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Course Title: Critical Care Nursing Course Number: NUR 4333 Prerequisite: Generic BSN students: Nursing 3320 Adult Health Nursing I Practicum Post-Licensure students: none Faculty: Melissa R. McDowell, MSN, RN, CCRN (Virtual Office Hours Thursdays 0800-1000 and 2000- 2200. Available on Campus by Appointment) Vincent Nursing-Physical Science Building, Room 134 E-mail: [email protected] Phone: (325) 212-6694 Course Description: Explores the interrelationship of human bio psychosocial dimensions of critical care nursing and examines the theoretical basis and nursing process for alterations in human functioning as consequences of critical illness and care. Grading will be pass or fail. Course Objectives/Student Learning Outcomes Linked to Program Objectives: By the end of the course, students will be able to: 1. 2. 3. 4. 5. Course Objective/Student Learning Outcome Prioritize, plan, and evaluate outcomes of care for the critically ill patient with multiple complex, and/or life threatening stressors using health data, evidence, clinical judgment, and patient preferences. Integrate principles of safety and quality into research-based interventions for adult patients and families with complex health needs and unpredictable outcomes. Deliver and coordinate compassionate, culturally, ethnically and patientcentered care based on evidence, guidelines, standards, and legal statutes/regulations. Analyze acute and critical illness or injury for the interrelationship of the following factors: epidemiology, demographics, pathophysiology, physical assessment, diagnostic tests, pharmacological interventions, EKG interpretation, basic hemodynamic monitoring, nutritional measures, and genomic competencies for clinical decision making. Formulate patient and family centered goals that assist toward health promotion, maintenance, and/or restoration. BSN Outcomes 1,2,3,4,6,9 1,2,3,4,6,9 1,2,3,4,6,7,8,9 1,2,3,4,6,7,9 1,2,3,4,6,7,9 6. Demonstrate collaboration and communication skills in advocacy actions 1 including improvements in quality, safety and error prevention. 7. Interact with peers, colleagues and interdisciplinary health team members to facilitate positive patient outcomes and a professional clinical environment. 8. Demonstrate standards of moral, ethical, professional and legal conduct in the critical care setting. 1,2,3,4,6,8 1,2,3,4,6,7,8,9 1,6,8 Clinical Requirements: 1. Maintain student liability insurance and current American Heart Association Health Care Professional CPR certification. 2. Provide safe nursing care to adult clients within level of knowledge and nursing skills. 3. Refer to the Angelo State University Undergraduate Nursing Handbook for the following: Clinical Attire - regulations; general appearance Behavior in Clinical Agency Professional Conduct Standards of Nursing Practice Patient Client Confidentiality Student absences o In the event of extenuating circumstances preventing a student from attending a clinical experience, the student will: Notify the agency before scheduled time to report on duty Notify the clinical instructor a minimum of one hour before scheduled time to report on duty Failure to call in will result in an unsatisfactory for that clinical day o Students will be prepared for all clinical activities. The faculty has an obligation to remove a student from the clinical setting if the student is not prepared. Repeated behavior reflects failure to meet clinical objectives o Students missing more than one day of clinical will result in reevaluation of a student’s ability to meet course objectives and may result in an unsatisfactory clinical grade. Dosage Calculation Testing Policy Policy on Exam Make-Up Policy on Universal Precautions Guidelines for Written Work BON Declaratory Statement All Guidelines for Referencing Materials Policies Related To This Course: All students are required to follow the policies and procedures presented in the Angelo State University Undergraduate Nursing Handbook. 2 Required Textbooks/Materials: Text - Urden, L. D., Stacy, K. M., & Lough, M. E. (2013). Thelan’s critical care nursing: Diagnosis and management (7th ed.). St. Louis: Mosby ISBN-10: 0323057489 | ISBN- 13: 978-0323057486 Materials – Name tag, bandage scissors, watch, stethoscope, penlight, ASU uniform, appropriate reference books, and appropriate clinical forms. We recommend the use of a PDA. Download and installation of Second Life Viewer software Optional Textbooks/Materials: Text- White, K. (2013) Fast facts for critical care. Kathy White Learning Systems ISBN978-0-9835750-5-4 Teaching Strategies: Web-based and asynchronous didactic modules Case studies/clinical reasoning activities Clinical practicum Second Life interactive exercises/gaming Written assignments Web sites/references Method of Assessing Learning Outcomes: Assessment Activity Case Study Assignment Clinical Competency Performance Clinical Assessment Tool American Heart Association NIH Stroke Scale Test Interdependent QSEN Competency Assignment Discussion Board Quizzes Course Objective 1,2,3,4,5,6 1,2,3,4,5,6,7,8 1,2,6,7,8 1,2,4,5,7 2,3,6,7,8 1,2,3,4,5,6,7,8 1,2,4,5 The grading system used in this course, NUR 4333 is: A, B, C, D, F, NC (No Credit)*, W (Withdrawn)* Grading System: 90 – 100 = A 80 – 89 = B 70 – 79 = C 60 – 69 = D 59 or below = F 3 Case Study Assignment 15% Clinical Competency Performance/Clinical Assessment Tool 15% American Heart Association NIH Stroke Scale Test 20% Interdependent QSEN Competency Assignment 20% Discussion Board 20% Quizzes 10% Practicum Hours: Students will spend 20 hours in clinical settings. Attendance: In the event of extenuating circumstances preventing a student from attending a clinical experience, the student will: Notify the agency before scheduled time to report on duty. Notify the clinical instructor a minimum of one hour before scheduled time to report on duty. Failure to call in will result in an UNSATISFACTORY for that clinical day. Students missing one day of clinical will result in reevaluation of a student’s ability to meet course objectives and may result in an unsatisfactory clinical grade. The instructor may assign the student work to supplement the experience. UNSATISFACTORY Clinical Performance: A student will be considered "Unsatisfactory" if clinical experiences reflect negative performances, lack of preparation or absence. Unsatisfactory incidents indicate that students may not be able to meet course requirements. A student whose clinical practice is UNSATISFACTORY will be given (a) counseling, opportunities for improvement, and/or remediation, and (b) a verbal and written warning. Faculty may remove a student from the clinical setting for lack of preparation or other unsatisfactory performance. A pattern of three (3) clinical "unsatisfactories" may result in the student failing the clinical portion of the course, and as a result, receive a failing grade for the course. UNSAFE clinical performance: When direct patient care is part of the learning experience, patient safety and well-being is of paramount concern. If a faculty member evaluates that a student is unable to provide safe nursing care in accordance with Standards of Professional Nursing Practice (BON, Nursing Practice Act, 2001), and if this deficit is such that it cannot be remedied, the student will be removed from the clinical setting and will receive a grade of “F” in the course. Policy on Late Work, Revisions, or Missed Assignments: Due dates and times for assignments are posted. Failure to submit an assignment by the deadline will result in a fifteen point deduction per day past the posted deadline. Assignments submitted more than one week past the deadline will result in a documented counseling, unsatisfactory, and a revised deadline. If revisions to the late 4 assignment are deemed necessary, a new submission deadline will be assigned and an automatic 15 point deduction will be taken (i.e. all revised assignments will start at an 85% as the maximum grade). Failure to submit the revised assignment by the deadline will result in another documented counseling and unsatisfactory. Further revisions are at the discretion of the instructor. Student Conferences with Instructors are Required: 1. At mid-term and during the week before final exams for performance evaluation. 2. Excessive absences. 3. Repeated UNSATISFACTORY PERFORMANCE in clinical setting. 4. Any situation that is considered UNSAFE, which can result in immediate dismissal from the nursing program. Academic Honesty: Students must maintain complete honesty and integrity in classroom, online and clinical learning experiences. Any student found guilty of any form of dishonesty in academic work is subject to disciplinary action. See the following site on the ASU web page for the ASU Academic Honor Code: http://www.angelo.edu/forms/pdf/honorcode5.pdf Disability Statement: Students with disabilities must contact the Student Life and Student Services Office to request any necessary academic accommodations. This student request should be made early in the semester to allow time for appropriate arrangements. Syllabus Changes: The instructor reserves the option to make changes as necessary to this syllabus. If changes become necessary during this course, the instructor will notify students of such changes, by email communication, class announcement, and/or via a course announcement on Blackboard. Student Evaluation of Course: Students are provided the opportunity, and are strongly encouraged to participate in a course evaluation at the end of the semester. Clinical Skills: 1. Endotracheal Tube Care 2. Tracheostomy Care 3. Ventilator Care 4. Nutritional Measures 5. Basic Hemodynamic Monitoring 6. SVO2 Monitoring 7. ECG Monitoring/12 Lead ECG Interpretation 8. Care of Patient with Intra-Aortic Pump 9. Care of Patient with Temporary Pacemaker 10. Care of Central Lines 5 CLINICAL EXPERIENCES OBJECTIVES A. GOAL: To provide opportunities for the student to gain knowledge and participate in patient care. B. DEFINITION: The Nurse must possess good assessment skills and sound clinical knowledge and be able to apply this knowledge. C. OBJECTIVES: The student will: 1. 2. 3. 4. 5. 6. 7. D. Become aware of the various aspects of nursing care as an interdisciplinary component of patient care. Identify the operation of the department, i.e. a. Duties and functions of the various personnel b. Equipment c. Role-play with the interdisciplinary team using SBAR Communication d. Use information and patient care technology to communicate effectively with members of the healthcare team Observe and/or assist with the use of treatments and therapeutic measures related to the department. a. Administer and document administration of medications in the critical care environment b. For assigned patients, compare observed practices with published standards Identify the needs for skills in assessment based on all body systems. a. Perform patient assessment and evaluation of patient’s response to pharmacological agents Identify the skills needed in patient and family teaching. a. Conduct basic genetic health screening b. Address end-of-life decision making Provide emotional support for the client, family members as needed. a. Provide evidence-based, patient-centered end-of-life care to a dying patient and their significant others. Infection control a. Reporting communicable diseases required b. Universal Precautions EVALUATION: 1. 2. 3. Onsite or Virtual Clinical Competency Evaluation/Clinical Assessment Tool Case Study Assignment Interdependent QSEN Competency Assignment 6 ROLE OF RN DURING CARDIAC EMERGENCIES & CARDIAC OR RESPIRATORY ARREST SUBJECT: Nursing Resuscitation and Cardiac Arrest Management PURPOSE: To provide the student with theoretical knowledge in performance of the nursing interventions essential during a cardiac arrest in the practice of professional nursing. SUGGESTED READING: LEARNING ACTIVITIES: Skills Manual Skills Performance CPR for Health Care Professionals VIEW: Videos: Cardiac Emergencies and Cardiac Arrest OBJECTIVES: The student will be able to demonstrate basic understanding related to the following assessment and psychomotor skills. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Assessment of need for and initiation of cardiopulmonary resuscitation. Utilization of the institutions mechanism of reporting a cardiac arrest that summons appropriate help. Know the location of and routine checking of “Crash Cart” with emergency equipment and medications on your unit. Recognize the role of the arrest team and leader and helping facilitate the life sustaining interventions. Identify the progression of resuscitative interventions until client is stabilized and/or heroic measures are terminated. Provide psychosocial comfort and understanding emotional support to family members of arrest victim. Identify the elements of Cardiac output. Describe assessment of client with complaints of chest pain. Recognize the role of the nurse in assessing the client with chest pains. Analyze signs and symptoms of myocardial infarction. EVALUATION: Required current American Heart Association “Health Care Professional.” 7 Clinical Assessment Tool Patient Patient name outside of room Wrist band: Name verified with patient and DOB Correct names/dates on whiteboard inside patient room Tubes and Lines – follow each line from patient to device, look at connections, amount of room to move, secured in place, and labels Oxygen Nares – any skin breakdown Source – flow rate , ordered flow rate Feeding tubes (DH) Nares – any skin breakdown Source– label on bag , dated Irrigation set-up – clean/dated Abdominal tubes Type: G-tube (input) Biliary tube (output) Site – described in pathway , labeled , bag attached Chest tube Site – described in pathway , dressing intact Tubing – no kinks , tight connections_ Pleurovac – check fluid levels and movement of fluid in Suction chamber H2O chamber Drainage chamber Drainage Amount noted on chamber Tracheostomy Description of trach and size written on pathway Suction catheters available in room Extra trach tube available in room Obturator in sight Sterile water at bedside for trach care? Dated if opened 8 Foley Date of original insertion noted on pathway Tubing – dependent and without loops Drainage bag – below level of bladder IV’s Site – inspect for redness, swelling, warmth, tenderness, drainage Follow tubing to solution – check connections , label Solution – Correct drug , time , dose , route Compare all of above to MAR/admin RX Pump: Green light Plugged in to wall socket Environment Side rails – necessary? Bed in low position Call light working and within reach No obstacles/clutter at bedside or in route to bathroom No obstacles in route to sink No obstacles at bedside Patient assistive devices within reach – i.e. glasses, hearing aids Correct date/nurse name on white board in patient room Water pitcher or glass available and clean Urinal at bedside Bathroom or Bedside commode emptied Trash receptacle available and within easy reach Questions for patient and/or significant other (5 minute sit-down) What would you like to see happen today? How would you describe your hospitalization – Is there anything that could be done to make it better? What should nursing students know about what it’s like being a patient in the intensive care unit? Assessment Tool completed by 9 Student Comments Student Score: Date of Evaluation NUR 4333 Clinical Competency Evaluation Preceptor Score: Preceptor/ Faculty Comments Chest Tubes Name three reasons for chest tube insertion. Monitor the security of the connection between chest tube and drainage system. Apply appropriate suction and monitor for kinking and large loops of tubing which impede drainage and air evacuation. Identify appropriate type of dressing. Recognize the significance of subcutaneous emphysema noted after chest tube insertion. Recognize the significance of no fluctuations in the water-seal chamber immediately after insertion. Identify common signs of tension pneumothorax. Correctly state when it would be appropriate to clamp a chest tube. Cite three possible reasons for noting absent drainage and fluctuation and/or continuous bubbling in the water-seal chamber with continued respiratory distress. Correctly state when the physician should be notified for excessive bloody drainage. Ventilator Management Ensure that the ventilator alarms are on. Instruct patient and family about rationale and expected sensations associated with use of mechanical ventilators. Routinely monitor ventilator settings, including temperature and humidification of inspired air. Check all ventilator connections regularly. Monitor for decrease in exhaled volume and increase in inspiratory pressure. Monitor for effectiveness of mechanical ventilation on patient’s physiologic and psychological status. Monitor for symptoms that indicate increased work of breathing (increased heart or respiratory rate, increased blood pressure, diaphoresis, changes in mental status). Provide care to alleviate patient distress (positioning, tracheobronchial toileting, bronchodilator therapy, sedation and/or analgesia, frequent equipment checks). Use aseptic technique in all suctioning procedures and as appropriate. Identify key assessment factors that indicate the need for suctioning. Demonstrate proper method for suctioning and cite two undesired outcomes of suctioning. 10 Monitor pulmonary secretions for amount, color, and consistency and regularly document findings. Monitor ventilator pressure readings, patient-ventilator synchronicity and patient breath sounds. Analyze ABGs and assess need for repeated ABGs. Monitor patient’s progress on current ventilator settings and make appropriate recommendations. Monitor for adverse effects of mechanical ventilation. Use commercial tube holders, rather than tape or strings, to fix artificial airways to prevent unplanned extubations. Monitor cuff pressure and evaluate ETT positioning via CXR. Provide routine oral care per facility policy and evidence-based data. Promote adequate fluid and nutritional intake. Promote routine assessments for weaning criteria. Monitor effects of ventilation changes on on oxygenation: ABG, SaO2, SvO2, end-tidal CO2, A-aDO2, patient’s subjective response. Document all changes to ventilator settings with rationale for changes. Document all patient responses to ventilator and ventilator changes. Monitor for postextubation complications. Ensure emergency equipment at bedside at all times (manual resuscitation bag, masks, suction equipment, and preparation for power failures). Basic and 12 Lead EKG Interpretation Arrhythmia Recognition Ventricular Fibrillation Ventricular Tachycardia Asystole Junctional. nd 2 degree AV block: Type I nd 2 degree AV block: Type ii rd 3 degree AV block Supraventricular Tachycardia Atrial Fibrillation 11 Atrial Flutter Identify reasons for dysrhythmia re: hypoxia, K, Mg, and ischemia Intervals/Durations PR Interval QRS Duration QT Interval 12 Lead Correct identification of abnormalities in the cardiac cycle that may signify cardiac disease. Correct identification of leads that reflect infarct location. Correct identification of the coronary artery responsible for both inferior and anterior MI’s. Correlation of infarct location with possible conduction defects. Distinguish between right and left bundle branch block. Correct identification of inferior wall MI. Correct identification of anterior MI. Management of Temporary Pacemaker Identify clinical indications for temporary cardiac pacemaker support. Define the following: asynchronous pacing, demand pacing, sensitivity, MA, and capture. Identify the routes used for insertion of temporary internal pacemakers. Differentiate between atrial and ventricular wires. Identify the positive pole (ground) and negative pole (heart). st nd Utilize codes for identification of pacer function re: 1 letter stands for chamber paced; 2 letter stands for the rd chamber sensed; and 3 letter stands for the mode of response to the sensed event. Comply with electrical safety precautions re: wear rubber gloves when handling the electrodes and identify patient as electrically sensitive per facility policy. Monitor dressing changes per facility policy with tips of leads covered and secured when not connected to pulse generator. Assess for signs of infection. Date of dressing change and an A on the atrial wires dressing and V on the ventricular wires dressing. Documentation of pacing mode, MA, sensitivity, intervals, rate, the patients underlying rhythm, appearance of the insertion site, and EKG strip. 12 Hemodynamic Monitoring Demonstration of correct method for establishing zero-reference line. State correct frequency of rezeroing. State correct frequency for changing fluid and lines. Identification of waveform pattern. Identify normal ranges for: CVP, PAS, PAD, PAM, PAOP, CO, CI, and SVR. and PVR uses pocket reference. Identify pertinent data to document in the EMR. Demonstrate correct method for obtaining blood from A-line: Vamp system. Correctly state how much air is injected in balloon to accomplish wedge position. Cognizant of significance of sensation of meeting no resistance when inflating balloon, or blood backing up. Read the PA pressures at correct phase of respiratory cycle. State correct definition of PAOP. Identify indications for using PAD instead of PAOP. Cite three clinical indicators for PA line insertion. Identify actions necessary when PA catheter becomes wedged. Identify four complications of PA catheters. Correlate hemodynamic pressures to potential clinical situations re: Hypovolemia, LV failure, RV failure, Pulmonary emboli, and Cardiac tamponade using pocket reference. Identify correct procedure for PA catheter removal. Management of IABP Identify three reasons for IABP insertion. Name two major contraindications to balloon pump therapy. Cite two major goals of IABP therapy. Identify catheter insertion site and where it should be located in the aorta. Correctly identify triggering mechanisms. Correlates inflation and deflation with the cardiac cycle. Describe the effect of balloon inflation on the diastolic pressure. Describe the effect of early inflation on the waveform and afterload. Describe the effect of late inflation on augmentation. Correctly identify the arterial pressure wave landmark that is used to time inflation. Knowledgeable of the significance of the dicrotic notch. 13 Correctly state the expected mmHg drop when the timing of deflation is optimal. Correctly state the frequency of testing the safety chamber. Correctly identify the longest length of time that the balloon should be allowed to remain inactive. State the correct interventions to minimize the incidence of thrombus formation. Knowledgeable of the procedure for defibrillation during pumping. Names 3 side effects and complications of IABP therapy. State correct actions to be taken if blood is noted in the balloon catheter. NIH Stroke Scale Practicum Identify and assess neurological deficits in stroke patients. Understand the measurement scale for quantifying neurological deficits in stroke patients. Consistently apply appropriate scores for neurological deficits in stroke patients Use the scale to assess changes in neurological deficits in stroke patients over time. Certification Demonstrate NIH SS competency through NIH SS Certification (Voucher for course issued). Nursing Considerations of ICP Monitoring Able to identify three clinical conditions that may require ICP monitoring. Identify normal ICP. Correctly define CPP and Normal CPP. State formula for CPP calculation. Correctly identify two methods for decreasing ICP. Define Cushing’s triad and understand the significance. Knowledgeable of when it is appropriate to withdraw fluid from the ventriculostomy. Correctly state when to flush an ICP line. Knowledgeable of when to change the pressure tubing fluid; what type of fluid is utilized. Name 2 contraindications for the use of ventriculostomy. Correctly identify the landmark used to level the transducer. Cite three signs and symptoms of increased ICP. Recommendations/Comments: 14 Preceptor/Faculty Signature: Student Action Plan or Remediation Required- Students Signature: Yes Date: No Scoring Scale 4 – Accomplished SAFE/ACCURATE Proficient, coordinated, confident. Expedient use of time. Focus on patient. Proficient Skills. Independent, Without direction 3 – Competent SAFE/ACCURATE Efficient coordinated, confident. Reasonable use of time. Competently skilled. Supervised, with occasional physical or verbal direction 2 –Developing SAFE BUT NOT ALWAYS ACCURATE Partial demonstration of skills. Inefficient or uncoordinated. Delayed time expenditure. Assisted, Frequent verbal and/or physical direction 1 - Beginning/Novice QUESTIONABLE SAFE and/or QUESTIONABLE ACCURACY Unskilled and inefficient. Considerable and prolonged time expenditure. Marginal, Requires continuous verbal and/or physical direction 0 –Dependent/ Deficient UNSAFE/INACCURATE Unable to demonstrate procedures. Lacks confidence, coordination, and/or efficiency. Potential harm to self or patient. Dependent, continuous verbal and/or physical direction Grading System: Average Scoring Scale of 4.0-3.5 (90 – 100 = A) Average Scoring Scale of 3.0-3.4 (80 – 89 = B) Average Scoring Scale of 2-2.9 (70 – 79 = C Average Scoring Scale of < 2 > 1 (60 – 69 = D) Average Scoring Scale of < 1 (59 or below = F) 15 Case Study Assignment Purpose: The purpose of this assignment is for evaluation of meeting course objectives. Focus: The focus for this assignment is patient care, data collection, and evaluation of care provided compared to evidence-based research. Due Date: August 7, 2015. Course Objective(s): 1, 2, 3, 4, 5, 6 Instructions –During the clinical rotations, students will select an assignment which fits with their interest in completing course objectives. The clinical objectives are to perform patient care, gather data for the concept map and the evaluation of care delivery. The case study consists of six sections with very specific criteria that the student must include to receive full credit. Required elements are included in each section description. Be thorough in gathering information and document the reason for any missing elements. 16 Angelo State University - Department of Nursing NUR 4333: Critical Care Nursing Case Study Guidelines and Rubric Criteria I. II. III. Introduction: Section consists of introducing/presenting the patient. Required elements: Patient initials, date of birth, age, race and gender, current ht & wt, BMI, and date of admission. Chief complaint: (why the pt came into the hospital) and primary admitting diagnosis. HPI: history of present illness (length of illness and signs and symptoms on admission). Provide a detailed course of illness and his or her present health state (are they better, worse or the same). Overview of patient: History, bio-psycho-social assessments, diagnostic tests, pharmacological interventions, EKG interpretation, hemodynamics, nutritional measures, and genomic considerations. Pathophysiology: Review pathophysiology of the condition including etiologies, clinical manifestations, expected outcomes, current research, demographics, and relating this information to the assigned patient. Possible Points Points Received 10 20 30 17 IV. Plan of Care: 20 Part 1: Generate and discuss nursing diagnosis in planning care for the patient. Part 2: Priorities of care, plan, and evaluation of outcomes V. VI. Research-based Interventions: Evaluate the care this patient received related to your research of the condition. References: Cite all references used in the paper. The references must include at least one peer-reviewed journal article. The article must be less than 5 years old, and must be longer than 2 printed pages to count. Your other references can be textbooks and internet sites. The reference section must follow APA 6th edition format Total 10 10 100 Limit your response to no more than 10 double-spaced pages with 1” margins all around. Use 12-point Times New Roman font. All of your work, except for the appendices, must be in type written form for this assignment. Follow APA 6th edition for this paper. Please do not plagiarize, as this is grounds for failure. As much as possible one should paraphrase (put into your own words) when referencing sources. One may use quotes as appropriate. All papers are subject to submission to http://safeassign.com/ to assess for plagiarism. Spelling, punctuation, and grammar needs to be correct. Point totals of 70 to 100 points equal “Satisfactory performance” on this assignment. Point totals of 0 to 69.99 points will result in an “Unsatisfactory performance.” Unsatisfactory assignments will be returned to the student for corrections. These assignments will be rescored using the same scoring guidelines. The student may have the assignment rescored once. 18 Interdependent QSEN Competency Assignment Purpose: The purpose of this assignment is to prepare students to actively participate as collaborative partners in a transforming healthcare system. Focus: The focus for this assignment is to apply real life healthcare problems in the critical care setting to the Interdependent QSEN Competency Model. Students identify how an issue with one competency is affected by other competencies for the creation of a quality improvement plan. Due Date: July 20, 2015. Course Objective(s): 2, 3, 6, 7, 8 Instructions – Prior to the Critical Care/ER rotations, students will do a library database assignment looking at research recommendations and standards for the assigned competency in those areas. Five or more peer-reviewed sources required for an APA formatted reference list. Three must be journal articles. Prior to the clinical rotations, students will collaborate with peers to identify issues/situations illustrating use or lack of use of assigned competency in the critical care setting. Students will collaboratively create a 10 slide PowerPoint presentation summarizing the issues/situations and recommendations with an APA formatted reference list. The PowerPoint presentation will be turned in to the instructor one week prior to the students’ clinical rotation. Post instructor approval, students will share the presentation with their peers in Blackboard (Bb) and Second Life (SL). Since access is not restricted on the virtual campus, no patient or facility identifiers to be presented. **Maintain confidentiality, including HIPAA policy at all times. 19 Angelo State University - Department of Nursing NUR 4321: Critical Care Nursing Interdependent QSEN Competency Assignment Rubric Criteria 1. Use library databases to review the literature exploring one of the six QSEN competencies. Include an APA formatted reference list of 5 or more peer-reviewed sources (Three must be journal articles). 2. Collaborate with peers to identify issues/situations illustrating use or lack of use of assigned competency in the critical care setting. 3. Identify how the issue with the competency is affected by other competencies. 4. Identify how the issue may compromise Safety and Quality Improvement; as well as how competencies could be part of the solution. Collaboratively formulate a quality improvement plan. 5. Create a 10 slide PowerPoint Presentation summarizing the issues/situations and recommendations with APA formatted reference list to share with your peers in Bb. Total Points Possible Evaluation 10 20 20 25 25 100 Please do not plagiarize, as this is grounds for failure. As much as possible one should paraphrase (put into your own words) when referencing sources. One may use quotes as appropriate. All papers are subject to submission to http://safeassign.com/ to assess for plagiarism. Spelling, punctuation, and grammar needs to be correct. 20 Angelo State University NUR 4333 Critical Care Nursing Discussion Board Assignment Description: Online protocols include: -Postings should be evenly distributed during the discussion period (not concentrated all on one day or at the beginning and/or end of the period). -Postings should be a minimum of one short paragraph and a maximum of two paragraphs. -Avoid postings that are limited to 'I agree' or 'great idea', etc. If you agree (or disagree) with a posting then say why you agree by supporting your statement with concepts from the readings or by bringing in a related example or experience. -Address the questions as much as possible (don't let the discussion stray). -Try to use quotes from the article that support your postings. Include page numbers when you do that. -Build on other responses to create threads. -Bring in related prior knowledge (work experience, prior coursework, readings, etc.) -Use proper etiquette (proper language, typing, etc.) Course Objective(s): 1, 2,3,4,5,6,7,8 21 Discussion Board Rubric Exit Excellent Timely Discussion Contributions Discussion and Demonstration of Knowledge and Understanding Gained from Assigned Reading Adherence to On-Line Protocols Good Average Poor Points Range: 9 (30%) - 10 Points Range: 8 (26.67%) - Points Range: 6 (20%) - 7 (33.33%) 8 (26.67%) (23.33%) Points Range: 0 (0%) - 5 (16.67%) 5-6 postings well distributed throughout the week Feedback: 2-6 not distributed throughout the week Feedback: 4-6 postings distributed throughout the week Feedback: 3-6 postings somewhat distributed Feedback: Points Range: 9 (30%) - 10 Points Range: 8 (26.67%) Points Range: 6 (20%) - 7 (33.33%) 8 (26.67%) (23.33%) Very clear that readings were understood and incorporated well into responses Feedback: Readings were understood and incorporated into responses Feedback: Points Range: 0 (0%) - 5 (16.67%) Not evident that readings Postings have were understood and/or questionable relationship not incorporated into to reading material discussion Feedback: Feedback: Points Range: 9 (30%) - 10 Points Range: 8 (26.67%) - Points Range: 6 (20%) - 7 (33.33%) 8 (26.67%) (23.33%) Points Range: 0 (0%) - 5 (16.67%) All on-line protocols followed Feedback: 4 or more online protocols not adhered to Feedback: 1 online protocol not adhered to Feedback: 2-3 online protocols not adhered to Feedback: 22