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NRSG 441 9.2009
NRSG 441 ADVANCED ADULT
HEALTH
Bachelor of Science in Nursing
Spiritual
Service
Spiritual
Growth
Personal
Growth
Personal
Change
Agent
Moral
Professional
Growth
ONU
Nurse
Leader
Professional
Life-Long
Learner
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NRSG 441 9.2009
CONTRIBUTORS
The following individuals contributed to the completion of this
course of study:
Susan Draine, MSN, CNS, CCRN, MBA, Doctoral Candidate
Associate Professor
Department of Nursing
Olivet Nazarene University
September 2007
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NRSG 441 9.2009
NRSG 441 ADVANCED ADULT HEALTH
Statement of Faith
“As an educational enterprise of the Church of the Nazarene, we
pursue truth in order to glorify the God and the Father of our Lord
Jesus Christ: praying for the coming of the spirit; remembering
the promise of Scripture and tradition; keeping our hearts
faithfully attuned to the voice of God; and being thoughtfully,
acutely, and critically engaged.” 2002-2004 Catalog.
Bourbonnais, IL: Olivet Nazarene University.
COURSE DESCRIPTION/OVERVIEW
This course focuses on a study of critical and crisis situations across the life span. Emphasis is
given primarily to the individual, but the impact of crisis on the family is also discussed.
COURSE LEARNING OUTCOMES
Upon completion of this course, the learner will be able to:
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Examine dynamics of complex issues prevalent in healthcare organizations as they relate
to patient outcomes.
Analyze the salient dynamics and complex issues prevalent in organizations that provide
healthcare services.
Apply previously acquired knowledge to case study to conceptualize strategies that will
produce positive patient outcomes.
Collaborate with colleagues to analyze and propose solutions to complex case study in a
virtual learning experience.
Conduct peer review case study presentations.
Design a case study for use in developing leadership.
COURSE MATERIALS
Required Textbooks:
Melander, S. (2004). Case studies in critical care nursing (3rd ed.). Philadelphia, PA: ElsevierSaunders.
Urden, L., Stacy, K., & Lough, M. (Eds). (2006). Thelan’s critical care nursing: diagnosis and
management (5th ed.). St. Louis, MO: Elsevier-Mosby.
Supplemental Resources:
Publication Manual of the American Psychological Association
Course Textbooks, articles, and access to blackboard will be made available to the learner.
Assignments may include discussion topics, individual assignments, and projects. Specifics are
outlined in the course syllabus.
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NRSG 441 9.2009
Special Requirements:
Internet Access
Microsoft Office 2007 Software
Completion of the Online Blackboard Training Student Classroom is required.
COURSE ASSIGNMENTS/ASSESSMENTS
Student learning outcomes will be fostered and assessed in a variety of ways through this course.
As best practice suggests, assessment will be formative and summative and will include the
application of acquired course knowledge to real world practice settings. This course will include
the following:
WEEKLY DISCUSSION POSTINGS
WRITTEN ASSIGNMENTS
CUMULATIVE PORTFOLIO
Assignments
Points
Discussion
The discussion assignment each week may be online or on
ground
6 @ 5 points
(Refer to the class instructor for discussion preference if not an
each week
online course)
30
Discussion Rubric is applicable for either online or on ground
participation requirements
Internal External Threats Assessment
DUE WEEK 3 – DAY 3
15
Case Manager Interview
DUE WEEK 3 – DAY 7
30
Reflection Paper
DUE WEEK 6 – DAY 3
25
TOTAL COURSE POINTS
100
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NRSG 441 9.2009
WEEKLY WORKSHOP TOPICS
WEEK 1:
WEEK 2:
WEEK 3:
WEEK 4:
WEEK 5:
WEEK 6:
COORDINATOR OF CARE
CAREGIVER
CONTINUING CARE PLANNER
EDUCATOR
ADVOCATE
CHANGE AGENT
STUDENT ATTENDANCE
Students are to communicate directly with the course instructor regarding any circumstance that
may result in absence of course participation. Course participation is met through discussions in
class and/or postings and submission of assignments by the required due date. Due to the nature
of some discussions, instructors may not allow students to post in advance or in retrospect to
discussions due to absences. Students with an unexcused absence will receive a 50% grade
reduction for any assignment submitted during that week.
RNBSN ACADEMIC INFORMATION AND POLICIES
School of Graduate and Continuing Studies – Attendance Policy

One absence (and only one) may be excused without the grade being affected provided
make-up work is satisfactory completed:
o The learner must contact the instructor.
o The absence must be the result of unavoidable circumstances.
o Make-up work is satisfactory completed before the start of the following
workshop.
If the first absence is unexcused, the following scale will be used for grade reduction:
o For courses with 7, 8, or 9 workshops/sessions:
 1st absence will result in a final course grade no higher than a “B”
 2nd absence will result in a final course grade no higher than a “C”
 3rd absence will result in a final course grade of “F”
o For courses with 4, 5, or 6 workshops/sessions:
 1st absence will result in a final course grade no higher than a “C”
 2nd absence will result in a final course grade of “F”)
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All subsequent absences (if first absence is excused) will result in an automatic grade
reduction.
The number of absences relative to grade reduction will reflect number of workshops in
the course (assuming one absence is excused based on the approved criteria listed above):
o For courses with 7, 8, or 9 workshops/sessions:
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NRSG 441 9.2009
 2nd absence will result in a final course grade no higher than a “B”
 3rd absence will result in a final course grade no higher than a “C”
 4th absence will result in a final course grade of “F”
o For courses with 4, 5, or 6 workshops/sessions:
 2nd absence will result in a final course grade no higher than a “C”
 3rd absence will result in a final course grade of “F”
o For courses with 2 or 3 workshops/sessions
 An alternative cohort must be found so learner can attend the course in
total
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Grades will be monitored with final attendance.
Grades must reflect absence – no exceptions.
If the first absence is not excused or the learner does not complete the necessary make-up
work, the grade will be reduced beginning with the first absence.
Instructors will address tardiness on an individual basis. Learners are expected to arrive
for class on time and remain for the entire four hour period.
Attendance – Online Courses
Students are required to participate in class three different days each week. Your initial
posting is NOT a RESPONSE to classmates. Both the quantity and quality of participation are
evaluated. In courses where there are team/group activities, those discussions are NOT counted
as part of the discussion postings. In addition to participation, the discussion rubric provides
further details on possible points according to quality of posting.
(Refer to the RNBSN Student Handbook for Policy Details)
Students are expected to communicate directly with the course instructor regarding any
circumstance that may result in absence of course participation. Course participation is met
through discussion postings and submission of assignments by the required due date.
1. Learners in online courses must post at least one substantive online message per course
week to be considered in attendance.
2. Failure to log in and post at least once a week will result in an unexcused absence. Grade
reductions according to the Attendance Policy in this handbook will be applied.
3. Participation is not the same as attendance. Participation requirements are determined by
the instructor and will be thoroughly explained in the course syllabus.
4. Students with an unexcused absence will receive a 50% grade reduction for any
assignments submitted during that week.
Instructors will address tardiness on an individual basis. Learners are expected to arrive for class
on time and remain for the entire session.(Refer to the RNBSN Student Handbook for details)
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NRSG 441 9.2009
EVALUATION PROCEDURE AND Grading System
95 – 100
A
92 – 94.9
A89 – 91.9
B+
86 – 88.9
B
83 – 85.9
B80 – 82.9
C+
77 – 79.9
C_____________________________________
74 – 76.9
CNon-passing scores
71 – 73.9
D+
68 – 70.9
D
65 – 67.9
DThe student will receive credit for assignments in the following ways:
DISCUSSIONS
The grading for discussion activities is outlined in the course-grading rubric. Students are
required to support their discussions with citations, write in APA and provide a reference list at
the bottom of their posting.
Participation points, which may be given, based on the Discussion Postings. If this is a required
part of the course assessment, the standard policy for discussion requirements and the grading
rubric are consistent in each course syllabus. When discussion is part of the required assessment
to ensure all members of the learning community have sufficient time to respond you are
expected to adhere to the following guidelines:

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Post your initial activity no later than the third day of each week by midnight.
Respond to three of your colleagues’ initial postings during each week on three different
days.
Provide colleagues with reflective thoughts, personal experience, resources, or general
thoughts on the topic.
Posting after the required date will result in a grade reduction as stated in the rubric.
ASSIGNMENTS
Points will be given based on the assessment outlined for each course. Refer to the course
assignments and the corresponding grading rubric provided found in the course link identified as
(rubric). Each week the course guide will provide the student with the required assignment. The
learner as a guide for formulating written objectives should utilize the grading rubric for the
assignment.
Students with an unexcused absence will receive a 50% grade reduction for any assignment
submitted during that week.
LATE WORK POLICY
No late papers/assignments will be accepted after the date and time stated in the syllabus or
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NRSG 441 9.2009
otherwise stated by the professor. In extreme circumstances exceptions may be made (i.e.
illness). However, this must be agreed upon by the student and professor prior to the due date.
POLICIES ON PLAGIARISM
Plagiarism is defined as use of intellectual material produced by another person without
acknowledging its course. For example:
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Wholesale copying of passages from works of others into an assignment, paper, posting,
or thesis without acknowledgement.
Using the views, opinions, or insights of another without acknowledgement.
Paraphrasing another person’s characteristic or original phraseology, metaphor, or other
literary device without acknowledgment.
Faculty will monitor for evidence of plagiarism. All work must be submitted through the
correct blackboard process to be assessed for evidence of plagiarism.
Self-plagiarism is the use of the learner’s work from a previous class and is highly
discouraged. Should the learner’s previous work be used, it must be cited as such.
For further information on Olivet Nazarene University Conduct and Responsibilities, see the
Catalog at the course link (ONU Bulletin).
Students suspected of plagiarism require faculty to contact the Chair, Director of Nursing
Department at ONU directly.
OVERVIEW WEEK 1
This course is designed to allow the learner to concentrate on a focused area of interest in clinical
nursing practice, i.e., gerontology, disaster, mental health, obstetrical, pediatrics, transcultural,
operating room, post anesthesia recovery, bariatric, neuro, rehab, critical care, emergency, office
practice, etc.
Course content is organized according to the registered nurse roles and provides perspective
regarding the dynamics of the nurse as an evolving leader. Described by Ignatavicius (2006), the
roles are Coordinator of Care, Care Giver, Continuing Care Planner, Educator, Advocate,
and Change Agent.
Our journey will include insight into the dynamics of complex issues prevalent in healthcare
organizations as it relates to patient healthcare services and outcomes. Advanced Adult Health is
complex and no longer is the focus on one level of care as critical patient level of acuity
transcends the healthcare environment.
As you read this week and begin your learning journey, consider this question, “Should there be
an ICU, a CCU, or NICU? Should critical care be care that is Advanced Health Nursing across
each discipline? Building a vision for the future, think about what your hospital of the future
should look like. The delivery of specialized care is transcending the specialized units. With an
aging population, we must consider the level of patient acuity. How sick are the patients we care
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NRSG 441 9.2009
for? What is the best way to deliver healthcare services in a cost effective manner, which
streamlines and redefines the professional practice of nursing?
Critical care tomorrow is going to be located everywhere," predicted Dr. Silverstein. "It’s going
to be across an enterprise. It’s not going to be in one location."
http://www.pulmonaryreviews.com/may06/critical.html
The textbooks selected for this course focus on critical care. The rationale for this textbook
selection is we believe critical care is found everywhere in the current healthcare facilities.
Although we will work specifically with the critical care textbook, students will determine their
own patient care setting to link learning.
To prepare for the course journey consider a patient care setting on which you would like to
focus through the course. Once selected you will not be allowed to move your focus to another
area. Each week you will build on linkage to advanced healthcare needs that interrelate whether
in the ICU, or CCU, or ED, or outpatient, or community, or clinic, or doctors’ offices. All nurses
will see levels of acuity that well define Critical Care needs.
1. Begin by determining a patient care setting on which to focus
The American Nurses Association provides the Standards of Practice for various
specialization areas. Visit the website and determine the
Standards of Practice for your
selected setting. We will begin now with the essentials of Coordinator of Care for your
patient area.
2. After you determine your Standards of Practice search the web for the professional
organization that corresponds to your selection.
3. Next, determine if there is a specific professional journal that is published for your
patient population.
4. Bookmark these sites as favorites as you will refer back to them often during the course.
RESOURCES WEEK 1
Devotion
READING ASSIGNMENT WEEK 1
Urden, L., Stacy, K., & Lough, M. (Eds). (2006). Thelan’s critical care nursing: diagnosis and
management (5th ed.). St. Louis, MO: Elsevier-Mosby.
Chapter 1 - “Critical Care Nursing”
WEBSITES WEEK 1
http://www.childrenshospitalla.org/body.cfm?id=74
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NRSG 441 9.2009
Building the Hospital of the Future
http://healthmgmtrx.blogspot.com/2007/06/ideal-hospital-of-future-make-believe.html
Blog, Building a Hospital of the Future
http://ccn.aacnjournals.org/cgi/content/full/25/3/16
Transitional Care after ICU
http://www.pulmonaryreviews.com/may06/critical.html
*Be sure to visit this discussion on redefining ICU
OTHER RESOURCES WEEK 1
There are no additional resources for this week.
DISCUSSION ACTIVITY WEEK 1
You have selected your area of focus for the course by now, you have found your supportive
organization, and journal related to your practice choice. You now must imagine you are the
Coordinator of Care in your selected area and post your discussion to the following:
1. Describe your practice area and the general patient population profile.
2. What are your actual and potential barriers in providing excellent care in your
practice area?
3. There will be challenges when managing and coordinating care for your patient
population. What are some that you anticipate?
4. Collaborate with colleagues who have selected the same or similar focus practice
area. Is your assessment of challenges alike?
5. Read all of your colleagues’ postings.
6. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
ASSIGNMENT WEEK 1
There is no additional assignment in Week 1.
OVERVIEW WEEK 2
The Care Giver role is the focus of Week 2. Care giving necessitates the registered nurse have a
knowledge base sufficient to effectively care for and supervise the meeting of the dimensional
needs of the patient.
Consider your practice setting and determine the prevalent disease or issue that permeates the
environment. Refer to your textbook for the overview of the disease and locate a case study in
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NRSG 441 9.2009
Melander (2004) that corresponds to your disease or issue. Develop a case study that
demonstrates your prevalent disease or issue. This should be one paragraph with three specific
questions the class will need to respond to in order to complete the case study.
WHY CASE STUDY LEARNING?
“A Short History of the Case Method of Teaching,” the analysis of cases provides a
simulated experience in which there is no single correct answer to the problems posed. In
fact, the problem may not even be stated directly but must be interpreted or inferred. In
the case method, colleagues collaborate and opinions and conclusions are communicated
and evaluated by all. While the process of analyzing complex situations—often with little
information—may be intimidating, it is nonetheless realistic, as leaders must often apply
sophisticated critical thinking skills to limited available information in an effort to
determine an appropriate course of action. In this regard, the simulation experience helps
prepare you for professional roles.
RESOURCES WEEK 2
Devotion
READING ASSIGNMENT WEEK 2
Melander, S. (2004). Case studies in critical care nursing (3rd ed.). Philadelphia, PA: ElsevierSaunders.
Urden, L., Stacy, K., & Lough, M. (Eds). (2006). Thelan’s critical care nursing: diagnosis and
management (5th ed.). St. Louis, MO: Elsevier-Mosby.
*Read chapters as needed related to selected topic.
WEBSITES WEEK 2
Getting to the Root of it! Visit root analysis websites!
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http://www.systems-thinking.org/rca/rootca.htm
http://www.sentinel-event.com/theory.php
http://www.valuebasedmanagement.net/methods_root_cause_analysis.html
http://www.bill-wilson.net/root-cause-analysis
OTHER RESOURCES WEEK 2
There are no additional resources this week.
DISSCUSSION ACTIVITY WEEK 2
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NRSG 441 9.2009
1. Post your case scenario for the class no later than Day Three.
2. You will respond to three of your classmates to articulate possible actions/interventions
that could be implemented to solve the identified problem. These should be
comprehensive and address the underlying theme or themes as well as the “symptoms.”
3. Include abstracts from two or more peer-reviewed journal articles that provide a
theoretical foundation for the courses of action you have identified.
4. Post your discussion to the board.
5. Read all of your colleagues’ postings.
6. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
ASSIGNMENT WEEK 2
Looking Ahead Tip: Case Management Interview
Due Week 3 - Day 7
Interview the Case Manager/Care Coordinator for your clinical area.
This assignment will be part of week three discussion postings.
Process:
Create an interview guide of at least 10 questions. One question should relate to the role of the
case manager/care coordinator at your institution. Another question should address the key
resources available within your community to help meet the needs of your patient population.
Interview the Case Manager/Care Coordinator for your clinical area using your guide.
This assignment will be part of Week Three discussion posting. You will submit the final
assignment to the instructor Week 3 - Day 7.
Looking Ahead Tip: Internal & External Threats
Due Week 3 - Day 3
In discussing the complex environments in which healthcare organizations function, five aspects
are identified as especially important: competition, scientific technology, community service,
funding, and workforce. Nurses often forget to consider the impact these factors have on patient
delivery and outcomes. Consider your practice area and broaden your lens to these actual and
potential factors.
For this assignment, you will consider your practice setting and determine how competition,
scientific technology, community service, funding, and workforce influence healthcare delivery
and patient outcomes. Provide a summary of your findings in a short paragraph and create a table
to define each category, with columns for strengths, opportunities, and actions to implement.
This assignment is due Week 3 - Day 3.
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NRSG 441 9.2009
OVERVIEW WEEK 3
In the role of Continuing Care Planner, the registered nurse in a care setting must identify
appropriate resources and approaches to meet the long term care needs of each client. The
challenge is to minimize chronicity, prevent exacerbations, and indeed seek a higher level of
wellness. This week will focus on identifying possible resources and methods to connect patients
to resources with the goal of maintaining high level wellness. This requires looking into concepts
of case management and the role of a case manager.
RESOURCES WEEK 3
Devotion
READING ASSIGNMENT WEEK 3
Mapping the Literature of Case Management
WEBSITES WEEK 3
Case Management Society of America
The Center for Case Management, Inc.
American Case Management Association
http://www.rncasemanager.com/
Case management effectiveness tool
Case management resource guide – need to register
Hospitalist Care and Length of Stay in Patients Requiring Complex Discharge Planning and
Close Clinical Monitoring
http://archinte.ama-assn.org/cgi/content/abstract/167/17/1869
OTHER RESOURCES WEEK 3
VIDEO DIABETIC CASE MANAGER - GO TO SITE AND CLICK ON VIDEO
RECORDING:
http://ceoncd.com/cd/cd0101/AB0504.htm#
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NRSG 441 9.2009
DISCUSSION ACTIVITY WEEK 3
1. Post your case manager interview findings on the discussion board.
2. Based on your interview describe what you think might help to take wellness and prevention
to a higher level for your patient population in your community.
3. Post your discussion to the board.
4. Read all of your colleagues’ postings.
5. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
ASSIGNMENT WEEK 3
Remember Case Manager Interview is due on Day 7 this week and will be posted to the
discussion board on Day 3.
Internal External Threats is due on Day 3 this week!
OVERVIEW WEEK 4
As an Educator, the registered nurse applies age and culturally appropriate learning strategies
for each of the learning domains, and effectively teaches clients in the primary, secondary, and
tertiary prevention phases. The complexity of the diversity in patient populations has raised the
need for nurses to be able to share knowledge and information in multiple languages to ensure
patient rights and informed consent. Think about a patient population that you are working with
in your setting and plan what learning needs you might address.
RESOURCES WEEK 4
Devotion
READING ASSIGNMENT WEEK 4
Urden, L., Stacy, K., & Lough, M. (Eds). (2006). Thelan’s critical care nursing: diagnosis and
management (5th ed.). St. Louis, MO: Elsevier-Mosby.
Chapter 4 – “Patient & Family Education”
WEBSITES WEEK 4
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NRSG 441 9.2009
Comprehensive Discharge Planning for the Hospitalized Elderly: A Randomized Clinical Trial
Online article from the Annals of Internal Medicine, 15 June 1994, vol. 120, no. 12.
Discharge from hospital: pathway, process and practice Workbook available for downloading
from the Department of Health, UK.
Enhancing Family Communications Online continuing education materials by Carolyn
Chambers Clark, ARNP, EdD, AHNC, FAAN & Susanne J. Pavlovich-Danis, ARNP-C, MSN,
CDE; from Nurse.com.
Family and Pet Visitation in the Critical Care Unit Online article from Critical Care Nurse,
October 2003, vol. 23, no. 5.
A Family Caregivers Guide to Hospital Discharge Planning A 20 page online document from the
National Alliance for Caregiving.
Family-Centered Critical Care: A Practical Approach to Making It Happen Online continuing
education article by Elizabeth A. Henneman and Suzette Cardin, from Critical Care Nurse,
December 2002, vol. 22, no. 6.
Family Doctor Consumer information web site from the American Academy of Family
Physicians - AAFP.
Getting your Message Across: Patient Teaching By Maureen Habel, RN, MA. Open access
online course from Nurse.com; continuing education credit requires payment of a fee.
Health Literacy: A Prescription to End Confusion Lynn Nielsen-Bohlman, Allison M. Panzer,
David A. Kindig, Editors, Committee on Health Literacy; 368 pages, 2004. Available full-text
online from the National Academies Press.
Healthfinder A comprehensive site for consumer health information from the U.S. government
and Página de entrada: español on Healthfinder; from the Department of Health and Human
Services.
The ICU Guide from Waiting.com, a site for families of patients in a coma, by attorney Gordon
S. Johnson, Jr. The ICU Guide provides very basic descriptions of the ICU environment and
equipment and the personnel in the unit.
ICU-USA Official Patient and Family web site of the Society of Critical Care Medicine. Includes
a Patient bill of Rights, and a section on Medical Information, with information on conditions,
tests, a medical glossary, and much more.
Impact of a Prolonged Surgical Critical Illness on Patients’ Families Online continuing education
article by Sandra M. Swoboda and Pamela A. Lipsett, from the American Journal of Critical
Care®, September 2002, Vol 11, No. 5.
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NRSG 441 9.2009
In Other Words… Can They Understand? Testing Patient Education Materials With Intended
Readers Online article by Helen Osborne, MEd, OTR/L, President, Health Literacy Consulting,
from the HLC articles collection.
InteliHealth One of the most extensive consumer sites on the Web, from Aetna.
Mayo Clinic.com Includes centers of information on specific disorders including Allergies and
Asthma, Alzheimer's Disease, Children's Health, and others.
MedicineNet From Information Network, Inc.
Medline Plus An online database designed to provide information to health consumers on a wide
range of topics from the National Library of Medicine; includes links to dictionaries,
clearinghouses, publications, organizations and traditional bibliographic database tools.
Meeting the Needs of Intensive Care Unit Patient Families: A Multicenter Study Online article
from the American Journal of Respiratory & Critical Care Medicine, January 2001, vol. 163, no.
1, pp. 135-139.
Merck Manual of Medical Information - Home Edition
Multicultural Health Resources Extensive full-text online resources from the Queensland
Government, Australia.
Multicultural Palliative Care Guidelines An extensive online text by Andrew Taylor and
Margaret Box, from the Palliative Care Council of South Australia.
National Diabetes Education Program Includes Spanish and Asian language materials.
National Institutes of Health (Spanish) and Consumer Health Information. Includes many
materials available in English and Spanish.
NOAH New York Online Access to Health information; an extensive consumer site in both
English and Spanish.
A Nurse's Guide to Discharge Planning Course by Marilyn Fuller Delong, MA, RN, CCM; from
Nurse.com. Open-access online; continuing education credit requires payment of a fee.
Nutrition.gov A site from the U.S. government that centralizes access to nutritional information.
Patient Education Materials: An Author's Guide From the University of Utah Health Sciences
Center; includes a section on readability and SMOG.
PreOp Patient Education An extensive illustrated site specifically "designed to help you
understand the nature of a medical condition and the surgical procedure most commonly used to
treat it."
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NRSG 441 9.2009
Preparing for Surgery An online tutorial from the National Library of Medicine's Medline Plus
site.
The Provider's Guide to Quality & Culture An extensive site "designed to assist health care
organizations throughout the US in providing high quality, culturally competent services to
multi-ethnic populations". Includes sections on Cultural Groups and a Quality and Culture Quiz.
A joint project of Management Sciences for Health (MSH), and the U.S. Department of Health
and Human Services, Health Resources and Services Administration, Bureau of Primary Health
Care.
Teaching Adult Patients with Learning Disabilities Open-access online continuing education
materials by Janet Hoffman Mennies, RNC, MSN, CRNP, from Nurse.com.
WebMDHealth A comprehensive health promotion resource including interactive tools such as
personal health assessment; tests and quizzes; step-by-step guide to breast self-examination;
customized food pyramids; tools for quitting smoking; and sleep, body mass, and calorie
calculators. Provides daily briefings, local health directory, conditions index with information on
hundreds of disorders, an Ask the Expert feature, and a searchable drug database which covers
thousands of medications.
What a Difference an Interpreter Can Make: Health Care Experiences of Uninsured with Limited
English Proficiency An online report in PDF format from the Access Project, April 2002.
YourSurgery.com A site that provides "easy to understand information for common and specific
surgical procedures." Includes information on consent. Basic overview information is available
for free. Additional information is available for a fee or by subscription.
AltaVista Translations
SYSTRAN A remarkable resource. You can translate an entire web page by placing the url
address in the translator box.
DISCUSSION ACTIVITY WEEK 4
To prepare for this week’s discussion activity you will need to complete the following
exercise:
Using the translation website SYSTRAN (above), translate a brief teaching topic to a patient
common to your population and clinical area. Attach it to your discussion thread in Blackboard
and respond to the following:
1. Describe the common clinical complications among your culturally diverse (nonEnglish speaking) patient population and the appropriate content to help them avoid
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NRSG 441 9.2009
2.
3.
4.
5.
subsequent problems. Attach your teaching item with this thread in its English and
translated language format.
Using Urden, Table 4-2, describe the different categories that help set teaching
priorities in each phase of a patient’s hospitalization.
Propose the savings to the health care system by helping patients to avoid
exacerbations, complications, and readmission compared to the cost of employing a
nurse educator.
Read all of your colleagues’ postings.
Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
ASSIGNMENT WEEK 4
Looking Ahead Tip:
Reflection Assignment: Due Week 6 - Day 3
For this assignment, you will reflect on the course experience of sharing and learning and write a
3-4 page paper that addresses the following:
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
What insights have you gained through the case study method and how will you transfer
these insights to new contexts?
How has your learning in this course helped you to understand the complexity of the
challenges you will face as an evolving leader?
What specific strategies will you use to help you effectively address complex issues in
the workplace?
How has working collaboratively to analyze complex issues and propose
recommendations prepared you for the real-world experience?
How has your learning expanded your awareness of the knowledge and skills you possess
and those you need to develop as a manager, leader, and critical thinker?
OVERVIEW WEEK 5
In the role of Advocate, the registered nurse assists the patient and family in interpreting
information from other health care team members. Additional assistance is sought as needed to
help the patient make decisions about health care.
RESOURCES WEEK 5
Devotion
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NRSG 441 9.2009
READING ASSIGNMENT WEEK 4
Urden, L., Stacy, K., & Lough, M. (Eds). (2006). Thelan’s critical care nursing: diagnosis and
management (5th ed.). St. Louis, MO: Elsevier-Mosby.
Chapter 2 – “Ethical Issues”
Chapter 3 – “Legal Issues”
WEBSITES WEEK 5
ETHICAL ISSUES
AACN Continuing Education articles From the American Association of Critical-Care Nurses.
AACN Standards: Standards for Acute and Critical Care Nursing Practice Online overview and
ordering information for the expanded version; from the American Association of Critical-Care
Nurses.
AACN Position Statement: Moral Distress Available full-text online from the American
Association of Critical-Care Nurses.
Active Euthanasia and Assisted Suicide Two of the Position Statements on Ethics and Human
Rights of the American Nurses Association.
Advance Directives From Ethics in Medicine, University of Washington. Includes sample case
studies.
Bioethics Resources on the Web From the National Institutes of Health.
Biotechnology: Science, Engineering, and Ethical Challenges for the 21st Century Frederick B.
Rudolph, PhD, and Larry V. McIntire, PhD, Editors; A Joseph Henry Press book; 296 pages,
1996. Available full-text online from the National Academies Press.
Changing the Game in the Intensive Care Unit: Letting Nature Take Its Course An online
continuing education article by Helen S. Chapple, from Critical Care Nurse, June 1999, vol. 19,
no. 3.
Code of Ethics for Nurses: With Interpretive Statements A free Independent Study Module by
Kevin G. Hook, MA, BSN, RN, and Gladys B. White, PhD, RN; from the American Nurses
Association.
Code of Ethics for Registered Nurses From the Canadian Nurses Association.
Critical Care Ethics: Do-Not-Resuscitate and Stratification-of-Care Forms in Rhode Island
Online continuing education article by Vera A. DePalo, Rhonda Iacobucci, and Robert S.
Crausman, from the American Journal of Critical Care, May 2003, vol. 12, no. 3.
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NRSG 441 9.2009
Ethical Decision-Making for Registered Nurses in Alberta: Guidelines and Recommendations A
position paper, June 2005, from the College and Association of Registered Nurses of Alberta.
Ethical Principles for Medical Research Involving Human Subjects [Declaration of Helsinki]
From the World Medical Association available full-text online.
Ethics and the Care of Critically Ill Infants and Children Policy Statement of the American
Academy of Pediatrics.
Ethics in Critical Care: Integrating Technology With Compassionate Care: Withdrawal of
Ventilation in a Conscious Patient With Apnea Online article by Margaret L Campbell, RN,
MSN, CS, Kathryn S Bizek, RN, MSN, CCRN, CS, and Rhonda Stewart, RN, from the
American Journal of Critical Care, March 1998, vol. 7, no. 2.
HIPAA Administrative Simplification Site from the Office of the Assistant Secretary for
Planning and Evaluation, DHHS.
ICN Code of Ethics From the International Council of Nurses - ICN. A selection of Fact Sheets
is also available which deals with issues such as human rights and displaced persons.
Making Ethical Decisions Introduction and Table of Contents linked to the full-text online; from
the Josephson Institute of Ethics.
The Nightingale Pledge At the Country Joe MacDonald's Florence Nightingale site.
Nursing and the Patient Self-Determination Acts Position Statement from the Task Force on End
of Life Decisions, American Nursing Association.
The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities From the
American Hospital Association.
Perioperative Care of Patients With Do-Not-Resuscitate (DNR) Orders Position statement from
the Association of periOperative Registered Nurses - AORN.
Position Statements From the American Nurses Association.
Professional Boundaries: Guidelines for the Nurse-Client Relationship March 2005 document
available in PDF format from the College and Association of Registered Nurses of Alberta.
Recognizing Bedside Rationing: Clear Cases and Tough Calls By Peter A. Ubel, MD, and Susan
Goold, MD, MHSA, MA; full-text online article from the Annals of Internal
Medicine1997;126:74-80.
BioethicsNet/American Journal of Bioethics Online Produced by University of Pennsylvania
Center for Bioethics and The MIT Press.
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NRSG 441 9.2009
American Nurses Association includes the Code of Ethics for Nurses; Position Statements
dealing with Ethics and Human Rights and the ANA Center for Ethics and Human Rights.
American Society for Bioethics and Humanities Society of individuals, organizations, and
institutions interested in bioethics and humanities.
American Society of Law, Medicine and EthicsHigh-quality scholarship, debate, and critical
thought on law, health care policy, and ethics.
Center for Practical Bioethics Kansas City, Missouri; formerly the Midwest Bioethics Center.
The Hastings Center An organization for the study of "fundamental ethical questions in health
care, biotechnology, and the environment". Publishes The Hastings Center Report and IRB:
Ethics & Human Research, which are available by membership or subscription. Includes
research and education on sections/ affiliates/health care, biotechnology and life sciences.
Kennedy Institute of Ethics Faculty devoted to research, teaching, and consultation in biomedical
and applied ethics.
National Reference Center for Bioethics Literature, Georgetown University. Large collection of
documents related to bioethics and biomedical research.
LEGAL ISSUES
Active Euthanasia and Assisted Suicide Two of the Position Statements on Ethics and Human
Rights of the American Nurses Association.
Adolescence, Medicine, and the Law: Dangerous Liaisons Online article by Rhonda Gay
Hartman, JD, PhD, from the newsletter of the Consortium Ethics Program, Center for Bioethics
and Health Law, co-sponsored by the University of Pittsburgh Department of Medicine, Division
of General Internal Medicine, Community Ethics/Special Supplement, Fall 2000, vol. 7, no. 1.
Advance Directives From Ethics in Medicine, University of Washington. Includes sample case
studies.
Americans with Disabilities Act From the U.S. Department of Justice.
Determination and Referral of Potential Organ Donors and Consent for Organ Donation: Best
Practice--A Blueprint for Success Online Continuing Education article by Ronald N. Ehrle,
Teresa J. Shafer, and Kristine R. Nelson, from Critical Care Nurse, April 1999, vol. 19, no. 2.
Federal Policy for the Protection of Human Subjects (Basic DHHS Policy for Protection of
Human Research Subjects From the Office for Human Research Protections.
Federal Register Online via GPO Access.
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NRSG 441 9.2009
For the Record: Protecting Electronic Health Information Full-text online from the National
Academies Press, 1997.
Guidelines on Forgoing Life-Sustaining Medical Treatment From the American Academy of
Pediatrics.
Health Hippo Provides connections to health policy and legal resources on the Internet.
Improving Fairness And Effectiveness In Allocating Organs For Transplantation From the
Health Resources and Services Administration; an update to and overview of the 1984 law.
Informed Consent for Research on Human Subjects with Dementia (1998) Updated 2002
Position Statement from the American Geriatrics Society.
Joint Statement on Maintaining Professional and Legal Standards During a Shortage of Nursing
Personnel Position Statement from the American Nurses Association Board of Directors
Policy/Position and the National Council of State Boards of Nursing and the National Federation
of Licensed Practical Nursing, Inc.
Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the
United States and Providing Palliative Care to Them Online article by John M. Luce and Ann
Alpers; from the American Journal of Respiratory and Critical Care Medicine, December 2000,
vol. 162, no. 6, pp. 2029-32.
Legal issues in caring for adolescent patients: Physicians can optimize healthcare delivery to
teens Online article by Lori Feldman-Winter, MD and Gary N. McAbee, DO, JD, from
Postgraduate Medicine, May 2002, vol. 111, no. 5.
Making Treatment Decisions for Incapacitated Elderly Patients Without Advance Directives
(1995) (reviewed and updated 2002) Position Statement from the American Geriatrics Society.
Medical Device Safety Reports This site is "a repository of medical device incident and hazard
information independently investigated by ECRI, a nonprofit health services research agency."
Medical Errors & Patient Safety An extensive site that includes online reports from the Agency
for Healthcare Research and Quality.
MEDWatch The FDA Medical Products Reporting and Safety Information Program.
National Standards to Protect the Privacy of Personal Health Information An extensive site from
the Office for Civil Rights, with links to many full-text documents related to this issue.
Nursing Malpractice: Protect Yourself: What to do when you’re the subject of a board of nursing
complaint. Online article by Winifred Y. Carson, Esq.; from American Journal of Nursing,
December, 2001, vol. 101, no. 12; on the American Nurses Association server.
Occupational Safety and Health Act of 1970 Amended on September 29, 1998.
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NRSG 441 9.2009
On Access to Patient Data A position statement from the American Nurses Association.
On the Defensive Online article by Todd Stein, NurseWeek. May 15, 2000.
Organ Donation A site from the U.S. government with links to many other resources.
Patient's Rights and Informed Consent Extensive section from the learning module Issues in Risk
Management by Thomas J. Balcezak, MD; Patrick Lynch, MS; Phillip Simon, BFA; Sean
Jackson, DMA; C. Carl Jaffe, MD; and Edwin C. Cadman, MD; Yale-New Haven Hospital, Yale
School of Medicine and Center for Advanced Instructional Media; revised February 1998.
Policy Guidance From the Office for Human Research Protections, DHHS. Includes sections on
Regulations, Guidance Materials (including the Belmont Report), and Informed Consent.
Researching Health Law From the Center for Health Law Studies, St. Louis University College
of Law.
THOMAS: U.S. Legislative Information on the Internet U.S.
US Code Title 42/USC TITLE 42: The Public Health & Welfare (01/24/94) From the Cornell
Legal Institute, full-text online.
U.S. Workplace Safety and Health Law, Overview Site from the Cornell Law School.
VersusLaw, Inc. A commercial subscription service for researching legal issues.
WashLaw An extensive site from Washburn University School of Law, provides access to legal
resources for specific states.
Withholding and Withdrawal of Potentially Life-sustaining Treatment A learning module from
The End of Life Project, Health Law Institute, Dalhousie University. Includes information on
Canadian standards concerning treatment refusals by mature minors and immature minors.
DISCUSSION ACTIVITY WEEK 5
1. Post a hypothetical or actual ethical scenario common to patients in your clinical setting.
2. Propose how you would actively advocate for the patient in the scenario, using an ethical
decision making model to frame your discussion.
3. Read all of your colleagues’ postings.
4. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
ASSIGNMENT WEEK 5
There is no additional assignment due in Week 5.
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NRSG 441 9.2009
OVERVIEW WEEK 6
In the role of Change agent, the registered nurse surveys the policies, processes, practices, and
procedures used for care delivery. This final week of class focuses on the use of research and the
resulting evidenced based practices as the driver of change, and the role of the nurse in
facilitating change.
In order to drive change one must understand the philosophical underpinnings associated with
theory of change.
Search the internet Google search “Change Theory Nursing” to review aspects of change
theory as you prepare for this week’s discussion.
RESOURCES WEEK 6
Devotion
READING ASSIGNMENT WEEK 6
There are no reading assignments for Week 6.
WEBSITES WEEK 6
Best Practice Evidence
http://www.joannabriggs.edu.au/pubs/best_practice.php
http://fpb.case.edu/HirshInstitute/index.shtm
http://www.library.vcu.edu/tml/bibs/ebnursing.html
http://www.nursing.uiowa.edu/hartford/nurse/best_practice.htm
http://www.ruralhealth.utas.edu.au/olga/adv-where.htm
DISCUSSION ACTIVITY WEEK 6
To prepare for this final discussion:
Reflecting on the course overall, determine a need to propose a policy, procedure, or practice
change for your setting. Also, apply ‘change theory’ and best practice evidence to your proposal.
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NRSG 441 9.2009
1.
2.
3.
4.
5.
Post an overview of your proposed change.
Describe the implications of change theory to your proposal.
What does the best practice evidence show in support of your recommendation?
What are some barriers, either actual or potential, that you might face?
What are some strategies that you will consider in order to remove barriers and
implement change?
6. Read all of your colleagues’ postings.
7. Respond to at least three of your colleagues’ initial postings.
*Be sure to support your posting with citations from this week’s resources. Refer to the APA
Publication Manual to assure your citations in the text and reference list are correct.
ASSIGNMENT WEEK 6
Your final assignment “Reflection Paper” is due this week on Day 3.
FINAL COURSE REMINDERS!

CHECK THE PORTFOLIO GUIDELINE FOR ARTIFACTS REQUIRED FOR
THIS COURSE.

REMEMBER TO COMPLETE THE ONLINE COURSE ASSESSMENT.
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NRSG 441 9.2009
References
Melander, S. (2004). Case studies in critical care nursing (3rd ed.). Philadelphia, PA: ElsevierSaunders.
Urden, L., Stacy, K., & Lough, M. (Eds). (2006). Thelan’s critical care nursing: diagnosis and
management (5th ed.). St. Louis, MO: Elsevier-Mosby.
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NRSG 441 9.2009
GRADING RUBRICS
DUE WEEK 3 - DAY 3: INTERNAL AND EXTERNAL THREATS
CONTENT
Presents overview
of threats and
rationale for
selection
Considers the 5
potential categories
Presents strengths
and opportunities
Determines
implementation
plan
Follows appropriate
APA, spelling, and
grammar. Utilizes
at least five
appropriate
scholarly sources.
Total Points
POSSIBLE
POINTS
3
POINTS
RECEIVED
FACULTY COMMENTS
4
3.5
3
1.5
Received
15
Support your work with citations from Journal articles, textbook assigned readings,
and other scholarly references utilized throughout the course.
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NRSG 441 9.2009
DUE WEEK 3 - DAY 7: CASE MANAGER INTERVIEW
CONTENT
Role & Resources
Questions
Remaining 8
Interview
Questions
Follows
appropriate APA,
spelling, and
grammar. Utilizes
at least five
appropriate
scholarly sources.
Total Points
POSSIBLE
POINTS
9
POINTS
RECEIVED
FACULTY COMMENTS
18
3
30
Received
Support your work with citations from Journal articles, textbook assigned readings,
and other scholarly references utilized throughout the course.
DUE WEEK 6 - DAY 3: REFLECTION PAPER
CONTENT
Reflection
Supporting
content
Follows
appropriate APA,
spelling, and
grammar. Utilizes
at least five
appropriate
scholarly sources.
Total Points
POSSIBLE
POINTS
12
POINTS
RECEIVED
FACULTY COMMENTS
10.5
2.5
25
Received
Support your work with citations from Journal articles, textbook assigned readings,
and other scholarly references utilized throughout the course.
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NRSG 441 9.2009
Discussion Requirements and Rubric (Online or On Ground)
Up to 0.5 points can be deducted for APA and/ or grammar.
5 Points (Exemplary)

Discussion postings and responses are responsive to the requirements of the Discussion
instructions and are posted by the due date.

Discussion postings and responses significantly contribute to the quality of interaction by
providing rich and relevant examples, applicable research support, discerning ideas,
and/or stimulating thoughts/probes, and are respectful when offering suggestions,
constructive feedback, or opposing viewpoints.

Discussion postings and responses demonstrate an in-depth understanding of concepts
and issues presented in the course (e. g., insightful interpretations or analyses, accurate
and perceptive parallels, and well-supported opinions), and are well supported, when
appropriate, by pertinent research.

Discussion postings and responses provide evidence that the student has read and
considered a sampling of colleagues' postings and synthesized key comments and ideas,
as applicable.
4 Points (Proficient)

Discussion postings and responses are responsive to the requirements of the Discussion
instructions and are posted by the due date.

Discussion postings and responses contribute to the quality of interaction by providing
examples, research support when appropriate, ideas, and/or thoughts/probes, and are
respectful when offering suggestions, constructive feedback, or opposing viewpoints.

Discussion postings and responses demonstrate some depth of understanding of the issues
and show that the student has absorbed the general principles and ideas presented in the
course, although viewpoints and interpretations are not always thoroughly supported.

Discussion postings and responses provide evidence that the student has considered at
least some colleagues' postings and synthesized some key comments and ideas, as
applicable.
3 Points (Sufficient)

Discussion postings and responses are posted by the due date but are not always
responsive to the requirements of the Discussion instructions.

Discussion postings and responses do little to contribute to the quality of interaction or to
stimulate thinking and learning.

Discussion postings and responses demonstrate a minimal understanding of concepts
presented, tend to address peripheral issues, and, while generally accurate, display some
omissions and/or errors.
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NRSG 441 9.2009

Discussion postings and responses do not provide evidence that the student has
considered at least some colleagues' postings or synthesized at least some key comments
and ideas, as applicable.
2 or Less Points (Developing)

Discussion postings and responses are posted past the late deadline, defined as 11:59 p.m.
on the due date, and/or do not address the requirements of the Discussion instructions.

Discussion postings and responses do not contribute to the quality of interaction or
stimulate thinking and learning.

Discussion postings and responses do not demonstrate an understanding of the concepts
presented in the course, and/or do not address relevant issues, and/or are inaccurate and
contain many omissions and/or errors.

Discussion postings and responses do not provide evidence that the student has read or
considered colleagues' postings, as applicable.
Possible Points = 30
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