This course builds on Critical Care Nursing - Clinical Nurse Specialist I - and is designed to transition the graduate nursing student into the Clinical Nurse Specialist role as a practitioner and provider of care.  The focus of this critical care specialty is adults with life-threatening, critical illness or injury who require advanced technology and monitoring.  Students have the opportunity to develop, apply and evaluate in-depth knowledge of pathophysiological processes and evidenced-based interventions for disease management.  The focus of the theoretical and clinical content of the course is on nursing and medical diagnosis and management, pharmacological and nonpharmacological treatments, and an interdisciplinary approach to critically ill patients.  Clinical experiences include the implementation and evaluation of Clinical Nurse Specialist roles in tertiary and other settings that comprise the continuum of care for critically ill patients.

Semester Credit

6 semester credit hours

Credit Hour Allocation                                    Clock Hour Allocation

3 semester hours class                                 3 clock hours class

3 semester hours clinical                              9 clock hours clinical (135 hours clinical practicum)

                                                                NOTE: 6 hours of the 135 hours of clinical practicum will be designated for

                                                                             clinical conference, times TBA

NURS 5226 Nurses Role in Financial Planning in HC; NURS 5339 Nursing Leadership & Policy; NURS 5307 Nursing Science II (or concurrent); NURS 5311 Nursing Assessment of Populations (or concurrent); NURS 5601 CCN I; NURS 5140 CCN: Skills Competencies

Upon completion of this course, the student will be able to:

1. Demonstrate in-depth knowledge of pathophysiological processes, disease management and health promotion for adults with critical illness and injury.
2. Analyze current practice issues, research, and technological advances that impact patients’ health and acute and chronic disease management.
3. Use diagnostic reasoning to make nursing and medical diagnoses.
4. Utilize evidence-based recommendations to develop interdisciplinary health care plans including pharmacologic and nonpharmacologic treatments.
5. Develop outcome criteria for evaluation of clinical practice.
6. Partner with patients* to develop and deliver customized care.
7. Evaluate the Clinical Nurse Specialist role in partnership with patients* and other health care providers.
8. Demonstrate core professional values and ethical/legal standards in the implementation of the Clinical Nurse Specialist role.
   

Clinical Practicum and Objectives:

The purpose of the clinical practicum is to:

1)  provide the opportunity to accomplish course objectives,

2)  apply course concepts, and

3)  implement the diagnosis and treatment process with patients 

Each student must complete 135 hours of clinical time. Clinical hours are arranged between the student and the preceptor. The student will work with a preceptor in an identified area to implement the role of the clinical nurse specialist and to complete course requirements.

The clinical grade will be based upon a Satisfactory/Unsatisfactory designation.  The clinical log, preceptor evaluation and faculty evaluation will be used to determine the clinical grade.

Students must satisfactorily complete the clinical portion of the course to receive credit for the course.

Written work: It is expected that all written assignments will be completed in a scholarly manner with attention to spelling, grammar, composition, and style.  Students are expected to correctly utilize the APA style for documentation.

Assignments are to be turned in on time.

Evidence of scholarship is one component of the grade of all written assignments. Up to 10 points may be subtracted for poorly written papers that do not use APA format where appropriate.  The majority of references should be from the last five years.  The exception to this would include classic articles on a topic or references that support historical development of a topic. 

The student must submit two copies of all papers.  One copy will be retained permanently by the faculty, and one will be returned to the students.  Articles used to reference the paper and the criteria sheet should be submitted with each paper.  These articles will be returned with the graded paper.

Bakerman, P., & Strausbauch, P. (2002). Bakerman's, ABC's of interpretive laboratory data. (4th ed.).
          Scottsdale: Interpretive Laboratory Data.

Gilbert, D. N., Moellering, R. C., & Sande, M. A. (2008). The sanford guide to antimicrobial therapy. (38th ed.).
           Hyde Park, VT: Jeb E Sanford Publishers.

Guide to Clinical Preventive Services: Recommendations of the US Preventive Services Task Force (USPSTF).
           (2007). Retrieved May 6, 2008, from http://www.ahrq.gov/clinic/pocketgd.htm

Tarascon Pocket Pharmacopoeia. (2008). Loma Linda: Tarascon Publishing.

Tierney, L., McPhee, S., & Papadakis, M. (Eds.) (2008). Current Medical Diagnosis and Treatment. (46th ed.).
           New York: McGraw-Hill.  Available online at stat Ref.

Turkoski, B., Lance, B., Bonfiglio, M. (2009). Drug information handbook for advanced practice nursing.
           (9th ed.). Hudson: LexiComp. (Available June 30th).

REQUIRED TEXT FROM PREVIOUS SEMESTERS
Hamric, A.B., Spross, J.A., & Hanson, C.M. (Eds.). (2005). Advanced practice nursing: An integrative approach.
            (3rd ed.). St. Louis: Elsevier-Health Sciences Division.

McKinley, M. (Ed.). (2007). Acute and critical care clinical nurse specialists: Synergy for best practices. St. Louis:
           Elsevier Saunders.

Stevens, K. R. (2005). Essential competencies for evidence - based practice. San Antonio, TX: Academic Center
            for Evidence-Based Practice, the University of Texas Health Science Center at San Antonio.

Urden, L.D., Stacy, K.M., & Lough, M.E. (2006). Thelan’s Critical Care Nursing: Diagnosis and management.
            St. Louis: Mosby. 

Green, G. (2007). The Washington manual of medical therapeutics. (32nd ed.). Philadelphia: Lippincott, Williams,
           & Wilkins.   

Wells, B.G., Dipiro, J.T., Schwinghammer, T.L., & Hamilton, C. W. (2006). Pharmacotherapy handbook 
          (6th ed.). New York, NY:  McGraw-Hill.

Web Site Resources

Board of Examiners: Rules and Regulations (Rule 221 & 222)

http://www.bne.state.tx.us

Board of Medical Examiners: Rules and Statutes regarding Standing Delegation Orders (Chapter 193)

http://www.tmb.state.tx.us

Access to Clinical Practice Guidelines Web Sites:

• National Guidelines Clearing House: http://www.guideline.gov
• Agency for Healthcare Research & Quality : http://www.ahrq.gov/cliniclcpgonline.htm
• National Heart, Lung, & Blood Institute: http://www.nhlbi.nih.gov/guidelines/index.htm

1. Diagnosis and management of common health problems related to the following systems: cardiovascular, respiratory, gastrointestinal, genitourinary, endocrine, neurological, hematological, immunological, and integumentary.
   
   (The following is only a partial listing of clinical problems or disorders covered under each system):
   Cardiovascular System
                 Management of dysrhythmias
                 Acute coronary syndrome (includes angina, ischemic heart disease)
                 Cardiovascular surgery
                 Heart failure
                 Hypertensive crisis
                 Shock/Hypoperfusion
   Pulmonary System
                 Acute Respiratory Distress Syndrome
                 Acute Respiratory Failure
                 Obstructive Pulmonary Disease
                 Respiratory infections
                 Thoracic Surgery
   Neurological System
                 Intracranial disorders: head injury, hemorrhage
                 Sensory and motor disorders
                 Neurovascular disease
   Renal System
                 Acute Renal Failure
                 Chronic Renal Failure
   Endocrine System
                 Endocrine Disorders: Thyroid & Pancreas - Type I and Type II Diabetes; Diabetic emergencies
   Hematological System
                 Hematological Disorders: Coagulation Disorders, Anemia
   Immunological System
                 Immunological Disorders: HIV/AIDS, Leukemia, drug resistant issues, autoimmune disorders
   Gastrointestinal System
                 Gastrointestinal Disorders: Acute GI Bleed, Liver Failure, Pancreatitis, GI Obstructive Disorders,                    Inflammatory bowel Disease, Esophageal Reflux
   Integumentary System
                 Integumentary Disorders: Necrotizing Disorders, Burns, Dermatitis
   Musculoskeletal System
                 Musculoskeletal Disorders: Fracture Bones, Low Back Pain
   Perioperative Nursing: Surgical Care
   Systemic Inflammatory Response Syndrome and Multiorgan Dysfunction Syndrome
   Organ Transplantation
   
2. Use of evidenced-based practice related to patient health, disease management and limited prescriptive authority.
3. Diagnostic reasoning
4. Prescriptive authority regulation and issues
5. Ethical, legal and professional standards of advanced practice nursing as it pertains to limited prescriptive authority.