Download Module description Module 10

Module description
Module 10
Nursing – Acute and Critically Ill Patients/Citizens
August 2015
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Contents
1.
Nursing – Acute and Critically Ill Patients/Citizens .................................................. 3
Learning objective ................................................................................................................... 3
2. Themes and transverse subject areas ......................................................................... 4
Theme 1: Nursing problems related to acute and critically ill patients undergoing surgery. ...... 4
Theme 2: Nursing problems related to acute and critically ill patients with medical heart
conditions. ............................................................................................................................... 4
Theme 3: Nursing problems related to patients with critical life-threatening cancers ................ 4
3. Organisation of the teaching ................................................................................................ 5
The study-activity model for module 10.................................................................................... 5
4. The module’s fixed and planned study activity .......................................................... 6
Study activity C ........................................................................................................................ 6
Planned study activity in general pharmacology and calculating dosages of medicine............. 6
Other study activities ............................................................................................................... 7
Theme day: Acute and critical nursing in clinical practice ........................................................ 7
5. Exam ............................................................................................................................... 7
Exam form ............................................................................................................................... 7
Frameworks ............................................................................................................................. 7
Guidelines for external exams ................................................................................................. 7
Oral exam ................................................................................................................................ 8
Assessment criteria ................................................................................................................. 8
6. Resits and make-up exams due to illness ................................................................... 8
Illness ...................................................................................................................................... 8
Resits ...................................................................................................................................... 9
7. Overview of the module ................................................................................................ 9
8. Literature ...................................................................................................................... 10
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1. Nursing – Acute and Critically Ill Patients/Citizens
This module centres on how patients/citizens experience and react to acute and critical illness, suffering and impending death. It also focuses on organisation and collaborative work, including nursing management.
Learning objective
On successful completion of the module, students will have achieved the following learning objective:
 the ability to search for, categorise and apply practice-, development- and research-based
knowledge of acute and critical nursing situations
 the ability to search for, categorise and evaluate knowledge about quality development in
nursing
 the ability to explain key methods and models for quality enhancement
 the ability to analyse and discuss patients’ perspectives in conjunction with critical illness,
suffering and impending death
 the ability to identify, analyse and evaluate selected complex nursing phenomena in the
event of life-threatening conditions, and justify selected interventions
 the ability to identify, analyse and evaluate selected interventions in the event of life-threatening conditions
 the ability to explain selected forms of pharmacological treatment
 the ability to calculate dosages and administer medication
 the ability to explain pathological conditions in relation to selected acute and critical illnesses
 the ability to reflect upon the importance of co-operation with critically ill patients, their relatives and other professionals
 the ability to explain the importance of prioritisation, co-ordination, delegation and the allocation of resources in nursing
 the ability to account for selected forms of organisation and management of patient care in
the health and social services
 the ability to apply the legal framework for professional practice, and to reflect upon the
consequences of legislation for professional practice.
The module’s core subject areas (nursing, pathology, pharmacology and organisation, administration and management) are addressed through the teaching of complex nursing problems.1
Core subject areas
Theoretical
ECTS credits
Clinical
ECTS credits
Nursing care
8
0
Pharmacology
2
0
Pathology,
including radiology
3
0
Organisation, administration
and management
2
0
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A nursing problem is defined as a problem that the patient/citizen already has, or risks contracting, and which the
nurse addresses on the basis of a professional evaluation in his or her sphere of activity. (Karoliussen, M & Smebye,
KL 1986. Sygepleje fag og proces (Nursing: Profession and Process), Munksgaard Copenhagen).
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2. Themes and transverse subject areas
The module starts with instruction in key, recurring concepts used in different ways in all of the
module’s themes. Students acquire knowledge on acute and critical nursing practice from the perspective both of the patient and of the nurse.
The module consists of three themes defined by complex nursing scenarios associated with: acute
and critically ill patients with medical illnesses, patients who undergo emergency surgery, and patients with life-threatening cancers. The themes arise from complex nursing problems.
The module’s four subject areas are integrated into the teaching and learning for each theme. Organisation, Management and Administration permeates all three themes. Organisation and Management provides students with knowledge of the delivery of patient care in Region H (The Capital
Region of Denmark) – at hospital and ward level – as well as of available packages and programmes, and a knowledge of the competencies required to provide professional nursing care
based on the nurse’s duties and the patient’s rights. This includes the competencies to evaluate
how quality development is integrated into nursing practice. Students acquire knowledge of different forms of health care delivery and how nursing is organised. They also acquire competencies to
evaluate the nurse's role in prioritisation and delegation, as well as knowledge of the contact person scheme.
Determining dosages and administering medicine is also an interdisciplinary subject, where students learn dose calculating skills, as well as acquiring knowledge of the nurse's responsibility
when preparing and administering medicine.
Theme 1: Nursing problems related to acute and critically ill patients undergoing surgery.
Students acquire knowledge and competencies to observe and provide nursing care to patients undergoing emergency surgery, including patients involved in accelerated/optimised care programmes. They acquire knowledge of diagnosis and treatment of patients with acute and deteriorating abdominal problems accelerating into hypovolemic shock. The students learn skills to identify, evaluate and analyse complex nursing problems such as pain and nausea, and to make suggestions for appropriate interventions. They acquire knowledge of anaesthesia, analgesia and
thromboprophylaxis, and skills needed to provide nursing care to patients requiring oxygen therapy, blood transfusions and fluid therapy.
Theme 2: Nursing problems related to acute and critically ill patients with medical heart conditions.
Students acquire knowledge of and competencies to observe and provide nursing care to patients
with acute heart disease, including patients who have a care package. They acquire knowledge of
diagnosing and treating patients with acute coronary syndrome (ACS), deteriorating into acute left
ventricular heart failure leading to pulmonary oedema, cardiogenic shock and acute kidney failure.
The students acquire skills to identify, evaluate, analyse and intervene when caring for patients experiencing pain. They also acquire knowledge of heart medicines and diuretics.
Theme 3: Nursing problems related to patients with critical life-threatening cancers
Students acquire knowledge of and competencies to observe and care for patients with cancer.
The students acquire skills to identify, evaluate and analyse complex nursing care conditions such
as fatigue, nausea and chronic malignant pain. They acquire knowledge of diagnosing and treating
patients with cancer, including the progression of the disease and side effects of the treatment.
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They acquire knowledge of palliative care, and competencies and skills to identify, evaluate, analyse and intervene effectively during end-of-life care. They acquire knowledge of cytotoxic agents,
anti-emetics, glucocorticoids and hormone therapy in the treatment of cancer.
3. Organisation of the teaching
The Department of Nursing expects a high level of participation from students. Preparation for and
active participation in classes are important prerequisites for the quality of both teaching and learning.
The figure below shows the different types of study activities covered by the module, and the expectations and requirements given to the students.
The study-activity model for module 10
The module involves classroom teaching and study activities. It also includes a planned study activity. This means that some of the teaching will be initiated and guided by teachers, some of it will
be initiated by groups of students working on nursing problems, and some of it will be based on
study questions.
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For the study activities, classes are divided into two study groups. The study groups use a variety
of teaching methods that incorporate and support different learning styles. There are three different
types:
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study activity A: simulation-based teaching
study activity B: workshops
study activity C: analysis and processing of cases.
4. The module’s fixed and planned study activity
Participation in both the fixed and planned study activity is a prerequisite for sitting the external
exam. Students must be able to document participation.
The fixed study activity consists of Study activity C:
Study activity C
The purpose of this study activity is for the students to integrate the module's core subjects and
overall learning objective into the work on a nursing problem that focuses on pharmacology, clinical
assessments and intervention in life-threatening conditions. This activity also provides students
with the opportunity to develop the skills required to complete the assignment for the external
exam. This study activity is organised in two inter-related components. In the first component, the
whole group meets to discuss and identify nursing problems based on a particular, recurring case.
The group then divides up into smaller sub-groups, each of which selects a nursing problem on
which to work. The sub-groups draw up a synopsis that covers the module's four subject areas for
the analysis of their selected nursing problem from the case study. At the second meeting of the
whole group, the sub-groups present their synopses and analyses of the nursing problem from the
case study.
In the event of illness or other absences
In the event of illness or other absences a predefined essay is produced and submitted instead.
The assignment is approved by the teacher. The procedure for the submission of the predefined
essay is published on Intrapol.
Documentation requirement
Attendance is documented at the end of both the first and second meetings of the whole group, by
the teacher.
Planned study activity in general pharmacology and calculating dosages of medicine
The planned study activity for module 10 consists of an e-learning-based test called the “Pharmacology test”. The test is compulsory and must be taken during the first four weeks of the module.
Danish students at the international module receive an e-mail with a link and login details for the
test. The test can also be found via IntraPol. New login details are provided if originals are forgotten or lost. Any student who encounters problems logging in is responsible for contacting the
named contacts listed on Intrapol via the link above.
International students will take a different test on the subject. Introduction will be given by the beginning of the module.
Documentation requirement
Student Services is automatically informed that you have completed the Pharmacology Test by the
deadline so students do not need to do anything else. After completing the test, students can print
a “diploma” proving that they took part.
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Other study activities
Study activity A
The objective is for the students to acquire knowledge of and practice in nursing tasks associated with patients receiving blood transfusions. The activity takes place in two parts:
The first part consists of work and reflection on the study question.
The second part is a practical exercise in SIMLAB: control, setup and registration for blood
transfusion.
Study activity B
Three workshops with exercises related to patient safety, contributing of adverse events, triage and sage communication practises.
Theme day: Acute and critical nursing in clinical practice
Objectives: To provide students with insight into development and research in acute and critical patient care in different areas of clinical practice, as well as into the nurse's duties and responsibilities associated with them. The focus for the day is on research and development related to acute and critical nursing in clinical practice.
5. Exam
The module culminates in an external exam.
The exam is designed to demonstrate the degree to which students have achieved the learning
outcomes for the module. It is assessed according to the 7-point grading scale. The module’s core
subject areas (nursing, pathology and radiology, pharmacology and organisation, administration
and management) are all covered.
Exam form
The external exam is an individual oral exam.
Frameworks
Students are automatically registered for the exams associated with the programme's modules.
Therefore as soon as the module starts, registered students have used one exam attempt. (Section 5 of Ministerial Order no. 1519 of 16.12.2013)
The only exemptions to this rule are cases of documented illness or parental leave.
Students who fail to complete the fixed or planned study activity by the deadline are not eligible to
sit the exam, and will be registered as having failed it.
The external exam is held during the last two weeks of the module.
Students are given access to the exam material two days before the oral exam. The procedure for
access to the exam material is published on Intrapol.
Guidelines for external exams
The exam material forms the basis for the external exam:
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The student analyses the exam material using practice-, development- and research-based literature and, based on this, selects a clinical nursing problem for further analysis.
The student prepares a synopsis with literature references
 The synopsis should include a brief explanation of the selected clinical nursing problem
 The synopsis must include a summary of content from the four subject areas that provides insight into the clinical nursing problem
 The synopsis must be max. one standard page, i.e. max. 2,400 keystrokes with spaces
The synopsis may be written in bullet points, or as a mind map
The students should draw up a bibliography listing the literature used for the synopsis. The bibliography must comply with technical guidelines
Students must bring the synopsis and bibliography with them to the exam.
Oral exam
The oral exam is designed to assess the student in regards to the learning objective for the module
and the subject areas.
Students must bring two copies of their synopsis and bibliography and submit one each to the internal and external examiners.
The exam is individual and lasts 35 minutes
 10-minute presentation by the student
 15-minute oral exam
 The exam concludes with 10-minutes voting and feedback to the student
In the oral presentation, the students must present the selected clinical nursing problem, and identify and justify proposals for selected interventions.
The oral exam is based on the student’s synopsis and oral presentation. The oral exam must cover
the module's learning outcomes and subject areas. Knowledge from previous modules that underpins the oral presentation can be incorporated into the exam.
Assessment criteria
Based on the oral exam, the examiners assess the extent to which the learning outcomes for the
module have been achieved. The exam is assessed according to the 7-point grading scale. (Ministerial Order no. 262 of 20.03.2007).
6. Resits and make-up exams due to illness
Illness
In case of illness, the student must submit a medical certificate to Student Services in accordance
with Metropolitan University College’s rules no later than three working days after the exam was
held (”Intrapol>Information and Guides>Study tools>Exam”)
Students who miss an exam due to illness are automatically registered for it the next time it is held.
(Ministerial Order no. 1519 of 16.12.2013).
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The programme secretary for the module, can be contacted for details on make-up exams. Makeup exams are held in the following weeks:
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For November–January modules between week 11 and week 16
For April-June modules, week 34
Resits
If your external exam is assessed “Failed”, you are automatically registered for it the next time it is
held.
Contact the programme secretary for your module for details of resits. Exams are scheduled as follows;

For November–January modules between week 11 and week 16

For April-June modules, week 34
To resit in week 11-16, you must have completed the Pharmacology test by Monday in week 9 at
12:00 at the latest. To resit in week 34, you must have completed the Pharmacology test by Monday in week 33 at 12:00 at the latest.
Please contact the module co-ordinator if you have any questions concerning make-up exams and
resits.
7. Overview of the module
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Module 10 – Overview
Topics:
Nursing care
½ week
2½ weeks
2½ weeks
2½ weeks
2 weeks
Teaching recurring concepts and nursing theory
Week
Nursing theme 1
Nursing theme 2
Nursing theme 3
External exam
Nursing problems
related to acute and critically ill pre-op
patients
Nursing problems related to acute and critically ill medical patients
Nursing problems related to patients with
life-threatening cancers
Complex nursing issues:
Observation, identification, evaluation and
interventions
Complex nursing issues:
Observation, identification, assessment and
interventions
Complex nursing issues:
Observation, identification, assessment and
interventions
Pre-, peri- and postoperative nursing
Nursing care for acute heart patients
Nursing care for cancer patients
 Receiving the patient and information
 ABCDE with focus on A and B observations
 Respiration, CPAP, O2
 Assessment and treatment of acute pain
 Probes, drains, sutures
 Hypovolemic shock
 Fluid therapy
 Accelerated patient care

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 The experience of the patient with cancer
 The experience of relatives of patients
with cancer
 Effects/side effects of the medical treatment and the cancer
 The troublesome symptoms: fatigue,
nausea, weakened immune system, effects on mucous membranes, pain,
weight loss, hair loss
 Sepsis
 Psychosocial effects
 Palliative care
Death and dying – including a social and
societal perspective
Emergency hospitalisation and receiving
ABCDE with focusing on C observations
Early Warning Score
Triage
Managing cardiac pain
Cardiogenic shock
Acute kidney failure
Nursing care for patients with ACS
8. Literature - See lessonplan on Intrapol
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Introduction
Individual
Oral
Pathology
Acute abdominal pain
 Etiology
 Pathophysiology
 Radiological diagnostics
 Blood tests
 Operation
 Fluid balance
 Complications: Infection, leakage, rupture
 O2. treatment
Acute Coronary Syndrome
 Etiology
 Pathophysiology
 Diagnosis and treatment
 UAP, non-STEMI and STEMI
 Acute left ventricular heart failure
 Acute kidney failure
Cancer
 Etiology
 Pathophysiology
 Tumour biology
 Diagnostics
Examples of cancers – progression and
treatment
Heart medicine, e.g. ACE inhibitors and
beta-blockers, digoxin (main group C)
Cytotoxic agents (main group L)
Blood transfusion
Pharmacology
Calculating
medicine
dosage
Organisation and
management
Anticoagulants, e.g. low molecular weight
heparin (main group B)
Acute pain treatment with primary analgesics, including opioid analgesics, paracetamol and NSAIDs (main group N)
The respiratory organs (main group R)
The autonomous nervous system
Anaesthetics

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Anti-emetics (main group A)
Anti-platelet agents ADP receptor inhibitors
(main group B)
Diuretics, nitrates and statins (main group
C)
The nurse's responsibility for administering medication
Calculating dosage
Organisation of patient care in Region H – at hospital and ward level
Care packages and programmes, Accelerated/optimised patient care
The Health Care Act – involving patients in decisions and informed consent
The Authorisation Act
Quality enhancement, the Danish Quality Model (DDKM), Clinical guidelines
Forms of care and the named-person scheme
The nurse's duties in connection with prioritisation and delegation
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Hormones (main group L)
Glucocorticoids (main group H)