205ASyllabusC8 July-August 2011

NATIONAL UNIVERSITY

Course Outline

NSG 205A

Medical-Surgical Nursing I

July 5, 2011 to August 29, 2011Summer Term

NSG 205A 1 July-August 2011

COURSE OUTLINE

COURSE NUMBER: NSG 205A

COURSE TITLE: Medical-Surgical Nursing I Clinical Laboratory

PREREQUISITES: NSG 204 and NSG 204A

COURSE COORDINATOR: Jennifer Powers, MSN, FNP, RNAssistant ProfessorContact email: [email protected]: (702) 531-7864Cell Phone: (702) 592-3084 before 9:00pm

CLINICAL TEACHING FACULTY: Jennifer Powers, MSN, FNP, RN (UMC)Contact: (702) 592-3083Email: [email protected]

Charlene Melton, MSN, RN (UMC)

Kandi Betts, BSN, RN (St. Rose)Contact: (702) 219-7202Email: [email protected]

Cheree Pettigrew (Sunrise)Contact: (480) 225-1800Email: [email protected]

OFFICE HOURS: to be announced by each clinical faculty and by appointment only

CREDIT: 4.5 quarter units

COURSE LENGTH: 8 weeks

COURSE DESCRIPTION:This course focuses on the practical application of knowledge and skills required for nursing care of adult patients with commonly occurring medical-surgical problems is demonstrated in both laboratory and clinical settings. Using the language of nursing, students will devise and implement care plans and teaching plans. Concurrent enrollment in NSG 205 is required. Clinical Laboratory is graded on a Satisfactory/Unsatisfactory basis based on successful completion of the course requirements.


mailto:[email protected]




COURSE GOALS:The primary goal of this course is to demonstrate use of the language of nursing, therapeutic communication techniques and professional nursing actions in planning and providing nursing care to adults with medical-surgical health needs in acute care settings

REQUIRED TEXTBOOKS:

Adams, M. P., & Koch, R. W. (2010). Pharmacology: Connections to nursing practice.

New Jersey: Pearson Education. ISBN – 10: 0-13-152599-9

American Psychological Association. (2001). Publication manual of the

American Psychological Association (5th Ed.). Washington, D.C., American

Psychological Association. ISBN NO: 1-55798-243-0.

Ignatavicius, D. D., & Workman, M. L. (2010). Medical-surgical nursing: Patient centered

collaborative care. (6th Ed.). St Louis, MO. Elsevier Saunders.

ISBN NO: 978-1-4160-4903-6

Ignatavicius, D. D., & Workman, M. L. (2010). Critical thinking study guide: Medical-Surgical

nursing. (6h Ed.). St Louis, MO. Elsevier Saunders. ISBN NO: 0721606148

Swearingen, P. A. (2004). All in one care planning resource. ISBN NO: 0323019536.

REFERENCE TEXTS:

Ebersole, P., Hess, P. & Luggen, A.S. (2004). Toward Healthy Aging: Human Needs and Nursing Response. (6th Ed.). Mosby. ISBN NO: 0323020127.

Grodner, M. et al. (2001). Foundations and Clinical Applications of Nutrition: A Nursing Approach. (3rd Edition). Mosby, ISBN NO: 0-323-02009-7.

LEARNING OUTCOMES:Upon successful completion of the course, the student will be able to:

1. Begin to utilize basic teaching-learning principles by implementing a standard teaching plan in a structured clinical setting.

2. Recognize the patient and family/significant others’ responses to impact of illness, hospitalization, interventions and procedures


3. Provide standardized nursing care to a group of adult patients in a structured clinical setting.

a. Perform basic nursing skills safely and effectively.b. Administer nursing care based on the patient’s present bio-psycho-social-

cultural-spiritual situation. c. Determine the patient’s priority of needs and plan care accordingly.d. Complete nursing care for one to two adult patients on time using an

organized and efficient approach.4. Utilize the nursing process to administer care to the adult patient with commonly

occurring health care needs and problems.a. Collect data on the patient’s health status in a systematic and objective manner

using the system’s review.b. Assess the data considering the normal physiologic and psychologic

parameters of the adult patient’s experience and identify the assets and deficits of that experience.

c. State a nursing diagnosis for each actual or potential problem which has been identified from the patient’s health assessment.

d. Devise a plan of care utilizing the concept care mapping method which provides nursing interventions to the patient as needed and reflects awareness of the priority problems in the care of the patient.

e. Implement the plan of care and state the rationale for the nursing interventions.

f. Evaluate the effectiveness of the care based on the stated expected outcomes or goals of care.

5. Provide basic health information to the patient and family using standardized teaching plans.

a. Assess the patient as to their learning needs and knowledge deficits.b. Implement a standard teaching plan to meet the patient’s learning needs.c. Evaluate the effectiveness of that experience.d. Identify hospital as well as community resources available to patients and

make referrals following consultation with team leader or instructor.6. Utilize therapeutic communication skills, guidance and support in interacting with the

adult patient and record observations in proper sequence and format.a. Recognize own values and behavioral responses which may be conditioned by

own culture and experiential background.b. Provide therapeutic and supportive communication to the adult patient and

family.c. Communicate and report pertinent observations and inferences to appropriate

personnel, i.e. instructor, team leader, etc. promptlyd. Record medications, treatments and subjective/objective observations

properly in the patient’s record.7. Assume responsibility for personal and professional growth in the medical-surgical

setting.a. Accept responsibility for his or her own actions/behaviors as a student

member of the health care team.b. Is prepared with pre-care level patient data prior to each clinical lab day.


c. Report promptly to clinical laboratory and pre/post conferences.d. Constructively use instructor’s feedback by initiating appropriate actions in

subsequent written work or clinical behavior.e. Identify and implement learning goals and objectives and seek appropriate

resources to achieve them.i. Identify specific experiences in clinical practice which are needed to

accomplish learning objectives.ii. Utilize those experiences in clinical practice seeking assistance where

needed. f. Contribute to the growth of self and classmates by sharing learning

experiences on the clinical units during pre and post conferences.g. Evaluate own clinical and academic performance based on these course

objectives by completing and turning in the weekly clinical journals

COURSE CONTENT:

1. Clinical Application of topics covered in the corresponding theory course2. Post-Conference Topics:

Each of these topics will form the frame for at least one post-conference during the clinical laboratory experience as it relates to the population being studied:A. Cultural diversityB. NutritionC. PharmacologyD. Legal aspectsE. Social aspectsF. Ethical aspects

3. HIPAA regulations4. Review of Universal Precautions5. Administering IV fluids and medications by piggyback6. Colostomy irrigation, N-G tube insertion, bowel decompression7. Orthopedic care8. Principles of sliding scale coverage 9. Unique observation and clinical experiences

COURSE REQUIREMENTS: 1. Completion of a minimum of 136 clinical hours2. Adherence to the Policy on Lateness or Absence from Clinical Laboratory,

Professional Appearance and Clinical Compliance.3. Adherence to standards of HIPAA, Safety Guidelines and Universal Precautions.4. Clinical research of patient (s)1 day prior to actual patient care and medication

administration5. Participation in clinical conference.6. Satisfactory, timely, completed written clinical assignments are expected. Any

assignment, which receives a grade of “U” may or may not be required to be revised and resubmitted, at instructor’s discretion, within one week after receiving the “U” grade. However, the original “U” grade will be unchanged.


7. Satisfactory demonstration of professional behavior in the clinical area. An instructor will counsel students with unsatisfactory behaviors. A learning contract may be written defining corrective actions to be taken within a specified time period. If unsatisfactory behaviors continue despite counseling, the student will be in jeopardy of failing the course

8. Satisfactory Clinical Performance Evaluation.9. Satisfactory Interpersonal Skills Evaluation.

CLINICAL ATTENDANCE:Students are expected to attend all clinical days and observations as assigned. If a student must miss a clinical day due to illness, the clinical instructor, in collaboration with the student and lead faculty, will determine if the student is able to successfully meet the course objectives in the clinical time remaining. If a student is unable to attend the orientation at the clinical facility, it will not be possible to meet the course objectives and the student will need to make arrangements to repeat the courses.

CLINICAL EVALUATION: Each student will be responsible for reviewing all clinical objectives and expectations as presented in the course syllabus. Each student is accountable for all previously introduced concepts and skills. Clinical evaluation is based on the continued application and integration of previously learned material within the current clinical learning experience.

Clinical instructors will evaluate student progress in a variety of ways such as: planned and incidental observation of client assessment, problem identification, care plan development, implementation and evaluation of client care, as outlined in the course clinical objectives. Students will receive a “Satisfactory” or “Unsatisfactory” for each clinical objective at course midpoint and endpoint.

If, at any point in the course, the student demonstrates less than satisfactory performance on any clinical objective, a failing grade may be assigned for the course and the course will need to be repeated. Midterm and end of term evaluation conferences are necessary to pass the clinical course.

If for some reason you are unsuccessful in this course, you will need to notify the Department of Nursing in regards to how you would like to readjust your schedule of nursing courses. To do so, print and complete the Program Change Request Form at http://www.nu.edu/Academics/Schools/SOHHS.nursing.html and submit it to the Department of Nursing.

CLINICAL MEDICATION QUIZ: Students must pass the medication examination with a score of 90 percent or higher. Students will have two available opportunities to complete the examination successfully. Should the student not attend one of the two testing periods, no make-up examinations will be scheduled. Students who are not successful on their first attempt at the examination are STRONGLY ADVISED to meet with the course faculty PRIOR to the subsequent test-taking attempt AND review ATI modules for remediation. If you are unable to pass the medication


http://www.nu.edu/Academics/Schools/SOHHS.nursing.html

examination after two attempts, you will not be allowed to continue in the course and will fail NSG 205 and receive an Unsatisfactory in NSG 205A.

ASSIGNMENT OUTLINE:Required assignments:

1. Preparation for and participation in clinical activities to your assigned patient. This entails research of the client the day prior to your assigned clinical shift

2. Presentation of client at clinical post-conferences3. Weekly clinical journal entries submitted to clinical faculty4. Weekly clinical maps for assigned client (minimum of three nursing diagnosis)5. Completion of Nursing Care Plan on WEEK SIX with a grade of Satisfactory6. Completion of Clinical Performance Evaluation at Mid-Term and Final of clinical

rotation7. Completion of Interpersonal Skills Evaluation8. Completion of all evaluation measures (i.e. clinical site, faculty, self)

GRADES AND GRADING SYSTEM:Definition of Grades:

S Satisfactory: Signifies average work. No grade points are assigned.U Unsatisfactory: Signifies no credit. No grade points are assigned.

ASSIGNMENT REQUIREMENTS:

1. ELECTRONIC WEEKLY JOURNAL ENTRIES: At the end of the clinical week, after the clinical experience, to reflect upon your clinical experiences or give detail of specific observation objectives. This must be sent via ECOLLEGE by SUNDAY at MIDNIGHT of the last clinical day each week. Students will be expected to discuss specific objectives in a separate journal after floating to specific units for observational experiences.

2. CLINICAL CONCEPT CARE MAPS: Written Clinical Maps form a significant part of your clinical evaluation because it is through these documents that your clinical instructor can evaluate your understanding and use of the nursing process and critical thinking skills. To record your daily clinical experiences, refer to a template that must be presented in its completed format to your clinical instructor per your instructor’s request.

A standardized format will be used to plan care for patients during the clinical course. You will be required to write a clinical concept care map for each patient clinical assignment using the format. You are required to do complete assessments, list diagnoses, prioritize and then decide on an appropriate plan of care (goals, comprehensive interventions, evaluation of expected outcomes, and modifications) for at least three priority diagnoses. How to write Clinical Concept Maps will be reviewed during orientation. Each Map will be due by the end of the clinical week on which care was provided and submitted into the drop box in ECollege. Clinical instructors will review Map’s to provide written feedback and guidance for improvement.


3. CARE PLAN: You are required to write one formal extensive care plan. Please be concise, no more than 10 pages. The written plan need to include complete assessments, list diagnoses with a brief description with reference source, prioritize and provide rationale for your choices, and then decide on a plan of care (goal and objectives, comprehensive interventions, brief rationale for interventions, evaluation of expected outcomes, and modifications) for at least four priority diagnoses. How to write NCPs will be reviewed during clinical orientation. Clinical instructors will review NCP’s to provide written feedback and guidance for improvement. If they are unsatisfactory on review, you will be required to resubmit a revised care plan or submit another care plan on the same type of patient.

HIPAA: Safeguarding patient information is paramount. Care should be taken in facilities with regard to conversations about patients in public areas such as the cafeteria, elevators, and hallways. You never know who may over hear your conversations. Do not use any patient identifiers on your work. This includes initials. The first-ever federal privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers took effect on April 14, 2003. Developed by the Department of Health and Human Services (HHS), these new standards provide patients with access to their medical records and more control over how their personal health information is used and disclosed. They represent a uniform, federal floor of privacy protections for consumers across the country. State laws providing additional protections to consumers are not affected by this new rule.

To review the details of HIPAA regulations please visit: http://www.hhs.gov/news/facts/privacy.html

ACADEMIC INTEGRITY:Ethical behavior in the classroom is required of every student. Students are also expected to identify ethical policies and practices relevant to course topics.

PLAGIARISM:Students are required to cite the use of materials written by others in all written communications for courses. The use of ideas, words, or phrases without proper attribution constitutes plagiarism. Plagiarism is the presentation of someone else’s ideas or work as one’s own. Students found plagiarizing are subject to the penalties outlined in the Policies and Procedures section of the University Catalog, which may include a failing grade for the work in question or for the entire course. The burden of proof rests on the student, not the instructor; in other words, the student will be required to prove that plagiarism has not occurred. Inadequately or improperly cited work receives no credit.

DIVERSITY:Learning to work with and value diversity is essential in every degree program. Students are required to act respectfully toward other students and instructors throughout the course. Students are also expected to exhibit an appreciation for multinational and gender diversity in


http://www.hhs.gov/news/facts/privacy.html

the classroom and develop leadership skills and judgment appropriate to such diversity in the workplace.

DISABILITY:National University complies with the Americans with Disabilities Act of 1990 and Section 504 of the Federal Rehabilitation Act of 1973. If you need accommodations due to a documented disability, please contact the Office of Scholarships and Special Services at (858) 642-8185 or via e-mail at [email protected]. Information received by this office is confidential and is only released on a 'need-to-know' basis or with your prior written consent. Accommodations can only be granted upon approval by the Committee for Students with Disabilities (CSD)..

NATIONAL UNIVERSITY SERVICES:National University provides all students with facilities to assist them in the completion of their course work. In particular the Writing Centers and NU Library provide access to materials and services in the area of academic writing, research and information literacy.

WRITING CENTER:The National University Online Writing Center is available to help with all your writing needs.

Make an appointment by going to http://tutor.nu.edu Email the online writing center at [email protected] if you have a quick question, or after

you’ve made an appointment. Check out the Writing Center web pages for other useful information:

http://www.nu.edu/OurPrograms/StudentServices/WritingCenter.html

NU LIBRARY:The NU Library System (NULS) supports academic rigor by providing access to scholarly books, journals, e-books, and databases of all text articles from scholarly journals. Library books and journal articles can be shipped to online students. Librarians are available to assist students at the Spectrum Library in San Diego, at regional Library Information Centers (LIC), and online.

GENERAL RESOURCE WEB SITES:Advice on writing in APA style: http://webster.commnet.edu/apa/apa_index.htmUpdates for APA Manual: http://www.apastyle.org/fifthchanges.html

BIBLIOGRAPHY: The course bibliography provides additional readings of relevant course topics. Students are encouraged to use these materials to enhance their investigations and discussions within the course.

Arbogast, D. (2002). Enteral feedings with comfort and safety. Clinical Journal of

Oncology Nursing, 6(5), 275.


http://www.apastyle.org/fifthchanges.html

http://webster_Commnet.edu/apa_intro.html

http://www.nu.edu/Academics/StudentServices/WritingCenter.html


http://tutor.nu.edu/


Bedell, C. (2003). Pegfilgrastim for chemotherapy-induced neutropenia. Clinical

Journal of Oncology Nursing, 7(1), 55.

Crimlisk, J. T. & Grande, M. M. (2004). Neurologic assessment skills for the

acute medical surgical nurse. Orthopaedic Nursing, 23(1), 3.

Fielden, J. M., Scott, S. & Horne, J. G. (2003). An investigation of patient

satisfaction following discharge after total hip replacement surgery.

Orthopaedic Nursing, 22(6), 429.

Graul, T. L.. (2002). Total joint replacement: Baseline benchmark data for

interdisciplinary outcomes management. Orthopaedic Nursing, 21(3), 57.

Idvall, E. (2002). Post-operative patients in severe pain but satisfied with pain

relief. Journal of Clinical Nursing, 11(6), 841.

Inzeo, D., Tyson, L. (2003). Nursing assessment and management of dyspneic

patients with lung cancer. Clinical Journal of Oncology Nursing, 7(3),

332.

Lower, J. (2002). Facing neuro assessment fearlessly. Nursing, 32(2), 58.

Strickler, R. & Phillips, M. L. (2000). Astrocytomas: The clinical picture. Clinical

Journal of Oncology Nursing, 4(4), 153.

Thomas, K., Burton, D., Withrow, L. & Adkisson, B. (2004). Impact of a

preoperative education program via interactive telehealth network for rural

patients having total joint replacement. Orthopaedic Nursing, 23(1), 39.

ONLINE RESOURCESThe course webliography provides additional Internet resources on relevant course topics. Students are encouraged to use these sites to enhance their investigations and discussions within the course.


American Academy of Pain Managementhttp://www.aapainmanage.org/

Joint Commission on Accreditation of Healthcare Organizationshttp://www.jcaho.org/

Healthy People 2010http://www.healthpeople.gov/

Center for Disease Control and Preventionhttp://www.cdc.gov/

The Virginia Henderson Internet Nursing Libraryhttp://www.stti.iupui.edu/virginiahendersonlibrary/

http://www.americanheart.org American heart association

http://www.diabetes.org American diabetes association

http://www.ocalaregional.com/CPM/ABG%20self%20learning%20module%2006.pdf ABG interpretation assistance

http://library.med.utah.edu/kw/ecg/index.html Learning EKG’s

http://www.aafa.org/ Asthma and Allergies

http://www.lungusa.org American Lung Association


http://www.lungusa.org/

http://www.aafa.org/

http://library.med.utah.edu/kw/ecg/index.html

http://www.ocalaregional.com/CPM/ABG%20self%20learning%20module%2006.pdf

http://www.diabetes.org/

http://www.americanheart.org/

http://www.stti.iupui.edu/virginiahendersonlibrary/

http://www.cdc.gov/

http://www.healthpeople.gov/

http://www.jcaho.org/

http://www.aapainmanage.org/

Policy on Professional Appearance

PURPOSE: The purpose of this policy is to set forth clear expectations for all students of professional appearance, representative of the values of National University. These will be adhered to in any clinical or non-clinical setting where the student is representing National University as part of their nursing coursework.

1. Students will be provided and fitted for four uniform pieces at the Program Orientation Session. Uniforms will have the NU patch sewn on the left sleeve. This is the ONLY acceptable attire for students to wear in the clinical setting, and they must be clean and unwrinkled. Please keep temperature in mind when choosing which uniform pieces you would like since the clinical may be cool. It is recommended that one piece be a jacket. Layers of clothing (such as t-shirts, turtlenecks, underwear) worn under the uniform pieces should not be seen. The only exception to this policy is appropriate, modest clothing dictated/customary by specific clinical agencies of which you will be informed by the clinical teaching faculty.

2. CLEAN, all-white, closed toe shoes and all-white socks (must cover ankles) are to be worn. Clogs must have a strap around the heels. No sandals or flip-flops.

3. A NU picture ID badge will be provided to students at the Program Orientation Session. This badge is to be CLEARLY VISIBLE at all times when the student is engaging in ANY clinical activity (including preparation) in clinical agencies. Some facilities require both school and facility ID badges.

4. Makeup should be applied with moderation.5. All tattoos must be completely covered at all times 6. Artificial enhancement, of any kind (polish, artificial components), to the fingernails is

prohibited. 7. Body scenting (perfumes, splashes, lotions, colognes, etc.) of hair or skin is to be

avoided. Ill patients are often adversely affected by scents. 8. One pair of stud earrings, an engagement/wedding band, and a watch can be worn. NO

OTHER JEWELRY is permitted. There will be no body-piercings or jewelry/hardware permitted at any time.

9. Hair must be kept clean, neat, confined (hair must not fall into the face or bodies of others) and of natural coloring (no purple, blue, maroon, etc). Personal hygiene must be maintained by all students when attending clinical activities. You may be dismissed from a clinical experience if you lack professional, personal grooming (offensive body odors, unclean hair, unkempt uniforms, etc.).

10. During cold weather, over-jackets or raincoats may be worn to facilities but must be stored inconspicuously during clinical hours


STUDENT/FACULTY LEARNING CONTRACT

This contract is to be negotiated between faculty and student in person.Instructor: please print below

Student’s Last Name First Middle Std. ID number

Course Number/Name Class Number Units: 4.5

Date of occurrence: Instructor:

This is to notify you, the student that you are in jeopardy of not successfully completing this course. Listed below are the areas of current deficiency and/or incident leading to the establishment of this learning contract:

Listed below are the corrective actions the student must take and the expected date of completion for each:

Instructor’s Signature Date Student’s Signature Date


Henderson Nursing Department Remediation Policy for Examination Based Assessments:

Policy Statement:

It is the policy of the Henderson Nursing department that students be required to remediate for any exam, quiz or midterm in which they do not attain a grade of 80% or higher. Failure to successfully complete the remediation may result in the student failing the course. Procedure:

1. Remediation may occur for any of the following criteria:a. Student scores below 80 on any quiz or test in a nursing course.b. Student’s clinical instructor refers student to remediation for skills practice.c. Student is referred to remediation for low score on medication calculation test.d. Student self-refers to remediation.

2. Remediation will be assigned by the course faculty and may vary per course as determined by the course lead faculty. The remediation plan will be signed by both student and the instructor.

3. Remediation dates/times will be assigned to the student by the lab coordinator/faculty member and require attendance at the Nursing Lab during scheduled lab hours.

4. Remediation lab hours will be based on the type of assessment that resulted in a score of less than 80%. The final exam is excluded from remediation.

a. Quiz = 2 hoursb. Test = 4 hoursc. Midterm = 6 hours

5. Remediation activities will be focused on the areas in which the student was not successful. Activities may include but are not limited to: ATI practice tests, NCLEX practice tests, assigned course reading, assigned course study guide activities, writing research papers, lab skills performance, and/or simulation lab scenarios.

6. Remediation must be completed within 5 business days or before the end of the course whichever comes first.

7. Documentation of successful remediation will be completed by the Lab Director/ Lead Faculty with a copy to be filed in the student’s file and a copy going to the course instructor.

8. The remediation policy ensures that students have access to Registered Nurse(s) during the remediation time in order to ask questions about course materials. Remediation also ensures that students are utilizing the time to focus on the areas of the course they are having difficulties with.


Student Learning Lab Referral Document:

Student Name: ______________________________ Date: ____________________________Course: ______________________________ Instructor:_______________________________Referral is a response to what kind of student performance?

Grade lower than 80% on quiz, test, assignment, other. Clinical performance Other (Please Describe)________________________________________________________

Learning strengths and preferred learning style: e. g. reading, interactive video, demonstration and return demonstration (Student completes this section):

1. __________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

Content on which remediation should focus (Instructor & Student together):

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

Possible reason for deficiencies if known?_________________________________

___________________________________________________________________

___________________________________________________________________

Other information (if any): _____________________________________________

___________________________________________________________________

___________________________________________________________________

Referring Faculty member: __________________________________________

Student signature:__________________________________________________

Student Contact Information:


Mobile Phone Home Phone Other Contact

Policy on Lateness or Absence From Clinical Laboratory

1. If the student is unable to attend for any reason, the clinical facility, the instructor needs to be notified AT LEAST 30 minutes prior to the scheduled start time.

2. If the student is going to be late for any reason, the clinical facility AND the instructor need to be notified as soon as this becomes evident to the student.

3 If a clinical day is missed because of an excused illness, the student must:1. Obtain a note from a physician or nurse practitioner, dated the day of

the absence and stating the nature of the illness.

2. A written teaching assignment may be given and will be due at the start clinical day the following week. The assignment will be presented to the class at post-conference. Assignments will be tailored to meet student needs.

4. Students who miss more than one day of clinical (whether excused or unexcused)must meet with the clinical instructor and the course coordinator faculty WITHIN 48 HOURS OF THE SECOND ABSENCE to determine if the course objectives can still be met and student is able to satisfactorily pass clinical.


CLINICAL COMPLIANCE:Students are required to have absolute compliance with the following:

A. Students are responsible for assessing their assigned patients and documenting their assessments (within first 90 minutes) at the start of their shift, prior to patient discharge, and 45 minutes before the end of their shift. The instructor may or may not be present for these assessments.

B. Check with the instructor prior to attempting any new procedure. Instructor may ask the nurse preceptor to observe you. Remember to record any new skills or procedures for your electronic journal and on your skills checklist.

C. The instructor or preceptor nurse MUST be present when the student is giving any and all medication, changing or hanging any IV or IVPB. The student is NOT to call a physician or take orders from a physician without instructor present.

CRITICAL BEHAVIORS THAT IMMEDIATELY RESULT IN PROBATION OR POSSIBLE FAILURE OF THE COURSE:

1. Falsifying a client record.2. Blatant disregard of client confidentiality.3. Denying responsibility for ones’ own deviation from standard practice. 4. Continual need of additional guidance, direction, and specific and detailed supervision

throughout clinical rotation.5. Actions that place the client in jeopardy.6. Actions that place the student or a colleague in jeopardy.7. Abusive behavior toward clients.8. Ignoring the need for essential information before intervening.

I have read the above and understand and/or have no questions regarding this.

Student Signature: Date:

Faculty Signature: Date:


General Safety Guidelines for Clinical Experiences

In all clinical experiences students should follow the clinical guidelines presented during each course orientation.

SHARPS: All syringes must be disposed of in red Sharps receptacles provided for that purpose. Syringes should not be recapped after use. If impaled by a sharp, students should notify their clinical instructor AS SOON AS SAFELY POSSIBLE. Students will be referred for medical treatment as outlined for the injury. It is highly recommended that all students receive the complete Hepatitis B immunization series and produce a positive titer prior to beginning their nursing education program. In addition, many of the clinical agencies require Hepatitis B vaccination (or signature of waiver).

EXPOSURE TO SECRETIONS: Prior to every procedure, every student/faculty member is encouraged to wash their hands with soap and water, rubbing the hands together vigorously for 15 seconds. Universal Precautions should always be adhered to.

INJURY DURING CLINICAL EXPERIENCE Any student who sustains an injury during clinical laboratory experiences will be referred to the nearest hospital emergency room or urgent care clinic for immediate treatment. The student is personally responsible for the cost associated with treatment of any injury. It is highly recommended that all students carry personal health insurance.


NATIONAL UNIVERSITYDEPARTMENT OF NURSING

CLINICAL SITE EVALUATIONName of Clinical site____________________________

Core Value

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Sat

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Ab

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Access Parking was easily facilitated for me 1 2 3 4 5

The information I needed to care for my patient(s) was readily accessible to me

1 2 3 4 5

I could easily locate and utilize the resource information needed to care for my patient

1 2 3 4 5

The nursing staff were available to me 1 2 3 4 5

Other members of the health care team were available to me 1 2 3 4 5

Relevance My experiences brought to life the theory covered in the classroom 1 2 3 4 5

I performed clinical skills new to me this semester 1 2 3 4 5

I was able to build on knowledge gained in previous coursework through this experience

1 2 3 4 5

I gained a better understanding of my role as a nurse 1 2 3 4 5

Values My experiences with patients here fostered my personal growth 1 2 3 4 5

My experiences here with other members of the health care team fostered my growth

1 2 3 4 5

I felt comfortable expressing my opinions 1 2 3 4 5

My experience reinforced my quest to join the nursing profession 1 2 3 4 5

The nursing staff demonstrated professionalism 1 2 3 4 5

Quality Compared to other clinical sites, I rate this site as 1 2 3 4 5

I was actively engaged and involved while at this site 1 2 3 4 5

My orientation prepared me to adequately assume patient care duties 1 2 3 4 5

I felt I was in a safe environment, providing care safely 1 2 3 4 5

I had the time to do what I needed for my patient/assignment 1 2 3 4 5

Community The people here made me feel like a valued team member 1 2 3 4 5

I participated in report, rounds, patient care conferences on a regular basis

1 2 3 4 5

I functioned as a member of a multi-disciplinary team 1 2 3 4 5

Month/Year attended ___________________________ Course Name: Med/Surg IPage 2 of 2


What else would you like the clinical facility or the National University Department of Nursing to know about your experience in this facility?

Please comment on anything you rated 1 of 2 on the previous page’s rating scale:


CLINICAL EVALUATION TOOL NSG 205 A

Student Name: ______________________________ Instructor: _____________________

* Mid = ~1/2 way through course * IP = In Progress* P = Progressing* NI = Needs Improvement

* Final = at the end of the course * U = Unsatisfactory* S = Satisfactory

Objective Mid Final

Demonstrates beginning ability to use nursing process in patient care.- Collects data accurately, using the human needs approach.

- Selects appropriate nursing diagnosis for problem.

- Organizes plan of care.

- Implements basic care safely and effectively.

- Has beginning skills in priority setting and goal directed behavior.

- Completes care for a patient within allotted time.

- Long Form Nursing Care Plan (due week seven)

Applies theory to clinical situations in providing safe, standardized care to patients.

- Demonstrates ability to apply concepts to clinical situations.

- Verbalizes understanding of patient situation and routine care required.- Performs required clinical skills according to critical requirements.

- Demonstrates ability to implement standardized, routine care to patients.- Able to identify at least three cultural variations related to health care beliefs and practices.- Recognizes patient and family/significant others’ responses to impact of illness, hospitalization and treatments.Demonstrates beginning applications of teaching-learning principles. - Identifies patient knowledge/lack of knowledge.

- Provides simple explanations and reinforces previous instructions.

- Report patient response to instructions.

-Utilized beginning communication skills with peers, patients and staff.

- Effectively uses beginning communication skills in interaction with others.- Recognizes and reports pertinent observations promptly.

- Documents care according to hospital protocol, e.g., SOAP format.

- Records accurately on proper forms.

Demonstrates increasing self awareness and behavior consistent with personal and professional development.


- Reports promptly to clinical lab for pre- and post- conferences.

- Is prepared for clinical lab.

- Uses instructor feedback constructively in subsequent behaviors.

- Identifies goals and objectives and seeks learning experiences to achieve them.- Identifies specific experiences in clinical laboratory which are needed to accomplish learning objectives.- Utilizes these experiences in clinical practice, seeking assistance where needed.- Shares learning experiences during pre- and post- conferences.

- Evaluates own growth by completing weekly evaluation forms.

- Accepts responsibility for own actions/inactions as a student member of the health team (includes adherence to agency policies and procedures).

Mid –Term Student Comments:

Mid-Term Faculty Comments:

End of Course Student Comments:

End of Course Faculty Comments:

Faculty Signature/Date_____________________ Faculty Signature/Date_______________________Midterm Midterm

Student Signature/Date_____________________ Student Signature/Date_______________________Final Final


INTERPERSONAL SKILLS FOR STUDENTSNURSING PROGRAMS

NATIONAL UNIVERSITY

_____________________________________ ________________________STUDENT NAME ID#__________________________________ ________________ _________________FACULTY NAME TELEPHONE E-MAIL______________________________________ _____________ ____________LOCATION COURSE CLASS#

Please use the following key:

0=Not Observed 1=Inadequate 2=Below Average 3=Average 4=Above Average 5=Excellent

The student:

1. Maintains appropriate eye contact when speaking with adult 0 1 2 3 4 5 clients.

Comments ______________________________________________________________

________________________________________________________________________

2. Restates content of communication accurately from: Peers 0 1 2 3 4 5 Instructors 0 1 2 3 4 5 Adult Clients (role-play) 0 1 2 3 4 5

Comments ______________________________________________________________

3. States interpretation of verbal communication accurately from:

Peers 0 1 2 3 4 5 Instructors 0 1 2 3 4 5 Adult Clients (role-play) 0 1 2 3 4 5

Comments ______________________________________________________________


4. States interpretation of non-verbal communication accurately from:


Comments ______________________________________________________________

5. Maintains caring, non-judgmental and appropriate language within the communication with:


Comments ______________________________________________________________

________________________________________________________________________

6. Asks open-ended questions in communicating with adult clients and health care professionals.

0 1 2 3 4 5 Comments ______________________________________________________________

________________________________________________________________________

7. Demonstrates sensitivity to cultural components of communication when interacting with adult clients and healthcare professionals.

0 1 2 3 4 5Comments________________________________________________________________

_________________________________________________________________________

8. Asks questions in class that indicate clarity of perception and appropriate interpersonal skills.0 1 2 3 4 5

Comments ______________________________________________________________

________________________________________________________________________

9. Responds to feedback in class in a constructive manner.

0 1 2 3 4 5

Comments ______________________________________________________________

________________________________________________________________________


10. Changes problematic behavior appropriately in response to feedback in class.

0 1 2 3 4 5 Comments ______________________________________________________________

________________________________________________________________________

11. Participates actively and constructively in class discussions and exercises.

0 1 2 3 4 5 Comments ______________________________________________________________

________________________________________________________________________

12. Discusses personal material in class in a way that is appropriate to course activities, course format, and instructor directions.

0 1 2 3 4 5Comments ______________________________________________________________

________________________________________________________________________

13. Takes responsible action to process emotionally provocative material presented in class.

0 1 2 3 4 5 Comments ______________________________________________________________

________________________________________________________________________

14. Demonstrates honesty in academic performance.

Yes NoComments ______________________________________________________________

________________________________________________________________________CLARIFICATION ON ANY BELOW AVERAGE AND INADEQUATE SCORES

___________________________________________ _________________FACULTY SIGNATURE DATE


CLINICAL ASSIGNMENTS CHECKLISTThis worksheet is for tracking your progress.

Please review weekly and submit to your clinical instructor at the end Assignment Date Completed

NAME

Completion of clinical site orientation documents

Orientation of clinical site

OR/PACU Observation

Endoscopy Observation

Interventional Radiology Observation

Map #1

Map #2

Map #3

Map #4

Map #5

Map #6

Map #7

Map #8

Map #9

Map #10

Map #11

Map #12

Map #13

Map #14

Midterm: Evaluation Tool

Nursing Care Plan-Long Form w/ Leininger’s Model

Submit completed Site Evaluation Form /Interpersonal

skills

Final: Evaluation Tool


PRINCIPLES OF MEDICATION ADMINISTRATIONMedication Room

Check medication sheet and compare with the medication provided by the pharmacy. Confirm that the patient’s name, medication, dose, and route concur.

The Physician order is checked with the medication sheet prior to 1st administration. A new MAR (Medication Administration Record) is generated every 24 hours. The staff nurse verifies the MAR is correct and initials the MAR before it can be used.

If a medication range is provided (e.g. with pain medications), select the lowest dose and greatest time range offered that is reasonable for the patient’s condition.

Confirm with the instructor that your calculations for the medication, IV dilution and IV rate are correct.

Many oral drugs are affected by meals. This information should be taken into consideration when administering oral medications.

Medications should not be crushed (i.e. enteric coated tablets) unless crushing is specified as appropriate.

Patient’s Room The medication sheet is taken to the patient’s bedside to confirm identity by comparing the ID

bracelet # against the Medication Administration Record for full patient name and hospital medical record number.

Check the 8 rights of drug administration:o Right Patiento Right Drugo Right Doseo Right Routeo Right Timeo Right to know the purpose drug/adverse effectso Right of patient to refuseo Right documentation on the MAR

Administer medication to the patient using the appropriate administration technique. Remain with the patient until the medication is administered or the infusion has started. Don’t aspirate for blood when giving insulin or heparin subcutaneous. If blood is aspirated with an IM injection, withdraw needle and discard medication.

Monitor Response of Medication Monitor the patient for the effectiveness of therapy/adverse reactions. Any detrimental response to a medication or medication errors must be reported immediately. Notify the physician regarding the medication error/detrimental response

Note: The following drugs are not to be administered by the student:

o Chemotherapeutic Agentso Any drug which the clinical instructor chooses not to administer


Nursing Assessment of the PatientPhysical AssessmentVital Signs/Circulation and Oxygenation

Apical Heart Rate: _____per minute Rate regular _________ BP_______Respirations: ________ per minuteTemperature_______ via ________routePatient’s state when vital signs assessed:__________Monitored patient? Skin color… Extremity temperature warm to … No edema Nailbeds pink Capillary refill brisk at <3 sec Peripheral pulses equal, palpable and of normal character (+/_, equal, quality)

____________________________________Chest inspection Cough present __________Secretions ___________Breath sounds clear and equal ______________________ Adventitious sounds auscultated _____________________________Pulse oximetry ordered Oxygen saturation readings: ____________Respiratory distress

Accessory muscles of respiration used Nasal flaring Chest expansion ________________________________

Supplemental Oxygen______Suction at bedside Bag/mask at bedside Respiratory treatment ________________________________________Chest tube ______________Drainage _________________

Neurological/Mobility

PERRLA - Pupils equally round and reactive to light and accommodationOriented to person place and timeMoving all extremities equally? Full ROM Equally strong hand grips/feet strength Able to ambulate: No supportive/assistive devicesAbsence of joint/extremity swelling and tenderness No gross muscular atrophy No deformities

HEENT Normocephalic No purulent eye drainage Pupil Response No ear drainage +-Nasal breathing comfortable/nares patent No oral lesions Swallow appears intact Dental Hygiene

GI/GU No pain on urination Discharge Urgency Frequency Hematuria Unpleasant odor Foley catheter Bladder non-distended No unusual voiding pattern or character of urine No unusual discharge Abdomen- BS present x 4 quadrants Quality__________________________ Abdomen soft/non-distended No pain on palpation Active bowel sounds Stool pattern ___________ Stool color/consistency


__________________No unusual bowel patterns, character or odor

Nutrition/Fluids & Electrolytes

Weight (kg) ____________ Diet: Regular NPO Clear Liquids Full liquids Diabetic Other Type:_____________________P.O: Solids Soft Self-feeding Assisted feeding Food Allergies______________________________________ Unexplained weight changes? Y/N _____________________________Tube feeding: N/G tube Gastric tube Continuous Feed Bolus feed TPN _________cc /hr Lipids ________cc/hr IV type:___________Rate/hr:_______ Rate/24 hours _______ IV site without redness, swelling, leaking at site, and checked hourly Minimum hourly output:________ Shift I & O _______________________Mucus Membranes moist Lab values of note:__________________________Skin Tugor ______________________________________

Skin Color WNL for patient’s race No unusual pigmentation No rashes

No contusions/abrasions/decubiti. Mucous membranes moist/pink

Skin warm, dry and intact. Normal turgor Birthmarks lymph nodes

Comfort No pain Patient’s pain level: FACCS score:___________ Smiley face system:______ 1-10 scoring system:______Document duration, location, behaviors, exacerbating factors:____________________________________________________________________________Pain management interventions:_____________________________________Pain score post-intervention:________Patient usual comfort measures:_____

Sensory (Vision/Hearing)

No hearing or visual deficits reported or assessed Visual or hearing deficits :___________________________________________

Autonomy / Self-Care

Patient’s level of self-care: ____________________________________________Self-care developmentally appropriate for age? Yes NoGrooming/hygiene – infant/child dressed appropriately for hospital conditions

Sexuality Sexually active: Y/N Use of contraception/STI precautions_____Information: safe sex /abstinence provided/referred to another professional? No irregular discharge assessed Complete assessment deferred

Safety / Security

ID Band Checked Bed rails up Activity Level __________ Patient oriented to call light and within reachPrimary caregiver present Interactions:____________________________

Cultural, Family & Social Dimensions


Cultural Background Ethnicity:_____________________

Significant OthersSelf-Esteem /Belonging

Primary caregiver presentSibling, friends or other relatives presentSocial worker involved in case Family History - list any major events, include any significant info on medical, psychiatric, intellectual and emotional functioning:_______________________________________________________________________________________________________________________Current Situation: Does the family have support systems in place to cope with this hospitalization? ________________________________________________Significant family dynamics: ___________________________________

Values & Beliefs/ SpiritualityHealth Practices

Spirituality/Special beliefs or health practices held by family that impact this hospitalization. ___________________________________________________

Political & Legal Factors

Legal Consent Person Notified/available Court hold in place Describe situation _____________________________Patient/ Family Immigrant

Economic Factors / Patient/ caregiver requires Social Work referral related to economics, transportation issues or other family stressors Financial issues

Educational Factors Patient’s Education: grade ________ success/failure in studies ________ Formal educational assistance provided in hospital

Language & Communication

Primary Language: ______________ Understands English Patient/family communicates such that health care team can meet needs Primary caregiver communicates patient/family needs appropriately Special communication concerns or issues:_______________________________________________________________________________________Non-verbal communication:_______________________________________

Patient Teaching Patient teaching done this shift:_____________________________________________No physical, emotional, cognitive, language, cultural barriers to learning assessed Learner’s priorities consistent with teaching plan Learners are available, motivated and ready to learnPrimary caregiver appears to be knowledgeable with home care regimen required post-hospitalization


Concept Map Worksheet

Student ___________________________ Date of Care_________ Pt. Age _____ Gender ____

Diagnosis/Past Medical History ___________________________________________________

Family/Cultural/Ethnic Considerations______________________________________________

Summary of Admission History and Progress Notes:

Pathophysiology:

Lab Data and Diagnostic Tests:

Medications with therapeutic actions intended for patient:

Treatments/Therapy:



N.Dx:

S/S:

Goal:

Interventions:1.

2

3.

4.

5.

Evaluation:

Concept Care MapN.Dx:

S/S

Goal

Interventions:1.

2.

3.

Evaluation:

Diagnosis:

Vital Signs:

Time BP Pulse Resp Temp



Procedures:

Pertinent labs:

N.Dx:

S/S

Goal

Interventions:1.

2.

3.

Evaluation:

Clinical Instructor Care Map Evaluation CriteriaCriteria S NI U Comments

Clinical Preparation1. Complete review of patient’s chart and

Kardex information 2. Describe the admission history,

pathophysiology of the disease and labs, tests and therapies for the patient

3. Complete medication information. Describe the therapeutic use for your patient.

Map5. Identify and Prioritize 3 top nursing diagnoses. The #1 nursing diagnosis should be in the right column. May include education6. Identify physical, educational and/or psychosocial assessment data to validate selection of nursing diagnoses (AEB)7. Identify appropriate Short term goals (ST) for the patient that may be achieved during the shift. Long term goals (LT) achieved by end of Hospital stay at discharge.8. Identify specific interventions for each of the nursing diagnoses 9. State outcomes noted during the shift when evaluating the interventions. Use proper terminology and spelling.10. Complete Vital Signs and Focused assessments. Provide an initial assessment and a second assessment.

11. Evaluate Care Map What needs revision? Is #1 diagnosis still #1?


WEEKLY JOURNAL ENTRIES:

To record your clinical experiences please send an email within 24 hours of the clinical experience to your clinical instructor.

Daily Clinical Electronic Journal Requirements

Date:

Student Name:

Clinical Unit & Assigned Nurse Mentor:

Clinical Faculty:

Clinical Objectives for Today's Experience or "Why did I come here today? What do I want to learn?" (To be identified prior to arrival at the clinical setting - attainment of these objectives is what you address in your journal entry for the day.)

1.

2.

3.

4.

Clinical Procedures Observed Clinical Procedures Performed

Your reactions to the setting, staff, client(s) and care you observed or provided. How did you feel? (positive or negative comments)

NSG 205A July-August 2011

Nursing 205AOperating Room Observation Experience

Post-Anesthesia Care Unit Observation Experience*Please note, not all students will have this opportunity*

Objectives:During this experience the student will:

1. Observe a major surgical procedure such as: open heart surgery, aortic aneurysm repair, cerebral aneurysm repair, craniotomy, neurosurgical procedures, major abdominal surgery, major vascular surgery, extensive orthopedic surgery.

2. Identify potential complications for a patient undergoing major surgery.

3. Identify two Nursing Diagnoses for a patient who has undergone extensive surgery.

Guidelines:

1. Review NSG 200 material on care of the Perioperative Patient including the effects of anesthesia, induction stages and reversal the night before your assigned rotation.

2. Be sure to eat a healthy breakfast the morning of your rotation. This observation requires wearing a mask and standing for long period of time.

3. Report to the OR Nurses’ Lounge AT LEAST 10 minutes before shift to change into OR attire. Do not bring valuables that you cannot put into your OR scrub pocket.

4. Change into appropriate OR attire:a. OR Scrubsb. Head Cover – all hair must be covered, including facial hair for menc. Shoe covers – at all times when past the lounge inside the OR corridorsd. Mask – must be over your face when in the OR observing the surgery.

5. Report to OR desk; ask for charge nurse who will direct you to personnel, OR suite, patient to follow.

6. Circulating Nurse for the OR Suite will direct you to the best and safest position. Avoid unnecessary conversation or movement during the observation. If you start to feel “badly” say something to someone and leave the room.

7. Remember the sterile field principles – do not touch anything sterile, including the patient once she/he is draped.


8. Report to Circulating Nurse if you need to leave the room for any reason. Acceptable reasons to leave include: restroom, meal break, end of shift, feeling ill, emergency call.

9. Accompany patient to PACU following surgery if time permits. Observe and perform assessment of the patient during recovery from anesthesia as allowed by RN with whom you are working.

10. Write an evaluation of the experience and submit in the electronic journal to your Clinical Instructor. Include the following:

a. about the type of surgery and the patient outcome(admitted to floor, ICU or dc’d home)b. two Nursing Diagnoses that you identified relevant to the patient surgery you observedc. what did you observe about the patient’s recovery from anesthesia.

*Please note that not all students may have the opportunity to have this experience during this clinical course.

Your Safety in the Operating Room

Your safety is very important to us! Please follow these guidelines.

Required Personal Protective Equipment1. You must wear a mask with an attached protective shield or a mask and a separate protective eye shield. The eyewear is mandatory for your protection. The illustration shows a scrubbed individual.

2. Masks must be worn in the rooms whenever sterile supplies are opened. Several types are available. They tie at the nape of the neck and at the top of the head. All have a metal strip at the bridge of the nose that you bend to prevent fogging.

Environmental Hazards and Your Safety:1. Stand at ease while observing and avoid locking your knees for long periods of time. It’s rare

(especially if you’ve eaten), but if you do feel faint, step back and sit down. The RN you are with will help you.

2. Beware of wet floors as you pass by the scrub sinks and walk carefully. 3. Beware of cords on the floor in the operating room, especially in rooms darkened for scope

procedures.4. In case of injury:Inform the circulating RN of the injury and receive immediate first aid (e.g.

eyewash station, thorough hand washing, band-aid) In the unlikely event of a sharps injury take the time to wash with soap and water

immediately A splash injury is also unlikely, especially if you are wearing the mandatory eye

protection, but if that occurs the RN you are with will immediately show you to the eye wash station in the utility/instrument room or shower in the locker room if applicable.

You will be asked to supply the information needed to fill out an occurrence report.


Consult with your instructor regarding further assessment and treatment.

What to do in Case of an Emergency:1. Continue to shadow the RN you are with.

If it is a patient emergency, step back out of the way and quietly observe. Save up any questions you have for after the crisis has passed and things have calmed.

In the case of a major disaster and/or possible evacuation, assist only as requested and follow the instructions of the RN you are with.

2. Each operating room contains: Fire extinguishers Code/emergency button Emergency flashlights\emergency back-up power

3. Fire response: In case of a fire, step back out of the way and quietly observe and assist only as requested. Rescue, Alarm (panic button in room), Contain, Extinguish or Evacuate There are fire extinguishers in each operating room and PACU. There are fire pulls located near each double door department exit Fire extinguishers are located along each hallway There are eight doorways leading out of the interior of the department along two walls.

The other two walls of our rectangular department have no exits. All evacuation routes are horizontal.

OR ETIQUETTE AND EXPECTATIONS

1. The circulating RN is your immediate supervisor while in the room. You may quietly ask questions of the RN at times when he/she is available. You will have to use your good judgment to determine the timing of your questions, e.g. avoid times when they appear too busy with patient care.

2. HIPAA reminder – Please remember not to discuss any confidential patient information outside the operating room. You may discuss generalities in your post observation conference with your instructor.

3. Infection control practices for you to follow: Traffic in and out of the room is kept to a minimum once sterile supplies are opened Non scrubbed people must stay at least two feet away from any of the sterile supplies

(usually blue or green) unless positioned at the head of the bed. If standing at the head of the bed, treat the (ether screen) tented area as a window and do

not lean into it or over it. Use good hand washing before and after each patient observation. Yours will be a non scrubbed observation only. There will be no patient care participation

since you’re not versed in sterile technique.4. Conversation:

Is limited, with quiet tones only.

Too much conversation may slow the surgeon down or disturb their focus and we try not to prolong patient anesthesia time.

You’ll see a little more talking prior to the incision and again during closure.


We use a lot of nonverbal communication.

OPERATING ROOM BASICS

Patient Flow1. There is an initial two-part process: Scheduling the procedure and registration of the patient.

The physician (or office) provides the patient identifiers and schedules the procedure in detail with equipment and special supplies needed. Universal protocol begins here and factors into every step of the peri-operative process.

The information is used to begin the registration process (entering the patient into our computer system. Their chart is assembled and the information in the computer is verified with the family/guardian. Financial issues are addressed.

From there they are directed to one of two pre-assessment areas and waiting rooms: 2. A Pre-Op RN interviews the patient in the pre-assessment area in order to determine patient

readiness for surgery. Baseline vital signs are documented.3. Three additional interviews will occur with the Surgeon, Anesthesiologist and circulating RN

from the operating room. Universal protocol continues with verification of the correct patient and correct procedure including side/site. The patient surgical site will be marked if applicable.

4. Once everyone is satisfied that the patient is ready and all consents have been signed, they proceed to the operating room.

5. Once in the room, many precautions are taken to prevent injury and prevent infection, examples: The patient will be properly positioned with appropriate safety straps used. The chosen form of anesthesia will be carried out. A final “time out” will occur and is part of the universal protocol for patient safety. The surgical site will be prepped and draped with sterile drapes and the surgical procedure

will begin.6. When the surgery is finished the patient is transported by gurney to the PACU. Patient

identification will be verified.

Team Members in the Operating Room1. Physician performing the procedure – May be assisted by other physicians including Fellows or

residents, physician assistants (PAs, ortho techs) “Surgeons”: General, Cardio-Thoracic, Craniofacial, ENT, Neuro, Ortho, Opthalmologist,

Plastics & Reconstructive, Transplant, Trauma, Urologist, Vascular and Oral Surgeons, Dermatologists

Gastroenterologists2. Anesthesiologist – May be assisted by anesthesia residents. We also have many visitors to our

Anesthesia department for intubation experience, e.g. paramedic interns, ALS nurses and residents. May utilized local with sedation, general, spinal, regional block anesthetics.

3. Registered Nurse – Usually functions as the circulator, but may scrub in when needed. The circulating RN applies the nursing process with the O.R. patient and is responsible as a patent advocate to prevent infection and prevent injury. They keep an eye on the total picture and complete the required documentation, which includes a care plan. They coordinate the positioning of the patient and prepping of the surgical site.

4. Surgical Technician (scrub person may also be an RN) – Sets up and maintains the sterile field. Assists Surgeon with instrumentation during the procedure. Graduate of a 1-2 year surgical technician program.


5. The above roles are always present. As needed, you will also see Ortho Techs (cast and traction applications), Laser Techs, Perfusionist for open heart procedures, Cardiovascular Techs (Cell salvage), Evoked Potential Technicians (monitor nerve response during spinal procedures).

6. Charge Nurse – Coordinates the entire effort. “Runs” the board and takes care of logistics.7. Service Coordinators and Lead Techs – Are assigned to the many subspecialties. They are our

resident clinical experts/mentors and help to coordinate their service and ensure that the procedures go smoothly.

8. There are also many other team members working behinds the scenes.

PACU GENERAL ORIENTATION

Here are a few notes about rotating through the PACU as a student.

1. If arriving with a patient in PACU, the circulating RN from the OR will introduce you to the PACU nurse.

2. If arriving directly to the PACU, please ask for the PACU charge nurse and introduce yourself; and he/she will then introduce you to your preceptor.

3. Please wear scrubs, or your approved student nurse uniform, and ALWAYS have your name badge on and in a visible location. Your shoes should not have an open toe, and heels/soles should be less than an inch high.

4. Keep in mind that we transport a lot of patients from PACU. You may be asked to assist with pushing gurneys or lifting patients. Please inform your preceptor if you have any health conditions that would preclude you from being able to safely perform these activities.

5. As a student, your PACU preceptor may involve you in many aspects of patient care including but not limited to nursing assessments, vital signs monitoring, managing drains, transporting patients, and bedside care. You should not attempt to perform any nursing interventions without your PACU preceptor’s permission. You will not be permitted to administer medications while rotating through the PACU.

6. In the event of an airway emergency or code blue in the PACU, please step back and observe. It will be an important learning experience for you, so try to remain in the area.

7. X-rays are often taken in the PACU with a portable X-ray machine. Be sure to stand at least 6 feet away from the machine when the films are being shot. Lead aprons are available if you are assisting with patient positioning during an X-ray.

8. As always, please be considerate of patient privacy and protect your patient’s rights at all times. It is prohibited to discuss patients in public areas including the elevators. You may only access patient information that is relevant to that patient’s care. Please do your best to keep the noise level down for patients and keep curtains closed when possible so that patients do not feel exposed.


Nursing 205AEndoscopy Observation Experience

Objectives: During this experience the student will:

1. Observe a procedure in the endoscopy suite including patient preparation, and patient recovery

2. Identify any untoward effects of the procedure on the patient, including psychosocial effects on patient and family.

3. Identify at least two Nursing Diagnoses related to a patient undergoing a specific procedure.

Guidelines:

1. Report to Endo Nurse who will direct you to personnel, procedure room, and patients.

2. Interview the patient at an appropriate time to determine the need for the procedure.

3. Interview the family / significant others of the patient (if available).

4. Do conduct any teaching for patients and family members; be sure to properly document per department / hospital policy.

5. Do NOT administer medications.

6. Do NOT perform procedures with which you are not familiar (i.e. non-invasive blood pressure is ok). In this instance you must be supervised by the instructor as per hospital policy.

7. Write an evaluation of the experience and submit in the electronic journal to your Clinical Instructor. Include the two Nursing Diagnoses that you identified relevant to the patient who’s procedure you observed.



Nursing 205AInterventional Radiology Observation Experience

Objectives: During this experience the student will:

4. Observe a procedure in the interventional radiology suite including patient preparation, and patient recovery

5. Identify any untoward effects of the procedure on the patient, including psychosocial effects on patient and family.

6. Identify at least two Nursing Diagnoses related to a patient undergoing this procedure.

Guidelines:

8. Report to IR Nurse who will direct you to personnel, procedure room, and patients.

9. Interview the patient at an appropriate time to determine the need for the procedure.

10. Interview the family / significant others of the patient (if available).

11. Do conduct any teaching for patients and family members; be sure to properly document per department / hospital policy.

12. Do NOT administer medications.

13. Do NOT perform procedures with which you are not familiar (i.e. non-invasive blood pressure is ok). In this instance you must be supervised by the instructor as per hospital policy.

14. Write an evaluation of the experience and submit in the electronic journal to your Clinical Instructor. Include the two Nursing Diagnoses that you identified relevant to the patient who’s procedure you observed.




Guidelines for Using the Nursing Care Plan Form

This form can be used by all Nursing courses at the discretion of the Nursing Faculty. Remember to complete all sections and submit your care plan according to your Course Coordinator’s preferences. The form is an MSWord document, using tables for the various sections (diagnoses, medications, orders, etc.). You can type your information directly onto the form on your computer. Remember that the form will expand as you type, and you can re-format as needed.

Guidelines:

1. Be sure to put your name, course and date submitted at the top of the form.

2. Identification of the patient should include only the room number, age, sex and date or dates of care. No other specific identifying information should be included such as initials, names, nick-names. This is to ensure maintenance of HIPPA regulations.

3. Medical Diagnosis(es): Include all of the medical diagnoses for the patient. Include a concise description of each diagnosis. Be sure to cite reference.

4. Surgical Diagnosis(es): Include any surgeries the patient undergoes and include a concise description of each surgery. If the patient has not had any surgeries, note this on the form.

5. Medications: Include the medications that are current for the day(s) you care for the patient.Name: generic and trade name if included; i.e. acetaminophen / TylenolClassification: general grouping of the medication; anti-inflammatoryAction: the mechanism by which the medication worksRationale: the reason this patient is receiving this medication. Cite reference source.Major side effects: side effects that are specific and unusual for this medicationNursing implications: specific nursing care you will do for this patient taking this medication

6. Treatments and Special Orders: Include nursing and physician orders in effect for the day(s) you care for the patient. The rationale should address why this patient needs this treatment / order. Cite reference source.

7. Physical Assessment: Enter your findings. Be complete and concise (may be written in narrative format).

8. Cultural & Social Dimensions: Use Leininger’s Theory of Culture Care Diversity and Universality as a background. Interview your client to obtain information.Cultural background: what culture does the patient associate with; this will be different from ethnicity and raceSignificant others: who are the important persons in the patient’s life; who are part of the


patient’s support system

Values & Beliefs: what does the patient believe about health and illness; what are the patient’s usual health practices (i.e. home remedies, special healing practitioners); are there any cultural factors/remedies that the patient usesSpiritual practices: what are the patient’s spiritual practices; what does the patient say is important to her/him; does the patient practice an organized religion, or no religionEconomic factors: how does this illness impact the patient economically, does the patient have insurance for this hospitalization; what is the patient’s occupation, family rolePolitical / Legal factors: what political or legal factors influence this illness and the ability of the patient to regain healthEducational factors: what educational and/or learning information does the patient believe is important for you to know about her/himLanguage & Communication: what language and/or communication issues does the patient state as most important to her/him; what language does the patient to prefer; what verbal and non-verbal communication patterns do you observe or experience with this patient.

9. Nursing Care Plan: Develop a plan of care for your patient using the 5-column format. Be sure to match the elements of each column with its respective nursing diagnosis, and individualize the elements to your patient. Nursing Diagnoses: (minimum 4)Based on your assessment, formulate nursing diagnoses using the NANDA approved list; choose diagnoses most appropriate for your patient; list the diagnoses IN ORDER OF PRIORITY (most important / critical 1st, etc)Patient Goals: Long Term – what the patient should accomplish by the end of the hospitalizationShort Term – what the patient should accomplish by the end of the time you are caring for them (your shift). The goals should be measurable and objectiveNursing Interventions: This will contain the plans and implementations based on one of the three Transcultural Care Modes of Decision and Action identified by Leininger. Be realistic

10. These include:-culture care preservation/maintenance – those nursing actions and decisions that help the patient maintain her/his care values while recovering from illness, dealing with a new handicap, or dying (maintain sense of self)-culture care accommodation/negotiation – those nursing actions and decisions that help the patient adapt to the health care environment and/or negotiate with the health care team for meaningful and beneficial health care outcomes within her/his beliefs (work with others)-culture care repatterning/restructuring – those nursing actions and decisions that help the patient reorder, change or modify her/his life for a new, different or beneficial health care outcome (change their life)Scientific Rationale: What is the reason for this intervention for this patient? The rationale must be referenced. Cite reference source using the correct APA format.Evaluation/Revision: Did the patient meet the short term goals? If the answer is yes then explain and no revision is needed at this time. If no explain and address revision.

11. Reference List: On a separate page, using the APA format, include a list of the references used in your care plan.


Student Course Date Submitted

NURSING CARE PLAN

Pt Rm # Age Sex Date of care

Medical Diagnosis

Surgical Diagnosis

Medications:Name / Classification Action / Rationale Major Side Effects Nursing Implications

Treatments and Special Orders:Order Rationale


Nursing Assessment(must be written in a narrative format )

Physical Assessment:Oxygenation / Circulation(Cardiopulmonary/Skin)Fluids & Electrolytes(Endocrine)Nutrition(GI/GU/Skin)Elimination(GU)Comfort(Musculoskeletal/Neuro)Mobility (Neurological/MS)Safety / Security(Neuro/MS)Self-Esteem / Belonging(Psychosocial)Autonomy / Self-Care(Neuro/Psych)Sexuality(Reproductive)

Cultural & Social Dimensions: Cultural Background

Significant Others(Family/Friends/Neighbors)Values & Beliefs / Health PracticesSpiritual Practices

Economic Factors / OccupationPolitical & Legal Factors

Educational Factors

Language & Communication


NURSING CARE PLANNursing Diagnoses Goals: Long

Term / Short TermNursing Interventions &Transcultural Care Modes of Decision and Action

Scientific Rationale Evaluation / Revision
