1. Design nursing processes to provide comprehensive care across the lifespan in unstructured settings with complex situations and unpredictable circumstances.
2. Create partnerships with patients in the customized therapeutic care process to protect, promote, and restore optimal health in patients with major health transitions.
3. Incorporate therapeutic communication skills when enacting professional practice in the context of major health transitions.
4. Evaluate practice decisions using critical thinking in the context of major health transitions.
5. Evaluate strategies to improve nursing care through scholarship in providing care for patients with major health transitions.
6. Manage and collaborate with heath care providers to deliver quality care to patients with major health transitions.
7. Adhere to ethical and legal conduct that reflects the standards of nursing practice in the care of patients with major health transitions.
8. Display behaviors that demonstrate the values of a self-directed professional.

1. Demonstrates ability to consistently identify complex, comprehensive assessment findings in patients experiencing major health transitions in varied environments of care from hospital to home.
2. Incorporates lab values and current medications into client assessment consistently in complex and unstructured situations.
3. Analyzes/interprets assessment data and plans care using a variety of appropriate resources including research based literature.
4. Organizes and prioritizes care based on accurate assessment findings and initiates/evaluates interventions.
5. Reevaluates nursing actions and alters plan based on reassessment of changing patient status.
6. Demonstrates appropriate and safe application of all nursing skills and technological equipment to include but are not limited to: three lead EKG interpretation; IV starts and blood draw; initiate, assess and regulate intravenous therapies including the use of IV pumps; and endotracheal suctioning.
7. Consistently uses the patient/family as a resource when developing the plan of care.
8. Establishes priorities for care with recognition of patient’s needs, beliefs and practices.
9. Integrates communication and interpersonal skills in provision of customized, comprehensive care to persons with complex needs.
10. Individualizes patient/family teaching based on patient needs, beliefs, and practices.
11. Demonstrates culturally competent nursing care for persons with complex needs.
12. Demonstrates safe, therapeutic, customized nursing care with dignity throughout the lifespan.
13. Demonstrates constructive verbal and written communication with faculty, clinical nursing staff, other health care providers and peers.
14. Communicates complex individualized needs of patients in a timely manner using appropriate terminology.
15. Demonstrates relevant, accurate, and thorough documentation of nursing process for patients with complex needs in varied environments.
16. Demonstrates appropriate use of technology for communication and acquisition of knowledge.
17. Uses critical thinking skills in applying the nursing process to the care of patients with major health transitions.
18. Demonstrates analytical thought verbally and in written work by asking critical questions, drawing inferences, testing assumptions, applying information, and evaluating practice decisions.
19. Critically examines multiple approaches to health care issues in the context of major health decisions in varied environments.
20. Bases nursing judgment on scientific rationales, anticipates possible outcomes prior to deciding nursing action, and evaluates patient response to interventions.
21. Applies problem solving techniques while providing care for more complex and increased number of patients across care environments.
22. Demonstrates scholarship for the acquisition and application of new knowledge to practice.
23. Uses evidenced based practice and/or research based knowledge for practice and quality improvement, and leading customized care.
24. Effectively critiques professional and/or nursing research articles.
25. Collaborates and coordinates nursing care with multidisciplinary health care team.
26. Collaborates with multidisciplinary health team members in developing, implementing, reinforcing and evaluating health teaching for patients with major health transitions.
27. Partners with multidisciplinary health team members in coordinating the utilization of healthcare resources including but not limited to community resources in providing quality health care across environments.
28. Relates professional code of ethics, the Nurse Practice Act, HSC nursing student policies, and clinical agency policies to own nursing practice in providing care to patients with major health transitions.
29. Practices within the legal framework of the Nurse Practice Act critical elements and clinical agency policies.
30. Uses ethical decision-making frameworks in clinical situations incorporating moral concepts and respect for diverse values and beliefs.
31. Analyzes practice situations with potential legal and/or ethical ramifications based on knowledge of the Nurse Practice Act, HSC nursing student policies, and clinical agency policies.
32. Assumes responsibility for self-development. Seeks out and actively participates in learning opportunities. Identifies own strengths and weaknesses and formulates a plan to improve.
33. Accountable for nursing care provided to patients in major health transition. Motivated and organized to maximize learning opportunities.
34. Accountable for own learning. Updates staff R.N. and clinical instructor on all aspects of patient care.
35. Seeks appropriate assistance and utilizes guidance to facilitate own learning.

Failure to meet the clinical objectives will result in failure of the course.

Grading
Successful completion of NURS.4614 requires the achievement of objectives for both the clinical and theory components of the course.

Clinical practice is evaluated according to the clinical objectives on a pass/fail basis. Successful completion of the clinical objectives must be demonstrated for the student to receive a passing grade.

Classroom and learning laboratory content will be evaluated by paper and pencil testing, using scantron answer forms, and skill performance.

To pass the course the student must receive a "pass" for the clinical component of the course. A clinical failure results in a final course grade of "failure". The letter grade for the course will be the grade achieved in theory.

NOTE: Completing the two ATI exams is mandatory for all students in this course.  When course grades are calculated (based on the course exams and other activities), any student passing the course who has not taken the ATI exams will receive an "incomplete" for a grade.  Any student who has not attained the required weighted average of 70% for their course grade will receive their achieved grade, whether or not they have taken the ATI exams.

The ATI content review and testing program provides each student with tutorial materials in book and CD format and both practice and proctored examination learning experiences.  In addition to providing a tool for self-assessment/evaluation of readiness for the NCLEX-RN licensing examination, the program provides the student with multiple opportunities to strengthen online test-taking skills.  Practice and proctored exams are required for successful completion of this course.

Assignments

1. All course work must be completed on or before due date. Under extraordinary circumstances a student may request an extension of the due date. Arrangements for an extension should be made with the clinical instructor.
2. All course assignments must represent the student's own accomplishments. Disciplinary action will be taken in the event of scholastic dishonesty. Scholastic dishonesty includes such acts as cheating, plagiarism, and collusion.
3. Every student will be required to show proof that they have taken at least one of the ATI Adult Medical-Surgical Practice exams and at least one of the RN Comprehensive Practice exams.  Specific details on how this will be accomplished and due dates will be provided to the students at the beginning of clinical.
4. The NURS.4614 teaching team reserves the right to make additional or alternate assignments in order to meet the needs of an individual student or a particular class.

Clinical Skills Lab

1. Clinical skills lab time is clinical time.
2. Study guides will be provided to assist in preparation for the learning lab experiences and students are expected to prepare for the labs.
3. The student is expected to be able to accomplish the stated objectives at the completion of the lab.
4. Evaluation of the achievement of the objectives will be by written examination incorporated in course exams.
5. Students are expected to wear a white uniform or colored scrubs (per clinical skill lab policy) and their name tags in the Clinical Skills Lab.
6. Students are expected to understand the emergency drugs listed in the handout.
7. Students are expected to understand and recognize the following dysryhythmias - normal sinus rhythm (NSR), sinus bradycardia (SB), sinus tachycardia (ST), atrial fibrillation (AFIB), ventricular tachycardia (VT), ventricular fibrillation (VF), premature ventricular contractions (PVC), and asystole.
8. Students are expected to perform all previously taught clinical skills. A performance lab will be held and all students will be scheduled to demonstrate satisfactory skill performance during that lab.

Examinations

1. Each course exam will have questions of equal weight and will be timed.
2. Calculations of medications will be included in all exams.
3. The final exam will be comprehensive.
4. Exams are graded by computer. An item analysis of all questions is done before the grades are determined. Only the scantron form will be used for grade determination.
5. Testable material is based on course and clinical objectives and includes, but is not limited to:
   1. All required readings, lectures, study guides, and discussion content.
   2. Related material in the course packet or Web syllabus, if applicable.
   3. Content covered by media presented or required for class and clinical skills lab.
   4. Materials given as handouts or placed on E-Reserves.
6. General examination policies are as follows.
   1. All exams are required and students are expected to take examinations at the scheduled time.
      1. Students missing an exam must take a make-up exam if the excuse for missing the exam is reasonable  and necessary.
      2. Make-up exams will be different from the scheduled exam.
      3. Make-up exams will be administered only at one scheduled time.
      4. The opportunity to take a make-up final exam is at the discretion of the faculty and will require documented evidence of the basis for missing the final exam.
   2. Students must notify the Administrative Assistant for Acute Nursing Care or Course Coordinator prior to the scheduled exam time if they are unable to take an exam. Failure to make this notification will result in a “zero” for that exam.
   3. It is the student's responsibility to insure that he/she has answered all test items before leaving the room.
   4. If a student arrives late for an exam, no extra time will be given to complete the exam.
   5. If the exam is not turned in when time is called, a grade of zero will be assigned.
7. To preserve the integrity of examinations, the following policies apply.
   1. Students cannot bring any items into the exam room (including purses, backpacks, cell phones, pagers, caps, jackets or other items).  Pencils, erasers, calculators and Kleenex will be provided.
   2. Students may be assigned seats by faculty proctors.
   3. Students will remain in the exam room until the exam is completed and both the exam and answer sheet have been turned in to the faculty proctor.
   4. Students will be required to show their Student ID to take the examination.
   5. Students will utilize the test identification number given to them by the Undergraduate Office.
8. To reinforce learning, promote understanding of content, and maintain the  integrity of exams, the following policies apply:
   1. Students who wish to review missed items have two weeks from the date exam results are posted.  The student must make an appointment with their clinical faculty member. 
   2. There will not be a key provided for student viewing.
   3. Test booklets will not be available after turned in the day of the exam.
   4. Group test reviews will not be done.
9.  A blueprint of each examination will be available at least two weeks prior to the scheduled date of the exam. Scheduled time for each exam may vary based on the number of items on the exam.
10. Exam grades will be posted on the course Electronic Reserve.

Attendance/Tardy: Attendance in Class, Clinical, and Clinical Skills Lab is required. Absences jeopardize achievement of course objectives. Clinical attendance is checked for each clinical experience. Clinical Skills Lab attendance is checked each lab. Students are expected to complete the designated number of course clinical hours. If greater than 15% of clinical time is missed in courses with clinical hours greater than 100, the student will not progress in that specific course that semester. In the event of a holiday or designated school function on a clinical day, students will be provided with an alternate learning activity. Missed clinical hours cannot be "made up." However, clinical faculty will assign alternative learning activities for missed clinical experience.

Class Cancellation: If class is canceled for any reason, the student is expected to do the readings and complete the class objectives for that day(s). The content will still be included on course examinations.

The following are required for all students enrolled in NURS.4614.

Assessment Technologies Institute (ATI) Materials

Gahart, B.L. (newest edition) Intravenous medications: A handbook for nurses and other allied health
        professionals. St. Louis: Mosby.

Huether, S.E., McCance, K.L. (2004). Understanding Pathophysiology. (3rd ed). St. Louis: Mosby.

Lewis, S.L., Heitkemper, M.M., & Dirksen, S.R. (2004). Medical-surgical nursing: Assessment and management of          clinical problems (6^th ed.). St. Louis: Mosby.  or:  Lewis, S.L., Heitkemper, M.M., & Dirksen, S.R., O'Brien, P..G. &         Becker, L. (2007).  Medical-surgical nursing:  Assessment and management of clinical problems (7th ed.).                    St. Louis: Mosby.

Potter, P.A., & Perry, A.G. (2005).  Fundamentals of nursing: Concepts, process, and practice. (6th ed.)St. Louis:     

       Mosby.

Smith, S., Duel, D. & Martin, B. (2004) Clinical Nursing Skills-Basic to Advanced Skills (6th ed.) St. Louis, Mosby. or:
      Smith, S., Duel, D. & Martin, B. (2008) Clinical Nursing Skills-Basic to Advanced Skills (7th ed.) Pearson/Prentice Hall.

Sole, M.L., Klein, D.G., & Moseley, M.J. (2005). Introduction to critical care nursing (4^th ed.).
        Philadephia: W. B. Saunders.

Dirksen, S.R., Lewis, S.L., & Heitkemper, M.M. (2004) Clinical companion to medical-surgical nursing. (6th ed.)

        St. Louis: Mosby  or:  Dirksen, S.R., O'Brien, P.G., Lewis, S.L., Heitkemper, M.M. & Becker,L. (2007).                                Clinical companion to medical-surgical nursing. (7th ed.).  St. Louis; Mosby                                     

1. Patient at Risk; DKA, Critically ill and Insulin Therapy
2. Patient experiencing acute alteration in cardiac output/tissue perfusion
3. Patient experiencing acute alteration oxygenation
4. Patient experiencing acute alteration in neurological status
5. Patient experiencing acute alteration in metabolism
6. Patient experiencing acute oncologic emergency
7. Patient experiencing acute alteration in renal function
8. Patient experiencing trauma/burns
9. Patient experiencing acute alteration of inflammatory response