Julie

Course Description: Concurrent with NUR 211, NUR 212 provides the student with an opportunity to examine and evaluate current experience, determine clinical proficiencies, and through the process of portfolio development, expand clinical nursing expertise within the acute care setting (medical or surgical areas, pediatrics and mental health). NUR 212 has 10 eight-hour clinical days; this happens off campus caring for clients at the clinical site. Students must be able to accommodate the various clinical schedules as clinical can start as early at 6:30 and and/or go as late as 11:30 pm and include weekends.
 * Course: NUR 212 - Client Care Management Practice I **

Specific Context of the Teaching and Learning Situation
 * Step 1: Identify Important Situational Factors **
 * a) Students in the class: 20 per quarter
 * b) Course Level: Second year nursing, first quarter
 * c) Class Meetings: Two 8 hour clinical days every other week
 * d) Course Delivery: Face to Face and Online
 * e) Student Presentation: Students are working with real patients in an acute care setting

Expectations of External Groups
 * a) Society at large: Safe, Competent, Knowledgeable Nurses
 * b) State: NCLEX state board licensed through examination
 * c) Institution and Department: NCLEX ready, Safe, Competent, Knowledge Seeking Graduates
 * d) Clinical Site: Hospital expects students to be Safe, Skilled and competent.

Nature of the Subject
 * e) Convergent or Divergent: Both
 * f) Cognitive or Physical: Both
 * g) Stability: Period of Rapid Change

Characteristics of the Learners
 * a) Life Situations: Part-time working LPN students, many with families
 * b) Goals: Advanced RN licensure, expanded income, expanded job
 * opportunities
 * c) Reasons for Enrolling: See goals
 * d) Prior Experience: All students are Licensed Practical Nurses and have
 * completed at least1000 hours working as an LPN
 * e) Learning Styles: Varied

Characteristics of the Teachers
 * a) Prior Experience: Varied. From new instructor with clinical nursing
 * experience, to experienced instructor with little clinical
 * nursing experience.
 * b) Times Teaching: Varied. From first time teaching the course to taught for
 * the past 4 years.
 * c) Teach Again: Yes.
 * d) Competence Level: Varied. From Competent to marginal.
 * e) Prior Experiences: All instructors BSN level prepared RNs. Some MN in
 * Nursing education, some in process, some new to
 * instruction.
 * f) Group Dynamic: Four different clinical instructors are potentially involved
 * with this course any given quarter.

Special Pedagogical Challenge
 * a) Students: Already working as LPNs, unsure of the difference between the levels of nursing.
 * b) Teacher: Assessing the widely different levels of skill, confidence and competence and effectively bringing each student up to an expected level of mastery.


 * Step 2: Formulate Significant Learning Goals **

Foundational Knowledge

a) Key Information i) Identify: Significant patient problems, priority nursing actions, interaction between lab values and patient condition or treatment ii) Remember: Correct procedure for advanced nursing care including: IV Therapy, Blood Administration, Accessing and Care of Central Lines, Insertion and Management of NasoGastric Tubes, Care of Chest Tubes iii) Understand: Value and Application of ongoing nursing assessment

Application

a) Thinking: i) Critical Thinking: Assess patient condition, Analyze ancillary information (history, lab work, imaging, etc…) ii) Creative Thinking: Solve patient care barriers by creating professional relationship with both patients and care team. iii) Practical Thinking: Make decisions about patient care and coordinate interdisciplinary care planning. b) Skills: Use available materials to implement nursing care. c) Complex Projects: Discover the satisfaction of beginning to see the bigger patient care picture.

Integration


 * a) Within this course: Identify the similarities between clinical lab preparation and skills implementation.
 * b) Between this course and others: Connect information learned in NUR 211 (Classroom portion of the quarter) with clinical manifestations of didactic material.
 * c) Between this course and students’ experience: Identify the similarities between previous work experience, previous learning, previous personal health experiences and clinical integration of advanced nursing practice.

Human Dimension


 * a) Self-Learning: Come to see themselves as progressing towards advanced practice and decide to become bachelors prepared nurses.
 * b) Understanding Others: Understand others in terms of the interplay between their socio-economic situation, physical health history and belief systems.

Caring


 * a) Feelings: Get excited about becoming advanced nurses.
 * b) Interests: Be more interested in advancing their nursing education.
 * c) Values: Be ready to hold themselves to the highest standard.

Learning How to Learn


 * a) Being a Good Student: Create a learning plan for achieving advanced nursing skills.
 * b) Constructing Knowledge: Be able to construct knowledge about complex patient situations.
 * c) Self-Directed Learning: Identify sources of information on rapidly changing and advancing nursing practices and skills.


 * Step Three: Feedback and Assessment Procedures **

· Forward-Looking Assessment o Formulate Clinical Expectations: As small groups the students will use the clinical performance rubric to determine expectations for clinical performance and relate them to specific nursing actions. Students will determine as a class which performance expectations should be included in the final product and why. Finished clinical expectations will be posted to the Angel site and used as a guide for weekly reflective journal writing. o Final Product Assignment: “What does an RN graduate look like?” At the beginning of the quarter, students outline what they will have achieved by the end of the quarter and how they will apply it to their nursing practice. o Clinical Lab Demonstrations: Students will divide the clinical lab learning objectives and work in small groups to develop a teaching plan for each required skill. Each group will present their teaching activity accompanied by a hands on demonstration. The class with return demonstration under the supervision of the presenting group. Presenting group members will be evaluated on their teaching plan and delivery. o Clinical Lab Peer Evaluation: Students will perform clinical lab activities in small groups, evaluating each other on the clinical performance grading rubric that will be used for their weekly self evaluation. This allows for peer-feedback, learning from each other, and confidence building for the students. o Clinical Lab Self Evaluation: Students will record themselves performing clinical lab tasks, review the tapes and evaluate and grade themselves based on the clinical performance grading rubric. The recording, the students self evaluation and at least one peer evaluation will be submitted to the teacher for review.

· Criteria and Standards In relation to the standards set for the course, the student has done an exceptionally high level of work || **__ Competent __** In relation to the standards set for the course, the student has significantly exceeded the average level of work || **__ Emerging __** In relation to the standards set for the course, the student accomplished an average level of work || **__ Not Competent __** In relation to the standards set for the course, the student did not do average work || - Needs minimal Supervision - Self directed || - Safe & Accurate - Needs limited supervision - Occasional physical & verbal direction || - Generally safe & Accurate - Needs close supervision - Freq physical &/or verbal direction || -Questionable safety &/or Accuracy - Continuous physical &/or verbal direction || - Exceptionally high level of work/skills || - Achieved all competencies - Significantly exceeds the average level of work/skills || - Inconsistent achievement of all competencies - Average level of work/skills || - Did not meet the minimum level of competencies. Did not do average level of work/skills || Has depth of insight into disease processes & nursing care || Clear, precise, well reasoned Comprehension of basic concepts & principles Basic insight into disease processes & nursing care || Inconsistently clear, lacks precision, not always well reasoned & sound judgment Does not display depth of insight into disease processes & nursing care || Knowledge is memorized rather than comprehended Unable to display insight into disease processes & nursing care || Appears relaxed & confident during performance of task || Efficient, coordinated, confident, organized Appears generally relaxed & confident; occasional anxiety may be noticeable || Inefficient, uncoordinated, unorganized Focuses primarily on task or own behavior, not on client || Inefficient, uncoordinated, unorganized Focuses entirely on task or own behavior || Enters data into health record independently without cues from instructor or staff nurse || Proficient interpersonal relationships Enters data into health record with occasional supportive cue || Satisfactory interpersonal relationships Enters data into health record with frequent supportive cues || Unsatisfactory interpersonal relationships Enters data into health record with continuous directive cues || Consistently dresses according to code Displays a professional attributes & accountability || Works safely with all team members Consistently dresses according to code Displays a professional attributes & accountability || Lacks initiative in involving all team members Inconsistent with dress code, needs cues to maintain Inconsistent in application of professional attributes &/or accountability || unable to initiate care independently Inconsistent with dress code needs multiple cues to maintain. Displays unprofessional attributes &/or is unaccountable || § Clinical Performance Rubric that reflects the above Criteria published in course curriculum and to Angel learning site.
 * **__ Exceptiona __** l
 * - Safe & Accurate
 * - Achieved all competencies
 * ** Assessment: Uses expanded assessment to recognize normal and changing patient health status. Identifies ethical issues in the clinical setting. ** ||
 * Strong knowledge base, sound judgment, excellent reasoning & problem solving skills
 * ** Analyzing/Planning: Sets priorities and organizes patient care. Demonstrates ability to problem solve and make sound judgments in caring for patients. Transition from the LPN role to the RN role by enhancing clinical decision making skills while incorporating critical thinking. ** ||
 * Raises significant questions & issues, Analyzes questions/problems clearly, Recognizes questionable assumptions & Clarifies key concepts effectively || Raises questions & issues, Analyzes questions/problems clearly, Recognizes questionable assumptions & Clarifies key concepts competently || Inconsistent comprehension of basic concepts/principles, Clarifies some concepts competently || Application of concepts & knowledge is lacking. Demonstrates Poor reasoning & problem solving skills ||
 * ** Implementation: Calculates basic nursing math correctly for safe administration of medication and IV fluids. Demonstrates safe and effective nursing practice. Performs in accordance with acceptable practice as defined by law. Follows policies, standards and procedures of clinical facility and BTC nursing program. ** ||
 * Proficient, coordinated, confident, organized
 * ** Communication: Demonstrates progressive skills in communication in order to communicate with pediatric and adult patients, a laboring mother, geriatric patients and their families, and patients demonstrating changes in mental health status. Report and document assessment, normal/abnormal observations and nursing care accurately and in a timely manner. Demonstrates assertiveness skills and resolves conflict in an appropriate manner. ** ||
 * Exceptional interpersonal relationships
 * ** Patient Teaching: Demonstrates expanded skills in the nursing process, by providing patient/family education based on assessment of need. ** ||
 * Applies theoretical knowledge of patient teaching accurately each time || Applies theoretical knowledge of patient teaching accurately with occasional cues || Identifies principles of patient teaching but needs direction to identify application || Identifies fragments of principles of patient teaching. Applies principles inappropriately. ||
 * ** Personal & Professional Responsibility: Implements a learning plan, based on self-evaluation, to expand nursing competence in a variety of healthcare settings. Evaluate clinical performance to determine if practice standards were or were not met. Develop a portfolio for clinical nursing practice. Acts as patient advocate to meet his/her needs. Seeks opportunities for continued learning, self-development, leadership and management skills. ** ||
 * Self directed, initiates assistance from other team members

· Self Assessment o Initial Self Assessment of Nursing Skills: Students evaluate themselves based on a listing of essential nursing skills. This is completed via Angel survey as an introductory exercise at the beginning of the quarter. o Final Self Assessment of Nursing Skills: Students evaluate themselves based on a listing of essential nursing skills. This is completed via Angel survey at the end of the quarter. o Clinical Self Evalution Form: Students submit a self evaluation based on above performance criteria after every clinical experience – total of 6. o Reflection Through Journal Writing: Students submit a journal entry to the clinical instructor after every clinical experience allowing them to analyze their experience, make changes based on their mistakes, keep doing what is successful and build on past knowledge based on new learning. Reflection also allows the student to make connections between theoretical concepts and experiential learning.

· FIDeLity Feedback o Clinical Lab: Immediate feedback from both peers and instructor with an emphasis on constructive criticism and the learning environment. Students have the opportunity to nominate each other for excellent performance of a skill. The best recorded skill performances will be posted to the Angel site for student reference. o Clinical Site: Clinical instructors are coached to be respectful and profession with the students at all times. Immediate constructive feedback for each student as soon as a clinical task is observed. If a student is threatening the safety of the patient in some way that necessitates the instructor to step in, the instructor will do so discreetly. Students needing addition instruction or intervention into their task performance will have the opportunity to immediately process the experience with the instructor and reflect on challenging clinical areas in their weekly journals. o Performance Evaluations: Each student will receive a performance evaluation with comments based on the performance rubric after each clinical experience.


 * Step 4: Teaching and Learning Activities **

· Information and Ideas 1. Textbook § Students complete required reading in their course textbook relating to the clinical skills to be learned and their implementation. 2. Skill Sheets § Students receive skill sheets as part of their textbook/workbook package. These skill sheets outline the skills and procedures that the student will be expected to master during this course. The student must be familiar with the procedure or skill prior to coming to clinical lab. 3. Video Modules § Online video clips that outline procedures to be learned will be posted on the clinical Angel site. Students will be expected to review each video online. 4. Internet Search § After reviewing the textbook, skill sheets and video modules, the student will perform their own internet search and post a relevant multi-media clip that demonstrates some aspect of the skills to be mastered. These clips will be posted to their clinical Angel site. 5. Evidence Based Practice § Each student group will be assigned 2-4 related skills and must research the current evidence based practice related to each. Their results will be posted to the clinical Angel site. · Experiences 1. Skills Demonstration § Instructors will demonstrate new skills in a simulated clinical lab setting. 2. Skills Practice § Students will practice a determined set of skills in small groups in the clinical lab setting. § Students will have open lab time in order to practice skills on their own time prior to being evaluated by their instructor. 3. Simulation § Given a clinical situation in the controlled clinical lab environment, students will work together in small groups to demonstrate integration of skill sets and application of critical thinking as it applies to changing patient condition. 4. Case Studies § After practicing lab skills and experiencing clinical lab simulation, students will create their own case studies focusing on a disease spectrum studied the previous quarter. 5. Skill Application § Students will perform procedures and skills learned in the clinical lab in an acute care patient setting with real patients under the supervision of their clinical instructor. · Reflection 1. Small Group Discussion § After each of the experience activities students will debrief about their experience in a large group discussion format. 2. Self/Peer Evaluation § Self Evaluation: Students will evaluate their own performance of skills in the clinical lab as well as during their clinical experience using a predetermined self-evaluation form based on class objectives. § Peer Evaluation: Students will evaluate their peers in small groups while practicing and demonstrating their clinical skills using a predetermined self-evaluation form based on class objectives. 3. Reflection Through Journal Writing § After each clinical experience in the acute care patient setting, students will reflect on their experience, what they have learned from the experience, and how they are meeting their performance goals.


 * Step 5: Integrate the Component Parts **

a) Key Information   i) Identify: Significant patient problems, priority nursing actions, interaction between lab values and patient condition or treatment ii)Remember: Correct procedure for advanced nursing care including: IV Therapy, Blood Administration, Accessing and Care of Central Lines, Insertion and Management of NasoGastric Tubes, Care of Chest Tubes   iii) Understand: Value and Application of ongoing nursing assessment  ||  o Initial Self Assessment of Nursing Skills: Students evaluate themselves based on a listing of essential nursing skills. This is completed via Angel survey as an introductory exercise at the beginning of the quarter. o Final Self Assessment of Nursing Skills: Students evaluate themselves based on a listing of essential nursing skills. This is completed via Angel survey at the end of the quarter. o Clinical Self Evalution Form: Students submit a self evaluation based on above performance criteria after every clinical experience – total of 6. || 1. Textbook § Students complete required reading in their course textbook relating to the clinical skills to be learned and their implementation. 2. Skill Sheets § Students receive skill sheets as part of their textbook/workbook package. These skill sheets outline the skills and procedures that the student will be expected to master during this course. The student must be familiar with the procedure or skill prior to coming to clinical lab. 3. Video Modules § Online video clips that outline procedures to be learned will be posted on the clinical Angel site. Students will be expected to review each video online. 4. Evidence Based Practice § Each student group will be assigned 2-4 related skills and must research the current evidence based practice related to each. Their results will be posted to the clinical Angel site. || a) Thinking:    i) Critical Thinking: Assess patient condition, Analyze ancillary information (history, lab work, imaging, etc…) ii) Creative Thinking: Solve patient care barriers by creating professional relationship with both patients and care team.   iii) Practical Thinking: Make decisions about patient care and coordinate interdisciplinary care planning. b) Skills: Use available materials to implement nursing care.   c) Complex Projects: Discover the satisfaction of beginning to see the bigger patient care picture. || o Clinical Lab Demonstrations: Students will divide the clinical lab learning objectives and work in small groups to develop a teaching plan for each required skill. Each group will present their teaching activity accompanied by a hands on demonstration. The class with return demonstration under the supervision of the presenting group. Presenting group members will be evaluated on their teaching plan and delivery. || 1. Skills Demonstration § Instructors will demonstrate new skills in a simulated clinical lab setting. 2. Skills Practice § Students will practice a determined set of skills in small groups in the clinical lab setting. § Students will have open lab time in order to practice skills on their own time prior to being evaluated by their instructor. 3. Simulation § Given a clinical situation in the controlled clinical lab environment, students will work together in small groups to demonstrate integration of skill sets and application of critical thinking as it applies to changing patient condition. 4. Skill Application § Students will perform procedures and skills learned in the clinical lab in an acute care patient setting with real patients under the supervision of their clinical instructor. || a) Within this course: Identify the similarities between clinical lab preparation and skills implementation.    b) Between this course and others: Connect information learned in NUR 211 (Classroom portion of the quarter) with clinical manifestations of didactic material. c) Between this course and students’ experience: Identify the similarities between previous work experience, previous learning, previous personal health experiences and clinical integration of advanced nursing practice. ||  o Clinical Lab: Immediate feedback from both peers and instructor with an emphasis on constructive criticism and the learning environment. Students have the opportunity to nominate each other for excellent performance of a skill. The best recorded skill performances will be posted to the Angel site for student reference.    o Clinical Site: Clinical instructors are coached to be respectful and profession with the students at all times. Immediate constructive feedback for each student as soon as a clinical task is observed. If a student is threatening the safety of the patient in some way that necessitates the instructor to step in, the instructor will do so discreetly. Students needing addition instruction or intervention into their task performance will have the opportunity to immediately process the experience with the instructor and reflect on challenging clinical areas in their weekly journals. o Performance Evaluations: Each student will receive a performance evaluation with comments based on the performance rubric after each clinical experience. || 1. Small Group Discussion § After each of the experience activities students will debrief about their experience in a large group discussion format. 2. Case Studies § After practicing lab skills and experiencing clinical lab simulation, students will create their own case studies focusing on a disease spectrum studied the previous quarter. || a) Self-Learning: Come to see themselves as progressing towards advanced practice and decide to become bachelors prepared nurses.    b) Understanding Others: Understand others in terms of the interplay between their socio-economic situation, physical health history and belief systems. || o Clinical Lab Self Evaluation: Students will record themselves performing clinical lab tasks, review the tapes and evaluate and grade themselves based on the clinical performance grading rubric. The recording, the students self evaluation and at least one peer evaluation will be submitted to the teacher for review. o Clinical Lab Peer Evaluation: Students will perform clinical lab activities in small groups, evaluating each other on the clinical performance grading rubric that will be used for their weekly self evaluation. This allows for peer-feedback, learning from each other, and confidence building for the students. || 3. Self/Peer Evaluation § Self Evaluation: Students will evaluate their own performance of skills in the clinical lab as well as during their clinical experience using a predetermined self-evaluation form based on class objectives. § Peer Evaluation: Students will evaluate their peers in small groups while practicing and demonstrating their clinical skills using a predetermined self-evaluation form based on class objectives. || a) Feelings: Get excited about becoming advanced nurses.    b) Interests: Be more interested in advancing their nursing education. c) Values: Be ready to hold themselves to the highest standard. ||  o Reflection Through Journal Writing: Students submit a journal entry to the clinical instructor after every clinical experience allowing them to analyze their experience, make changes based on their mistakes, keep doing what is successful and build on past knowledge based on new learning. Reflection also allows the student to make connections between theoretical concepts and experiential learning.    o Final Product Assignment: “What does an RN graduate look like?” At the beginning of the quarter, students outline what they will have achieved by the end of the quarter and how they will apply it to their nursing practice.   ||  1. Reflection Through Journal Writing    § After each clinical experience in the acute care patient setting, students will reflect on their experience, what they have learned from the experience, and how they are meeting their performance goals. || a) Being a Good Student: Create a learning plan for achieving advanced nursing skills.    b) Constructing Knowledge: Be able to construct knowledge about complex patient situations. c) Self-Directed Learning: Identify sources of information on rapidly changing and advancing nursing practices and skills. ||  o Formulate Clinical Expectations: As small groups the students will use the clinical performance rubric to determine expectations for clinical performance and relate them to specific nursing actions. Students will determine as a class which performance expectations should be included in the final product and why. Finished clinical expectations will be posted to the Angel site and used as a guide for weekly reflective journal writing.   ||  1. Internet Search    § After reviewing the textbook, skill sheets and video modules, the student will perform their own internet search and post a relevant multi-media clip that demonstrates some aspect of the skills to be mastered. These clips will be posted to their clinical Angel site.     ||
 * **Learning Goals ** ||  **Feedback and Assessment **  ||  **Teaching and Learning Activities **  ||
 * **Foundational Knowledge **
 * **Application **
 * **Integration **
 * **Human Dimension **
 * **Caring **
 * **Learning How to Learn **