Nursing in Chronic Illness II and End-of-Life Care

Course Number: NRS 221
Transcript Title: Chronic Illness II
Created: May 30, 2018
Updated: July 10, 2019
Total Credits: 9
Lecture Hours: 40
Lecture / Lab Hours: 0
Lab Hours: 150
Satisfies Cultural Literacy requirement: No
Satisfies General Education requirement: No
Grading options: A-F (default)
Repeats available for credit: 0

Prerequisites

Completion of first year of the OCNE Nursing curriculum or admission by advanced placement.

Course Description

Builds on NRS 111 Foundations of Nursing in Chronic Illness I. Expands the student's knowledge related to family care giving, symptom management and end of life concepts. Focuses on these concepts as a basis for nursing interventions with patients and families. Explores ethical issues related to advocacy, self-determination, and autonomy. Develops complex skills associated with the assessment and management of concurrent illnesses and conditions within the context of patient and family preferences and needs. Explores skills related to enhancing communication and collaboration as a member of an interprofessional team and across health care settings. Exemplars include patients with chronic mental illness and addictions as well as other chronic conditions and disabilities affecting functional status and family relationships. Includes classroom and clinical learning experiences. Prerequisites: Completion of first year of the OCNE Nursing curriculum or admission by advanced placement.

Intended Outcomes

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

  1. Conduct a health assessment that is in-depth, evidence-based, family-centered, and both developmentally and culturally appropriate, and interpret health data.
  2. Apply evidence-based nursing practices in support of patient and family in self-health care management across the lifespan.
  3. Incorporate measures to enhance quality of life in the plan of care by: facilitating patient in developing their personal definition of quality of life; and addressing patient needs for preparedness and predictability.
  4. Identify and use community resources to provide support for the patient and family caregiving.
  5. Communicate with agencies involved in patient care to assure continuity of care across settings (e.g., schools, day care, adult foster care, etc.) by negotiating with others to modify care; and advocating for patients.
  6. Utilize nursing- and interprofessional-based knowledge of death and dying trajectories to support patients/families across the lifespan who are experiencing transitions at the end of life.
  7. Analyze the impact of health care delivery system issues, policy and financing on individual and family health care needs for chronic illness and end of life care.

Outcome Assessment Strategies

  • Clinical performance evaluation
  • multiple choice exams
  • lab performance evaluation
  • project and participation evaluation
  • papers

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 increased complexity in chronic illness
    • Chronic illness trajectory
    • Anticipatory care planning including grief and bereavement planning and content
    • Family-centered issues in care planning
    • Mental status changes
    • Co-morbidities
    • Physical changes
    • Environmental issues
    • Cultural issues
    • Transitions to levels of care
  2. Symptom management in chronic illness and palliative care
    • Fatigue
    • Dyspnea
    • Hypoxia
    • Anxiety
    • Depression
    • Pain
    • Nausea, vomiting and diarrhea
    • Agitation
    • Interprofessional teams
    • Patient engagement (self-care)
    • Patient prioritizing and quality of life issues
    • Patient directed care
    • [Exemplars: Cancer, chronic neurological diseases, and HIV/AIDS]
    • End of life care
    • Interprofessional symptom management, complementary therapies
    • Epidemiology and physiology of dying
    • Age and culturally competent communication at end-of-life
    • Assessment of family capacity to provide care
    • Psychosocial issues
    • Meaning of life and dying
    • Grief and bereavement
    • Pain management
  3. Case/care management
    • Care options-long-term, foster care, home health, short term skilled care, respite care, community based care; continuity of care in complex situations
    • Coaching for behavior change (e.g. motivational interviewing)
    • Care transitions
    • Resource stewardship
  4. Chronic mental illness and related issues
    • Exacerbations of mental illness
    • Suicide
    • Family Violence (includes child, spouse and elder abuse)
    • Care of people with mental illnesses
    • Psychotic disorders
    • Mood disorders
    • Anxiety disorders
    • Post-Traumatic Stress Disorder
    • Personality disorders
    • Eating disorders
    • Therapeutic communication
  5. Substance use disorders
    • Assessment of substance use
    • Communication around addiction issues
    • Management of withdrawal
    • Treatment of substance use disorders
    • Management of relapse
    • Substance use disorder recovery
  6. Ethical/legal considerations in chronic care/end of life care
    • Ethical issues
    • Advance directives and Physician Ordered Life Sustaining Treatment (POLST)
    • Power of Attorney and Guardianship
    • Nurse‚Äôs role in legally-mandated care (e.g. civil and court commitment and holds)
    • Physician assisted death, including Death with Dignity Act
  7. Health care systems and financing
    • Analyze the impact of chronic illness on the US health care system
    • Supplemental Security Income (SSI)
    • Centers for Medicare and Medicaid Services (CMS)
    • Triple Aim (access, cost, patient satisfaction)
    • Current state and federal health care plans: Medicaid, Medicare, Oregon Health Plan (OHP)
    • Coordinated Care Organizations (CCOs)
    • Affordable Care Act

Department Notes

See OCNE Megacase List and Minimum Skill Set by end of Year 2 List

See OCNE universal CCOG for additional information on course content