Foundations of Nursing in Chronic Illness I

Course Number: NRS 111
Transcript Title: Chronic Illness I
Created: May 30, 2018
Updated: July 10, 2019
Total Credits: 6
Lecture Hours: 20
Lecture / Lab Hours: 0
Lab Hours: 120
Satisfies Cultural Literacy requirement: No
Satisfies General Education requirement: No
Grading options: A-F (default)
Repeats available for credit: 0

Prerequisites

Course Description

Introduces assessment and common interventions (including technical procedures) for patients with chronic illnesses common across the life span in major multiple ethnic groups. Explores the patient’s and family's "lived experience" of the condition. Includes use of clinical practice guidelines and research evidence to guide clinical judgments in care of individuals with chronic conditions. Explores multidisciplinary team roles and responsibilities in the context of delivering safe, high quality health care to individuals with chronic conditions (includes practical and legal aspects of delegation). Examines cultural, ethical, legal and health care delivery issuesthrough case scenarios and clinical practice. Case exemplars include children with asthma, adolescents with a mood disorder, adults with type 2 diabetes, and older adults with dementia. Includes classroom and clinical learning experiences. Prerequisites: NRS 110, NRS 232.

Intended Outcomes

Upon successful completion of this course, students will be able to:

  1. Conduct a health assessment that is patient- and family-centered and both developmentally and culturally appropriate, interpret, and use the resulting health data.
  2. Provide safe and effective, developmentally and culturally appropriate care to patients with chronic illness.
  3. Develop and implement a patient-centered and family-oriented plan of care for a patient with a chronic illness that incorporates evidence-based intervention strategies, assessment data, child and family developmental considerations, and demonstrates a deep understanding of the patient’s perspective and illness experience within the framework of exacerbation, trajectory, and plateau.
  4. Apply ANA Code of Ethics and nursing values in the care of persons with a chronic illness or disability.
  5. Identify roles and functions of members of the health care team in order to provide care for the chronically ill.
  6. Use therapeutic communication skills in the development of therapeutic relationships with patients and families.
  7. Recognize potential legal and ethical issues related to patient autonomy across the lifespan in at risk populations.

Outcome Assessment Strategies

  • Clinical evaluation
  • Papers
  • Multiple choice exams
  • Lab performance evaluation
  • Group Case Study
  • Patient Teaching Project

Course Activities and Design

The determination of teaching strategies used in the delivery of outcomes is generally left to the discretion of the instructor. Here are some strategies that you might consider when designing your course: lecture, small group/forum discussion, flipped classroom, dyads, oral presentation, role play, simulation scenarios, group projects, service learning projects, hands-on lab, peer review/workshops, cooperative learning (jigsaw, fishbowl), inquiry based instruction, differentiated instruction (learning centers), graphic organizers, etc.

Course Content (Themes, Concepts, Issues and Skills)

Modules:

  1. Concepts of Chronicity
    • Altered mobility
    • Multidimensional aspects of chronicity including aspects of health promotion and quality of life
    • Body image, stigma, social isolation, chronicity vs. acute illness
    • Illness differentiated from disabling condition
    • Progressive & stable conditions including transitions across the lived experience
    • Addressing basic questions about prognosis of illness.
    • Health disparities
  2. Nursing Care & Care Planning:
    • Symptom(s) management and teaching. Exemplars: altered mobility; fatigue; pain; alterations in bowel and bladder; falling and fall risk; physician ordered life sustaining treatment (POLST) and do not resuscitate (DNR) planning; medication management.
    • identifying and providing for comfort needs (physical and emotional),
    • Common chronic conditions. Exemplar: asthma and other chronic respiratory conditions, e.g., chronic obstructive pulmonary disease (COPD), tuberculosis (TB); type 2 diabetes mellitus; hypertension; stroke; cancer; heart failure and chronic cardiac disease; depression; cognitive impairment such as Alzheimers, other dementias.
    • Teaching patients about self-assessment and self-management in highly prevalent chronic conditions, such as (but not limited to) congestive heart failure, dementia, type 2 diabetes, and depression, and
  3. Ethical & Legal Considerations in Chronic Care:
    • Ethical and legal issues related to the care of patients and clients with chronic conditions and disabilities
    • American Nurses Association (ANA) code of ethics in care of the chronically ill
    • Legal protections
    • Professional role, medical & legal liability
  4. Comprehensive Family Assessment:
    • Family structures, development, functions
    • Cultural variations
    • Assessment tools used for Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs)
    • Safely and effectively assisting patients with ADLs & IADLs,
    • Home & community safety
    • Family coping, adaptation, frailty
    • Children with special health care needs
    • Mental and functional status
    • lived experience of chronic illness, including recognition of stigma and its impact on vulnerability and maintaining health,
    • specific lab value interpretation and medication concerns such as polypharmacy.
  5. Communication:
    • Establishing a therapeutic milieu
    • Establishing rapport with parents, children, schools
    • Communication with the interprofessional team
    • Communication with the older adult Therapeutic communication including health literacy in chronic illness
    • Communication regarding patient safety issues
    • Situation Background Assessment Recommendation (SBAR)
  6. Health Promotion & Health Teaching:
    • Age and culturally appropriate health teaching
    • Wellness and health promotion activities
    • Caring for self and self-management of care
    • Use of health care system or resources
  7. Introduction to Case/Care Management:
    • Community resources
    • Planning within patient, family context
    • Case Management
    • Care coordination
    • Role of the nurse in various settings
    • Caregiver burden/stress
    • Implications of environment in the delivery of care
  8. Documentation (Threaded throughout): Health care record in various settings

Department Notes

See OCNE Megacase List and Minimum Skill Set by end of Year 1 List

See OCNE universal CCOG for additional information on course content