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NURS 166R

Medical Surgical Nursing 1 Laboratory

SPRING SEMESTER 2016

Instructors:

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

Lisa Dunkelberg MSN, RN

Dr. Cindy Pitlock DNP, CNM, APRN

NURS 166R: Medical Surgical I Laboratory

Spring Semester - 2016

Number of credits: 1

Prerequisite:Must be an accepted nursing student

Co-requisite courses: NURS 165R, and NURS 167

Must pass NURS 165R, 166R, & 167 to continue on in the nursing program.

This series of courses must be repeated if the student is not successful with any of the three courses.

  1. Course Description

Prepares students to safely perform intermediate nursing skills (therapeutic procedures) that are encountered in the care of hospitalized adult patients with common alterations in body systems.

  1. Course Objectives

Upon successful completion of the course the student will be able to:

1.Demonstrate appropriate verbal and non-verbal skills while performing selected procedures.

2.Successful completion of assessments and procedural skills in the following modules: Medical, Surgical, Therapeutic Communication, Diagnostics; and care of the patient with an IV.

3.Appropriate interviewing skills to establish a therapeutic relationship.

4.College level writing skills in clear and concise documentation.

5.College-level mathematics in dosage calculations and conversions.

6.Competency and critical thinking application in the performance of selected simulation scenarios.

III. Linkage of course to nursing program educational outcomes.

Student Learning Outcomes

  1. Utilize the nursing process in a competent and caring manner to safely meet the bio/psycho/social/cultural and spiritual needs of patients across the lifespan in a variety of health care settings.
  2. Utilize therapeutic communication skills when interacting with patients and their families.
  3. Provide care that reflects the ethical values of nursing within professional practice standards and the legal parameters of the profession.
  1. Method of Instruction:

Mini lecturesDemonstrationConcept MappingSimulation

  1. Learning Activities

Scenario reflection and self-critique Case StudyRole play

Practice & return demonstration Math examSimulation

ATI Modules (Certificate of Completion) Open Lab

  1. Credit Hour Designation

This course has 45 contact hours, with 45 hours actual lab time (9 hours preload and 3 hours per week for 12 weeks).

  1. Grading & Method of Evaluation

Laboratory skills are evaluated upon a pass/fail grading system. In order to achieve a passing grade the student must participate in all laboratory sessions, and pass all components specified within each individual module. Absence from the lab must be approved by the instructor. Missed sessions must be made up in a manner determined by the instructor.

  • Math exam covering ongoing dosage calculation and administration will be given in lab – week 1. This math exam must be passed with a 100%. Two retests will be allowed. Medication administration is not allowed in clinical until this requirement has been met. Refer to the WNC nursing student handbook.
  1. Dress Code

Nursing program approved uniforms are to be worn for each lab experience. Royal blue pants with white hose or socks, white nursing shoes (closed toe and heel) and white scrub shirts with the school’s emblem are to be worn. A long sleeve white T-Shirt may be worn under the scrub shirt for warmth. No sweat jackets or colored sweaters are to be worn over the uniform. Long hair must be tied back in such a manner that it will not fall forward during patient care. Students must wear the WNC photo ID.

IX. Nursing Laboratory Cleanliness

Students are responsible for the cleanliness of the lab. All supplies must be returned, beds made, and chairs returned to their original places before students are excused by the laboratory instructor. Refer to WNC student handbook for Nursing Laboratory Policy. The lab personnel are there to assist you in finding and setting up supplies. They are not instructors. If you have questions consult your resources (textbooks, ATI videos, etc.). You are expected to neatly return all supplies and clean up areas used.

  1. ATI Certificate of Completion

Certificates of completion are required to be submitted at the start of each scheduled laboratory experience.

The ATI module assignments pertain to the nursing skills selected for the week. ATI modules must be completed (100%) before coming to the assigned skills lab. Students are expected to come prepared to practice and demonstrate selected skills.

If the ATI module is not completed before the lab experience the student will be required to complete the assignment before attending that lab session. The student is also held responsible for content that was discussed while absent from the laboratory experience.

  1. Skills Practice & Skills Check List

Students are required to attend all laboratory sessions. The instructor will provide a demonstration of the skill and the student will have time to practice the skill during the lab session. If the student misses a lab the student must make up that lab session. The student must schedule a makeup with the instructor. Open lab sessions are available for additional skill practice. These are posted in the course calendar and outside the nursing lab.

Lab referral: If faculty feel a student needs additional practice or instruction as evidenced by the students return performance during the lab session of a skill, a lab referral form will be completed. The student may practice during open lab sessions or may contact the lab coordinator 775-445-3293 to set up additional lab time by appointment.

  1. Resources
  • 8 GB Flash drive for skill recording/taping

Lewis, S., Heitkekmper, M.E., Dirksen, S., O’Brien, P.G., Bucher, L. (2014). Medical-surgical nursing: Assessment and management of clinical problems(9th ed.) St. Louis: Mosby.

Elsevier: Simulation Learning System Access Code for Medical-Surgical Nursing (Included in the page burst bundle, though available individually also). Links to the Lewis Medical-Surgical Nursing textbook.

Doenges, M. E., Moorhouse, M.F., Murr, A.C. (2013). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales (13th ed.) Philadelphia: F.A. Davis Company.

Gahart, B. & Nazareno, A. (2015). Intravenous medications. (32rd ed.). St. Louis: Mosby.

Lilley, L., Rainforth Collins, S., Harrington, S., & Snyder, J. (2014) Pharmacology and the Nursing Process (7th edition) St. Louis: Mosby

Manning L., & Zager, L (2014) Concepts Made Insanely Easy for Clinical Nursing! Duluth, GA: ICAN Publishing

  1. Evaluation of skills performance in Lab

The nursing student is evaluated on his/her ability to perform skills correctly in order to ensure safe patient care. New skills are practiced, and then evaluated in a laboratory setting. These skills will continue to be evaluated in the clinical setting when the student is providing patient care. As the first year nursing student moves into and completes the second semester, he/she is expected to demonstrate higher levels of competency, dexterity, efficiency, and documentation in skill performance.

The student must demonstrate nursing procedures according to established standards of care (refer to Potter & Perry Fundamentals and ATI modules). To evaluate the student for safe and correct performance of skills, the nursing faculty will utilize checklists which breakdown nursing skills into a sequence of anticipated patterns of behavior.

Critical Skills: Many nursing skills require a high degree of accuracy and strict adherence to a sequence of steps. That is, these critical skills are characterized by strict compliance with the method and chronological order of the skill. Deviation from the sequence or an incorrect method may result in an actual or potential risk to the patient’s health, discomfort or pain, and/or an increase of time and/or resources. The student must demonstrate critical skills or actions with 100% accuracy.

Less Critical Skills: These skills allow for varied methods, as long as the desired end result is achieved and principles are followed.

Universal Procedural Steps: The student must demonstrate the following universal procedural steps before and after ALL procedures:

Before:

  1. State the purpose of the procedure.
  2. Take special needs of the patient into consideration (i.e. age, mentation, physical impairments)
  3. Identify safety concerns.
  4. Gather equipment.
  5. Hand hygiene, gloves as indicated.
  6. Identify patient using 2 identifiers, verify allergies
  7. Explain procedure.
  8. Provide privacy

After:

  1. Collect used items and dispose correctly (biohazard, etc.).
  2. Provide for patient comfort.
  3. Leave call light in place
  4. Hand hygiene (discard gloves if used).
  5. Leave bed in low position.
  6. Report and document procedure and any unusual findings.

EVALUATION:

SSatisfactory: “S” Student demonstrates safe and competent performance of skill according to established standard of care and guidelines listed below.

UUnsatisfactory: “U” Student is unsafe and lacks competency in the performance of critical skills and/or procedures.

It is the student’s responsibility to practice skills to the level required to perform the skill safely and competently according to ATI modules or provided material with minimal prompts. Check off of the designated procedures will be held during the individual skill lab. Catheterization check offs will be scheduled individually during week 3-4 (sign ups during lab week 1).

  1. Check offs are done after sufficient practice. The student must be ready to do the procedure without prompting.
  2. A student who requires more than 2 prompts during check off will be asked to practice the skills with the instructor, lab instructor, or fellow student. Open lab practice sessions are available to practice skills – schedule is posted on the bulletin board outside the nursing lab.
  • Additionally a “U” will be given for any student who is noncompliant with the Nursing Program Immunization and/or CPR requirements. A student will not be allowed to attend lab if noncompliant and all missed labs must be made up.
  • See WNC Nursing Program Student Handbook for number of allowed “U”’s.

Simulations

High-fidelity simulation scenarios will be used throughout the semester with return demonstration during the lab sessions. One video-taped simulation session with a written self-reflection activity will provide the student faculty and self-reflective performance feedback.

Intravenous Management Check-off

Intravenous management check-off will be conducted during semester weeks two and three. Specific rubric is included and follows the procedure protocol from:

Potter, P.A., Perry, A.G., Stockert, P.A., and Hall, A. M. (2013). Fundamentals of Nursing (8th ed). St Louis, MO: Elsevier.

ATI skill modules

  • There is 45 minutes allowed for completion of the procedure and documentation. If unsuccessful a lab referral for remediation will be completed and the student required to practice during open lab time. One redo is allowed.

XIV. Instructor Contact Information

Debi Ingraffia-Strong MSN, RNOffice: Cedar 231

Professor of NursingOffice phone: 775-445-3334

ell phone: 775-901-0612

Lisa Dunkelberg Office: Cedar 229

Nursing Instructor Office phone: 775-445-4409

ell phone: 775-450-6865

Dr. Cindy Pitlock Office:Cedar 217

Nursing Instructor Office phone:775-445-3245

ell phone:775-720-5974

Kim Maccheverna BSN, RN TBA

Nursing Instructor

  • Office hours are posted outside of office door and on the WNC website.
  • Always available by appointment in office or on-line!
  • Cell phone limitations: faculty may be contacted by cell phone during the hours of 6am to 8pm for emergency questions. Please use email for nonemergency communication. Emails will be returned within 24 hours or the next school day.

XV. Laboratory Schedule ~ Course Calendar ~ Skills Checklist & Rubrics (attached)

XVI. Laboratory Simulation SLS Information

  • In this course we will be using the Evolve simulation learning system for electronic medical records, documentation, and scenarios. The actual course ID number for access follows.
  • Simulations –(Purchased in the Fall semester)
  • SLS COURSE ID: 154359_dingraffiastrong_1001INSTRUCTOR: Debi IngraffiastrongSimulation Learning System for RN 2.0 - Spring '17 Grads

Intravenous (IV) Medication & Management Module

Lab Module Outline and Daily Schedule

Module Overview:

This IV module includes both a lab simulated IV skill-set focused experience and a clinical component that includes patient focused IV safety, assessment, discontinuation, IV fluid management, medication calculation, medication administration, and blood products administration and safety.

This module is a 12 hour IV Therapy Laboratory and Simulation with an additional 1 hour student return demonstration of successful IV management and medication administration. The laboratory focused activity introduces the student to principles of IV therapy, demonstrations, return demonstrations and critical thinking skills via simulated activities of IV therapy. A focus on IV concepts, asepsis and safe medication calculations/delivery is paramount in order for the student to succeed in this course. Application of the Institute of Medicine’s (IOM) Quality and Safety Education for Nurses (QSEN) competencies will be reviewed to guide the student and to assure safe IV medication delivery.

This document provides a general overview of the topics to be discussed and the skills to be practiced in theory class and lab. The purpose of lab is to also ready the students for the clinical setting. The best way to prepare each day is to read the assigned chapter (s) and use the ATI material as needed for specific skills addressed.

  • IV initiation (starts) will not be covered this semester. This skill will be taught in the 4th semester of the nursing program.

January 19-21, 2016 Preload Days Meeting Rooms:

Cedar 207 & Cedar 2nd Floor Nursing Lab (Rooms 219 & 220)

IV Medication and Management

IV Module Schedule, Readings, and Skill check-off rubric attached

IV Module Schedule and Readings

DATES / TOPIC / READING / LAB ACTIVITY
Day 1
1/19/16
(preload) / Safety
Assessment
IV maintenance fluids and regulating flow rates
Drip calculations / ATI skills module “IV Therapy”
Print off the ATI post-test for “IV Therapy Module” and bring to class. You must be a score of 75% or higher.
Potter & Perry pp. 904-909; table 41-12,13,14; p. 925 (starting at skill 41-2) thru p. 936
Lewis et al. pp. 308-309
ATI (pharm book) Chap. 4
pp. 34-36 / Medication calculation Quiz
Working with IV pump, IV tubing, peripheral line dressing, and site assessments & documentation
*all documentation will be computerized, so be sure you bring your evolve SLS login info.
Day 2
1/20/16
(preload) / IV medications
IV push
Piggy Backs
Bolus / ATI skills module “Medication Administration 4”
Print off the ATI post-test for Medication Administration 4 and bring to class.You must be a score of 75% or higher.
Potter & Perry pp. 608-611
Starting with IV administration
pp. 632-639 / IV flow rate quiz
Lab practice of all IV medication administration
Compatibility
Equipment
Day 3
1/21/16
(preload) / Central lines, PICC lines
Ports, Shunts
Administration of central line TPN & lipids. Pulling it all together
Documentation and nursing diagnosis / Parenteral nutrition pp. 1021-1024; Box 44-11, table 44-8
Lewis p.309 starting at central venous access devices thru p. 312. / Assessments
Sterile dressing changes
Discontinuation of lines
Practice for all scenarios presented this week.
Day 4
1/24/16 or 1/25/16
(regular lab session) / Blood and Blood products administration / ATI skills module “Blood Administration”
Print off the ATI post-test for “Blood Administration” must be a score of 75% or higher.
Potter & Perry p. 909 starting with blood transfusions thru p. 913 / Blood administration quiz
Blood administration do’s and don’ts
Clinical MathTest
Check off skill return demonstration sign ups

NURS 166: Intravenous Medication and Management Check-off~ Spring 2016

Student Name______Faculty______

ACTIVITY / Pass / Practice Needed
1.Review the MAR - if there is a question or discrepancy verify the order with the physician’s order or medical record
2. Patient I.D. [2 identifiers] Verify Allergies
3. Explain Procedure to patient.
4. Perform Hand Hygiene before procedure and after procedure
IV Medication Administration
1. Prepare medications only 1 medication at a time.
2. Calculate correct dosage
3. Check compatibility of medication
4. Prepares medication according to standard practice guidelines *
5. 5 rights of medication administration verified.
6. 3 checks: Compare prepared medication with MAR and container label
7. Prepare IV primary solution and tubing. Label
a. Maintain strict aseptic technique when opening sterile packages and IV solution
b. Clamp IV tubing, uncap spike on the administration set, and insert into entry site on the IV bag
c. Squeeze the drip chamber and allow to fill it at least halfway
d. Remove the cap at end of the IV tubing while maintaining sterility, open the IV tubing clamp, and allow fluid to move through tubing. Allow fluid to flow until all air bubbles have disappeared and the entire length of the tubing is primed with IV solution. Close the clamp and recap the end of the tubing maintaining sterility
8. Take the medication directly to the patient’s room. Do not leave unattended.
9. Ask the patient to state his/her name and another form of pt. identification (DOB)
and allergies, compare from the MAR and/or chart with the name on the patients armband.
10. Complete any preadministration assessment (blood pressure, pulse, etc.)
required by the specific medication.
11. Explain purpose and potential adverse effects of the medication to the patient.
12. Assess Intravenous site 13. Clean IV port with alcohol
14. Administer the medication via correct port (IV piggyback or IV push)
a. Set pump correctly for secondary infusion
b. Give IV push medication per appropriate timeframe
15. Dispose of syringe/needle in sharps container and wash hands.
16. Document - time medication was administered
17. PRN medications are documented with follow up of pt. outcome.
Sterile technique dressing change
1. Donning & removing sterile gloves
2. Sterile tray set up – maintains sterile field & principles
3. Assess Central line or PICC line insertion site and surrounding area
4. Sterile dressing applied and secured; date, time, initials on dressing
Documentation Clear, Complete, Concise – including signature, initials, title, etc.
Care is organized and prioritized appropriately
Maintains safety, privacy and comfort at all times

*standard practice guidelines per Potter, Gahart & ATI

comments:______

NURS 165/166 - Medical-Surgical Nursing I

Grading Rubric for Patient Teaching Demonstration

1 Point / 2 Points / 3 Points / 4 Points / 5 Points
Teaching plan is disorganized, unclear / Teaching plan is not clear and is poorly organized / Teaching plan is somewhat clear with key information missing / Teaching plan is clear, concise but key information is missing / Teaching plan is clear, concise, creative and comprehensive
Learner outcomes
are incomplete, difficult to understand and
inappropriate to the subject being taught / Learner outcomes are not complete and are inappropriate to the subject being taught / Learner outcomes are not complete and are somewhat appropriate to the subject being taught / Learner outcome(s) are not complete but are appropriate
to the subject being taught / Learner outcomes are comprehensive and appropriate to the subject being taught
Teaching strategy is not clear. / Teaching strategy and format are inappropriate to the subject. / Teaching strategy is higher or lower level and not the best format for teaching the subject. / Teaching strategy is appropriate level but not the best format for teaching the subject. / Teaching strategy is appropriate level and format for the subject.
Message is complicated, inconsistent and not enhanced with photos or graphics / Message is complicated and inconsistent – enhanced with a few photos / Message is simple, not enhanced photos or graphics / Message is simple, somewhat creative and enhanced with a few photos and graphics / Message is simple yet creative and enhanced with photos and graphics
Poorly presented ; significantly <or> appropriate grade level; Lacks resources and references / Written at either <or> 5-6 grade level; Lacking resources and references / Written @ greater than 5-6 grade level
Lacking either resources or references / Written @ greater than 5-6 grade level
Resources included
Material referenced / Written @
5-6 grade level
Resources included
Material referenced

Written Teaching Plan and Patient Teaching Guide: 25 Points