WINONA STATE UNIVERSITY
PROPOSAL FOR NEW COURSES
Department _____Nursing______Date _____August 18, 2004
__N 311______Clinical Decisions: Adult Health_I__ 2
Course No. Course Name Credits
This proposal is for a(n)_____X_ Undergraduate Course ______Graduate Course
Applies to: ___X___ Major ______Minor ______University Studies*
__X___ Required _____ Required
_____ Elective _____ Elective
Prerequisites____N320, N330, N345, 360, 366______
Grading method _____X_ Grade only ______P/NC only ______Grade and P/NC Option
Frequency of offering ______Every semester______
Provide the following information (attach materials to this proposal):
A. Course Description
1. Catalog description.
2. Course outline of the major topics and subtopics (minimum of two-level outline).
3. Basic instructional plan and methods.
4. Course requirements (papers, lab work, projects, etc.) and means of evaluation.
5. Course materials (textbook(s), articles, etc.).
6. List of references.
B. Rationale
1. Statement of the major focus and objectives of the course.
2. Specify how this new course contributes to the departmental curriculum.
3. Indicate any course(s) which may be dropped if this course is approved.
C. Impact of this Course on other Departments, Programs, Majors, or Minors
1. Does this course increase or decrease the total credits required by a major or minor of any other department? If so, which department(s)?
2. List the departments, if any, which have been consulted about this proposal.
D. University Studies Course Proposals
The form Proposal for University Studies Course must also be completed and submitted according to the instructions on that form.
Attach a Financial and Staffing Data Sheet.
Attach an Approval Form.
Department Contact Person for this Proposal:
_
Name (please print) Phone e-mail address
N 311 Clinical Decisions: Adult Health I 2 semester credits
A. Course description
1. Catalog description: This course will introduce students to beginning clinical-decision making and the application of therapeutic nursing interventions for adult clients and their families. Students will be expected to apply theory and scientific principles, as well as begin analyzing client responses to nursing and medical interventions.
Curriculum Concepts, Roles, Sub-concepts, Roles and/or Theories: This course is the first of 2 Clinical decision making courses. Theoretical, scientific, developmental, and nursing theories will be applied to the care of individual adults/older adults. Students will plan therapeutic nursing interventions for selected health conditions and select basic needs.
Major concepts:
1. Nursing process in selected health conditions (Hypertension, Coronary Artery Disease, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Diabetes, Osteoarthritis, Cancer management, specifically lung cancer, and complications (nutrition, fatigue, palliative care, and chronic pain).
2. Fluid/electrolytes, acid-base, Pain, Wound Care, Oxygenation.
3. Therapeutic Nursing interventions.
Course Outcomes:
1. Apply/synthesize scientific principles and nursing theory in the clinical decision-making process.
2. Incorporate clinical decision-making skills in the planning of care for selected health problems and for basic health needs.
3. Explore the application of evidence-based practice in developing the plan of care for selected health problems.
4. Utilize models of care used in the providing nursing care (standards of care, protocols, critical pathways, case management).
5. Incorporate the professional roles of teacher, researcher, scholar, advocate and provider in the care of adults with acute and chronic health conditions.
2. Course outline of the major topics and subtopics
Content Outline
I. Framework for Adult Health Nursing practice
Collaboration with multidisciplinary team
Managed care
Clinical pathways
Prioritizing care / interventions
Risk management
Discharge Planning
II. Cardiovascular Disease: Hypertension(HTN), Congestive Heart Failure
A. Risk Factor Appraisal / Precipitating Factors
Diagnostic and lab tests: ECG, ECHO, CXR, BUN/Cr, Electrolytes, Lipid profile,
(HTN-search for target-organ damage)
B. Common therapeutic modalities
Medical Management
Pharmacologic therapy
Nutrition therapy
Complimentary & Alternative Therapies
C. Nursing management
Decreased Cardiac Output
Fluid Volume Excess
Managing Therapeutic Regimen (HTN: risk factor modification,
therapeutic interventions)
Knowledge deficit: Patient & family education
Ineffective therapeutic regiment management.
D. Potential complications
Pulmonary edema
Pleural effusion
Hypoxia
Dysrhythmia: Atrial Fibrillation
Fluid/Electrolyte Imbalances r/t diuretic therapy
Renal Insufficiency
Hypertensive crisis (HTN)
E. Continued care and Rehabilitation
Risk factor modification, pharmacologic compliance, Follow-up care, cardiac rehabilitation, teaching S/S of potential complications
III. COPD (chronic bronchitis, emphysema)
A. Risk factor appraisal
Diagnostic & lab tests: ABGs, CXR, PFTs, Sputum specimen
Procedures: bronchoscopy (related Nursing care)
B. Common therapeutic modalities
Pharmacologic therapy
Nutritional/Hydration therapy
Oxygen therapy / Oxygenation
C. Nursing Management
Ineffective airway clearance
Anxiety
Activity Intolerance
Knowledge deficit: patient family teaching: meds: use of DPI
D. Potential complications
Pneumonia
Cor pulmonale, dysrhythmia
Acute exacerbations
GERD, PUD
E. Continued care and rehabilitation
Smoking cessation, pulmonary rehabilitation
IV. Diabetes
A. Risk factor appraisal
Diagnostic & lab tests: GTT, FBS, glucose monitoring (RMG, HbA1c), lipids, triglycerides
weight-obesity-BMI
pre-diabetes
screening
B. Common therapeutic modalities
Pharmacology (Insulin, Oral agents)
Nutrition
Exercise
Home monitoring
C. Nursing Management
Management of Therapeutic regimen: Patient & family teaching
Risk for infection
Ineffective therapeutic regimen
D. Potential complications
Acute: Hypo-/Hyperglycemia
Chronic: Micro-Macro complications
CVD, retinopathy, nephropathy, neuropathy
Diabetic Ketoacidosis/Hyperosmotic Hyperglycenic Nonketonic Syndrome
E. Continued care and rehabilitation
Follow-up monitoring and screening for early detection of potential
complications: Fundoscopic exam, Neurological exam lower
extremities,…
Secondary preventative measures: foot care, …
Sick Day Rules
V. Cancer (Colon)
A. Risk Factor Appraisal
Diagnostic and Lab Tests: Related to specific cancer
-CT, MRI, and/or PET scan, CEA, CBC, LFTs, Guiac,
-procedures: endoscopies (colonoscopy, proctoscopy – related nursing
care)
Staging and Grading: Tumor Node Metatasis classification
B. Common Therapeutic Modalities
Surgery
Radiation
Chemotherapy --- current protocols
Pharmacology
Complimentary & Alternative Therapies
C. Nursing Management
Acute/Chronic Pain
Imbalanced Nutrition
Fatigue
Anticipatory Grieving
Altered body image: ostomy
Impaired Skin Integrity: Complex wound care
D. Potential Complications
Metastatic disease
Therapy related: problems r/t chemo, radiation
Surgical wound infection
E. Continued care and Rehabilitation
Palliative care
Follow-up care
VI. Osteoarthritis / DJD
A. Risk factor Appraisal
Diagnostic & lab tests: X-ray, arthroscopy, Magnetic Resonance Imaging,
Hematocrit/Hemaglobin
Common Therapeutic Modalities
Medical management
Pharmacology (NSAIDs, non-opiod analygesics)
Physical therapy, assistive devices
Surgical Management – Total Knee Arthroplasty, Total Hip Arthroplasty, transfusion therapy
Nursing Management
Impaired Physical Mobility
Altered elimination
Acute/Chronic pain
Potential Complications
Deep Vein Thrombosis /Pulmonary Embolism
Osteomyelitis
Neurovascular integrity
Continued care and Rehabilitation
Physical therapy, rehabilitation
VII. Plan interventions for selected nursing diagnoses (should be different from the Nursing Diagnosis covered in Semester I)
Decreased Cardiac Output
Fluid Volume Excess
Knowledge Deficit: Patient & Family education re: therapeutic management for HTN, CHF (lifestyle, nutrition, meds, etc.)
Ineffective Airway Clearance
Anxiety
Activity Intolerance
Knowledge Deficit: Patient & Family education re: therapeutic management of COPD (meds: DPI, hydration, breathing tech, nutrition, etc.)
Management of therapeutic regimen: Diabetes
Risk for Infection
Acute/Chronic Pain
Imbalanced Nutrition
Fatigue
Anticipatory Grieving
Altered Elimination: Bowel
Altered body image: Ostomy
Impaired Physical Ability
Altered elimination: bladder & bowel
Acute/Chronic pain
VIII. Learning Activities: Case Studies, Clinical pathways, Patient/Family teaching plans, Lectures, Discussion.
IX. Course Requirements/Evaluation: Attendance, student participation and 5 exams including NCLEX-type questions (20% each).
X. Resources.
Faculty
Textbooks:
Lewis/Heitkemper/Dirksen (2004) Medical-Surgical Nursing: assessment and management of clinical problems (6th edition). Mosby, Inc.
Fischbach, F. (2004). A manual of laboratory and diagnostic tests (7th ed). Lippincott Williams & Wilkins.
Potter & Perry (2005). Fundamentals of Nursing (6th Ed.). St. Louis: Mosby.
Winningham & Preusser (2001). Critical thinking in medical-surgical settings: A case study approach (2nd ed). Mosby.
Gutierrez, K. & Queener, S. F. (2003). Pharmacology for nursing practice. Mosby, Inc.
Raingruber & Happer (2001). Using your head to land on your feet: A beginning nurse’s guide to critical thinking. F.A. Davis.
Benner, Tanner, & Chesla (1996). Expertise in nursing practice: Caring, clinical judgement, & ethics. Springer.
Wilson, Shannon, Stang (2005). Nurses’s drug guide 2005. Prentice Hall
Websites:
www.cdc.gov
www.nih.gov
http://amsn.com
Health Related Search Engines
* CliniWeb http://www.ohsu.edu/cliniweb/search.html
* Medscape http://www.medscape.com
* OncoLink http://www.oncolink.upenn.edu
* Health A to Z http://www.healthatoz.com
Other Sites for Health Care Professionals
Diseases and Specialties
* National Council of State hhtp://www.ncsbn.org
Boards of Nursing
* Digital
Anatomist http://www1.biostr.washington.edu/DigitalAnatomist.html
* Drug Formulary http://www.intmed.mcw.edu/drug.html
* Nutrition http://www.fsci.umn.edu/tools.htp
* Center for Disease http://www.cdc.gov
Control and Prevention
Nursing Sites
* Nursing Index http://www.lib.umich.edu/tml/nursing.html
Patient Education Sites
* CancerNet http://www.nci.nih.gov/hpage/cis.htm
Mayo Clinic’s Web Site
* Mayo Clinic http://www.mayo.ivi.com
Job Search Sites
* Mayo Clinic Career Site http://www.mayo.edu:80/career/career.html
* MN Dept of Ecnomic Security http://www.des.state.mn.us/
* City of Rochester http://www2.isl.net/city/joblink.html
B. Rationale
1. Major focus of this class is to improve student experience and performance in beginning nursing clinical decision-making earlier in the program. See course outcomes above. The major emphasis in this course is the selection of, and rationale for, therapeutic interventions in the care of adult clients. Based on selected health problems, students will be expected to apply theoretical and scientific principles. Providing opportunities for beginning clinical-decision making is foundational for students as they progress to N411 Adult Health Nursing (II) in which higher levels of clinical-decision making skills are required.
Several factors led to this decision.
· Undergraduate nursing program evaluation data demonstrated a weakness in student performance in the area of clinical decision-making. Our Benchmark NCLEX performance dropped 2 years ago and the nursing curriculum committee has proposed creating this course to improve student performance as part of a long range plan.
· Students who were applying for nursing internships between the junior and senior year lacked sufficient background in nursing care and expressed their desire to have a course of this kind as a junior.
· Higher patient acuity in the practice arena led to leveling of clinical decision making skills essential to student development.
2. This change is a reorganization of the nursing curriculum that involves shifting material into different courses and in this case, creating a new course to address weaknesses in the nursing program. The department had added some of this material to the current 321 and 346 courses as a short term fix. This proposal is part of a long-term plan to reorganize the semester 2 courses for congruence and coherence for students.
3. The current nursing curriculum was implemented in AY97 and was initially taught in quarters for one year before the semester conversion. Since that time evaluation data have assisted in assessing effectiveness and organization of curriculum delivery to meet benchmarks. Based on that data, 311 has been developed. One course, NURS 346 Health assessment II will be dropped after the program revision and after this new course is approved. The content of N346 will be subsumed into 321 and 331.
C. Impact of this course on other departments: None. No departments notified
WINONA STATE UNIVERSITY
FINANCIAL AND STAFFING DATA SHEET
Course or Program______N 311 Clinical Decisions: Adult Health I______
Include a Financial and Staffing Data Sheet with any proposal for a new course, new program, or revised program.
Please answer the following questions completely. Provide supporting data.
1. Would this course or program be taught with existing staff or with new or additional staff? If this course would be taught by adjunct faculty, include a rationale.
This change will increase efficiency of curriculum delivery. Nursing expects and has been promised additional faculty (probationary) to be hired for the overall plan to admit students to the major twice a year.
2. What impact would approval of this course/program have on current course offerings? Please discuss number of sections of current offerings, dropping of courses, etc.
This course is consistent with program evaluation. Although it will result in one additional credit in the major, the content is essential. One course section will be offered each semester. Additionally, the entire curriculum every semester, and have the biggest effect on course offerings. This nursing department initiative has received funding. This course will eliminate N346, the content of 346 will be added elsewhere. See program revision.
3. What effect would approval of this course/program have on the department supplies? Include data to support expenditures for staffing, equipment, supplies, instructional resources, etc.
No extra supplies, equipment or resources other than the faculty will be needed because this is a theory course.
APPROVAL FORM
. Course or Program: NURS 311 Clinical Decisions: Adult Health I
Department Recommendation______
Department Chair Date e-mail address
Dean’s Recommendation _____ Approved _____ Disapproved
______
Dean of College Date
A2C2 Recommendation _____ Approved _____ Disapproved
For: _____ Major _____ Minor
______
Chair of A2C2 Date
Graduate Council Recommendation _____ Approved _____ Disapproved
(if applicable)
______
Chair of Graduate Council Date
______
Director of Graduate Studies Date
Faculty Senate Recommendation _____ Approved _____ Disapproved
______
President of Faculty Senate Date
Academic Vice President Recommendation _____ Approved _____ Disapproved
______
Academic Vice President Date
Decision of President _____ Approved _____ Disapproved
______
President Date
Please forward to Registrar.
Registrar ______Please notify department chair via e-mail that curricular change has been recorded.
Date entered