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Course Outline

School of Health Sciences Program: Specialty Nursing Option: Critical Care Start Date: Total Hours: HourslWeek: Prerequisites Course No. Course Name

NSCC 7200 Critical Care Nursing Theory 1

End Date: Term/Level: Lab: Shop:

September, January, April

Total Weeks: Lecture: 12

November, March, June

Course Credits: Seminar: 4 Other:

NSCC 7200 is a Prerequisite for: Course No. Course Name

NSCC 7]50
•

Dysrhythmia Interpretation (75%)

NSCC 7310

Critical Care Nursing Clinical]

Course Description

Critical Care Nursing Theory 1 is the third course in the British Columbia Institute of Technology (BClT) Critical Care Nursing Specialty Certificate. In this course, learners will continue to build foundational knowledge based on concepts explored in NSCC 7100 and 7150 and further develop their understanding of patients' experiences of critical illness. Specifically, learners have opportunities to further explore critical care nursing practice as they consider the contribution of research, the nature of evidence, and the application of best practices in the care of critically ill patients. Additionally, learners will explore additional comprehensive assessment strategies (e.g., hemodynamic monitoring, arterial blood gas analysis, renal assessment) and strategies employed to optimize oxygen supply and demand balance in critically ill patients (e.g., CPAP/BiPAP, vasoactive and inotropic medications, and fluid management). Finally learners will be challenged to make clinical decisions and plan care for selected critically ill individuals including those experiencing respiratory insufficiency, acute coronary syndrome, heart failure, and hemodynamic instability. Throughout this course learners will continue to reflect on the significance of relational nursing practice in critical care and their vision of self as a critical care nurse .

Detailed Course Description

This course consists of six modules. Module 2 is further divided into three parts: A, B, and C. Module 1: Best Practices in Critical Care Nursing In this module, learners will critically examine the nature and sources of evidence for specific aspects of critical care nursing practice. An examination of the links between research, best practice, and best practice guidelines will be considered. Learners will also explore the relationship between best practice guidelines and clinical decision making and consider their professional responsibility in relationship to best practice.

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Course Outline NSCC 7200 Critical Care Nursing Theory 1

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Detailed Course Description

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Module 2: Assessment and Monitoring Strategies for Patients with Imbalances in Oxygen Supply and Demand Module 2 is a collection of small 'stand alone' modules that explore/introduce comprehensive assessment and monitoring strategies for critically ill patients. Each module provides essential knowledge and specific assessment tools to support practice as a critical care nurse. Learners will have opportunities within the modules to relate assessment findings and patient responses to oxygen supply and demand balance and end-organ cellular perfusion. In subsequent modules learners will apply this expanded knowledge of comprehensive assessment and monitoring as they work through cases of patients experiencing respiratory insufficiency, acute coronary syndrome, cardiac failure, and hemodynamic instability. Module 2 Part A: Arterial Blood Gases Arterial blood gases (ABGs) are an important tool in assessing critically ill patients. ABG results provide information about oxygenation, ventilation, and acid-base balance disturbances the patient may be experiencing. The focus of this module is to learn to systematically analyze arterial blood gases. In NSCC 7100 you were introduced to the oxygen supply and demand framework and, within this, the concepts of ventilation and oxygenation. This module will integrate arterial blood gas results with the patient's respiratory assessment and the oxygen supply and demand framework. You will have opportunities to practice ABG analysis and consider potential causes of oxygenation, ventilation, and/or acid-base imbalances, as well as specific interventions for these. Module 2 Part B: Invasive Hemodynamic Monitoring and Hemodynamic Assessment Learning to understand hemodynamic monitoring, and the subsequent implications for patient care, is a key aspect of developing competence as a critical care nurse. An invasive hemodynamic monitoring system is a mechanism that allows nurses to monitor, assess, trend, and calculate various pressures associated with the patient's oxygen supply and demand balance. It can provide the critical care nurse with assessment data that may not otherwise be measurable via non-invasive measures of assessment. We will explore arterial and central venous pressure monitoring. We will begin with an overview of the equipment necessary for invasive hemodynamic pressure monitoring and then move on to address arterial and central venous pressure "specifics" in greater detail. In this module, the main focus is on developing an understanding of invasive pressure monitoring: how it works, and what the hemodynamic pressures mean in terms of hemodynamic assessment, oxygen supply and demand balance, end-organ and overall tissue perfusion. In many of the remaining modules you will have the opportunity to integrate this knowledge into your understanding of critically ill patients' experiences. Module 2 Part C: Renal Assessment and Acute Kidney Injury Assessing the critically ill patient's renal function is an important component of comprehensive assessment. In this module we begin building an understanding of renal assessment by reviewing anatomy and physiology of the renal system. From there, we will consider the process of renal assessment, recognizing the importance of a systematic assessment in detecting and preventing renal dysfunction. Exploration of the specific assessment criteria, causes and associated pathophysiology of acute kidney injury leads into a brief consideration of specific management strategies for the patient with acute kidney injury. As you follow a patient's story within this module, you will have opportunities to relate patient's responses associated with acute kidney injury to oxygen supply and demand and end-organ cellular perfusion. This module is intended to provide an introduction to renal assessment and acute kidney injury in critically ill patients. In subsequent courses we will expand this discussion by considering more complex treatment modalities.

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Course Outline NSCC 7200 Critical Care Nursing Theory 1

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Module 3: The Patient's Experience of Respiratory Insufficiency In Module 3, leamers will have the opportunity to explore the pathophysiological processes associated with community acquired pneumonia (CAP) and integrate this knowledge with their understanding of oxygen supply and demand balance. Further, by considering a patient's story, learners will have the opportunity to develop an understanding of a patient's experience of respiratory insufficiency and dyspnea, and integrate this knowledge to further develop capacities of relational practice in critical care nursing. Additionally, learners will integrate comprehensive assessment strategies (ABGs) into their patient assessment and critically consider current management guidelines and interventions for patients experiencing CAP. Specifically, learners will explore nursing roles and responsibilities integral to providing care for patients receiving antibiotic therapy, oxygen therapy, CPAP, and BiPAP. Module 4: The Patient's Experience of Acute Coronary Syndrome In this module, learners will explore the story of Ranbir Grewal, a woman experiencing a second episode of Acute Coronary Syndrome (ACS) that, this time, results in an Acute Myocardial Infarction (AMI). As the story of Ranbir's experience unfolds, learners will explore the pathophysiological processes associated with acute coronary syndrome (angina, unstable angina, MI) and integrate this knowledge with their understanding of oxygen supply and demand balance. Further, learners will explore assessment strategies and diagnostic modalities used for patients experiencing acute coronary syndrome, as well as critically consider current management guidelines and interventions for patients like Ranbir. Specifically, learners explore nursing roles and responsibilities integral to providing care for patients receiving thrombolytic therapy and experiencing complications of an inferior AMI. Opportunity to reflect on the nature of this experience of critical illness for Ranbir and patients like her will be provided. Module 5: The Patient's Experience of Acute Decompensated Heart Failure In this module, learners will explore the story of Sandra as she experiences an acute exacerbation of heart failure. Learners will consider the pathophysiology of heart failure and integrate this knowledge with their understanding of oxygen supply and demand balance. Further, learners will explore Sandra's experience by focusing on her responses of acute heart failure superimposed on her experience of progressive heart failure as they continue to develop their capacities for relational practice in critical care nursing. As learners follow Sandra's story, they'll have the opportunity to specifically consider current practice guidelines and associated interventions and practice clinical decision making directed toward relieving symptoms and preventing end-organ damage for patients experiencing the continuum of heart failure. Learners will also consider prevention of disease progression, long-term management strategies, and palliative care for patient experiencing the progression of heart failure. Module 6: The Patient's Experience of Hemodynamic Instability In this module learners explore hemodynamic instability within the experience of a patient who requires surgical intervention for an abdominal aortic aneurysm (AAA). After an overview of AAA, including pathophysiology, indications and procedures for surgical and non-surgical intervention, and postoperative management concerns and issues, the module focus moves to hemodynamic instability. Like many patients who undergo surgical repair of an AAA, Arthur is hemodynamically unstable during his postoperative period. With various changes in Arthur's condition as a backdrop, learners explore the concept of shock and its hemodynamic consequences, with a specific focus on assessment and management of hypovolemic shock This discussion includes the role fluid and drug therapy plays in managing hemodynamic instability and optimizing oxygen supply and demand, and also presents considerations of managing hypertension. By following nursing care provided within the case, learners are offered insight into clinical decision making and relational nursing practice related to hemodynamically unstable patients.

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Course Outline NSCC 7200 Critical Care Nursing Theory 1

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Evaluation

Learning is assessed in NSCC 7200 by completion of one assignment based on theory presented in Module I, three quick quizzes after each part of Module 2, and two exams. The quizzes can be found in the online section of NSCC 7200. The percentages each assessment contributes to your final course mark are as follows: Assignment #1: Best practices in Critical Care Nursing Quiz Quizzes Exam 1 Exam 2 TOTAL 10% 20% 35% 35% 100% Comments: Students must achieve a grade of 75% on each assignment/quiz/exam to progress to NSCC 7310.

Course Learning Outcomes/Competencies

In this course, learners will have opportunities to use the processes of reflective critical thinking, systematic inquiry, communication, collaboration, and professionalism to: 1. 2. Further explore critical care nursing practice by examining the contribution of research, the nature of evidence, and the application of best practices in the care of critically ill patients. Based on conclusions drawn regarding oxygen supply and demand balance, select and evaluate appropriate therapeutic interventions for patients experiencing respiratory insufficiency, acute coronary syndrome, heart failure, and hemodynamic instability. Utilize foundational knowledge of critical care nursing practice to critically analyze data, make decisions, and plan care for patients experiencing respiratory insufficiency, acute coronary syndrome, heart failure, and hemodynamic instability. Further develop relational capacity in critical care nursing practice.

3.

4.

Verification

I verify that the content of this course outline is current.

Authoring Instructor

Date

I verify that this course outline has been reviewed.

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PrOgrmHeaarChief Instructor

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D,miAssociate Dean

Date

I verity that this course outline complies with BCIT policy.

Date

Note: Should changes be required to the content of this course outline, students will be given reasonable notice.
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Course Outline NSCC 7200 Critical Care Nursing Theory 1

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Instructor(s)

Tutor is assigned on a term basis.

Learning Resources

Required: Text: Morton, P.G., Fontaine, D.K., Hudak, C.M., & Gallo, B.M. (2009). Critical care nursing A holistic approach (9th ed.). Philadelphia: Lippincott Williams and Wilkins. Online Text: Deglin, l.R. (2007). Davis's drug guidefor nurses. Philadelphia: F.A. Davis. Various journal articles are also included as required reading in this course. These are provided in a reading package. Recommended: Various additional learning resources can be found in the online course section of BCIT's online learning environment, Desire2Leam (D2L).

Information for Students

(Information below can be adapted and supplemented as necessary.) The following statements are in accordance with the BCIT Policies 5101, 5102, 5103, and 5104, and their accompanying procedures. To review these policies and procedures, please refer to: http://www.bcit.calabout! administration/pol icies. shtml AttendancelIllness: In case of illness or other unavoidable cause of absence, the student must communicate as soon as possible with hislher instructor or Program Head or Chief Instructor, indicating the reason for the absence. Prolonged illness of three or more consecutive days must have a BCIT medical certificate sent to the department. Excessive absence may result in failure or immediate withdrawal from the course or program. Please see Policy 5101 - Student Regulations, and accompanying procedures: http://www.bcit.calfiles/pdfi.policies/51 0 l.pdf Academic Integrity: Violations of academic integrity, including dishonesty in assignments, examinations, or other academic performances are prohibited and will be handled in accordance with Policy 5104 - Academic Integrity and Appeals, and accompanying procedures: http://www.bcit.calfiles/pdf/policies/5104.pdf Attempts: Students must successfully complete a course within a maximum of three attempts at the course. Students with two attempts in a single course will be allowed to repeat the course only upon special written permission from the Associate Dean. Students who have not successfully completed a course within three attempts will not be eligible to graduate from their respective program. Accommodation: Any student who may require accommodation from BCIT because of a physical or mental disability should refer to BCIT's Policy on Accommodation for Students with Disabilities (Policy #4501), and contact BelT's Disability Resource Centre (SWI-2300, 604-451-6963) at the earliest possible time. Requests for accommodation must be made to the Disability Resource Centre, and should not be made to a course instructor or Program area.
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Course Outline NSCC 7200 Critical Care Nursing Theory 1

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Information for Students (cont'd.)

Any student who needs special assistance in the event of a medical emergency or building evacuation (either because of a disability or for any other reason) should also promptly inform their course instructor(s) and the Disability Resource Centre of their personal circumstances.

Assignment Details

The details each assessment contributes to your final course mark are as follows: NSCC 7200 Module 1 Assignment This assignment corresponds to Module 1: Best Practices in Critical Care Nursing. • • • For students learning in the 'guided' or distance education format, the assignment is due according to the study schedule (see NSCC 7200 course introduction). Your tutor will mark the assignment. For full-time students, the assignment is due as indicated on your classroom schedule. The assignment will be peer marked in class time. You will be given a marking template to facilitate assignment marking. The assignment is worth 10% of NSCC 7200 course marks. Full-time students please note: To protect anonymity and promote fair marking DO NOT put your name on your assignment. Rather identify your assignment with your BClT student number and a unique identifying word, such as your mother's maiden name. For this assignment you will need access to the Internet. The American Association of Critical Care Nurses publishes regular "Practice Alerts." In essence, these are best practice guidelines. Practice Alerts are short directives designed for easy reference. The first part of the Practice Alert is clinical information followed by references to support the clinical statements. 1. Visit http://www.aacn.org/AACN/practiceAlert.nsf/vwdoc/pa2 Choose only one of the following "Practice Alerts": • • • • 2. 3. ST segment monitoring Family Presence During CPR and Invasive Procedures Verification of Feeding Tube Placement Oral Care in the Critically III

In your assignment, briefly comment on why you chose this particular Practice Alert. Comment on the adequacy of the evidence used to inform the practice guidelines. • • • What kinds of evidence were examined? (type and amount of research, expert opinion, etc.) Is the evidence broadly applicable or specific to a certain critically ill population? Have the authors identified gaps in the evidence? Do you think there are unidentified gaps?

4.

Identify and discuss two factors you think would support the implementation of the suggested practice guidelines, and two factors you think would challenge the implementation of these guidelines. Briefly comment on how you think this particular best practice guideline contributes to critical care nursing practice.
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5.

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Course Outline NSCC 7200 Critical Care Nursing Theory 1

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Assignment Details (cont'd.)

Format 1. 2. This assignment must be legible, written in full sentences, and grammatically correct. This assignment does not require APA format, but if references are used they should be cited and a reference list included. Total assignment length 4-5 double spaced typed pages.

3.

Evaluation Criteria 1. Rationale for choosing Best Practice is provided 2. 3. The analysis of the supporting evidence is thoughtful and complete. The factors influencing the implementation of best practices in this situation are presented in a clear and logical manner. A brief discussion outlining contribution of the best practice guideline to critical care nursing practice is included. Presentation is logical, understandable. AP A format not required. References, if used, are cited.

4.

5.

Quick Quizzes • • • • Online, multiple choice, open book Correspond to each Module 2, parts A, B, C Each open for a week, as indicated on study schedule Combined 20% of course mark

Examl • • • • Online. multiple choice and short answer, supervised at BCIT or by a proctor Focuses on Modules 3 and 4 Incorporates concepts from NSCC 7150 and NSCC 7200 Modules I and 2 35% of course mark

Exam 2
• • • • Online, multiple choice and short answer, supervised at BCrr or by a proctor Focuses on Modules 5 and 6 Incorporates concepts from NSCC 7150 and NSCC 7200 Modules 1 and 2 35% of course mark

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Course Outline NSCC 7200 Critical Care Nursing Theory 1

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Suggested Learning Plan NSCC 7200 Critical Care Nursing Theory 1 is a 4-credit course designed to be completed over one term of 12 weeks by guided learning (distance). The learning plan below suggests the weekly activities required to progress through the course in one term. You'll note there are due dates for the assignment, quizzes, and exams. If you are unable to meet the dates for any of these assignments, please contact your tutor to negotiate a revised schedule at least one week before the due date. Marks will be deducted for late submissions if an extension has not been negotiated with your tutor. Students who require more than one term to complete the activities and course requirements may pay a re-registration fee and register for one additional term. If you find yourself regularly unable to complete course activities according to the schedule below, please discuss the option ofre-registering with your tutor.
Week Learning Activities in Modules Papery Quizzes, and Final Exam

Before Term Start 1 2 3 4 5 6 7 8 9 10 11 12

Read Introduction Review "Student Handbook" and begin selecting proctors for exams as necessary Contact tutor and introduce yourself Complete Module 1 Complete Module 2A Complete Module 2B Complete Module 2C Begin Module 3 Complete Module 3 Begin Module 4 Complete Module 4 Study for Exam 1 Begin Module 5 Complete Module 5 Begin Module 6 Complete Module 6 Study for Exam 2 Complete Exam 2 Complete Exam 1 Assignment # 1 due Quiz 2A opens Complete Quiz 2A Quiz 2B opens Complete Quiz 2B Quiz 2C opens Complete Quiz 2C

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