Catalog Description

Prerequisite: Completion of NRSR 22 with grade of "C" or better or current LVN licensure and BIOL 4 or 8A/8B, 5 or 7A/7B, 6, NUTF 10, HDEV 1, PSYC 100, MATH A, and ENGL 1A with grades of "C" or better; Completion of or concurrent enrollment in COMM 1 and SOC 1 or ANTH 2 with grades of "C" or better
Hours: 387 (104 lecture, 283 laboratory)
Description: Theory and clinical practice related to application of the nursing process based on Roy's Adaptation Model. Students provide care for the adult client having a variety of complex medical-surgical health problems and learn to apply the nursing process for clients experiencing common mental health issues. Focus is on the role of the registered nurse in therapeutic communication, health teaching, leadership, management, and team work. Students further develop skills and apply theory introduced in NRSR 22 in varied and more complex settings, and gain additional theory and skills related to new clinical areas and levels of responsibility. (letter grade only) (CSU)

Course Student Learning Outcomes

  • CSLO #1: Apply the nursing process, and effective transfer of care based on Roy's Adaptation Model to a team of 2-3 adult clients within the medical-surgical/mental health environment.
  • CSLO #2: Demonstrate effective professional communication, and personal safety in a high-risk environment.
  • CSLO #3: Identify the learning needs of clients with common or remedial illnesses/mental health stressors and those of their families.
  • CSLO #4: Utilize teaching principles specific to client's learning needs.
  • CSLO #5: Demonstrate effective principles of leadership: Delegation, supervision, team communication, legal aspects of care, and quality management in a team environment.
  • CSLO #6: Initiate and manage intravenous therapy according to community standards and the principles set forth by the Infusion Nurses Society.

Effective Term

Fall 2020

Course Type

Credit - Degree-applicable

Contact Hours

387

Outside of Class Hours

208

Total Student Learning Hours

595

Course Objectives

Lecture Objectives:
1. Review and remediate previous semester skills and objectives.
2. Identify community standards and the principles set forth by the Infusion Nurses Society when initiating intravenous therapy.
3. Compare effective principles of leadership: Delegation, supervision, team communication, legal aspects of care, and quality management in a team environment.
4. Analyze strategies to successfully manage total patient care for 3 patients in the medical surgical environment to include application of the nursing process and effective transfer of care.
5. Summarize components of effective professional communication and personal safety in high risk environment.
Clinical Laboratory Objectives:
1. Maintain previous semester skills and objectives while caring for patients in the medical-surgical and mental-health settings.
2. Safely initiate and manage intravenous therapy according to community standards and the principles set forth by the Infusion Nurses Society.
3. Demonstrate effective principles of leadership, delegation, supervision, team communication, legal aspects of care, and quality management in a team environment.
4. Successfully manage total patient care for 3 patients in the medical surgical environment to include application of the nursing process and effective transfer of care.
5. Demonstrate effective professional communication and personal safety in a high risk environment.

General Education Information

  • Approved College Associate Degree GE Applicability
    • CSU GE Applicability (Recommended-requires CSU approval)
      • Cal-GETC Applicability (Recommended - Requires External Approval)
        • IGETC Applicability (Recommended-requires CSU/UC approval)

          Articulation Information

          • CSU Transferable

          Methods of Evaluation

          • Objective Examinations
            • Example: Sample Objective Question: 1. Which is an indication for use of seclusion and restraints for a client in a psychiatric facility? A. Patient is loudly using profanities B. Patient cannot verbally contract for safety C. Patient is striking at other patients and staff D. Patient is continually using the phone to call the White House Sample test question for leadership & management: 2. A client has just returned from the surgical suite following a colon resection. Which of the following tasks is appropriate for a nurse to delegate to assistive personnel? a. asking the client about his pain level every hour. b. Checking the placement of the nasogastric tube at least once a shift. c. Looking at the client's dressing and determining the amount of drainage every other hour. d. Obtaining the client's vital signs every hour x 4 and then every 4 hours for 48 hours.
          • Projects
            • Example: Clinical Leadership, Quality Improvement, & Change Proposal: Identifying an area needing change, proposing a specific change and outlining how the change process could be implemented and evaluated. Present a 5-minute overview of your proposal to your fellow students utilizing PowerPoint or other visual support.
          • Skill Demonstrations
            • Example: Initiate IV placement with two successful IV insertions. Skill validation and evaluation consists of scheduled faculty supervision and 100% success on skills checklist.

          Repeatable

          No

          Methods of Instruction

          • Laboratory
          • Lecture/Discussion
          • Distance Learning

          Lab:

          1. Prior to the IV Start Skills Lab, the instructor will assign (a) readings from the Manual of IV Therapeutics (b) completion of the online Intravenous Therapy Learning Module/Healthy Community Forum (c) Mosby’s IV Therapy Skills Modules and (d) direct students to review the product web site product animations. In addition, the students will take the 101-question IV therapy exam and pass with 90% or will remediate. The instructor will also review safety protocols for the lab, with a focus on prevention of blood-borne contamination and accidental needle stick. With a maximum of 10 students in each lab, the instructor will demonstrate IV placement using a variety of catheters with a mannequin arm or IV start simulator. The instructor will observe each student simulating IV catheter placement. The instructor will review the Healthy Community Forum checklist criteria with volunteer RNs and will oversee the RNs directly observing students performing IV starts on each other. The instructor will offer direct guidance as needed. In the hospital clinical lab, the instructor will continue the observation/checklist criteria process and document when the student has successfully placed 6 IV catheters in human arms.
          2. In preparation for the Clinical Leadership, Quality Improvement, & Change Proposal project, the instructor will assign the students to review chapters in the leadership textbook, Whitehead. The instructor will distribute the Unit Assessment Worksheet and the Diagnosis & Planning Worksheet via the course syllabus. Once submitted, the instructor will review each group’s preliminary work and offer pertinent, formative feedback. Each group will post a Nursing Process SBAR (Situation, Background, Assessment, Recommendation)and details regarding their identified change proposal. At the conclusion of group presentations, the instructor will give overall feedback and grade the project according to the Clinical Leadership, Quality Improvement, & Change Proposal grading criteria/rubric is in appendix A of syllabus.

          Lecture:

          1. The instructor lectures on focused care, pathophysiology and standards of care. Students will then complete focused care plan, pathophysiology, standards of care, and medication sheet for each patient. These are then turned in to the instructor who reviews and discusses with student.

          Distance Learning

          1. Faculty will enter a question in the discussion board pertaining to the content covered of the disease process. The student will answer the question and respond to two other student replies. Faculty will provide constructive feed back to the initial student post.

          Typical Out of Class Assignments

          Reading Assignments

          Students will follow weekly content from assigned readings in required and recommended text books and professional journals. 1. Medical-Surgical Nursing: read "Neurosensory Disorders." Use information to identify changes in patient condition and provide care. 2. Mental Health Nursing: read "Schizophrenia and other Psychotic Disorders." Use information to identify changes in patient condition and provide care.

          Writing, Problem Solving or Performance

          1. Case studies are assigned as individual or group work to help the students learn concepts, nursing interventions and to stimulate critical thinking. Part of the lecture time is used for discussion of case studies. 2. Weekly Interpersonal Process Recordings, student journals and patient assessments are required when student is in the hospital clinical setting with clients. 3. Nursing care plans using the nursing process and assessment tools are required in each area: leadership, management, adult medical surgical nursing and care of the client with mental health illness. The care plans demonstrate the student's ability to use the Nursing Process to problem-solve a plan for safe patient care. 4. Complete Case Study: "Working with a Person who is Paranoid," completing the assessment, nursing diagnosis, planning, intervention and evaluation.

          Other (Term projects, research papers, portfolios, etc.)

          Using the Nursing Process, select a Quality Improvement project and research best practice guidelines using OVID (Sierra College library link. Design and present change proposal.

          Required Materials

          • Medical-Surgical Nursing Assessment and Management of Clinical Problems
            • Author: Lewis, Dirksen, Heitkempe & Bucher
            • Publisher: Elsevier Mosby
            • Publication Date: 2017
            • Text Edition: 10th
            • Classic Textbook?:
            • OER Link:
            • OER:
          • Essentials of Nursing Leadership
            • Author: Whitehead
            • Publisher: F.A. Davis
            • Publication Date: 2015
            • Text Edition: 6th
            • Classic Textbook?:
            • OER Link:
            • OER:
          • Manual of IV Therapeutics
            • Author: Phillips & Gorski
            • Publisher: F.A. Davis
            • Publication Date: 2014
            • Text Edition: 6th
            • Classic Textbook?:
            • OER Link:
            • OER:
          • Varcarolis' Foundations of Psychiatric Mental Health Nursing: A Clinical Approach
            • Author: Halter
            • Publisher: Elsevier
            • Publication Date: 2018
            • Text Edition: 8th
            • Classic Textbook?:
            • OER Link:
            • OER:

          Other materials and-or supplies required of students that contribute to the cost of the course.

          Books required and suggested for previous semesters; NRSR 21 and NRSR 22.