63-272 – Official 2006F

COLLABORATIVE BACHELOR OF SCIENCE IN NURSING PROGRAM

(University of Windsor, LambtonCollege, St. Clair College)

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63-272 Course Outline – F06

63-272 – Official 2006F

1

63-272 Course Outline – F06

63-272 – Official 2006F

Clinical Nursing Experience

63-272

(10 hours/week x 13 weeks)

Site: Faculty of Nursing, University of Windsor

Fall 2006

Lead Teacher:

Maher M. El-Masri, PhD, RN

University of Windsor

©Faculty of Nursing 2006

ALL RIGHTS RESERVED

63-272

CLINICAL NURSING EXPERIENCE

I.Course Description

This is the third of a sequence of 10 clinical practice courses. It is designed to provide the student with the opportunity to learn and practice professional and technical skills including assessment, goal-oriented planning, interventions and evaluation of clinical outcomes for young adults, adults and older adults experiencing acute and long-term health needs within the context of family and community.

II.Program Competency Outcomes

By the end of the program, graduating students will be able to:

1. Implement behaviours to promote personal and professional self-development.

2. Integrate the ethical, legal, professional and regulatory parameters into nursing practice.

3. Formulate clinical judgements that are based on critical inquiry and analytical reasoning.

4. Integrate nursing and multidisciplinary knowledge into nursing practice.

5. Integrate research findings into clinical practice, education and management.

6. Implement the nursing process to promote, maintain and restore the health of individuals, families, groups and communities.

7. Use the teaching/learning process to promote the health of individuals, families, groups and communities.

8. Collaborate with clients, their families, communities, members of the health team and other organizations for the promotion, achievement and restoration of optimal health.

9. Integrate leadership and management roles into the delivery of health care.

10. Engage in activities to promote the development of the profession of nursing.

III.Course Competency Outcomes

1. Implement behaviours to promote personal and professional self-development

  • Analyze own philosophy/values about the care of adults and older adults experiencing episodic and long-term health alterations.
  • Using reflective journal, analyze how own personal growth as a member of a family has influenced his/her nursing practice.
  • Integrate feedback from individual client, families, peers, faculty and other health professionals to set goals to improve own practice.
  • Analyze own learning needs, readiness, style and their impact on care of individuals and/or families experiencing episodic and long-term alterations.
  • Evaluate own behaviours that document goal achievement against program competencies.

2. Integrate ethical, legal, professional and regulatory parameters into nursing practice

  • Advocate for the rights of individual clients and/or families in provision of care during episodic and long-term health alterations.
  • Use the College of Nurses of Ontario Standard of Practice in the care of adults experiencing health alterations.
  • Adhere to the policies of the Collaborative Nursing Program and the participating agencies when caring for individual clients and/or families with episodic and long-term health alteration.
  • Analyze with assistance ethical dilemmas encountered in the care of individual clients and/or families experiencing long-term health alterations.
  • Document client care accurately.

3.Formulate clinical judgements that are based on critical inquiry and analytical reasoning

  • Use inductive and deductive reasoning to assess and determine health needs.
  • Use critical analysis skills to prioritize the needs of individual clients and/or families experiencing episodic and long-term alterations.
  • Use analytical reasoning in collaboration with clients, to generate strategies to promote optimal health.
  • Verify with clinical faculty and/or health care professionals evidenced based clinical judgements.
  • Analyze own nursing actions that promote optimal health of individual clients and/or families experiencing episodic and long-term alterations.

4.Integrate nursing and multidisciplinary knowledge into nursing practice

  • Provide theoretical rationale for all actions taken to promote health of individual adult clients and/or families.
  • Analyze the factors that contribute to the development of selected episodic and long-term health alterations.
  • Apply relevant multidisciplinary theories to the care of individual adult clients and/or families.

5.Integrate research findings into clinical practice, education and management

  • Analyze how research is applied in the care of individual clients and/or families experiencing health alterations.
  • Use evidenced based practice in the care of individual clients and/or families experiencing health alterations.
  • Formulate researchable questions to promote the health of individual clients and/or families.

6.Implement the nursing process to promote, maintain and restore the health of individuals, families, groups and communities

  • Perform holistic health assessment for individual clients and/or families experiencing episodic and long-term health alterations.
  • Perform preoperative and postoperative assessments for individual clients and/or families using selected tools
  • Perform gerontological assessments for individual clients using selected tools.
  • Perform pain assessment.
  • Formulate nursing diagnoses in collaboration with clients and/or families.
  • Collaborate within individual clients and/or families to formulate expected outcome criteria.
  • Implement interventions that are relevant to the nursing diagnoses identified.
  • Administer medications safely following the rights of medication administration.
  • Evaluate client outcomes by comparing actual to anticipated outcomes, modifying the plan of care as required.

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63-272 Course Outline – F06

63-272 – Official 2006F

7.Use the teaching/learning process to promote the health of individuals, families, groups and communities

  • Collaborate with clients to determine learning needs.
  • Determine learning needs of client in preparation for diagnostic procedures and preoperatively.
  • Determine client readiness to learn.
  • Mutually develop learning goals with individual clients and/or families.
  • Implement learning plans based on teaching/learning principles to promote optimal health of clients and/or families with episodic and long-term health needs.
  • Evaluate the effectiveness of teaching/learning strategies for clients and/or families by comparing actual to anticipated outcomes and modifying the plan as required.

8.Collaborate with clients, their families, communities, and members of the health team and other organizations for the promotion, achievement and restoration of optimal health. Use therapeutic and professional communication techniques.

  • Respect clients/families and apply the principles of a helping relationship.
  • Advocate for the rights of client and family.
  • Collaborate with the members of the health team and related agencies to promote optimal health.

9.Integrate leadership and management roles into the delivery of health care

  • Demonstrate time and resource management in the care of individual clients and/or families experiencing episodic and long-term health alterations.
  • Analyze the leadership and management roles of nurses in the promotion of optimal health in clients and/or families experiencing episodic and long-term health alterations.

10.Engages in activities to promote the development of the profession of nursing.

  • Participate in nursing and other professional discussions in promotion of optimal health of clients and/or families experiencing episodic and long-term health alterations.
  • Explore the role of nursing in advocating for the rights of clients and/or families to quality care in a variety of settings.
  • Identify factors that enhance or inhibit quality care of clients and/or families in a variety of settings.

Adapted Concepts of Bevis’ Curricular Framework

Philosophical Foundation and Key Theoretical Concepts

Introduction

The University of Windsor, St. Clair and LambtonColleges have adopted the key concepts from Em Bevis’ Curricular Framework (1973, 1983) as the theoretical basis for the collaborative nursing program. This brief outline provides the philosophical and theoretical underpinnings of the collaborative program.

Philosophical Foundation

The philosophical underpinnings of the curriculum are important in that they provide insight into nursing’s beliefs about persons, environment, health and nursing, as well as knowledge and ethics which underlie nursing practice. The theoretical foundation for Bevis’ concepts is based on a humanistic existentialism philosophy.

Humanism

Humanism emphasizes the value, beauty and importance of being human and a concerned action geared to human ideals, human existence and quality of life. Humanism is characterized by a value system that places great importance and high priority on caring about people.

Existentialism

Existentialism holds that each person is unique and inexplicable by science or philosophy. It is a natural part of holistic philosophy and proposes that the whole of a human being is different from his/her parts. Existentialism proposes that human are thinking beings who make choices.

The tenet that a human is free (freedom to choose) is the most basic of all freedoms. Two other attributes spring from this freedom. Freedom of choice makes a human being a suffering individual and unpredictable. Freedom to choose and being a thinking being implies accountability. If one makes one’s own choices, then one is accountable to self and other human beings.

Theoretical Basis

The theoretical base for Bevis’ concepts is “General Systems Theory”. A system is anything that functions as a unit of “wholes” because its parts are interdependent. Persons have open systems in that energy and matter are imported from other systems and free exchange causes the system to achieve more complexity and heterogeneity. All open systems have subsystems and all but the largest have supra systems. Systems have inputs (energy and information going into the system) and outputs (energy and information going out of the system).

The key concepts for the collaborative nursing program are outlined below:

Person: Individuals are unique holistic persons with inherent dignity and are worthy of respect and care. Individuals are capable of entering reciprocal relationships that foster health, growth and self-actualization.

Environment: The milieu within which individuals, families and communities strive to achieve optimal health. As persons attempt to mature and adapt, there are dynamic interactions that can serve as a source of growth.

Health: Is a dynamic process whereby the individual, family or community is able to realize aspirations, satisfy needs and change or cope with the environment. Health is a resource for everyday life. It is a positive concept emphasizing social and personal resources a well as physical capacity. Health is the goal of all nursing behaviours.

Nursing: Is a process. Its purpose is to promote optimal health through nursing activities. These activities are carried out with three client systems-individuals, families and communities. Nursing’s role is to facilitate maturation and adaptation in these client systems. The tools with which nurses function are: communication, caring, problem-solving/decision-making, management/change and teaching/learning. Nurses are autonomous health professionals, who collaborate with other members of the health care team for the benefit of clients. They are accountable for their activities; they monitor and regulate the quality of nursing care given and prove each other with mutual protection, nurturing and facilitation of growth. The purpose of nursing is “the highest possible level of health or self-actualization for clients/patients”. (Bevis).

LIFE PROCESSES: Bevis has identified two life processes: (maturation and adaptation) which are health-producing tasks.

Maturation: Clients/patients are involved in maturational tasks that influence health. Individuals, families and communities have tasks to achieve to continue to grow. Clients, developing beings, move through life from one level to another, each level progressively differentiated from the other and integrated with the other at more advanced levels. Developmental status is one of the variables that influence nursing care because health and consequently nursing care impinge on, encourage or inhibit development as it moves from differentiation to integration.

Adaptation: Is the outcome of the interaction of variables with the dynamics of stress as it influences persons, families and/or communities. Stress is a physical and emotional state always present in the person, one influenced by various environmental, psychological, and social factors but uniquely perceived by the person and intensified in response when environmental change or threat occurs internally or externally and the person must respond. The stress response is always an attempt at adaptation. For example, eustress is the stress that comes with successful adaptation and that is beneficial or promotes development and self-actualization. Distress is negative, noxious, unpleasant, damaging stress that results when adaptive capacity is decreased or exhausted.

FIVE TOOLS OF NURSING PRACTICE

Problem-Solving/Decision Making: Problem solving, a process, is used to arrive at a place where decision can be made. Decision-making presupposes that problem solving has taken place and is the end product of problem solving. Problem solving involves all of the analytical processes including the nursing process and research. Decision-making is the acquiring, ordering and selecting of tools, resources, or alternatives for reaching goals or fulfilling needs. Problem solving is the system/process used to arrive at a place where decision can be made. Decision-making involves all of the analytical processes, including the nursing process and research process and utilizes critical thinking abilities of participants.

Communication: Communication involves a series of processes such as becoming self-aware, sensitive and responsible to oneself and others. There are overt and covert signs and symbols as well as verbal and nonverbal cures to promote message-sending, an receiving activities plus processing, intuiting activities and the sending of feedback messages.

Teaching/Learning: Learning is a change in behaviour, perception, insights, attitude, or a combination of these that can be repeated when the need is aroused. The change in behaviour may/may not be directly observable; however, the effects of learning are always observable. Teaching is a purposeful activity designated to facilitate learning and hence, becomes linked to learning.

Caring: “Caring gives comprehensive meaning and order to one’s life (Mayeroff, 1971). Caring is one of the basic drives of life is to complete oneself. It is manifested in the drive to grow, to fulfill, to transcend one’s “prison of self”. The conditions of caring and the caring process enable mutual growth.

Management/Planned Change: The process of management/planned change subsumes the processes of leadership, organizational structure and management. Planned change is the purposeful planned adaptation to a shift in the environment. “Planned” indicated collaborative and cooperative endeavours. The phrase “shift in the environment” means an increase in the number and complexity of variables as opposed to the stability of the environmental factors.

V.Course Requirements, Evaluation Methods and Grading System.

63-272 will be offered on a pass/non-pass basis.

Each week students will have a laboratory experience during which there will be case-studies, technical skills, calculation skills and critical thinking exercises presented. Students are expected to read the assigned readings and have a good understanding of the theoretical basis of the skills prior to each lab. There will be skills evaluation session related to technical skills and theoretical knowledge as well as two written medication calculation quizzes in which the student must obtain 100%. The above evaluation methods will constitute the Competency Performance Evaluation (CPE) for the laboratory experience. All CPE’s and all of the critical elements must be passed. If unsuccessful in CPE skills, students must set aside time to practice and will be retested on one further opportunity to demonstrate progress from a “Non-Pass” to a “Pass”. If students are unsuccessful in calculation quizzes, they must set aside time to review and will be given twofurtheropportunities to pass.

Each week, students will also have the opportunity to care for clients in the clinical area.

These clients will include young adults, adults, and older adults experiencing acute and long-term health needs. Students will be expected to practice both professional and technical skills. Students will be expected to demonstrate both UC’s and Course Competency Outcomes (CPE’s) and their critical elements at an acceptable level (see evaluation format). There will be a written mid-term performance evaluation. If a student obtains a non-pass, a written plan will be devised by the student and instructor in order to assist the student to obtain a “Pass” grade. There will also be a final written performance evaluation. Students are expected to pass all critical elements indicated in the CPE’s.

All Universal Competencies must be passed. All Competency Outcome Elements (CPE’s) must be passed.

A pass in BOTH the laboratory and the clinical experience must be obtained in order for the student to obtain a Pass in 63-272.

The written assignments (CPAs) for the 63-272 clinical experience are as follows:

CPA #1 – Learning Plan

  1. A written learning plan is to be handed to the clinical instructor by Week 2. The plan should consist of an evaluation of the learning plan from first year as well as 2 new goals relevant to 63-272. Students are required to submit their revised learning plan and their portfolio for the instructor to assess.

CPA #2 – OR Assignment

  1. Pre and post-op assessment. Completion of Peri-operative Case Study assignment.

CPA #3 – Assessment Tool (Appendix A) & NCP (Appendix B)

  1. Assessment tool: includes an assessment of the client and his family. Relevant nursing diagnosesmust be included based on assessment findings. Due the week of November 6, 2006.
  2. Care plan (one only), based on the clients for whom the assessment tools were completed. However, if the student’s writing of the care plan is deemed unsatisfactory, the instructor has the right to ask the student to rewrite or do more than one care plan until a satisfactory care plan is presented. Teaching activities, including assessment of learning needs and actual teaching must be included within the care plan or done separately. Due the week of November 6, 2006.

CPA #4 – Research Article

Research article related to some aspect of the clinical experience including a copy of the article and a one-page summary and its relevancy to the clinical area. Also include one researchable question relevant to the promotion of health of clients and/or families. Due the week of November 20, 2006.