Course catalogue no : 8009 NRS
Course title : Critical Care Nursing Interventions 11
Field of Education Code
Program/s Master of Critical Care Nursing
Master of Critical Care Nursing (Honours)
Convenors – Patricia Johnson /Anne Evans-Murray
School : Nursing
Faculty : Nursing and Health
Status of Course within program/s or
Credit point value 10
Prerequisites : Nil
Year and semester : 2003 Semester 2
Course convenor Patricia Johnson
(07)55718283 or page 404
Teaching team members :
Date course outline was last modified June 2002
Students completing this course will:
1. Describe selected pathophysiological processes encountered by patients in the critical care environment.
2. Describe the role the critical care nurse plays in implementing, monitoring and evaluating complex therapies in the
critical care environment.
3. Explain the use of selected technologies in management of critically ill patients.
4. Demonstrate an understanding of therapies utilised by other health care professionals in the critical care environment.
5. Critically evaluate research findings related to nursing care of the critically ill patient.
6. Complete an in-depth exploration of one aspect of critical care nursing, which may include advanced critical care
practice, teaching, research and management.
Interrelationship of the Course with other Courses and the Program
This course is one of four core critical care nursing specialty courses within the Master of Critical Care Nursing, which is
80 credit points, and the Master of Critical Care Nursing (Honours) which is 120 credit points. The other core critical
care nursing specialty courses are 8015NRS Introduction to Intensive Care, Coronary Care and Emergency Nursing,
8008NRS Critical Care Nursing Interventions 1, and 8010NRS Critical Care Nursing Interventions 111. This course will
further develop and extend the knowledge and skills that were the focus of Introduction to Intensive Care, Coronary Care
and Emergency Nursing, and Critical Care Nursing Interventions I.
This course will focus on multi-disciplinary, technologically dependent approaches to patient care and the role the critical
care nurse plays in implementing, monitoring and evaluating the efficacy of these approaches. Body system support,
organ replacement technologies, complex infusion therapies and invasive monitoring will be discussed. Aspects of
advanced practice, teaching, research or management in critical care will be explored.
Generic Skills Development
This course will develop skills of problem solving and decision making, analysis and critical evaluation, information
retrieval, teamwork, professional effectiveness, oral and written communication.
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This course will have some print materials supplemented. Attendance is recommenced but not compulsory with the
exception of the Compulsory Attendance day.
Rationale for Content
This course will further develop and extend the knowledge and skills that were the focus of Introduction to Intensive
Care, Coronary Care and Emergency Nursing, and Critical Care Nursing Interventions I. The skills and knowledge learnt
in this course will enable students to practise in a variety of critical care settings, and equip them for future roles of
nursing leadership in critical care nursing.
Organisation and Teaching Methods
This course comprises 42 contact hours over seven (7) weeks. A variety of teaching and learning strategies will be used
and will include lectures, tutorials, self-directed learning exercises and reflective sessions. Students will undertake
weekly reading and will be required to participate in discussions generated by the content of the material.
This course will be coordinated through the Faculty of Nursing and Health, School of Nursing and conducted at the Gold
Rationale for Teaching Methods
The teaching and assessment strategies in this program reflect the philosophies and strategies of other graduate certificate
level programs offered by the School of Nursing. That is, they are designed to advance students’ professional practice
skills, promote lifelong learning strategies, encourage critique and debate, improve oral and written skills and facilitate
interdisciplinary collaborative relationships.
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Week Content Speaker
A. Evans-Murray /Trish Johnson
Advanced cardiac: SVT versus VT, BBB
Compulsory Attendance today
Advanced Life support:
Clinical skills workshop
Complications of M.I
Clotting and thrombolytic therapy
Treatment of M.I
Congestive Cardiac Failure
Dr. Nasser Essack
Dr. Jon Fields
Burnout/ bullying / communication
Exam Review /Evaluation
September 4th Exam 9am A. Evans-Murray
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1. Discuss the credentialling procedure relating to the specialist critical care nurse.
Gerontological Alterations and Management of the Elderly Patient in Critical Care
1. State the clinical significance of age-related physiological changes (neurological, cardiac, gastro-intestinal) and
the expected nursing consideration or interventions used in caring for the elderly critical care patient.
2. Relate the age -related changes in hepatic function and accompanying pharmacolinetic changes to the
administration of various cardiovascular medications.
3. Describe the age-associated physiological changes that occur in the elderly. (neurological, cardiac, gastro-
• 1998 - Thelan et al., pp. 271 to 292
• 2002 Urden et al., pp. 199- 209
• Chelluri, L (2001). Critical Illness in the Elderly Review of Pathophysiology of Aging and Outcome of Intensive
Care. Journal of Intensive Care Medicine. 16 (3), pp. 114-127.
1. Review the nutritional assessment of a critically ill patient and identify the altered parameters in the critically ill
2. Explain mechanisms for energy use in the critically ill including the hypermetabolic state.
3. Outline indications for parenteral and enteral nutrition for a critically ill patient.
4. Describe the nutritional solutions available.
5. Describe methods of evaluating nutritional support, nursing care and complications.
• 1998 - Thelan et al., , pp. 121 - 126.
• 2002 –Urden et al., pp. 93 – 100, 109 -117
WEEK 2 Advanced cardiac
1. Explain the pathology of pre-excitation of the ventricle. (Wolff-Parkinson-White and Torsades)
2. Describe the ECG changes associated with accessory pathway conduction.
3. Differentiate between the features and management of SVT and VT.
4. Identify ECG changes associated with selected disease processes. (ie. pericarditis, pulmonary embolus)
5. Describe the ECG pattern that is characteristic of right and left bundle branch block.
6. Discuss rate dependent bundle branch block
7. Compare the hemiblock patterns that may be seen in both fascicles of the left bundle branch.
8. Determine the electrical axis on the basis of given complexes in the six limb leads and state whether they are
normal or abnormal.
Pacemakers and Internal Defibrillators
1. Identify principles of cardiac pacing.
2. Outline the purpose and indications for cardiac pacemakers.
3. Differentiate between temporary and permanent pacemakers.
4. Describe the various types of pacemakers currently in use.
5. Describe the management of a patient receiving cardiac pacing.
6. Describe the nursing response associated with caring for patients with AICD, Automatic Implantable Cardiac
7. Correctly interpret a 12-lead electrocardiography of paced rhythm (noting pacing spikes), capture, intrinsic,
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• Morton, P. (1997). ECG / Pacemaker Critical Care Nurse, 17, 1
• 1998 – Thelan et al., pp. 529 - 541
• 2002 – Urden et al., pp. 440 – 450, 322 – 323, 338 – 339,
• Evans-Murray A. (2001). Wolff- Parkinson-White (WPW) syndrome: what the critical care nurse needs to
consider when administering antiarrhythmics. Aust Critical Care 14 (1), pp. 5-9.
Advanced Life Support
1. Discuss ARC’s policies on resuscitation.
2. Demonstrate the team leader’s role in a mega code.
3. Identify life threatening arrhythmias.
4. Review treatment of life-threatening arrhythmias.
THE STUDENT WILL DEMONSTRATE SUCCESSFULLY THE TEAM LEADERS ROLE IN A MEGA-CODE.
• Advanced airway and ventilation maintenance
• Electrocadiographic monitoring
• Arrhythmia analysis
• Arrhythmia management (mechanical , chemical, electrical )
• Management of resuscitation equipment
• Occupational health and safety issues
• ARC advanced guidelines
• Team leader decision-making
• Review life threatening arrhythmias from previous course – Introduction to Intensive Care, Coronary Care and
• 1998 - Thelan et al., pp. 406 -428
• 2002 – Urden et al., pp. 332 -342
1. Discuss current trends and indications for cardiac surgery.
2. Describe the effects of cardiopulmonary bypass.
3. Contrast the management of patients with valve replacement surgery to that of coronary artery surgery.
4. Outline assessment data in the post-operative period and implications for nursing management.
5. Identify specific complications and long term prognosis.
• 1998 – Thelan et al., pp. 541 -550
• 2002 – Urden et al., pp. 466 –484
Cardiac: Haemodynamic Monitoring
1. Identify the principles of invasive pressure monitoring.
2. Explain the physiological significance of monitoring haemodynamic parameters.
3. Interpret data from arterial, central venous and pulmonary artery pressures, cardiac output, cardiac index,
systemic and pulmonary vascular resistance readings and calculations including the significance of
4. Identify the indications for, nursing care of and complications related to haemodynamic monitoring.
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• 1998 – Thelan et al., pp. 442 - 480
• 2002 – Urden et al., pp. 355-387
Flynn, pp. 161 to 206
1. Discuss the complications of myocardial infarction.
2. Describe the medical and nursing treatment of myocardial infarction.
3. Briefly outline the clotting cascade and relate to thrombolytic therapy.
4. Explain the use of thrombolytic therapy after myocardial infarction.
5. Describe the nursing care of patients receiving thrombolytic therapy.
• 1998 – Thelan et al., pp. 490 -501
• 2002 – Urden et al., pp. 409 –414, 452 -465
1. Discuss the pathophysiology, clinical manifestations and treatment of the following cardiovascular disorders:
2. Describe the pathophysiology of congestive cardiac failure.
3. Discuss the treatment of congestive cardiac failure and recent research into pharmacological agents.
• 1998 – Thelan et al., pp. 502-510,
• 2002 – Urden et al., pp. 418 –420, 414 - 418
• Taccetta- Chapnick, M. (2002). Using Carvedilol to Treat Heart Failure Critical Care Nurse 22, (2), pp. 36 –56.
Neuro 1: Management of Head Injuries
1. Describe autoregulation of intracranial pressure (including Munoe Kelly Doctrine).
2. Review the factors that alter intracranial pressure (ICP).
3. Describe the various methods to monitor ICP.
4. Explain the role of the nurse in the management of ICP monitors and CSF drainage systems.
5. Describe the nursing interventions to decrease ICP.
6. Describe the pharmacological management of increased ICP including the implications for nursing.
7. Explain the five critical areas of neurological assessment:
• Motor Movements
• Pupillary reaction and eye movement
• Respiratory patterns
• Vital signs
8. Differentiate between types of head injuries:
• Scalp/skull injuries
• Brain injuries
• Haematomas (subdural, epidural, intracerebral)
9. Describe the Babinski, Occulocephalic and Occulovestibular reflexes.
10. Discuss the pathophysiology of Guillain Barre and Myasthenia gravis.
11. Outline the nursing and medical treatment of Guillain Barre and Myasthenia gravis.
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• Wong, F. (2000). Prevention of Secondary Brain Injury. Critical Care Nurse, 20, (5), pp. 18-27.
• Littlejohns, L, & Bader, M. (2001). Guidelines for the management of Severe Head Injury: Clinical Application
and Changes in Practice. Critical Care Nurse, 21 (6), pp. 48 -65
• 1998 – Thelan et al., pp. 763 -774, 812 - 814
• 2002 – Urden et al., pp, 671 – 692, 701 -714
• 1998 – Hudak et al. pp. 615 to 621, 624-627, 665 to-670, 678 to 682
Communication / verbal abuse / Self esteem
Objectives will be given out in class
REVIEW OF CONTENT
1. Learning Contract Weighting 50%
Due: August 21st
2. Examination Weighting 50%
Date: Sep 4th
3. Pass the clinical assessment in the workshop / megacode (ACCCN curriculum)
*NB. All pieces of assessment must be passed to pass the course.
1. The learning contract will be assessed in terms of the following:
A learning contract will be used as a means of negotiating learning and evaluating outcomes of this course. A learning
contract’s purpose is to allow you, the adult learner, flexibility in designing an individualised learning and assessment
plan that meets your specific learning needs. The use of learning contracts is a tool that allows students’ input into their
learning experience. It ensures that students will have the opportunity to learn those things that they, as individuals, think
are important to learn. It allows the learning experience to be individualised and creates more options for the type of
studies undertaken. A learning contract is devised by the student with input from the course convener and is approved by
both of them. Learning contracts may evolve over the course. They will be revised whenever students and their convener
think that they could be improved on.
The purpose of the learning contract is to enable you to explore an area of interest drawn from advanced practice,
teaching, research or management in critical care. You will enter into a learning contract to develop your knowledge and
skills in critical care nursing. You will examine the course rationale, description and content in your course outline, then
decide upon the learning activity you wish to pursue and how you wish to be evaluated. You are required to submit
details of your learning contract for approval no later than week two (2).
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Guidelines for the learning contract
1. Consider why you enrolled in this specific program. What are your goals in relation to this course and program.
2. Indicate a clear statement of the specific outcome objectives to be accomplished on completion of the learning
3. Describe the learning activities that will be completed by you and the learning resources to be used, including
identifications of the responsibilities of the lecturer and anyone else who may be supervising your work (ie
health care agency staff).
4. Describe how you will be evaluated. That is, what will demonstrate that you have met your objective/s.
5. Indicate the award (ie. Pass, Credit, Distinction, High Distinction) you expect to receive upon satisfactory
completion of the contract. Cognitive and psychomotor difficulty and personal creativity will influence the
6. Indicate a timeframe for your work.
7. You may be expected to present your results to the class in order to share the expertise you have developed.
There will be opportunities in class to discuss your progress and receive input from your peers.
8. Signatures of both yourself and your course convenor must appear on your contract.
Learning objective Learning strategies Resources required Time-line Evaluation
This will be a 2 hour multi-choice and short answer written examination held at the end of the course on the date specified
3. Clinical Assessment
The clinical skills stations and advanced life support lectures follow the set curriculum of the accredited Gold Coast
Hospital Advanced Life Support Course. This course is accredited through ACCCN Ltd.
The program reflects current guidelines and policies of the Australian Resuscitation Council (ARC) throughout its
Rationale for Assessment
The two items address each of the objectives for the course in addition to promoting writing skills. In addition, the
compulsory clinical assessment underpins the development and assessment of the advanced clinical and decision making
skills required for this particular nursing specialty.
Texts and Supporting Materials
Thelan, L.A., Urden, L.D., Lough, M., & Stacy, K. (1998). Critical Care Nursing. St Louis: Mosby.
Urden, L.D, Stacy, K. M, & Lough, M.E. (2002) Thelan’s Critical Care Nursing Diagnosis and management (4th Ed.).
St. Louis: Mosby.
Hudak, C., Gallo, B., & Morton, P. (1998). Critical Care Nursing: A Holistic Approach (6th Ed.). Philadelphia: J.B.
Required readings will be available to purchase from the Gold Coast Campus bookshop.
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Scope of Course Evaluation
Student evaluation of the course will be undertaken informally throughout the semester by inviting students to discuss
with the convenor any concerns or issues they have with the content relevancy, teaching/learning strategies, assessment
items and/or guest lecturers. A formal student course evaluation will be undertaken at the end of semester. In addition,
relevant professional bodies (for example, the Australian College of Critical Care Nurses) will be asked to provide
feedback in relation to national developments.
Your attention is drawn to the following important policies and guidelines relating to assessment.
Submission of Assignment:
All written assignments must be submitted to the course convenor at the Staff Development Centre Gold Coast Hospital.
The assignment must have the attached an Assignment Cover Sheet (this sheet is included in your Assignment Writing
and Study Guide for you to photocopy). This sheet will be date stamped and filed as proof of submission. You are also
advised to keep a copy of all assignments in case of accidental loss.
All assignments will be due by 4.00pm on the designated date unless an alternative time is stipulated.
Written submissions should be presented in accordance with APA format, or in accordance with A Writing Guide for
First Year Students. (2002), written by Dr Chris Vose and Dr Wendy Moyle, School of Nursing Griffith University.
It is the student’s responsibility to keep a copy of all assignments – both electronic and hard copy, in case of accidental
If for medical reasons or for any other unforseen circumstances, you are prevented from completing an assignment on
time, you may apply for an extension on the appropriate form in the Assignment Writing Guide. Such application should
be made to the course convenor as early as possible, before the due date of submission.
Penalties for Late Submission
Assessment items submitted after the due date without authorised extensions will be subject to penalty. Marks will
normally be deducted at a rate of 10% of the assignment for every working day it is late. A weekend will be counted as
one working day. A late submission will be awarded 0% after five working days.
Students should consult the relevant sections of the Griffith University Assessment Policies which are on the net at:
http://www.gu.edu.au/ua/aa/ppm/tal/content/aad_asspol_fs.html and the School of Nursing Assessment Policy (a copy of
which is displayed on the School notice board, level 3, Health Science Building at GU GC Campus).
It is the student’s responsibility to familiarise themselves with these policy documents.
The course convenor/s can be contacted by any means detailed on the front page.
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Aspects missing/or inadequately covered
Misunderstanding of the subject matter
Little evidence of original thought on topic
Irrelevant and/or inappropriate to topic
Insufficient relevant or recommended reading
Uncritical acceptance of author's viewpoints
Insufficient or incorrect referencing of sources
Arguments illogical or relies on unsupported
Concepts appear muddled and inadequately
Report rambles and lacks coherent structure
Inappropriate introduction and conclusion
Not in accordance with Divisional
Grammatical, spelling and punctuation
problems detract from making the meaning
Paragraphs of inappropriate length for
MARKING CRITERIA FOR
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1 2 3 4 5
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All aspects of the question covered
Shows evidence that the topic is clearly
Demonstrates original and creative thought
Appropriate and relevant to assignment
Shows evidence that relevant literature has
Good critical understanding of authors
Citations appropriate and adequate
(within the text and reference list)
Uses reasoned argument substantiated
Concepts and ideologies clearly explained
Report follows a logical order of
Appropriate introduction and conclusion
In accordance with Faculty requirements.
Sentences grammatical and easy to follow
with attention to spelling punctuation
Paragraphs chunk information into