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Catalog Description Prerequisite: Completion of NRSR 22 with grade of "C" or better or current LVN licensure and BIOL 4, 5, 6, NUTF 10, HDEV 1, PSYC C1000, MATH 12 , and ENGL C1000 with grades of "C" or better; Completion of or concurrent enrollment in COMM C1000 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, based on Roy's Adaptation Model, to a team of 2-3 adult and/or geriatric clients having a variety of complex health problems within the medical-surgical environment.  CSLO #2: Make use of the care planning process to aid in applying theory to clients in the clinical setting.  CSLO #3: Utilize therapeutic communication (writing/verbal) skills to interact effectively with clients and their families who have complex and/or chronic physical and mental illnesses.  CSLO #4: Formulate an effective transfer of care report for 2-3 adult and/or geriatric clients having a variety of complex health problems within the medical-surgical environment.  CSLO #5: Evaluate the learning needs of geriatric and adult clients with common or remedial illnesses/mental health stressors and of their families.  CSLO #6: Implement teaching plan for individuals, families and staff from various social, emotional, cultural and intellectual backgrounds specific to their learning needs.  CSLO #7: Demonstrate effective principles of leadership: Delegation, supervision, team communication, legal aspects of care, and quality management in a team environment.  CSLO #8: Prioritize advocacy for clients and self with members of the health care team.  CSLO #9: Adhere to all college, program, and agency policies and regulations.  CSLO #10: Model safe initiation and management of intravenous therapy to all adult age groups according to community standards and the principles set forth by the Infusion Nurses Society.  CSLO #11: Evaluate progress towards weekly learning objectives based on identification of individual learning needs through joint instructor-student evaluation.  Effective Term Fall 2025 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 care for 3 clients 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 clients 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 care for 3 clients 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. Client is loudly using profanities B. Client cannot verbally contract for safety C. Client is striking at other clients and staff D. Client 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: 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. 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: 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 client. These are then turned in to the instructor who reviews and discusses with student. Distance Learning 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 client condition and provide care. 2. Mental Health Nursing: read "Schizophrenia and other Psychotic Disorders." Use information to identify changes in client 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 client 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 client 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: Harding, Kwong, Hagler, Reinisch Publisher: Elsevier Publication Date: 2023 Text Edition: 12th Classic Textbook?: OER Link: OER: Manual of IV Therapeutics Author: Gorski Publisher: F.A. Davis Publication Date: 2023 Text Edition: 8th Classic Textbook?: OER Link: OER: Varcarolis' Foundations of Psychiatric Mental Health Nursing: A Clinical Approach Author: Halter Publisher: Elsevier Publication Date: 2022 Text Edition: 9th Classic Textbook?: OER Link: OER: Other materials and-or supplies required of students that contribute to the cost of the course. Books and supplies required and suggested for previous semesters: NRSR 0021 and NRSR 0022.