Course Syllabus
NURS 242 Syllabus
MEDICAL SURGICAL NURSING III
Winter 2020
Lake Washington Institute of Technology
Course Information
- 5 Credits practicum
- Class time 6:30 am to 4:00 pm Mondays, Tuesdays and Fridays
- Class location is Evergreen Hospital
- Last day to withdraw is _________
- Advising day is Tuesday February 12th
Professor Contact Information
- Terri Fredlaw BSN RN, Laura Ouellette BSN RN and Karen Verlinden BSN RN
- Phone numbers: Terri 843-425-2127, Laura 542-2926105, and Karen 509-554-4282
- Email addresses: Terri.fredlaw@lwtech.edu; Laura.Ouellete@lwtech.edu and Karenjoy.Verlinden@lwtech.edu
- Canvas (http://lwtech.instructure.com)
- Office hours: By appointment
COURSE DESCRIPTION
This course provides opportunities for students to combine, integrate and relate critical thinking skills, knowledge of the nursing process, communication techniques, and technical skills in an acute care setting with clients manifesting multi-faceted physiological, mental, and social health disturbances.
This course teaches to the Global Outcomes of:
Communication
Teamwork
Technical and Information and Literacy
Intercultural Appreciation
Critical Thinking
PREREQUISITE(S):
NURS 221, NURS 222, NURS 225, NURS 226
COREQUISITE (s):
NURS 241, NURS 240
STUDENT OUTCOMES/COMPETENCIES
Upon successful completion of this course students will:
- Construct an approach for culturally competent care that elevates patient wellness and human dignity while supporting the therapeutic relationship within the medical-surgical, critical care and emergency settings. (GO- Communication; GO- Intercultural Appreciation; QSEN - Patient centered care)
- Investigate and evaluate technical and communication strategies to obtain, organize, analyze and record data that convey information pertaining to health education and multidisciplinary treatment for patients in medical-surgical, critical care and emergency settings.(QSEN – Informatics, Teamwork and Collaboration GO- Teamwork)
- Analyze signs and symptoms of unpredictable/unstable physiologic, mental and social health disturbances to help formulate appropriate nursing diagnoses and combine these with advanced clinical knowledge and skills to develop a comprehensive plan of care. (GO- Technical and Information and Literacy; GO- Critical Thinking)
- Examine, critique and evaluate the implementation of prescribed interventions per nursing plan of care for scientific value, safety, proficiency, while supporting patient and family advocacy. (GO- Technical and Information and Literacy; GO- Critical Thinking; QSEN- Safety; QSEN - Evidenced based practice; QSEN - Patient centered care; GO- Teamwork)
- Execute an array of organizational skills that will effectively deliver care to a caseload of patients while maintaining personal and professional responsibility and self-direction in pursuing short-term and long-term opportunities for learning. (QSEN-Safety; GO-Critical Thinking)
*Commit to using global outcomes of Teamwork, Information and Technical Literacy, and Critical Thinking.
METHOD OF INSTRUCTION
- Guided Practice (Lab and Clinical): Students are actively engaged in practicing and mastering skills under the supervision of the instructor. This category of instruction could include but is not limited to labs, studios, shops, clinical experiences, computer-mediated learning, hands-on projects, or other skill building activities. Instruction may be individualized or group-focused and include skills assessment. One credit is generated by two weekly contact hours of instruction or the equivalent amount of work over a different amount of time. May also include out-of-class student effort, typically one hour per two class hours. Specifically, this practicum provides the registered nurse student the opportunity to provide care for the patient with complex medical/surgical disturbances as well as to integrate the responsibilities of the registered nurse in day to day practice. Observation, demonstration, discussion/lecture, hands-on skill practical
TEXTBOOK(S) AND REQUIRED TOOLS / SUPPLIES /MATERIALS
- Lewis, S., Heitkemper, M., Dirksen, S. Medical surgical nursing; assessment and management of clinical problems. Mosby 10th edition
Recommended Reference Materials:
- Deglin, J., Vallerand, A. (2015/2017) Davis’s drug guide for nurses. Philadelphia; F.A. Davis
- Schnell, Z., Van Leeuwen, A, Kranpitz, T. (2015) Davis’s comprehensive handbook of laboratory and diagnostic tests with nursing implications Philadelphia F.A. Davis Company 7th edition
- Carpenito-Moyet L. (2017) Handbook of nursing diagnosis. 11th edition Philadelphia;
- Lippincott Williams
- ATI Medical-Surgical Nursing RN edition Review Module
Recommended resources for additional exploration
See Canvas modules for additional resources: handouts, scanned documents, YouTube videos, power points, etc.
REQUIRED ATTIRE, TOOLS, UNIFORMS, ETC.
The student must provide: stethoscope, pen light, watch with second hand, ruler calibrated with centimeter, specified student uniform with required LWTC Nursing Student Badge. White or black leather or vinyl (closed toe and heel) shoes (No sandals, high heels, or fabric shoes allowed). Students are expected to be in full uniform (scrubs, shoes, name badge) for clinical. Failure to do so can result in dismissal from class. Clinical equipment is also outlined in the nursing handbook
Course rubric & grading scale
Grading for the course will follow a 4.0 grading system used for the nursing program (see below). Nursing theory course, lab and clinical must be passed with a cumulative score of 80% in order to progress to the next quarter.
Nursing Program Grading Scale
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Each student is unique in life experiences, motivation for learning, and scholastic achievement. The success of the student’s journey in nursing depends upon the amount of commitment the student is willing to make. You oversee your own learning and the instructor is here to provide direction and facilitation in your learning processes.
ASSESSMENT METHODS:
- Skill demonstration
- Faculty/Staff Observation
- Observation Papers
- Staff RN feedback
- Instructor written and verbal evaluation
- Assignments, care plans, concept maps, reflective observation paper
- Conference participation
- Clinical case presentation
- Demonstration
- Self-evaluation
- Field trip paper
- Field of nursing paper-optional activity
Key Criteria for successful grade; the student will
- Employ safe and competent nursing care.
- Demonstrate clinical reasoning skills utilizing nursing process
- Practice appropriate communication and psychomotor skills in the care of healthy, acute and chronically ill individuals across the lifespan.
- Demonstrate responsibility and accountability for his/her nursing practice and growth/learning development.
- Abide by the policies and procedures of Lake Washington Institute of Technology and Evergreen Hospital
- Abide by the ANA code of nursing ethics at all times (see ANA website for details).
- Attend all scheduled clinical days or re-schedule with instructor.
- Complete all care plans/assignments satisfactorily.
Medication Math
This class has a medication mathematics component. During the class the student will be required to demonstrate safety and proficiency in medication mathematics. This/these test(s) must be passed with a score of 100% for a student to receive a passing grade for this course, regardless of other grades earned in the course. If a student fails to pass the medication math exam on the first try they will be allowed further attempts to demonstrate proficiency as arranged by the instructor. The Med math must be passed before being allowed to give medications. Please refer to this the following document: Med math and med passing progression (4).docx
Preparation for the exam is on your own. Class time will not be specifically allotted to math, however, if a student is challenged by a particular topic, instructors will be available to assist as time allows.
ASSIGNMENTS (Please see Canvas for details):
In addition to attending all clinical days, satisfactorily caring and documenting care for their assigned patients, students are required to complete the following satisfactorily:
- Provide a full report of their patient’s needs and the student’s role at the bedside in meeting those needs for each patient on instructor rounds including medication knowledge.
- 3 Care plans/concept maps on a patient they cared for. See Canvas for deadlines and submission details. Written patient care plans with 80% score or above (THREE care plans/or concept maps must receive an 80% or better score). Instructor written and verbal evaluation. (Mid-term-oral and Final-written) *It is the student responsibility to gain familiarity with clinical evaluation tool and understand the requirements and expectations for a satisfactory clinical experience.
- Reflection paper on the role of the RN in either the CCU or ED setting (see course rubric – to ensure all elements are included). See Canvas for deadlines and submission details.
- “Presentation” Clinical case study will take place on the last clinical day: present “favorite patient” and ask peers a thought-provoking question to stimulate critical discussion. For example: What would be a priority nursing diagnosis for this patient? What signs and symptoms would you typically see with this patient? What priority nursing intervention should take place? What problems could be seen with a physician order (named), etc.?
- Drug cards
- Clinical topics discussion posts
Course Policies and Procedures
PROFESSIONAL STANDARDS EXPECTATIONS:
The student will adhere to the Student Responsibilities, Professional Behavior/Personal Accountability and Essential Abilities as stated in the Nursing Programs Student Handbook. Students are expected to adhere to the ANA Code of Ethics, expectations addressed in the LWIT Student Handbook and the policies and procedures of outside clinical institutions.
STUDENT EXPECTATIONS AND RESPONSIBILITIES:
- It is expected that assigned readings be completed prior to class and that students are prepared to discuss these readings and to participate in classroom activities.
- Students are responsible for information on course outline and schedule. Instructor is not responsible to remind students of deadlines.
- Schedule is tentative. Instructor reserves right to change schedule as necessary to accommodate need to cover content areas and any circumstance that arises. It is your responsibility to keep track of your unit and assignment scores. The instructor must give at least 7 days change notice to graded items/written assessments
- If you are not passing unit exams, it is your responsibility to contact instructor for assistance.
- Outside study time. For the average student to be successful in the nursing program and individual courses, significant study time outside of class is necessary to read, analyze, and retain the course material. The amount of study time to complete required readings, assignments, prepare for exams, and perform group work varies based upon an individual student’s study habits, learner style, and level of understanding. For labs, it is expected that students have familiarized themselves to the equipment and practiced (where possible) the practical portions of each skill prior to attending class.
- Attendance and punctuality is an expected professional behavior. This should be a graded portion of each course. Please refer to the Nursing Student Handbook for details.
- It is the student’s responsibility in the event of an absence to obtain information and materials provided in class.
Additional course specific expectations:
- Students are responsible to maintain their clinical passport and all facility requirements in current standing through the duration of the clinical experience. Students can be sent home from clinical by the facility for missing requirements.
- Arrive to clinical on time: greater than 5 minutes late is considered tardy. If a student is tardy 2 times it is equal to an absence. Punctuality is an expected professional behavior.
- Attendance at all clinical days is mandatory. If student is absent from clinical for any reason he/she will need to meet with instructor to discuss circumstances and ability to achieve course objectives.
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If a student must miss a clinical day, it is the student’s responsibility to notify the instructor prior to the start of clinical. If the student is unable to reach the instructor, the student should contact the charge nurse of the unit where they are scheduled for clinical.
- Signs of illness: Student should contact their clinical instructor and their primary care physician with questions in regard to illness, communicability and safety of attending clinical.
- Review the handbook for dress code rules/EHMC policy. Unacceptable attire, and/or hygiene (body odor, cigarette or perfume odor, unclean appearance) will result in student being sent home and the day will be marked an absence
- Students are expected to provide safe nursing care
- Correctly utilize all safety measures/devices (i.e., transfer belt for transfers, ambulation, etc.)
- Demonstrate 7 rights in medication administration (right drug, right dose, right route, right time, right client, right reason, right documentation)
- Accurately and completely document in patient record assessment/interventions and evaluation of patient care
- Demonstrate knowledge of patient limitations, allergies
- Demonstrate understanding of relationship between diagnosis**/medications/lab results and assessment
- Evaluate all nursing actions
- Understand facility emergency policies and procedures
- Report immediately any significant changes in patients’ condition to primary nurse, and instructor
- Follow all policies and procedures of Evergreen Hospital and LWTC nursing program
- Self-evaluate all actions and participate in mid-term and final course evaluations
- Communicate professionally with staff, classmates and instructors
- Demonstrate professional behavior in all nursing activities
- Be accountable and positive in all actions
- Be respectful to clients, colleagues, staff and instructor
**It is an expectation that students come prepared to clinical understanding common acute care conditions and medications. See list of conditions and medications provided by instructor. The unprepared student may be sent home and/or required to complete a remediation assignment and an educational plan may be initiated.
ADDITIONAL COURSE INFORMATION:
GOALS: Develop proficiency in basic and advanced skills (as noted below). Provide safe and effective care to two clients. Establish effective relationships with the hospital patient care team.
Apply nursing process, critical thinking and legal/ethical/and safety principles in performing nursing care
Nursing Skills
Each hospital clinical experience is different as to the type, and quantity of procedural skills that come available to perform. The student is encouraged to let their interest in performing specific skills be known to the primary nurse. If an intermediate to advanced skill becomes available to perform either on an assigned client or another client, student must seek approval from instructor before proceeding. Instructor will discuss with student specifics of situation and determine if supervision by primary nurse or instructor is required. It is expected that the student demonstrates clinical competence in the following skills;
- Head to toe physical exam
- Basic nursing skills
- Sterile wound care
- Enteral feeding including NG and PEG
- Maintenance of Nasogastric tube for suctioning
- IV site assessment
- Peripheral IV flush, dressing management
- Ostomy care
- Oral/pharyngeal suctioning
- JP/hemovac emptying of drainage container
- Urinary catheterization
- Urinary catheter maintenance, emptying of foley bag
- Safe administration of medications: Oral, IV, IM, SQ
ALL medication administration requires supervision of the clinical instructor or assigned/primary RN (the assigned RN may supervise medication administration after approval of the instructor). The student will not administer medications if the RN or instructor is not available to directly supervise. In such situations when medications are due to be delivered and the RN or instructor is not available to supervise, the student will ensure that the primary RN responsible for the patient has been notified. Students are expected to understand the reason the patient is receiving the medication, check to see if the ordered dose is within dosing range, identify side effects of the medication, and ensure the patient is not allergic to the prescribed drug. Under no circumstances will a student give medication by bypassing the organization’s bar-coding process.
The student role for the following nursing responsibilities is limited to observation only (in addition, please refer to hospitals’ policies regarding restrictions):
- Administration of TPN
- Administration Blood products
- Warming fluids
- Conscious sedation
- Administration of chemotherapy
- Telephone or verbal orders
- Transcription of MD orders
- Regulation of any medication or dose rate calculator
- Accessing a central line port a cath
- De-accessing a central line port a cath
- Use of therapeutic equipment such as CPM’s
- Management of PCA or epidural pumps
- Signing out for or witnessing wasting of controlled substances
- DC epidural lines or central lines
- (Please see Evergreen Hospital’s specific guidelines included in orientation documents for further guidelines)
Student should not be left alone on the unit. If assigned RN goes to lunch or break, student must communicate with the nurse that temporarily takes responsibility of patient assignment.
Observational experiences and assisting hospital staff with treatments/procedures is encouraged. Unless the “level of assistance” is in question, this activity does not require instructor notification.
The student is responsible for understanding and following (not exceeding) practice boundaries of the student nurse per LWTC, and facility guidelines. The student will provide care within practice boundaries and ensure primary nurse is aware of patient needs/physician orders that student is unable to safely/legally provide. If questions arise as to limitations or expectations speak with the instructor. It is the student responsibility to adhere to the student limitations that are specific to each facility.
Expectations and organization of clinical day
- Report to the RN assigned you by the charge nurse.
- Introduce self to assigned RN, share learning goals and student boundaries for week
- Listen to shift report. Discuss with primary nurse appropriate patient assignment based on course objectives and learning goals for the week. (Ensure patient consent to have a student nurse do care)
- Review client chart: paper and electronic
- Note upcoming meds
- Recent progress notes
- Recent labs
- Recent vital signs
- Impending orders/procedures
- Note isolation and fall precautions
- Perform a focused assessment, including vital signs
- Document and report promptly to primary nurse
- Communicate to instructor priority problems, plan of care based on assessment findings using SBAR communication format.
- Provide basic nursing care including AM or HS hygiene.
- Address or seek RN support to meet client needs staying within boundaries established by hospital, instructor and scope of practice.
- Organize and manage time effectively to ensure delivery of timely care.
- Recognize and report abnormal findings, changes, or trends in client assessment.
- Prioritize care appropriately
- Communicate effectively
- Strictly adhere to client isolation precautions
- Evaluate the nursing process, plan of care
- Complete all required documentation
- Evaluate performance and establish goals for next clinical
Vital signs must be documented by the time designated by facility. Any abnormal findings or abnormal trends must be reported immediately to primary RN (or if unavailable, the charge nurse).
The student is responsible for providing safe and effective nursing care to the assigned client(s). The student is responsible to stay informed of changes in medical orders and plan of care. The student is responsible to recognize and report changes in client status to primary RN in a timely manner recognizing situations that require immediate notification.
The student is required to report to Primary RN (and instructor) prior to leaving floor for break/lunch or post conference.
It is expected that the student practice professional communication with all team members.
The student will recognize (and defer to) the primary RN authority and responsibility for the care of the patient.
The student will follow the directions of the RN regarding documentation. Hospital policy will be followed regarding co-signatures for medication administration and/or documentation.
Observation Experiences.
Observational experiences are meant to be an opportunity for student to observe the RN role in a different setting. Students can provide basic (NAC) care to clients (utilizing safe/legal/ethical nursing principles) at the discretion of the primary RN assigned. The students will not administer medications. Student will consult with instructor if there is any question in regard to student boundaries.
Following an observation experience, the student will prepare a 2-4-page reflection paper. The paper should include a description of the environment, nursing roles, and responsibilities of collaborative team members. Also address unique aspects of the experience that you considered valuable to your learning. This paper will be typed and submitted per instructor instructions. PLEASE REFER TO CANVAS FOR DETAILS.
There will be no opportunity to make up missed observation experience due to absence.
If student is not meeting course expectations, per instructor, the student will forfeit observation experience in lieu of additional med/surg floor time.
Late assignments will receive a 25 % reduction in grade.
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Academic Integrity
Students should review the Academic Dishonesty and Classroom, Lab, Clinic Conduct section of the Student Code of Conduct (WAC 495D-120, beginning on p. 22). Academic dishonesty includes, but is not limited to, cheating, plagiarism, and fabrication.
- Cheating includes any attempt to give or obtain unauthorized assistance relating to the completion of an academic assignment.
- Plagiarism includes taking and using as one’s own, without proper attribution, the ideas, writings, or work of another person in completing an academic assignment. Prohibited conduct may also include the unauthorized submission for credit of academic work that has been submitted for credit in another course.
- Fabrication includes falsifying data, information, or citations in completing an academic assignment and also includes providing false or deceptive information to an instructor concerning the completion of an assignment.
Violations of academic honesty as defined in the Student Code of Conduct, including plagiarism, shall result in failure for the assignment or assessment in question. A second violation of academic integrity shall result in failure in the course. All violations of academic integrity shall be reported to the college's confidential database, which may result in additional investigation and corrective action through the student conduct process.
Computer and Cell Phone Usage
- Example: Use of cell phones is not allowed inside the classroom.
- Example: Cell phones may be used only when directed by the professor for class activities.
- Example: Utilize laptops and classroom computers for class activities only.
Community Standards
You may add other expectations to support community development in your class.
It is expected that you will respect the rights and dignity of classmates, faculty, and all others on campus at all times. This includes doing your part to create a safe, distraction-free, and collaborative learning environment. Homophobic, racist, sexist, and other demeaning language and/or actions are not permitted.
Equal Opportunity Information
Lake Washington Institute of Technology is an equal opportunity college and is committed to principles of diversity. The college accepts students without regard to race, color, religion, national origin, gender, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam-era veteran.
Campus Public Safety
Your safety and security are taken seriously at LWTech. All incidents of confirmed or suspected crimes are reported. If you require assistance or would like to report an incident, please dial 425-739-8224 to reach Campus Public Safety. In an emergency, call 911 and then Campus Public Safety.
- Evacuation procedures—posted in each classroom
- School closures – Please check Emergency Communications in case of inclement weather
- Campus Security Location: Room E145
- If You See Something, Say Something: In support of the college safety plan, the Campus Assessment, Response, and Evaluation (CARE) team uses collaboration, information collection, risk assessment, and intervention to create a safe campus community. Based upon reports of student behavior, the CARE team plans preventive strategies and interventions to assist students, faculty, and staff in supporting students who may be at risk. Please use our online reporting form to contact us.
Support Services for Learning
You can choose to include other resources not listed here. For a complete list of resources, which can also be added to any Canvas course, go to LWTech Student Connect in the Canvas Commons. Contact the Office of eLearning for support in adding the content to your course.
Disability Services, West Building, W207
If you have a physical, psychological, medical, or learning disability that may impact your course work, you may request accommodations and apply for services through DSS Online (https://cascade.accessiblelearning.com/LWTech/ApplicationStudent.aspx).
After you provide documentation of a disability, the office will coordinate directly with your faculty to ensure you are given reasonable accommodations to support your success. All information and documentation is confidential. DSS is located in W207 in person, by phone at 425-739-8300, or by email (dssinfo@lwtech.edu). For additional information please refer to lwtech.edu/dss.
Computer Lab, Library, T215
Hours and available computer programs are posted at the entrance. The Computer Lab is also a Quiet Zone for individual study sessions.
Tutoring, East Building, E214
Drop-In tutoring is available for all students in The Learning Lab in E214. Subjects include English, math, science, humanities, and social science, as well as some program areas. Stop by to see a full schedule by subject, to meet with a tutor, to use a computer or the interactive SmartBoard, or to work on study skills development.
Bookstore, East Building, E127
Library-Learning Commons, Technology Building, T215
Supplemental Instruction Library, T217
Supplemental Instruction provides students in this course with additional learning opportunities related to course content. Study sessions are hosted in the Supplemental Instruction Center in T217 at the following times.
- Include your course’s assigned SI session times.
- Describe how SI is used in your class.
Safety Rules
Your clinical instructor will guide you through out your experience and will highlight and assess the various safety issues as they come up. Any skills learned in lab before this clinical will be assumed learned along with any safety measures relating to patient care and nursing administration.
Equal Opportunity Information
Lake Washington Institute of Technology is an equal opportunity college and is committed to principles of diversity. The college accepts students without regard to race, color, religion, national origin, gender, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam-era veteran.
Campus Security
Your safety and security are taken seriously at the college. The campus hires security personnel and off-duty police officers. All incidents of confirmed or suspected crimes are reported. If you require assistance or would like to report an incident, please dial 425-739-8224.
SUPPORT SERVICES FOR LEARNING
Disability Services, West Building, W207
If you have a physical, psychological, medical, or learning disability that may impact your course work, please contact the Disability Support Services office. They will coordinate reasonable accommodations for students with documented disabilities. All information and documentation is confidential. DSS is located in W207 in person, by phone 425-739-8300, or by email dssinfo@lwtech.edu. For additional information please refer to www.lwtech.edu/dss
Computer Lab - Hours are posted on the entrance to the Library
Peer Tutoring - Peer tutoring is available for students who are having difficulty in a class. If you would like to request a tutor, please contact the coordinator in the Academic Skills Center to obtain and complete the appropriate paperwork. If you have any general questions about tutoring, please contact at tutor@lwtech.edu
Bookstore: http://www.lwtech.edu/Student_Life/Bookstore.xml
Library-Learning Commons: http://lwtechlearningcommons.com/
EMERGENCY INFORMATION
- Evacuation procedures—posted in each classroom
- School closures – Please check https://www.flashalert.net/ in case of inclement weather
- Campus Security Phone: 425-739-8224, Room E145
- IF YOU SEE SOMETHING, SAY SOMETHING: In support of the college safety plan, the Behavioral Intervention Team (BIT) uses collaboration, information collection, risk assessment, and intervention to create a safe campus community. Based upon reports of student behavior, the BIT plans preventive strategies and interventions to assist students, faculty, and staff in supporting students who may be at risk. Please use our online reporting form to contact us.
CANVAS AND OTHER ONLINE ASSIGNMENTS
Canvas is an integral component of this course. It is the student’s responsibility to develop familiarity and regularly access for announcements, assignments, and discussion board. It is the student’s responsibility to update the system with current/valid email address.
My signature below indicates that I have read and understand this syllabus and have been given a copy of my own to keep.
_____________________________________________________________________________
Student Signature Quarter Date
Course Summary:
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