completes all patient care and paperwork within the clinical time allowed. Other assignments are completed in a timely manner or by the date specified by the instructor.
ATTIRE	The student’s dress follows the student Uniform Policy as listed in the BTC A.D.N. Handbook.
COMMUNICATION	The student’s verbal and written communication with patient/residents, colleagues and peers is accurate, concise and effective and occurs in a professional manner. The student recognizes the difference between social and therapeutic communication and uses both appropriately.
SAFETY	The student demonstrates safe clinical practice in the areas of clinical health policies, skill performance and environmental issues.
ETHICAL CONDUCT	The student follows the Ethical Conduct for BTC students (see BTC and A.D.N guidelines)
RESPONSIBILITY/ACCOUNTABILITY	The student prepares adequately for clinical, identifies the need for and seeks assistance from the instructor and/or staff when necessary; self-evaluation of personal abilities, strengths, and areas in need of improvement; identifies learning goals and plans for improvement as needed, accepts responsibility for personal actions. Meet BTC Core Abilities.

PROFESSIONAL BEHAVIORS

COURSE: INSTRUCTOR: STUDENT

Week 1: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Week 2: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Week 3: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Week 4: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Week 5: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Week 6: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Week 7: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Week 8: Dates	Patient Diagnosis:	Skills:
Attendance S U Timeliness S U Attire S U	Safety S U Communications S U Ethical Conduct S U		Accountability S U Caring Behaviors S U
Comments

Final Class Evaluation

Course: Nursing Advanced Clinical Practice - Fall 2008 Due: Week 8

1. From what I expected, this class ranks as follows:

q Excellent. I’m really learning a lot

q O.K. It meets my expectations

q It is not as good as I expected

2. The book and course materials are:

q Helpful and easy to understand

q Average

q Hard to understand

3. The information taught in this course is:

q Important, useful and up-to-date

q Not sure right now

q A waste of my time

4. The class is moving at a pace which I would describe as:

q Well paced

q Too fast for me

q Too slow for me

5. This class is:

q Interesting

q Okay

q Boring

6. The instructor’s explanations are:

q Clear and easy to follow

q Sometimes hard to understand

q Very difficult to understand

7. The instructor:

q Listens and connects effectively with students

q Usually listens to students

q Does not listen or care about student concerns

8. The tests and projects for this course are:

q Appropriate learning opportunities

q Sometimes hard to understand

q A waste of my time

Student Self-Evaluation

I have been attending class regularly Yes q No q

I actively participate in class discussions Yes q No q

I am putting forth a reasonable amount of effort for this class

Yes q No q

I utilize all the learning opportunities provided in this course:

Yes q No q

See reverse side for additional comments.

Clinical Evaluation – Nursing Advanced Clinical Practice

Term/Year:

Instructor

Student

Mid-Term Evaluation

Instructor Comments: (instructor must initial applicable box below, instructor must sign/date)

Each course competency must be met satisfactorily.

One or more unsatisfactory course competencies (At risk for course failure – comment below)

Professional Behaviors > 80%

Instructor Date

Student Comments: (student must sign/date & may write comments related to performance)

Student Date

Final Evaluation

Instructor Comments: (instructor must initial applicable box below, instructor must sign/date)

Each course competency must be met satisfactorily

One or more unsatisfactory course competencies

Professional Behaviors > 80%

Instructor Date

Student Comments: (student must sign/date & may write comments related to performance)

Student Date

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Use appropriate communication techniques consistently with instructor, peer group and members of the health care team

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You efficiently communicate complete, accurate, pertinent information.
You use appropriate channels of communication.
You document complete, accurate, pertinent information.
You document according to agency guidelines.
You establish therapeutic relationships with clients and family.
You use therapeutic communication techniques appropriate to the situation to assist clients in attaining health care goals.
You determine how to improve your skills.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Assess the client for changes in health status

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You perform a comprehensive client assessment.
You include the clients’ family and community in the assessment.
You collect accurate data and validate assessment findings.
You perform a focused assessment based on health needs.
You adapt assessment techniques based on client characteristics (age, culture, development, mental state, etc.).
You anticipate and assess for changes in health status.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Assure client-centered nursing care in complex situations

Mid – Term Score	S/U
Final Score	S/U

Criteria

Comments/Examples

Mid=term

Final

You maintain a safe, effective care environment.

You maintain client’s dignity, privacy, and confidentiality.

You demonstrate caring behavior towards the client and family.

You implement the prescribed care plan.

You performing nursing skills and use technology competently.

You consider client’s family and community when developing and implementing nursing care.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Make clinical decisions with supervision

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You describe decision making process use.
You gather adequate and relevant information for decision making.
You use rational thinking strategies in decision making.
You consult with instructor and staff for assistance with and validation of decisions.
You evaluate the effect and/or appropriateness of decisions made.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Modify a plan of care

Mid – Term Score	S/U
Final Score	S/U

Criteria

Comments/Examples

Mid-term

Final

You evaluate effectiveness of existing plan of care.

You select appropriate modifications after considering alternatives.

You respond to changes in client health status by modifying the plan of care.

Your response reflects awareness of the significance of the change.

You collaborate with the client and health care team members in changing the plan of care.

You evaluate the effectiveness of the modification(s).

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Develop individualized teaching plans based on assessed needs

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You assess client learning needs.
You assess readiness for and barriers to learning.
You consider client characteristics (age, culture, development, etc) in development of the teaching plan.
You provide relevant health information.
You evaluate the client’s attainment of learning outcomes.
You revise the teaching plan as indicated by the evaluation.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Provide instruction to other health care team members

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You assess a need for learning.
You provide relevant information in a respectful manner.
You evaluate the attainment of the learning objectives.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Manage multiple priorities with supervision

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You determine and support client preferences.
You select cost-effective strategies.
You prioritize individual client needs and the needs of groups of clients.
You consider available time, resources and environmental factors.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Collaborate with other members of the health care team in developing a plan of care

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You seek information from other health care team members.
You share relevant client information with other health care team members.
You confer with other health care team members regarding client care needs.
You incorporate information from other health care team members into clients’ plan of care.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Delegate nursing care with supervision

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You supervise and evaluate the activities of assistive personnel.
You provide clear, complete directions when delegating.
You determine if the directions were correctly understood.
You provide feedback regarding performance of delegated acts.
You delegate tasks based on competence of assistive personnel, needs/conditions of the client, potential for harm, complexity of task, and predictability of outcome.

NURSING ADVANCED CLINICAL PRACTICE

PERFORMANCE ASSESSMENT TASK

Perform within the role of the RN with supervision

Mid – Term Score	S/U
Final Score	S/U

*Criteria*	*Comments/Examples*
	*Mid-term*	*Final*
You report errors promptly and take appropriate corrective action.
You comply with school and agency guidelines.
You practice within the legal and ethical frameworks for nursing.
You perform procedures consistent with current level of knowledge and skills.
You evaluate own performance based on standards of practice.
You demonstrate satisfactory behaviors of the student nurse role (timeliness, attendance, appearance, preparation, positive attitude).
You serve as an advocate for individuals and groups.

Blackhawk Technical College

Nursing Advanced Clinical Practice

Learning Plan One

Nursing Skills Lab Review

Week 1

Nursing Advanced Clinical Practice

Learning Plan One

Nursing Skills Lab Review

Purpose/Overview: This plan offers the opportunity for the student to review previously learned skills which occur more frequently in the acute care setting. The experience not only allows for strengthening of psychomotor skills, but also critical thinking and prioritizing skills in a simulated, non-threatening environment. The student will review a variety of selected skills during week 1. In addition, the student will be given a scenario which incorporates several skills. The student will need to prioritize the order the skills should be performed in and perform each skill according to previously learned critical elements. Also the student will need to make appropriate assessments and anticipate changes in patient condition and identify possible solutions in a simulated environment.

Target Competencies

Assure client-centered nursing care in complex situations

Performance Standards

You will demonstrate your competence:

* in nursing skills lab

* working with peers, CI

Your performance will be successful when:

* you maintain a safe, effective care environment

* you maintain client's dignity, privacy, and confidentiality

* you demonstrate caring behavior towards the client and family

* you implement the prescribed care plan

* you perform nursing skills and use technology competently

Provide instruction to other health care team members

Performance Standards

You will demonstrate your competence:

* in nursing skills lab

* working with peers

Your performance will be successful when:

* you assess a need for learning

* you provide relevant information in a respectful manner

* you evaluate the attainment of the learning objective

Perform within the role of the RN with supervision

Performance Standards

You will demonstrate your competence:

* in nursing skills lab simulated scenario

* working with clients, peers, and staff

Your performance will be successful when:

* you report errors promptly and take appropriate corrective action

* you comply with school and agency guidelines

* you practice within the legal and ethical frameworks for nursing

* you perform procedures consistent with current level of knowledge and skills

* you evaluate own performance based on standards of practice

* you demonstrate appropriate behaviors of the student nurse role (timeliness, attendance, appearance, preparation, positive attitude)

* you serve as an advocate for individuals and groups

Learning Objectives

What you will learn as you master the competencies.

a. Apply the principles of priority setting when given a scenario with multiple nursing care needs that are to be completed within one hour.

b. Demonstrate the principles of work organization and effective use of available resources.

c. Review the critical elements for previously learned psychomotor skills.

d. Utilize peer review to provide feedback of student's performance in a scenario situation.

Learning Activities

1. Review the critical elements in the scoring guides from the two (2) previous skills' courses (543-102 and 543-112).

2. Practice all the skills on the designated list according to critical elements.

3. Review procedures in clinical skills text.

4. Review AV material for specific skills, as needed (see previous courses for AV list).

5. Utilize open lab time to practice skills as needed.

6. Review JCAHO Center for patient safety website, www.jcipatientsafety.org.

Assessment Activities

1. Completes simulated scenarios.

2. Completes peer review feedback documentation.

3. Completes 100% attendance for lab sessions.

STANDARD PROTOCOLS FOR ALL NURSING SKILLS

All nursing skills include basic steps for the safety and well being of the patient/resident and the nurse. These steps are essential and must be followed to deliver appropriate, quality and responsible nursing care.

Clean Gloves

Clean gloves are used to protect both the patient/resident and the caregiver. Most microorganisms are kept off the caregiver’s hands by wearing clean gloves before contact with mucous membranes, non-intact skin, or moist body substances. Remember, gloves are not 100% effective and can have invisible small holes or tears. Hand washing after removing the gloves effectively prevents transfer of microorganisms.

Effective hand washing, as well as changing clean gloves, is required between clients and between activities with the same client or when gloves become excessively soiled. (Centers for Disease Control, CDC, 1992).

Standard Equipment for Each Nursing Skill

1. Armband for patient/resident identification. You must use at least two forms of identification:

a. Patient name

b. Medical record number

c. Birth date

2. Consent form (if required by facility policy).

3. Clean disposable gloves (if contact with body secretions or excretions is anticipated).

Before the Skill

1. Verify physician’s order if skill is a dependent or collaborative nursing intervention. Independent nursing interventions (skills) can be verified with the nursing care plan or Kardex.

2. Introduce self to patient/resident, including both name and title and explain what you plan to do.

3. Identify patient/resident by checking armband and having him/her state name (if able to do so).

4. Explain the procedure and the reason it is to be done in terms patient/resident can understand.

5. Assess patient/resident to determine that the intervention is still appropriate.

6. Gather equipment and complete necessary charges.

7. Wash hands for at least 10-15 seconds before each patient/resident skill.

8. Adjust the bed to appropriate height and lower side rail on the side nearest you.

9. Provide privacy for patient/resident. Position and drape as needed.

BLACKHAWK TECHNICAL COLLEGE

NURSING ADVANCED CLINICAL PRACTICE

543-115

Skills Lab Review

All skills must be practiced according to previously learned critical elements. These skills will be incorporated into a scenario experience. This learning plan must be completed before the start of clinical.

Skills List:

1. Physical Assessment

2. Wound Care – Sterile Dressing Change & Aseptic Technique

* Cleansing/packing

* Obtain wound culture

* Measure wound

3. Perform enteral feeding with residual check and flush using gastrostomy feeding tube

4. Medication Administration

* Oral

* Enteral tube

* Rectal

5. Medication administration via parenteral routes

* Subcutaneous

6. IV Therapy

* Spike bag and prime tubing

* Establish IV flow rate (gravity flow and pump)

* Change IV

* Prepare and hang secondary IV piggy-back

* Change IV site and dressing

* Discontinue peripheral IV

* IV insertion

7. Perform tap water enema, fleets enema

8. Perform ostomy care

9. Straight cath for urinary specimen and obtain closed urinary specimen

10. Set oxygen flow rate using fixed and portable equipment

11. Perform respiratory care:

* Select appropriate oxygen therapy

* Incentive spirometry

* Cough/deep breathe

* Peak flow meter

* Percussion/positioning

12. Perform tracheostomy care with inner cannula, tie change and suctioning

13. Perform oral, nasal, and pharyngeal suctioning

14. Perform a peripheral venipuncture

Nursing Advanced Clinical Practice

Learning Plan Two

Clinical Management Experience

Purpose/Overview: The experience will emphasize management of a small group of acute care patients with multiple needs. The student will follow a RN in preparation for the experience. A team assistant will have a supportive role. The manager of care role is implemented while strengthening leadership skills, delegation, supervision, and evaluation skills. Priority-setting, time management, and organizational abilities is also stressed. The student leader is also expected to promote a strong team atmosphere and collaborate with interdisciplinary team members. The student will attend rounds, discuss concerns with primary providers (as available).

1. Demonstrate professional behaviors.

Performance Criteria:

· Comply with agency and school policies, state laws and regulations.

· Treat all individuals with dignity and respect.

· Prepare for clinical experiences.

· Protect client rights (privacy, autonomy, confidentiality).

· Practice within the legal and ethical frameworks of nursing.

· Demonstrate appropriate behaviors (attendance, appearance, honesty, attitude, accept criticism, punctual, etc.)

· Report errors promptly and respond appropriately.

· Assume responsibility for learning.

· Maintain professional boundaries.

· Accept responsibility for assigned client care.

· Demonstrate accountability for actions.

· Demonstrate accountability for delegated acts.

· Advocate for clients and family.

2. Communicate effectively with clients, families and groups.

Performance Criteria:

· Provide accurate information to clients and families.

· Use appropriate and respectful words and tone in verbal communications.

· Demonstrate appropriate non-verbal communication strategies.

· Use communication techniques to assist clients/families in coping with stressful events and changes in health status.

· Adapt communication strategies based on clients’ age, developmental level, disability, and/or culture.

· Evaluate the effectiveness of therapeutic interactions.

3. Document effectively.

Performance Criteria:

· Document complete, accurate, pertinent information in a timely manner.

· Complete documentation according to agency guidelines (format, timing, abbreviations, etc.)

· Use appropriate terminology, spelling and grammar in written communications.

4. Analyze comprehensive client assessment data.

Performance Criteria:

· Use correct techniques for physical assessment.

· Use effective interview techniques in data collection.

· Use appropriate sources in collecting data.

· Identify support systems and laboratory and diagnostic test results.

· Identify community resources.

· Validate data collected.

· Adapt assessment techniques based on client characteristics (e.g. age, culture, development, illness, mental state)

· Follow up on abnormal data.

· Assess clients in a timely and efficient manner.

· Assess the needs of clients’ families.

· Anticipate changes in health status based on assessments.

5. Make complex clinical decisions.

Performance Criteria:

· Gather adequate, relevant information for decision-making.

· Report abnormal data and changes in client condition to the instructor or appropriate health care professional.

· Respond to information from team members and/or other sources.

· Use data/evidence to support decisions.

· Verify data with instructor or health care professional.

· Validate nursing decisions with instructor or health care professional.

· Anticipate client/family care needs.

· Cluster data to identify client/nursing problems.

· Identify priority problems.

· Plan individualized nursing care with appropriate outcomes.

· Use critical thinking strategies in decision-making and care planning.

· Evaluate client outcomes.

· Modify client outcomes.

· Modify client care based on evaluation.

6. Apply knowledge relevant to client care.

Performance Criteria:

· Takes initiative to obtain needed knowledge.

· Integrate theory from nursing, natural and social sciences.

· Relate pathophysiology of disease(s) to clients’ assessment findings, medications, laboratory and diagnostic test results, medical and nursing interventions.

7. Adhere to principles of safety and infection control.

Performance Criteria:

· Come to clinical mentally and physically prepared to provide safe and effective care.

· Protect clients from injury, infection, and harm.

· Protect self and others from injury, infection, and harm.

· Maintain a safe, effective care environment.

· Use available technology/equipment in accordance with agency policies and procedures.

· Request assistance when needed.

8. Provide individualized client care.

Performance Criteria:

· Determine and support client preferences.

· Prepare clients for interventions.

· Perform nursing skills competently.

· Demonstrate caring behaviors towards clients and families.

· Respond to clients in distress.

· Ensure clients’ ADLs are completed.

· Consider clients’ family and community when developing and implementing the plan of care.

· Provide complex cares efficiently and effectively.

· Provide nursing cares for more than one client.

· Modify plan of care based on changing health needs.

9. Administer medications safely.

Performance Criteria:

· Recall client medication information including classification, indication, action, dosage, side effects, interactions, and nursing implications.

· Calculate medication dosages and IV rates correctly.

· Check “five” rights and client identifiers prior to medication administration, and allergies.

· Perform appropriate assessments prior to, during, and after medication administration.

· Follow correct procedures in preparing and administering medications.

· Administer medications within the agency-allotted timeframe.

· Evaluate the effects of medications administered.

· Incorporate assessment data in decision-making related to medication administration.

· Relate clients’ medications to their health status.

· Administer medications to a small group of patients.

10. Provide individualized client/family education.

Performance Criteria:

· Provide relevant, accurate health care information.

· Assess clients’ learning needs.

· Assess readiness for and barriers to learning.

· Develop individualized teaching plans based on learner assessment.

· Use appropriate teaching and learning principles when implementing the teaching plan.

· Teach clients and their significant others the information and skills needed to achieve optimal health.

· Provide clients with the information they need to make informed decisions.

· Evaluate clients’ attainment of learning outcomes.

· Revise the teaching plan as indicated by the evaluation.

11. Ensure collaborative client care.

Performance Criteria:

· Use appropriate channels of communication.