Nursing in Acute Care II and End-of-Life Care

Course Number: NRS 222
Transcript Title: Acute Care II
Created: June 6, 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

Course Description

Builds on NRS 112 Foundations of Nursing in Acute Care I, focusing on more complex and/or unstable patient care conditions, some of which may result in death, and require strong noticing andrapid decision making skills. Uses evidence base to support appropriate focused assessments, and effective, efficient nursing interventions. Integrates life span and developmental factors, cultural variables, and legal aspects of care to frame the ethical decision-making employed in patient choices for treatment or palliative care for disorders with an acute trajectory. Utilizes case scenarios that incorporate prioritizing care needs, delegation and supervision, and family and patient teaching for either discharge planning or end-of-life care. Exemplars include acute conditions affecting multiple body systems. Includes classroom and clinical learning experiences. Prerequisite: NRS 221.

Intended Outcomes

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

  1. Conduct evidence-based assessment, using age, and developmentally and culturally appropriate communication skills.
  2. Develop and use evidence-based, individualized, developmentally appropriate interventions that are dynamic and based on changing needs of patient and family.
  3. Collaborate with health care team members to provide comfort and symptom management.
  4. Develop discharge plans in collaboration with patient, family, health care team members, and service providing agencies.
  5. Reflect on experiences in caring for patients with acute conditions.

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:

Introduction to concepts of complex acute care nursing:
  • Complex Acute Care Nursing (patient situations often unstable/unpredictable; requires rapid observational/prioritization skills; triage; crisis and trauma management; holistic; issues of imminent death, post-mortem care and grief)
  • Communication (SBAR; interpersonal and interprofessional; delegation)
  • Symptom Management (synchronous multiple symptom management; prioritized; evidence-based)
  • Advocacy (cultural considerations; ethical decisions and dilemmas; acute end-of-life; RN selfcare)
  • Teaching (individualized; prioritized; validated learning; discharge planning to varied care settings)
  • Evidence-based best practices, e.g. Core Measures and NPSG
  • Clinical Judgment Model
  • Care coordination
  • Also includes: monitoring a variety of data and accurately interpreting obvious deviations from expected patterns in increasing complex acute conditions (e.g. co-morbidities, complications, high-risk pregnancies, acute psychosis, life threatening situations, diverse health beliefs); recognizing potential problems and rapidly changing physiologic and behavioral situations; recognizing pathophysiological changes and symptoms experienced by the patient which are associated with the dying process; regularly monitoring patients level of comfort and ability to manage symptoms and symptom distress; assessing family’s response to patient’s illness; and recognizing impact of individual development, as well as family development and dynamics on physiologic and behavioral status.
Apply Concepts of Complex Acute Care Nursing:
  1. Cardiovascular alterations: dysrhythmias, valve disorders, cardiomyopathy, acute blood disorders, cardiac tamponade, pericardial effusion, congenital cardiac disorders
  2. Respiratory alterations: pulmonary edema, pulmonary embolism, respiratory failure, anaphylaxis, acute respiratory distress syndrome (ARDS)
  3. Endocrine alterations: diabetes acute complications (e.g. diabetic ketoacidosis; hyperglycemic hyperosmolar nonketotic syndrome)
  4. Maternal child complications: pregnancy complications, neonatal complications
  5. Renal/Genitourinary (GU) alterations: acute kidney injury (AKI), chronic kidney disease (CKD) and end state renal disease (ESRD) exacerbations, reproductive cancers
  6. Neurological alterations: spinal cord injury (SCI), tramatic brain/head injury (TBI), increased intracranial pressure (IICP), menigitis
  7. Gastrointestinal (GI) alterations: acute pancreatitis, acute hepatitis, liver failure
  8. Trauma and multisystem failure: burns; shock; sepsis; disseminated intravascular coagulation (DIC); abdominal, chest, head trauma; orthopedic trauma; end of life; code

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