NURS 167: Medical Surgical Nursing I Clinical

Course Syllabus

NURS 167: Medical Surgical Nursing I Clinical

Debi Ingraffia-Strong PhD(c), MSN, RN

Professor of Nursing

Spring 2017

NURS 167: Medical-Surgical Nursing I Clinical

Spring 2017

Number of credits 1

Prerequisite: Must be an accepted into the nursing program

Co requisite: NURS 165 and NURS 166

Must pass NURS 166 and NURS 167 in order to receive a grade of C or better in NURS 165.

Course Description

Provides opportunities for students to utilize knowledge from the bio/psycho/social sciences, humanities, nursing and current literature to provide safe, competent care of adult patients experiencing common alterations in body systems. The course utilizes the nursing process in order to achieve best practice outcomes in a medical/surgical setting. Particular emphasis is placed on concepts of holistic care, patient education and discharge planning.

Course Objectives

Upon successful completion of the course the student will be able to:
Use effective verbal and nonverbal communication skills when proving care for patients and working with family members and the health care team.
Apply ethical and legal concepts to the care of patients in acute care settings.
Demonstrate the role of the nurse as provider and manager of care to patients experiencing commonly occurring acute and chronic disruptions in health.
Demonstrate development of critical thinking skills through the use of reflective thinking, journaling, and problem solving through the nursing process.
Develop organization and independence in the performance of nursing skills for two patients by the end of the medical/surgical rotation.

B. Linkage of the course to nursing program educational outcomes

Student Learning Outcomes

Incorporate principles from the bio/psycho/social sciences, mathematics, literacy and nursing in the provision of patient care.
Apply the nursing process in a caring manner to safely meet the holistic needs of patients across the lifespan
Utilize a broad range of communication skills to promote understanding
Utilize a spirit of inquiry to integrate current evidence-based guidelines and nursing science when making clinical practice decisions
Apply concepts of caring, cultural sensitivity and respect for all persons
Apply principles of teaching and learning to empower patients and families to effectively manage healthcare
Incorporate principles of collaboration and teamwork with patients, families and the health care team to achieve patient centered care
Provide and manage care that reflect the ethical values of nursing within professional standards and legal parameters of the profession

Clinical Schedule: 90 hours
Wednesday, Thursdays or Fridays for (8) 9 hour days from 0630 to 1500 with a 30-minute lunch and (2) 15 minute breaks on a medical/surgical unit and a pre and post-conference at 0630 - 0700 and 1500 - 1600.
OR experience:Wednesday, Thursdays or Fridays for (2) 9 hour days from 0630 to 1445 with a 30-minute lunch and (2) 15-minutes breaks in a peri-operative setting and post-conference at 1500-1600.
Aclinical orientation to the facility that provides an understanding of the location of different areas within the facility, core measures, and the policies and procedures that students need to follow.
A one hour Intravenous (IV) medication and IV management clinical check-off to be scheduled during first and second weeks of the semester.

Grading:

The clinical grade is PASS/FAIL. It is determined by:

Mandatory completion of 8 medical surgical clinical experiences and 2 OR experiences or make-up for missed days designated by the clinical instructor.
Maintaining a satisfactory (S) performance in the clinical rotations. The student receives a “Satisfactory” for clinical performance by maintaining safe practice and receiving a Satisfactory evaluation as determined by objectives in the Basic Student Clinical Performance Evaluation Tool (BSCPET)

3. Completion of all assignments. Submitting written assignments on the assigned due dates (online in the appropriate assignment drop box).This is a weekly expectation and no late work will be accepted!

4. Participation in pre and post-clinical conferences that is respectful and contributes to the learning experience of self and others. (Refer to the student handbook for standards of behavior and misconduct)

Mandatory Assignments:
Daily patient Plan of Care: Parts 1 (Initial Assessment/Analysis) and 2 (SOPPIET) with progression to concept care mapping completed.

i.Pre-clinical work-up (Part 1) completed, printed, and brought to pre-conference of each medical/surgical clinical day.

ii.SOPPIET (Part 2) completed and submitted to the Canvas weekly drop box by midnight of the day following the medical/surgical clinical experience.

OR Report, graded by clinical faculty, grade applied to NURS 165 (due 1 week following the second scheduled OR day).
Discharge Plan, graded by theory faculty, grade applied in NURS 165(due 05/07/17 by midnight to Canvas drop box).
Journaling, reflective thoughts on each day’s clinical experience (due every 5 weeks)
Daily clinical performance feedback form (due daily)
Clinical self-evaluation (due at course end)
Facility evaluation (due at course end)
Course evaluation (due at course end)

Dress Code
Uniform:

During medical surgical clinicals: White scrub shirts with Logo, royal blue uniform pants, WNC lab coat, white socks (or nylons) and white or black shoes. A long sleeve white T-shirt may be worn under scrub tops. No jackets, or sweat shirts are to be worn over scrubs during clinical experience. Long hair must be up off the collar not just tied back. All facial piecing jewelry must be removed. Students must have their student & facility ID visible.

Pre-care work-up: students must wear their WNC uniform or business dress clothes with WNC white lab coat, and name tag (no jeans or shorts!)

2. Supplies:

Scissors, stethoscope, pen light, watch with a second hand, and black ink pen
Students who show up without all of the above supplies or completed pre-clinical work-up (Part 1) will be considered unprepared for clinical and may be sent home and/or given a "U".

Attendance
Students must notify the instructor if they are going to be late or absent. All clinical absences must be made up. Method of make-up is to be discussed with the clinical instructor. See student handbook for further information.

General Time Line Expectation for Medical/ Surgical Units

0630Pre-conference with clinicalinstructor, review Care Plan Part 1, activities of day

0700 Change of shift report with nurse

0730Initial assessment including VS, check all dressings, IV’s; check orders and review treatments and medications, develop plan of care

0800 You are responsible for total patient care of your assigned patient

0830Complete assessment, begin administering medications

0930 Provide personal hygiene, treatments, procedures, patient teaching

1000 Morning documentation completed, includes hourly rounding on an hourly basis

1100 30-minute lunch (coordinate specific time with the nurse you are working with)

1200

1300Continue monitoring patient, complete treatments/teaching, focus assessments, admissions, discharges, afternoon documentation completed, hourly rounding

1430SBAR report off to resource nurse.

1500Post-conference

General Time Line Expectation for OR

0630 Dressed in OR attire, receive case assignment

Lunch and Breaks (coordinate with the nurse you are working with)

1500 Post-conference

Reporting on a Change or Critical Condition

Students are expected to know the following information on their patient when there is a change in condition. SBARis a standard format used at Carson Tahoe Regional MedicalCenter. This information is standard knowledge the nurse should assess.Any change in condition must be immediately reported to the RN caring for the patient AND your clinical instructor.

S Situation

B Background

A Assessment

R Recommendations

End of Shift Report to the RN

Before leaving unit for breaks, lunch and end of day a report on the patient’s current condition and care received must be communicated to the RN caring for the patient.

Shift Report Using SBAR Format

The Situation and Background will only need to be entered the first time you report on this patient
Situation / Patient name, age, sex
Room number
Physician/Providers
Background / Admission diagnosis (date of surgery)
Past medical history that is significant (hypertension, CHF, etc.)
Allergies
This information should be included in each report if applicable
Assessment / Code status (any advance directives, DNR orders, POAHC)
Procedures done in previous 24 hours including results/outcomes (include where we stand with post procedure vitals/assessment)
Abnormal and relevant assessment findings
Abnormal vital signs
IV fluids/drips/site; when is site to be changed
Current pain score – what has been done to manage pain
Safety needs – fall risk, skin risk, etc.
Recommendations / Needed changes in the plan of care (diet, activity, medication, consultations)?
What are you concerned about?
Discharge planning
Pending labs/x-rays, etc.
Calls out to Dr. ______about______
What the next shift needs to do or to be aware of – i.e., labs to be drawn in the AM, etc.

Clinical Faculty

Debi Ingraffia-Strong PhD(c), MSN, RNOffice: Cedar 231

Professor of NursingOffice phone: 775-445-3334

ell phone: 775-901-0612

Lisa Dunkelberg MSN, RNOffice: Cedar 227

Nursing InstructorOffice phone: 775-445-4409

ell phone: 775-450-6865

Sarina Gould MSN, RNCell Phone: 775-315-3999

Nursing Instructor

Molly Davisson MSN, RNCell Phone: 415-686-0079

Nursing Instructor

Mary Foraker MSN, RNOffice:Cedar 215

Nursing InstructorOffice phone:775-445-4279

ell phone:775-901-6663

CTH Vocerasystem:

During clinical hours the following faculty are available on the CTH Vocera system. If calling on an outside line call 775-445-5510 and ask for the person you are attempting to reach. If calling from an in-house line or from Sierra Surgery dial 5510 and ask for the person you are attempting to reach. You are able to leave a message at any time.

Debi Ingraffia-Strong

Sarina Gould

Molly Davisson

VIII. Clinical Forms Attached

General Clinical Schedule

Grading Rubrics

Clinical Forms

Medication Administration Policy

Basic Student Clinical Performance Evaluation Tool (BSCPET) (continued from semester 1 – available in the students file @ WNC)

NURS 167 & NURS 151General Clinical Schedule

C = NRS 167 Medical-Surgical Nursing - CTH/Sierra

P = NURS 151 Mental Health Nursing - West Hills

Clinical Group:

01/25/17 – 04/05/17 (CTH)04/14/17 – 05/12/17 West Hills

03/01/17 – 05/10/17 (CTH)01/27/17 – 02/24/17 West Hills

01/26/17 – 02/23/17 & 04/13/17 – 05/11/17 (CTH)03/03/17 – 04/07/17 West Hills

03/02/17 – 05/11/17 (CTH)01/27/17 – 02/24/17 West Hills

01/27/17 – 04/07/17 (CTH)04/14/17 – 05/12/17 West Hills

01/27/17 – 02/24/17 & 04/14/17 – 05/12/17 (CTH)03/03/17 – 04/07/17 West Hills

Sem Week / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13 / 14 / 15
F
Wed / C / C / C / C / C / C / C / C / C / C / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5
C
Wed / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / C / C / C / C / C / C / C / C / C / C
D
Th / C / C / C / C / C / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / C / C / C / C / C
E
Th / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / C / C / C / C / C / C / C / C / C / C
A
Fri / C / C / C / C / C / C / C / C / C / C / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12 / P
Fri
7-12
B
Fri / C / C / C / C / C / P Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / P
Fri
12-5 / C / C / C / C / C

***Highlighted purple days are when there are 16 students and 2 faculty members

WESTERN NEVADA COLLEGE

NURS 167: Plan of Care

Evaluation Rubric

Student Name:

Date:

Instructor:

Part 1 completed and discussed with clinical instructor in timely manner:

Concept map clear, complete, and concise. Individualized.

Satisfactory ______Comment:

Unsatisfactory ______Comment:

Part 2: 2 SOPPIETs submitted in timely manner: Satisfactory ______Unsatisfactory ______Total Score ______

Domains / Level: Not Evident
Score = 0 / Level: Development
Score = 1 to 4
Each area worth 1 point / Level: Proficient
Score = 5 to 8
Each area worth 2 points / Level: Distinguished
Score = 9 to 12
Each are worth 3 points / Total
Critical
Thinking / No interpretation of data
(0) / Logical interpretation of data with maximum help from instructor
(1) / Logical interpretation of data with minimal help from instructor
(2) / Logical interpretation of data independently
Creative
(3)
Problem
Identification / Unable to identify problems
(0) / Able to identify problems with maximum help from instructor
(1) / Able to identify problems with minimal help from instructor
(2) / Able to identify problems independently
(3)
Problem
Solving / Fails to identify and implement appropriate nursing interventions with maximum assistance
(0) / Identifies and implements appropriate nursing interventions with maximum help from instructor
(1) / Identifies and implements appropriate nursing interventions with minimal help from instructor
(2) / Identifies and implements appropriate nursing interventions independently
(3)
Cognitive
Skills / Fails to evaluate outcomes
No teaching plan
(0) / Evaluation and Teaching require maximum assistance from instructor
(1) / Evaluation and Teaching require minimal assistance from instructor
(2) / Evaluation and Teaching
Independently
(3)
Comments

The student’s ability to utilize the nursing process in a competent and caring manner to safely meet the needs of the patient in an acute care setting is evaluated each week when completing Part 1 and 2 of the Plan of Care.

Students are given a satisfactory grade for completing Part 1 prior to the clinical experience and discussing their plan with their clinical instructor at the pre-conference. If the student fails to complete Part 1, the student is given an unsatisfactory grade for the day. Students are scored using a rubric for Part 2 to show progression of learning and implementation of the nursing process. The student earns a grade in one of four levels: Not evident, Development, Proficient, and Distinguished determined by how much help is needed by the student to develop the plan of care.

It is expected that the student will achieve scores (5 to 8) at the Proficient Level by the sixth week in the medical/ surgical clinical rotation. If the student does not demonstrate progression to the Proficient Level by the sixth week, the student will receive an advisement plan for improvement needed to achieve the Proficient Level on the remaining plans of care.

WESTERN NEVADA COLLEGE

NURS 167: Concept Care Map

Evaluation Rubric

Student Name:

Date:

Instructor:

Preclinical Concept Map completed and presented to clinical instructor at the start of the clinical day:

Concept Care Map clear, complete, and concise. Individualized.

Satisfactory ______Comment:

Unsatisfactory ______Comment:

Complete Concept Care Map with NANDA Nursing Plan of Care, Nursing Interventions, and Patient Education submitted in timely manner: Satisfactory ______Unsatisfactory ______Total Score ______

Domains / Level: Not Evident
Score = 0 / Level: Development
Score = 1 to 4
Each area worth 1 point / Level: Proficient
Score = 5 to 8
Each area worth 2 points / Level: Distinguished
Score = 9 to 12
Each are worth 3 points / Total
Critical
Thinking and Review of Systems / No interpretation of data
(0) / Logical interpretation of data with maximum help from instructor
(1) / Logical interpretation of data with minimal help from instructor
(2) / Logical interpretation of data independently
Creative
(3)
Problem
Identification/ Nursing Plan of Care / Unable to identify problems/develop plan of care
(0) / Able to identify problems/develop plan of care with maximum help from instructor
(1) / Able to identify problems/develop plan of care with minimal help from instructor
(2) / Able to identify problems/develop plan of careindependently
(3)
Problem
Solving/Nursing Interventions / Fails to identify and implement individualized nursing interventions with maximum assistance
(0) / Identifies and implements individualized nursing interventions with maximum help from instructor
(1) / Identifies and implements individualized nursing interventions with minimal help from instructor
(2) / Identifies and implements individualized nursing interventions independently
(3)
Cognitive
Skills/Patient Education / Fails to evaluate outcomes
No teaching plan
(0) / Evaluation and Teaching require maximum assistance from instructor
(1) / Evaluation and Teaching require minimal assistance from instructor
(2) / Evaluation and Teaching
Independently
(3)
Comments

Students are given a satisfactory grade for completing the Preclinical Concept Care Map prior to the clinical experience and discussing their plan with their clinical instructor at the pre-conference. If the student fails to complete the Preclinical Concept Care Map, the student is given an unsatisfactory grade for the day. Students are scored using a rubric for the completed Concept Care Map with NANDA Nursing Plan of Care, Nursing Interventions, and Patient Education to show progression of learning and implementation of the nursing process. The student earns a grade in one of four levels: Not evident, Development, Proficient, and Distinguished determined by how much help is needed by the student to develop the plan of care.

It is expected that the student will achieve scores (8 to 12) at the Proficient Level by the ninth week in the medical/ surgical clinical rotation. If the student does not demonstrate progression to the Proficient Level by the ninth week, the student will receive an advisement plan for improvement needed to achieve the Proficient Level on the remaining plan of care.

Medical-Surgical Clinical Weekly Experience

Western Nevada College

Journal

Name ______Date______

Clinical experiences can be meaningful, pointless, or harmful. Reflection is the key to getting meaning from your service experience. What is reflection? The experience is a process by which learners think critically about their experiences. Reflection can happen through writing, speaking, listening, and reading about the service experiences. Why is reflection important? Learning happens through a mix of theory and practice, thought and action, observation and interaction. The encounter allows the student to learn from his or her experience and that of others. You may use these questions to guide your reflections, or free writing.

What did you learn about yourself?

What excited, troubled, or unnerved you?

What do you think your clients gained?

What was the most significant thing that happened to me as a learner this week?

The experience shows that I have more to learn about?

NURS 167 ~ First Year Nursing Student ~ Daily Clinical Performance Feedback~ Spring 2017

Student Name______DATE______

E = Excellent / The student consistently performs at a level superior to most student nurses, asks questions and is interested in learning.
S = Satisfactory / The student consistently performs in a manner that is safe and within the guidelines of standard nursing process.
NI = Needs Improvement / The student demonstrates inconsistent performance. Performs safely but needs morepractice.
U = Unsatisfactory / The student performs in an unsafe manner or not at all.
N/A = Not Applicable / Not observed

Resource RN – Please provide brief feedback to the clinical instructor by circling the appropriate letter on the following checklist.