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Course catalogue no : 8009 NRS Course title : Critical Care ...



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  • 1. 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 academic plan/s Core course Credit point value 10 Prerequisites : Nil Year and semester : 2003 Semester 2 Course convenor Patricia Johnson (07)55528849 email: Anne Evans-Murray (07)55718283 or page 404 email: Teaching team members : Date course outline was last modified June 2002 Objectives 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. Brief Description 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.
  • 2. - 2 - Flexible Learning 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 Coast Hospital. 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.
  • 3. - 3 - Content Week Content Speaker 1 July 10 Introduction Credentialling Gerontological Alterations Nutritional Support A. Evans-Murray /Trish Johnson Michelle Foster Anne Evans-Murray Alan Spencer 2 July 17 Advanced cardiac: SVT versus VT, BBB Pacemakers A. Evans-Murray Deborah Stiles 3 July 24th Compulsory Attendance today Advanced Life support: Mega Code ARC standards Clinical skills workshop Anne Evans-Murray Deborah Stiles Robyn Harris 4 July 31st Cardiac Surgery Complications of M.I Haemodynamic monitoring George Cornwell Darren Maclean A. Evans-Murray 5 August 7 Clotting and thrombolytic therapy Coronary reperfusion Treatment of M.I Cardiovascular disorders Congestive Cardiac Failure Anne Evans-Murray Deborah Stiles Deborah Stiles Anne Evans-Murray Dr. Nasser Essack 6 August 14 Neurological dysfunction Neurological assessment Guillain Barre Myasthenia Gravis Neurology Lyn Jenyns Robyn Harris Dr. Jon Fields 7 August 21 Self Esteem Burnout/ bullying / communication Exam Review /Evaluation Kay Laemmle Anne Evans-Murray September 4th Exam 9am A. Evans-Murray
  • 4. - 4 - Weekly Objectives: WEEK 1 Introduction Credentialling 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- intestinal) Required Reading • 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. Nutrition Support 1. Review the nutritional assessment of a critically ill patient and identify the altered parameters in the critically ill individual. 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. Required Reading • 1998 - Thelan et al., , pp. 121 - 126. • 2002 –Urden et al., pp. 93 – 100, 109 -117 WEEK 2 Advanced cardiac Advanced Electrocardiology 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 Defibrillator. 7. Correctly interpret a 12-lead electrocardiography of paced rhythm (noting pacing spikes), capture, intrinsic, beats, etc).
  • 5. - 5 - Required Reading • 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. WEEK 3 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 • Documentation Required Reading • Review life threatening arrhythmias from previous course – Introduction to Intensive Care, Coronary Care and Emergency Nursing • 1998 - Thelan et al., pp. 406 -428 • 2002 – Urden et al., pp. 332 -342 WEEK 4 Cardiac Surgery 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. Required Reading • 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 abnormalities. 4. Identify the indications for, nursing care of and complications related to haemodynamic monitoring.
  • 6. - 6 - Required Reading • 1998 – Thelan et al., pp. 442 - 480 • 2002 – Urden et al., pp. 355-387 Recommended Reading Flynn, pp. 161 to 206 WEEK 5 Myocardial Infarction 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. Required reading • 1998 – Thelan et al., pp. 490 -501 • 2002 – Urden et al., pp. 409 –414, 452 -465 Cardiovascular Disorders 1. Discuss the pathophysiology, clinical manifestations and treatment of the following cardiovascular disorders: • cardiomyopathy • endocarditis 2. Describe the pathophysiology of congestive cardiac failure. 3. Discuss the treatment of congestive cardiac failure and recent research into pharmacological agents. Required reading • 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. WEEK 6 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: • LOC • Motor Movements • Pupillary reaction and eye movement • Respiratory patterns • Vital signs 8. Differentiate between types of head injuries: • Scalp/skull injuries • Concussion • 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.
  • 7. - 7 - Required Reading • 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 Recommended reading: • 1998 – Hudak et al. pp. 615 to 621, 624-627, 665 to-670, 678 to 682 WEEK 7 Communication / verbal abuse / Self esteem Objectives will be given out in class COURSE EVALUATION REVIEW OF CONTENT Assessment 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).
  • 8. - 8 - 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 contract. 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 award. 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 2. Examination This will be a 2 hour multi-choice and short answer written examination held at the end of the course on the date specified above. 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 content. 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. OR Urden, L.D, Stacy, K. M, & Lough, M.E. (2002) Thelan’s Critical Care Nursing Diagnosis and management (4th Ed.). St. Louis: Mosby. Also recommended: Hudak, C., Gallo, B., & Morton, P. (1998). Critical Care Nursing: A Holistic Approach (6th Ed.). Philadelphia: J.B. Lippincott. Required readings will be available to purchase from the Gold Coast Campus bookshop.
  • 9. - 9 - 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. Administration 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 loss. Extensions 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. Policies Students should consult the relevant sections of the Griffith University Assessment Policies which are on the net at: 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. Course Communications The course convenor/s can be contacted by any means detailed on the front page.
  • 10. - 10 - CONTENT/UNDERSTANDING Aspects missing/or inadequately covered Misunderstanding of the subject matter Little evidence of original thought on topic Irrelevant and/or inappropriate to topic RESEARCH Insufficient relevant or recommended reading Uncritical acceptance of author's viewpoints Insufficient or incorrect referencing of sources LOGIC Arguments illogical or relies on unsupported assertions Concepts appear muddled and inadequately explained Report rambles and lacks coherent structure Inappropriate introduction and conclusion PRESENTATION Not in accordance with Divisional requirements Grammatical, spelling and punctuation problems detract from making the meaning clear Paragraphs of inappropriate length for cohesive argument ASSESSOR COMMENTS MARKING CRITERIA FOR ASSIGNMENTS 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| ---- 20 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| ---- 15 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| 1 2 3 4 5 |_____|_____|_____|_____| ---- 20 0 1 |_____| 0 1 2 3 |_____|_____|_____| 0 1 |_____| ---- 5 TOTAL ---- 60 CONTENT All aspects of the question covered Shows evidence that the topic is clearly understood Demonstrates original and creative thought Appropriate and relevant to assignment topic RESEARCH Shows evidence that relevant literature has been read Good critical understanding of authors referred to Citations appropriate and adequate (within the text and reference list) LOGIC Uses reasoned argument substantiated appropriately Concepts and ideologies clearly explained Report follows a logical order of development Appropriate introduction and conclusion PRESENTATION In accordance with Faculty requirements. Sentences grammatical and easy to follow with attention to spelling punctuation Paragraphs chunk information into meaningful units