RNRS 205: Nursing Health and Illness Concepts II - Complex Acute and/or Chronic Health Conditions

• A. Evaluate the concepts of ethics, evidence-based practice (EBP), systems-based care, information technology, quality improvement, safety, and its impact on health care delivery. \\nB. Analyze the concepts of the nursing process and clinical judgment in the care of patients with alterations in perfusion, inflammation, metabolism, oxygenation, mobility, fluid and electrolytes, acid-base imbalance, and intracranial regulation. \\nC. Implement a teaching plan for patients with alterations in perfusion, inflammation, metabolism, oxygenation, mobility fluid and electrolytes, acid-base imbalance, and intracranial regulation.\\nD. Implement therapeutic communication and documentation techniques applied to patient care situations. \\nE. Evaluate the patients' cultural, ethnic, or spiritual needs and its impact on the patient's health and delivery of care. \\nF. Utilize caring interventions when performing:\\n1. Perfusion: Central line care.\\n2. Perfusion: Blood products and transfusion.\\n3. Perfusion: Total Peripheral Nutrition (TPN) infusion and line care. \\n

Health and Illness Concepts

NCLEX Client Needs Categories:

Concepts and Exemplars:

• Oxygenation - Pneumothorax, pulmonary emboli, pleural effusion, anemia
• Metabolism - Exogenous adrenocortical dysfunction (acute/chronic), liver disease (acute/chronic), hematologic cancers 
• Perfusion - Heart failure
• Inflammation - Acute inflammation (pancreatitis, hepatitis, etc.), inflammatory bowel disease (acute/chronic)
• Mobility - Spinal cord injury defects (chronic), skeletal fractures (acute), neuromuscular disorders
• Fluid and Electrolyte - Renal failure (acute and chronic, including electrolyte imbalances: NA, K, Mg, Phos., CA), hemodynamics (i.e. hemodialysis)
• Acid Base Balance - Intro to acid base balance, laboratory values
• Intracranial Regulation - Cerebral vascular accident (CVA), seizures

NCLEX Client Needs Categories:

• Ethics - Ethical dilemmas 
• Evidence Based Practice (EBP) - Evidence based practice (core measures, pathways, protocols)
• Systems Based Practice - Health care systems. work unit inefficiencies and operational failures, work unit resources

Intracranial Regulation

1. Analyze the physiology of normal intracranial regulation 
2. Compare and contrast alterations in intracranial regulation.       
3. Outline the relationship between intracranial regulation and other concepts.
4. Explain health promotion as it relates to patients with alterations with intracranial regulation.
5. Differentiate common assessment procedures and tests used to evaluate patients with alterations in intracranial regulation. 
6. Analyze nursing interventions for patients with alterations in intracranial regulation.
7. Compare and contrast collaborative therapies used by interprofessional teams for patients with alterations in intracranial regulation.
8. Differentiate lifespan considerations in the care of patients with alterations in intracranial regulation.

Inflammation

1. Analyze the concept of inflammation (Ticket to Class)
2. Differentiate types of inflammatory conditions. 
3. Outline the relationship between inflammation and other concepts.
4. Create a health promotion plan for patients with inflammatory conditions
5. Differentiate common assessment procedures and tests used to evaluate patients' inflammatory conditions.
6. Prioritize nursing interventions for patients with inflammatory conditions.
7. Summarize collaborative therapies used by interprofessional teams for patients with inflammatory conditions.
8. Examine lifespan considerations in the care of patients with inflammatory conditions.

System Based Practice

1. Analyze the types of patient care delivery models.
2. Outline the roles and responsibilities as a member of the health care team in planning and using work unit resources. 
3. Explain the relationship between the outcomes of one’s own nursing care and work unit resources.
4. Analyze common work unit inefficiencies and operational failures.
5. Outline the relationship between system-based care and other concepts.
6. Utilize resources available on the work unit when contributing to the plan of care for patients and groups of patients.

Evidence Based Practice

1. Review the elements of Evidence based practice. (Ticket to class)
2. Examine the relationships of evidence-based practice and other concepts.
3. Discuss the concept of evidence-based practice (EBP), including the components of research evidence, clinical expertise, and patient/family values.
4. Explain the role of evidence in determining best clinical practice.
5. Apply current evidence-based practices in the care of patients with complex chronic and acute conditions.

Acid-Base Balance

1. Review the normal physiology of Fluid and Electrolytes in the body (Ticket to class).
2. Differentiate types of fluid and electrolyte imbalances. 
3. Outline the relationship between fluids and electrolytes and other concepts.
4. Explain health promotion as it relates to fluid and electrolyte imbalances.
5. Differentiate common assessment procedures and tests used to evaluate fluid and electrolytes imbalances.
6. Analyze independent nursing interventions for patients with fluid and electrolytes imbalances.
7. Summarize collaborative therapies used by interprofessional teams for patients with fluid and electrolyte imbalances.
8. Differentiate age-related considerations for patients with fluid and electrolyte imbalances.

Metabolism

1. Review the physiology of metabolism (ticket to class)
2. Analyze alterations in metabolism.
3. Outline the relationship between a patient’s metabolic conditions and other concepts.
4. Examine common assessment procedures and tests used to evaluate patients with metabolic conditions.
5. Develop nursing interventions for patients with metabolic conditions.
6. Discuss collaborative therapies used by interprofessional teams for patient’s metabolic conditions.
7. Compare and contrast lifespan considerations in the care of patients with alterations in metabolism

Mobility

1. Analyze the physiology of mobility in the body (ticket to class)
2. Differentiate alterations in mobility.
3. Compare and contrast the relationship between cognition and other concepts.
4. Explain measures to promote optimal mobility.
5. Differentiate common assessment procedures and tests used to evaluate mobility.
6. Analyze nursing interventions for patients with alterations in mobility.
7. Summarize collaborative therapies used by interprofessional teams for alterations in mobility.
8. Distinguish lifespan considerations in the care of patients with alterations in mobility.

Ethics

1. Review the relationship between values and ethics in nursing. (Ticket to Class)
2. Integrate collaborative strategies used by interprofessional teams in ethical decision making.    
3. Apply strategies to enhance ethical decision making.
4. Analyze ethical dilemmas as they relate to ethics.

Oxygenation

1. Analyze the physiology of normal oxygenation (ticket to class).
2. Differentiate alterations in oxygenation.
3. Outline the relationships between oxygenation and other concepts.
4. Explain the promotion of healthy oxygenation.
5. Differentiate common assessment procedures and tests used to evaluate patients with oxygenation.
6. Analyze nursing interventions for patients with alterations in oxygenation.
7. Compare and contrast collaborative therapies used by interprofessional teams for patients with alterations in oxygenation.
8. Differentiate lifespan considerations in patients with alterations in oxygenation.

Perfusion

1. Analyze the concept of perfusion (Ticket to class)
2. Compare and contrast alterations in perfusion. 
3. Outline the relationship between perfusion and other concepts.
4. Differentiate common assessment procedures and tests used to evaluate perfusion.
5. Discuss nursing interventions for patients with alterations in perfusion.
6. Summarize collaborative therapies used by interprofessional teams for patients with alterations in perfusion.
7. Differentiate lifespan considerations for patients with alterations in perfusion.

Application of Concepts to nursing skills:

NCLEX Client Needs Categories:

• Perfusion - Central line dressing change, TPN, Blood products and transfusion 

Patient-Centered Care:

Provide holistic care that recognizes an individual’s preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care.

Knowledge

• Understands multiple dimensions of patient-centered care including: 

1. Patient/family/community preferences and values. 
2. Coordination and integration of care. 
3. Information, communication, and education. 
4. Physical comfort and emotional support. 
5. Involvement of family and significant other. 
6. Care transition and continuity. 

Attitudes/Behaviors

1. Values and respects assessing health care situation from the patient's perspective and belief systems. 
2. Respects and encourages the patient's participation in decisions about health care and services. 

Skills

1. Assesses patient values, preferences, decisional capacity, and expressed needs a part of ongoing assessment, clinical interview, implementation of care plan, and evaluation of care. 
2. Communicates patient values, preferences, and expressed needs to other members of health care team. 

Professionalism:

Demonstrate accountability for the delivery of standard-based nursing care that is consistent with moral, altruistic, legal, ethical, regulatory, and humanistic principles.

Knowledge

• Understands the professional standards of practice, the evaluation of that practice, and the responsibility and accountability for the outcome of practice

Attitude/Behaviors

1. Accepts responsibility for own behavior. 

2. Respects others during clinical activities (i.e., no talking while others are talking, cell phone is silenced, and no inappropriate use of computers).

Skills

1. Implements plan of care within legal, ethical, and regulatory framework of nursing practice. 

2. Demonstrates ability for reflection in action, reflection for action, and reflection on action. 

3. Serves as a patient advocate. 

4. Utilizes an ethical decision-making framework in clinical situations.

5. Complies with the Standards of Practice, policies, and procedures of nursing program and/or clinical agency. 

   6. Completes assignments as required and scheduled.

   7. Provides prior notification to appropriate faculty when he/she is unable to  meet commitments or requirements.

   8. Participates in clinical activities as scheduled, arriving on time and prepared for the daily assignment throughout the length of the nursing program.

   9. Demonstrates professional appearance and professional presentation in clinical settings.

 10. Demonstrates respect and politeness to all individuals regardless of culture, ethnicity, religion, work experience, gender, age and sexual orientation.

 11. Maintains confidentiality of all client information in conversation, electronic and written means.

12. Provides and receives constructive feedback to/from peers and instructor.

Leadership:

Influence the behavior of individuals or groups of individuals within their environment in a way that will facilitate the establishment and acquisition/achievement of shared goals.

Knowledge

• Identifies leadership skills essential to the practice of nursing

Attitudes/Behaviors

1. Recognizes the role of the nurse as leader.
2. Accepts accountability for nursing care delegated
   to others.
3. Recognizes the value of leadership to empower others and enhance collaboration and shared decision making. 

Skills

• Integrates leadership skills of systems thinking, communication, and facilitating change in meeting patient care needs.

System-Based Practice:

Demonstrate an awareness of and responsiveness to the larger context of the healthcare system, and will demonstrate the ability to effectively call on work unit resources to provide care that is of optimal quality and value (Adapted from ACGME, n.d.).

Knowledge

• Understands role and responsibilities as a member of the health care team in planning and using work unit resources to achieve quality patient outcomes.

Attitudes/Behaviors

1. Recognizes the complexity of individual and team practice on a work unit.

2. Appreciates role in identifying work unit inefficiencies and operational failures.

Skills

1. Plans, organizes, and delivers patient care in the context of the work unit.

2. Participates in solving work unit inefficiencies and operational failures that impact patient care, such as those involving supplies, medications, equipment, and information.
3. Considers resources available on the work unit when contributing to the plan of care for a patient or group of patients.
4. Collaborates with members of the healthcare team to prioritize resources, including one’s own work time and activities delegated to others, for the purposes of achieving quality patient outcomes.
5. Evaluates outcomes of one’s own nursing care.
6. Uses education and referral to assist the patient and family through care transitions.

Informatics and Technology:

Use advanced technology to analyze as well as synthesize information and collaborate in order to make critical decisions that optimize patient outcomes. (National Academies of Sciences, Engineering, and Medicine. 2015).

Knowledge

• Understands the use of electronic communication strategies among healthcare providers in the healthcare system.

Attitudes/Behaviors

• Values and protects confidentiality of protected health information.

​Skills

1. Uses the electronic health record system to access relevant patient information, including accessing and interpreting patient history, diagnostic and laboratory findings.
2. Utilizes technology fully and accurately document patient assessment, plan of care, referrals, care provided. 

Communication:

Interact effectively with patients, families, and colleagues, fostering mutual respect and shared decision making, to enhance patient satisfaction and health outcomes.

Therapeutic Communication

Knowledge

1. Understands the principles of effective communication through various means.
2. Knows grammar, spelling, and health care terminology.

​Attitudes/Behavior

• Values individual cultural and personal diversity.

​Skills

1. Uses clear, concise, and effective written, electronic, and verbal communications.
2. Documents interventions and outcomes of care according to professional standards and work unit policy. 

3. ​Demonstrates effective interviewing techniques and adapts communication as needed based on patient’s response.

Collegial Communication

Skills

• Uses standardized communication approaches (e.g. SBAR) in all communications and in care transitions.

Teaching and Learning

Knowledge

• Understands the principles of teaching and learning.

​Attitudes/Behaviors

•  Values different means of communication used by patients and families.

​Skills

• Assesses factors that influence the patient’s and family’s ability to learn, including readiness to learn, preferences for learning style, and levels of health literacy.

Teamwork and Collaboration:

Function effectively within nursing and interdisciplinary teams, fostering open communication, mutual respect, shared decision-making, team learning, and development (Adapted from QSEN, 2007).

Knowledge

1. Identifies own strengths, limitations, and values in functioning as a member of a team.
2. Understands the impact of effective collegial communication on patient outcomes.

3. Discusses how authority and hierarchy influence teamwork and patient safety.

​Attitudes/Behaviors

• Appreciates the importance of collaboration.

Skills

1. Acts with honesty and integrity when working with patients, families, and team members.
2. Functions competently within own scope of practice as a member of the health care team.
3. Follows communication practices to minimize risks associated with transfers between providers during care transitions. 
4. Contributes to effective team functioning.

​Safety:

Minimize risk of harm to patients and providers through both system effectiveness and individual performance (QSEN, 2007).

Knowledge

1. Identifies human factors and basic safety design principles that affect safety.

2. Describes the benefits and limitations of commonly used safety technology. 

Attitudes/Behaviors

• Recognizes that both individuals and systems are accountable for a safe culture.

Skills

1. Demonstrates effective use of technology and standardized practices that support safe practice.
2. Communicates observations or concerns related to hazards and errors involving patients, families, and/or healthcare team.
3. Sufficiently prepares for and completes clinical assignments to implement safe and effective care, including identifying key nursing assessment data, analyzing data, developing priority-nursing diagnoses, plans of care, interventions, and evaluation criteria.

4. Incorporates clinical judgment in the performance of care, skills, and education.

 Quality Improvement:

Use data to monitor the outcomes of care processes, and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. (QSEN, 2007).

​Knowledge

• Comprehends that nursing contributes to systems of care and processes that affect outcomes. 

​Attitudes/Behavior

• Comprehends that nursing contributes to systems of care and processes that affect outcomes. 

​Skills

• Actively seeks information about quality initiatives 

Knowledge

• Identifies evidence-based rationale when developing and/or modifying clinical practices.

Attitudes/Behaviors

• Values the concept of EBP as integral to determining best clinical practice.

Skills

• Bases individualized care on best current evidence, patient values, and clinical expertise.