UNIVERSITY OF SOUTH CAROLINA SPARTANBURG MARY BLACK SCHOOL OF NURSING ASSOCIATE DEGREE PROGRAM IN TECHNICAL NURSING SANU 202P: NURSING CARE OF ADULTS III PRACTICUM SYLLABUS Fall 2005

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UNIVERSITY OF SOUTH CAROLINA SPARTANBURG

MARY BLACK SCHOOL OF NURSING

ASSOCIATE DEGREE PROGRAM IN TECHNICAL NURSING


SANU 202P: NURSING CARE OF ADULTS III PRACTICUM

SYLLABUS

Fall

2005


Mary Lou Hodge




Trish McCallister

mhodge@uscupstate.edu




tmccallister@uscupstate.edu


Room 141





Room 106

503
-
5468





503
-
5404


I.

Course Description


Clinical applications of theoretical concepts for the nursing care of a
dults with acute and chronic health

care needs, utilizing the nursing process for advanced clinical decision making. Coordination and

management of care for a group of clients in acute care settings is emphasized utilizing basic

management principles.


Prerequisites:

SBIO 242/242L, SBIO 330/330L, SPSY 203, SNUR 301, SNUR 302,
SANU 101/101P,
SANU 103L, SANU 104/104P, SANU 201/201P,


Corequisites:

SANU 202,
SANU 20
3/203P, SANU 206


II.

Conceptual Framework



Health



Patient



Nursing



Nurse



Setting


III.

Course Goals and Objectives



A.

Course Content: This course is designed to allow clinical application of theoretical concepts

essential to the nursing care of adults at various stages of adaptation on the health
-
illness

continuum with respect to p
otential and actual complex human needs interferences. This course

also allows for clinical application of basic nursing leadership and management skills.


B.

Course Goals: This course will enable the participant to perform and expand assessment skills,

formulate and prioritize nursing diagnoses, implement nursing interventions and evaluate

patient outcomes at an advanced level.


C.

Course Objectives: Upon completion of this course, the participant will be able to

independently and/or with consultatio
n of faculty:




a.

Basic Human Needs




1.

Assist adult patients in resolving human need interferences.




2.

Plan care consistent with goals, recognizing the interrelatedness of basic human

needs.



b.

Nursing Process




1.

Apply the nursing process as
a framework for determining nursing


care for adult

patients experiencing interferences in human needs in both the acute and

community based setting.


2

2.

Collect, cluster, interpret and validate assessment data (to include diagnostic

studies) as it spec
ifically relates to individuals experiencing inte
r
ferences in the

human needs within the nursing process framework.


3.

Formulate and prioritize actual and/or potential nursing diagnoses




4.

Construct measurable goals for adults experiencing interferen
ces in human

needs.




5.

Plan nursing care consistent with goals and organized by priority of needs.




6.

Prioritize and perform nursing interventions (to include pharm
a
cologic and

nutritional interventions) appropriate to individuals experiencing inte
rferences in

human needs. Interventions will reflect adaptations appropriate to variant

patient situations and established agency policies and procedures.




7.

Evaluate goal attainment according to established outcome criteria to determine

the effective
ness of nursing interventions and resolution of human needs

interferences.



c.

Manager of Care

1.

Manage an organized plan of care for adults in collaboration with other members

of the health team, considering safety, resources, and time management.



d
.

Communication




1.

Communicate therapeutically with patients and family members using effective

communication skills during interactions.




2.

Communicate effectively when documenting the delivery of health care.



e.

Caring




1.

Apply knowledge of c
ultural diversity in planning and implementing nursing care.




2.

Provide nursing care to patients with interferences in human needs in a manner

that is empathetic, respectful of individual needs, and is unconditional in nature.




3.

Implement nursing i
nterventions that facilitate physical and emotional

independence of patients with interferences in human needs.




4.

Implement nursing interventions that meet anticipatory needs of adults

experiencing interferences in human needs.




5.

Collaborate with

individuals and family members experiencing interferences in

human needs when developing a plan of care.




6.

Function as a patient advocate for individuals experiencing interferences in

human needs.



f.

Teaching/Learning

1.

Apply appropriate principl
es in meeting teaching/learning needs of adults across

the health
-
illness continuum.

2.

Develop a teaching plan with consideration of developmental levels and

resources for a client in the home setting.



g.

Skills




1.

Perform previously learned skills

independently and with faculty supervision

according to established criteria and critical elements when providing patient

care.




2.

Integrate cognitive, psychomotor and effective dimensions in the performance of

previously learned skills.



h.

Respon
sibility/Accountability




1.

Demonstrate responsibility and accountability as a provider of care to adults

experiencing interferences in human needs.




2.

Discuss the findings of nursing research on specific nursing actions.




3.

Provide patient care w
ithin an ethical and legal framework.






3

4.

Discuss moral and ethical issues that impact individuals experiencing

interferences in human needs and their family members both the acute and

community based setting.


IV.

Methods of Instruction


Critical th
inking exercises, group discussion in clinical pre and post conferences, observational

experiences, nursing care of selected clients in acute care settings, computer assisted instructions

and video programs.


V.

Course Requirements and Grade Calculation
s



A.

Course Requirements



1.

See items 2
-
10 for specific assignments

a.

The schedule of course events is subject to change in the event of unforeseen
circumstances. Notice will be given if the schedule will vary.



2.

Comprehensive drug calculation comp
etency exam (92% is required to successfully

complete course; you will have three opportunities to complete this requirement).
See
course calendar for dates of required drug dosage calculation quizzes.
The

following calculations will be included on the e
xam:




a.

oral medications




b.

parenteral medications





-
premixed solutions




c.

intravenous medications





-
calculation of flow rates





-
calculation of infusion times





-
adding drugs to IV fluids





-
calculating drug infusion rates

(i.e. Hepar
in drip using a protocol)




d.

Students will be expected to perform calculations based on body weight




e.

All calculations must be shown on the quiz



3.

Skills competency evaluation for previously learned skills will be done on the second day

of clini
cal. Each student will randomly select TWO of the following skills to perform to be

evaluate
d/validated by the instructor during a summative 1:1 evaluation opportunity.




a.

Nasogastric tube insertion and removal




b.

Indwelling catheterization of the
female urinary bladder




c.

Tracheostomy suctioning and care




d.

Changing the central intravenous line dressing

e
.

Insulin injection and intramuscular injection




f
.

Intermittent IV medication via existing IV fluids




g
.

IV bolus medication via periph
eral INT




h.

Intermittent IV medication via unused port of a central intravenous

catheter line




i.

Irrigating the unused port of a central intravenous catheter





NOTE
: Failure to demonstrate competency of skills will result in course failure.






S
ee Skills Evaluation Guidelines.



4.

One graded nursing care plan. Please submit the “Nursing Care Plan Grading Criteria”

with

t
h
e

care plan.




a.

Re
-
submissions
ARE NOT

allowed, however students have the option of asking

the instructor to review the c
are plan
PRIOR

to submission for feedback.




b.

Each care plan must consist of 3 nursing diagnosis
excluding

the use of “pain”

and/or “knowledge deficit”.

Students should use more than 3 nursing diagnoses

if needed.

5.

Two

physical assessment form
s with

a grade of 9
0

or better is required.

The physical
assessment form will be graded using criteria of the
“Nursing Assessment/Clinical
Preparation Grading Criteria” form
.

Students may hand up to 4 assessments in order to

4

obtain the 90 required for 2 assessme
nts without penalty. If additional assessments are
required to obtain the grade of 90, all of the grades of all of the assessments will be
computed in the final assessment grade. The student
must

hand in a written assessment
on each patient assignment unti
l two assessments have been graded with a grade of


90 or above to obtain satisfactory.

(p. 54)

Students must make an appoinmtnet with the
clinical instructor for assistance if unable to obtain a grade of 90 after three (3)
assessments.




6.

Home Health P
aper



See Grading Criteria

form and





“Guidelines for Home Health Care Observational Experience”

(p. 40 & 42)



7.

Dialysis Paper


See Grading Criteria

(p. 44)

8.

Endoscopy Paper


See Grading Criteria

(p. 43)

9.

Charge Nurse/Leadership Paper


See Gra
ding Criteria

(p. 46, 47)



10
.

Clinical Exam

a.

Exam content will include questions related to skills (as outlined in syllabus),

course objectives, delegation, prioritization of patient care,
math calculations,
nursing leadership/management, observational

experiences, and clinical foci.




b.

Format of exam will be multiple choice, short answer and/or essay.



11
.

Laboratory and Clinical Performance





a.

The participant is expected to demonstrate the following behaviors in laboratory

and clinical experi
ence:

1.

The day
prior to

each clinical
experience,
each student will go to the
nursing unit and

select a patient(s) for clinical the following day. The
student will research

the medical record for the patient’s history,
diagnosis(es), labs, meds, and prog
ress.

The student should introduce
themselves to each patient and visually assess the environment each day.
The student is expected to communicate each assignment to the
instructor as arranged.



2.

Be prepared for the laboratory or clinical experience by
completing the




C
linical
P
rep
T
ool
and
M
edication
F
orm
for each assigned patient.







Students are expected to hand in the Clinical Prep Tool during pre





conference each day.

(p. 48
-
50)





3.

Be on time for the laboratory or clinical experience





4.

Provide safe nursing care to patients during the clinical experience





5.

Contribute to post
-
conference discussions regarding (1) the findings






of nursing research on specific nursing actions, (2) moral and ethical






issues that impact indivi
duals experiencing interferences in human






needs and their family members both the acute and community






based setting, and (3) related topics.

6.

Apply the basic p
rinciples of nursing leadership, management, delegation
and prioritization of patient

care.





7.

Pagers and cell phone use are not allowed during any clinical






experience.




b.

Students will earn a grade of “satisfactory” only if the predetermined





clinical criteria are met (See Clinical Evaluation Tool)





*The student who rece
ives an “unsatisfactory” clinical grade will receive






a
course

grade of “unsatisfactory” (U) for SANU 202P



12
.

Clinical and Laboratory Attendance




a.

Attendance is required for all clinical and lab experiences. If a laboratory

or clinical experien
ce is missed, a
clinical make
-
up day will be assigned if
possible. A formal paper will be required for a second clinical absence.

If more than
two

absence occurs, a grade of

unsatisfactory will be assigned for
the course.


*See Revision of Policies for ADN

Program
and SANU 202P Syllabus Addendum


5



1
3
.

ERI Testing must be completed before a final grade will be issued.



B.

Final Grade Calculation



The final course grade will be calculated as “satisfactory” or “unsatisfactory”.



1.

In order to earn a course

grade of “satisfactory”, the following must be achieved:




a.

An averaged score of 78 for components that are assigned a numerical grade;





the exception is the math (competency) grade in which a minimum grade of





92 is require
d and the assessments
in which a minimum grade of 90 is required.




b.

A grade of satisfactory for components that are not assigned a numerical





grade.











Compo
nents assigned a numerical grade




Nursing care plan



Dialysis Paper




Home health paper



Endoscopy Pap
er




Clinical exam




Charge/Leadership Paper




Physical

Assessment Forms (a grade of 90

or better is required)




Group Clinical Review Presentatio





Components
assigned a satisfactory/unsatisfactory




Skill competency




Clinical Prep Tools
/Medicati
on Forms

(must correct all unsatisfactory papers)




Clinical evaluation



*Math Competency (must score 92 or higher to receive a “satisfactory”)



ERI Testing




2.

Calculations




a.

Math competency…………………………………..satisfactory or unsatisfactory




b.

Skil
ls competency…………………………………..satisfactory or unsatisfactory




c.

Clinical evaluation…………………………………
..30%




d
.

Physical assessment forms………………………
5
%




e
.

Dialysis Paper……………………………
…………
..5%




f
.

Endoscopy Paper………………………
………….
..5%




g
.

Nursing care plan…………………
…………………
1
0%




h
.

Home health paper…………………………………
1
0
%






i
.

Clinical exam………………………………………….2
0
%

j
.

Demonstration leadership/charge nurse

responsibilities and paper……….……………….
1
0%

k.

Clinical
Review/P
resentation……………………..5%



C.

Policies



1.

The student is re
sponsible for the policies in the
Associate Degree Program in




Nursing: Student Handbook

and the
USCS Catalog
.



2.

Please refer to the Student Handbook and Catalog for specific policies.



3.

All written work must be completed and submitted as schedul
ed in order to pass




the course. Five (5) points will be taken off per day or any portion of the twenty
-
four




hours on any late paper or assignment to include Saturday, Sunday, and holidays.




Failure to complete work as assigned may result in a cours
e grade of “unsatisfactory”




(U).




NOTE: See revision of policies for ADN Program



D.

Student Responsibilities



1.

During the semester, faculty/student conferences will be scheduled at mid
-
term and

at the end of the semester. Students are required t
o attend these conferences.



Students who fail to attend any scheduled conference will receive a grade of F in the


6


course unless prior arrangements have been made with this instructor.

2.

The instructional work of SANU 202P is designed for
lab
/clinical a
ttendance and




participation.



3.

Students are responsible for the content of all classes as outlined in the course




syllabus, including announcements regarding policies and academic activities.



4.

Students are expected to complete assigned readings
, computer assisted instruction,




and videos prior to class. Class time will be used to discuss, clarify and supplement




written materials. All content included in the reading assignments will not be repeated




in class. The student is responsible for

the assigned content regarding the clinical foci.




5.

Students are expected to be present for all scheduled tests. In the event that a student




is unable to attend a scheduled test, the student must:




a.

Notify the faculty member regarding absence P
RIOR to the scheduled time for





the test. In the event of an emergency on the day of the test, notify the faculty





member as soon as possible.




b.

Tests are to be made up
during exam week
.




c.

Faculty reserve the right to change the test format w
hen giving make
-
up test.




d.

Students who fail to attend clinical on the same day of ANY scheduled





SANU course exam will NOT be allowed to take the exam
.



6.

The student is expected to initiate a meeting with the instructor to determine how





mis
sed work/tests will be made up within 1 week of the absence.



7.

It is the responsibility of the student to inform the faculty member of any circumstances




that warrant special accommodations as soon as the circumstance presents itself.




8.

Nursing Sk
ills Laboratory (Learning Resource Center [LRC])




a.

The LRC provides the opportunity to learn and practice nursing skills that will





be performed in the clinical setting. Specific nursing skills for demonstration, lab





practice (individual and sma
ll group), and competency evaluation are scheduled





before the semester begins
.




b.

The skills lab is an integral component in the preparation of clinical practice to





ensure patient safety. Therefore, absence from any scheduled skills lab is





considered as failure to prepare adequately for clinical practice and will be

counted as a clinical absence.

c.

Students are expected to be present, on time and prepared for ALL scheduled





laboratory experiences.




d.

In case of an emergency or illne
ss, the student is expected to notify the





appropriate faculty member PRIOR to the scheduled lab. Upon return to campus,





the student will be responsible for contacting the appropriate faculty member to





schedule lab make
-
up.




e.

Course evaluat
ion is dependent upon laboratory attendance, therefore, absences





may jeopardize the student’s grade.




f.

It is the responsibility of the student to inform the faculty member of any





circumstances that warrants the extension of special accommodatio
ns in the





skills lab.



9.

Clinical Practice (hospital or other health care agency)




a.

Students are expected to adhere to *dress code, be punctual, and prepared for





all scheduled clinical/laboratory experiences. Students who report to the clinic
al





area late, unprepared and/or not in adherence to the dress code will be





dismissed. This will count as a clinical absence. *See “Dress Code Policy for





Clinical Agencies” in the ADN Student Handbook.




b.

The faculty reserve the right to ref
use clinical access at any time during the





semester to a student who performs unsafe/unsatisfactory clinical practice.





Please refer to the “Statement of Unsafe Practice” in the
Associate Degree





Program in Nursing Student Handbook
.


7

c.

Students a
re required to maintain current CPR, OSHA & physical requirements

to attend the clinical area.



d.

Attendance at clinical orientation is considered a clinical requirement.

e.

It is the responsibility of the student to inform the faculty member of any





circumstances that warrants the extension of special accommodations in the





clinical setting.

f.

Pre
-

and post
-
conferences are considered an essential component of the clinical





experience and attendance is required. Students are evaluated on partici
pation





in these conferences.

g.

In case of an emergency or illness, the student is expected to notify the





appropriate faculty member PRIOR to the scheduled lab. Upon return to campus,

the student will be responsible for contacting the appropriate f
aculty member
and course coordinator to
schedule lab make
-
up.

h.

A student may fail a clinical course prior to the completion of the course under


certain circumstances. A student whose conduct is judged to be clinically unsafe
may be dismissed at any time

from a clinical unit. Unsafe clinical performance is
defined as behavior that is actually or potentially injurious to patients or staff and
is out of the range of ordinary student mistakes. Dismissal for the remainder of
the course results in a failing gr
ade for the course as does any failure to meet
course objectives.

i
.

Contingency Plan


In the event a clinical faculty member has an emergency and
is unable to attend clinical, the students in the clinical will follow those
guidelines.
Students assigned t
o an observational experience should attend that
experience.
Return to USCS and the LRC by 8 am. Notify the LRC instructor of
the situation. A contingency plan will be completed during the morning and all
written assignments will be turned in to the LRC in
structor before leaving at
12:45. Alternate arrangements may be needed utilizing clinical make
-
up day if
the instructor misses a second clinical day.

j.

Violation of patients’ rights under HIPPA regulations constitutes cause for





immediate clinical fai
lure.

Students
MUST NEVER

have any paperwork with a

patient’s name on it.



VI.

Instructional Materials


A.

Instruction Methods: Demonstration/return demonstration of skills in laboratory and

clinical settings, role modeling, care of selected patients in

the clinical agency, role

playing, conferences, discussion, independent learning modules, current



nursing literature, computer programs and audio
-
visuals will be utilized to

facilitate learning. The student is expected to use and maintain supplies in t
he Sophomore
Nurse Pac.



B.

Required Textbooks:




Ackley, B., & Ladwig, G. (200
4
).
Nursing diagnosis handbook: A guide to


planning care

(
6
th ed.). St. Louis: Mosby.

Bates, B., Bickley, L. & Hoekelman, R. (2000).
A pocket guide to physical examination
a
nd history taking

(3
rd

ed.). Philadelphia: Lippincott.

Hausman, K. & Ignatavicius, D. (2002).
Clinical companion for medical
-
surgical nursing:
Critical thinking for collaborative care

(4
th

ed.). Philadelphia: Saunders.

Ignatavicius, D. & Workman, L. (2002)
.
Medical
-
surgical nursing: Critical

thinking for collaborative care

(4
th

ed.). Volume I & II. Philadelphia: Saunders.

Kennedy, E. (2002). Virtual clinical excursions for medical
-
surgical nursing: Critical
thinking for collaborative care (4
th

ed.). Philad
elphia: Saunders.

Pagnana, K. D. & Pagnana, T. J. (200
5
).
Mosby’s diagnostic and laboratory test
reference

(6
th

ed.). St. Louis: Mosby Year Book.


8

Skidmore
-
Roth, L. (200
5
).
Mosby’s drug guide for nurses
. St. Louis:

Mosby.

Taylor, C., Lillis, C., & LeMone, P
. (2001).
Fundamentals of nursing: The

art and science of nursing care

(4th ed.). Philadelphia: Lippincott.

Taylor, C., Lillis, C., & LeMoore, P. (2001).
Study guide: Fundamentals of

nursing: The art and science of nursing care

(4th ed.). Philadelphia: Li
ppincott.

Thomas, C. L. (Ed.). (2001).
Taber’s cyclopedic medical dictionary

(19th

ed.). Philadelphia: Davis.

United Way of the Piedmont. (200
4
).
Directory of Services
.




Refer to your previous textbooks used in SNUR 301 (Nutrition) and SNUR

302 (Pharmac
ology,
including clinical calculation book).



9



202P

CLINICAL

FOCI


















10

Date/Section

Topic

Assignment


Section 1, 2, 3, 4

Week 1

August 18, 23, 24










Sections 1, 2, 3, 4

Week 2

August 25, 30, 31





Sections 1, 2, 3, 4

Week 3

Septembe
r 1, 6, 7





Sections 1, 2, 3, 4

Week 4

September 8, 13, 14








Sections 1, 2, 3, 4

Week 5

September 15, 20, 21




Sections 1, 2, 3, 4

Week 6

September 22, 27, 28







Sections 1, 2, 3, 4

Week 7

September 29

October 4, 5

0700
-
1100 Campus Lab Orientati
on

1130
-
1245 Orientation to Nursing Unit

Review equipment


HIPPA
requirements.









1:1 Skills Competency Performance
Evaluation






Glasgow Coma Scale

Cranial Nerves

Mental Status Exam





Time Management

Delegation of Tasks









Communication






Urinary Elimination

Hemodialysis

Peritoneal Dialysis

Kidney Transplantation






Patient Teaching/Education






Review syllabus, course requirements, expectations.

Care plans, policy changes, clinical rotation schedule

*Practice documenting on care mana
ger system in LRC
for future clinicals (It is the student’s responsibility for
continued practice of Care Manager in LRC on their own
time throughout the semester)


Review records/charts of assigned client using the
computer, practice use of Accu
-
chek and
IMED pump,
review unit specific manuals. Sign in on Care Manager at
SRMC


Students will have a 30
-
minute appointment with their
clinical faculty. They will randomly select 2 skills from
the skill list on page 3 numbers 3:a
-
i and perform the
skills with 100
% accuracy. Students must have a Nurse
Pac with supplies correctly arranged to be utilized in the
skill.


Perform neurological assessment using Glascow Coma
Scale; cranial nerves, mental status exam be prepared to
discuss findings (Ignatavicius:

p. 889
-
89
1)


Assignment: Perform cranial nerve assessment of
assigned client cranial nerves I
-
XII

*Do not assess corneal reflex (Ignatavicius: p. 882, 886
-
890)


Chap. 9 (Zerwekh & Claborn)

Develop strategy/plan for providing care in a timely
manner

Chap. 10 (Zerwek
h & Claborn)

Observe how the nurse manager and charge delegates
tasks to staff members and their responses


Chap. 7 (Zerwekh & Claborn)

Observation, communication, and interactions between
staff, PCT, unit secretary, patient’s, physician’s, social
workers,

therapists.



Perform renal assessment to include lab values, intake
and output, related dietary modifications; Be prepared to
discuss (Ignatavicius: p. 1600
-
1613)

Discuss the procedure used with hemodialysis and
peritoneal dialysis. Identify the advantag
es and
disadvantages of each type of dialysis. Identify nursing
responsibilities for each type of dialysis.



Assess learning needs of client, provide the appropriate
education and document in computer

(Taylor, Lillis, & LeMone: Chap. 22)





11



Date/Sectio
n

Topic

Assignment


Sections 1, 2, 3, 4

Week 8

October 6, 11, 12









Sections 1, 2, 3, 4

Week 9

October 18, 19, 20



Sections 1, 2, 3, 4

Week 10

October 25, 26, 27



Sections 1, 2, 3, 4

Week 11

November 1, 2, 3




Sections 1, 2, 3, 4

Week 12

November
8, 9, 10



Sections 1, 2, 3, 4

Week 13

November 15, 16, 17



Sections 1, 2, 3, 4

Week 14

November 29, 30

December 1



Enteral/Parenteral Nutrition

Bowel Assessment










Endoscopy

IV Moderate Sedation




Home Health





The Role of the RN:

Leadership





The Role of the RN:

Delegation

Prioritizing of Care



Assessment

“Rule of Nines”

Consensus Formula



Clinical Review


Assess nutritional status of assigned client to include
ht., wt., nutritional lab values, diet therapy and
available resources: be prep
ared to discuss
(Ignatavicius:

p. 1368
-
1373).


Perform bowel assessment of assigned patient to
include size, appearance, abnormalities, related lab
values and dietary modifications, etc; be prepared to
discuss (Ignatavicius: p. 1166
-
1167).


Discuss the nu
rsing responsibilities preceding, during,
and after endoscopic procedures. Identify the nursing
responsibilities specific to moderate sedation during
and after a procedure.


Discuss the nursing responsibilities and legal
requirements for patients receiving

Home Health
Services. Relate the services and responsibilities to the
Home Health Standards of Practice.


Describe the responsibilities of leadership for the
registered nurse in the acute care setting. Be specific.

How does the attitude of the charge RN a
ffect the
quality of patient care.








Describe the assessment of a burn victims skin/wound.
Identify the nutritional needs and wound management
for patient’s with burns.



Each student group will develop a handout on one of
the assigned foci and presen
t and discuss with the
other students in the rotation.

12/5


All Sections

Final Exam


3:00
-
6:00 p.m.




12







PROCEDURE CHECKLIST FOR

SKILLS COMPETENCY VALIDATION



13

UNIVERSITY OF SOUTH CAROLINA
UPSTATE

MARY BLACK SCHOOL OF NURSING

ASSOCIATE DEGREE NURS
ING PROGRAM


SKILLS EVALUATION GUIDELINES


Nursing faculty believe that skills performance is a critical indicator of a student’s potential for success in the
nursing program and ultimately the profession. Therefore, the following guidelines are provided t
o facilitate
that success and provide consistency in the evaluation process.


1.

The student is expected to come prepared for skill evaluation. Faculty will determine what preparation


student has completed. Faculty will terminate the evaluation if the stu
dent demonstrates obvious lack


of preparation. Lack of preparation counts as an evaluation attempt.


2.

Faculty will not coach or teach during the evaluation.


3.

Students may self identify and/or report errors during the evaluation at any point until the

faculty


terminates the session.


4.

Students have three opportunities to demonstrate competence in skill performance. Students must

schedule re
-
evaluation at a later date to allow for further practice and remediation. Re
-
evaluations


are not allowe
d on the same day as the initial attempt. Course syllabi address pass/fail requirements.

14


PROCEDURE CHECKLIST FOR SKILLS COMPETENCY VALIDATION



INSERTING A NASOGASTRIC TUBE


S


NP


U


Check physician’s order.





fden瑩fy pa瑩en琠and explain procedure.





䝡瑨er equipmen琮





Assess patient’s abdomen.





tash your hands. mu琠on clean disposable gloves.





Assist patient to high Fowler’s position, and drape chest with towel. Have emesis basin

and 瑩ssues available.






䍨eck nares for pa瑥ncy by

asking 瑨e pa瑩en琠瑯 occlude one nos瑲il and brea瑨e

normally 瑨rough 瑨e o瑨er nos瑲il. pelec琠瑨e nos瑲il 瑨rough which air passes more
easlily.






jeasure 瑨e dis瑡nce 瑯 inser琠瑨e 乇k瑵be by placing 瑨e 瑩p of 瑨e 瑵be a琠瑨e
patient’s nostril an
d ex瑥nding 瑯 瑨e 瑩p of 瑨e earlobe and 瑨en 瑯 瑨e 瑩p of 瑨e
xiphoid process. jark 瑨e 瑵be wi瑨 瑡pe or by using 瑨e marks on 瑨e 瑵be.






iubrica瑥 瑨e firs琠NM
-
OM cm E4
-
U inF of 瑨e 瑵be wi瑨 wa瑥r soluble lubrican琮





mosi瑩on 瑨e pa瑩en琠wit
h 瑨e neck hyper
-
ex瑥nded. fnser琠瑨e 瑵be in瑯 瑨e nos瑲il
while direc瑩ng 瑨e 瑵be downward and backward.






fns瑲uc琠瑨e pa瑩en琠瑯 flex 瑨eir head 瑯ward ches琮 bncourage him 瑯 swallow as 瑨e
瑵be is being inser瑥d. 䅤vance 瑨e 瑵be in a downward a
nd backward when 瑨e
pa瑩en琠swallows. p瑯p when he brea瑨es. mrovide 瑩ssues for 瑥aring or wa瑥ring eyes.
ff gagging and coughing persis琬 check placemen琠of 瑨e 瑵be wi瑨 a 瑯ngue blade and
flashligh琮 heep
advancing 瑨e 瑵be un瑩l 瑨e mar
k on 瑨e 瑡pe
is a琠瑨e nos瑲il. al
乏q use force. oo瑡瑥 瑨e 瑵be if you mee琠resis瑡nce.






aiscon瑩nue 瑨e procedure and remove 瑨e 瑵be if 瑨ere are signs of dis瑲essI such as
gaspingI coughingI inabili瑹 瑯 speak or hum and cyanosis.






ae瑥rmine 瑵be placeme
n琮


a. 䅴瑡ch syringe 瑯 end of 瑨e 瑵be and aspira瑥 NM
-
OM ml of gas瑲ic con瑥n瑳.


b. jeasure pe of aspira瑥d fluid.


c. mlace NM
-
OM ml of air in syringe and injec琠air in瑯 瑵be. pimul瑡neously


auscul瑡瑥 over gas瑲ic regio
n wi瑨 s瑥瑨oscope.









15

Secure tube with tape.


a. Cut 4
-
inch piece of tape and split bottom 2 inches.


b. Place unsplit end over bridge of patient’s nose.


c. trap spli琠ends around 瑨e 乇k瑵be. jake sure 瑨e 瑵be does no琠pu琠



pressure on 瑨e nos瑲il.



Attach tube to suction or clamp the tube, according to physician’s orders.





Secure tube to patient’s gown by using rubber band or tape and safety pin. Attach

a琠shoulder level.






tash handsI remove equipmen琬 make

pa瑩en琠comfor瑡ble.




eave x
-
ray for 瑵be placemen琬 if ordered.

aocumen琠inser瑩on procedureI 瑹pe and size of 瑵beI descrip瑩on of gas瑲ic con瑥n瑳I

and patient’s response.






heyW

p = pa瑩sfac瑯ry;

乐 = 乥eds mrac瑩ce;


r = rnsa瑩sfac瑯ry


p瑵de
nt’s Name _________________________________________________

Date ___________________


Instructor’s Signature ____________________________________________


Comments:


16



REMOVING A NASOGASTRIC TUBE


S


NP


U


Check physician’s order. Clamping may be require
d before removing 乇k





fden瑩fy pa瑩en琬 explain procedure and assis琠pa瑩en琠瑯 semi
-
Fowler’s position.





䝡瑨er equipmen琮





tash your hands. mu琠on clean disposable gloves.





arape ches琠wi瑨 瑯wel or disposable pad. 䝩ve 瑩ssues 瑯 pa瑩ent
.





Discontinue suction and separate tube from patient’s gown. Carefully remove tape
from patient’s nose.






䅴瑡ch syringe and flush wi瑨 NM ml normal saline solu瑩on or clear wi瑨 PM
-
RM ml air.






fns瑲uc琠瑨e pa瑩en琠瑯 瑡ke a deep brea瑨 and h
old i琮





䍬amp 瑵be wi瑨 fingers by doubling 瑵be on i瑳elf. nuickly and carefully remove 瑵be
while pa瑩en琠holds his brea瑨.






mlace 瑵be in disposable plas瑩c bag. oemove gloves and place in bag.





lffer mou瑨 care 瑯 pa瑩en琠and make pa瑩ent

comfor瑡ble.






jeasure nasogas瑲ic drainage. oemove all equipmen琠and dispose according 瑯
agency policy. tash hands.






Document removal of tube, patient’s response, and amount of drainage.





heyW

p = pa瑩sfac瑯ry;


乐 = 乥eds mrac瑩ce;


r = rn
sa瑩sfac瑯ry


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature _____________________________________________


Comments:


17



INDWELLING CATHETERIZATION OF THE FEMALE URINARY BLADDER


S


NP


U


Check physician’s order.





fden瑩fy pa瑩en琠and explain procedure.





䝡瑨er equipmen琮





tash your hands.





mrovide for good ligh瑩ng and privacy.





䅳sis琠pa瑩en琠瑯 dorsal recumben琠posi瑩on wi瑨 knees flexed and fee琠O fee琠apar琠and

ape pa瑩en琮 plide wa瑥rproof drape under pa瑩en琮






lpen s瑥rile ca瑨e瑥riza瑩on 瑲ay on over bed 瑡ble using s瑥rile 瑥chnique.





mu琠on s瑥rile gloves. 䝲asp upper corners of drape and unfold drape wi瑨ou琠瑯uching
uns瑥rile areas. cold back a cu
ff over gloved hands. 䅳k pa瑩en琠瑯 lif琠her bu瑴tcks
and slide s瑥rile drape under her wi瑨 gloves pro瑥c瑥d by cuff.






Place the sterile tray on drape between patient’s thighs.





lpen all supplies.


a. qes琠瑨e ca瑨e瑥r balloon. oemove prot
ec瑩ve cap on 瑨e 瑩p of syringe and


a瑴tch syringe filled wi瑨 s瑥rile wa瑥r 瑯 injec瑩on por琮 fnjec琠appropria瑥


amoun琠of fluid. ff balloon infla瑥s properlyI wi瑨draw fluid and leave syringe


a瑴tched 瑯 por琮


b.

mour an瑩sep瑩c solu瑩on over co瑴tn balls or gauze.


c. iubrica瑥 N
-
O inches of ca瑨e瑥r 瑩p.






ti瑨 瑨e 瑨umb and one finger of nondominan琠handI spread labia and iden瑩fy
mea瑵s. _e prepared 瑯 main瑡in separa瑩on of labia wi瑨 one hand un瑩
l urine is
flowing well and con瑩nuously.






rsing co瑴tn balls held wi瑨 forcepsI clean bo瑨 labia and folds and 瑨en direc瑬y over
瑨e mea瑵s. jove co瑴tn ball from above 瑨e mea瑵s down 瑯ward 瑨e rec瑵m.
aiscard each co瑴tn ball af瑥r one downward
s瑲oke.






ti瑨 uncon瑡mina瑥d gloved handI inser琠ca瑨e瑥r 瑩p in瑯 mea瑵s R
-
T.R cm EO
-

inchesF or un瑩l urine flows. ao no琠use force 瑯 inser琠ca瑨e瑥r. fns瑲uc琠pa瑩en琠瑯
brea瑨e deeplyI and ro瑡瑥 ca瑨e瑥r gen瑬y if sligh琠resis瑡nce is me琮 lnce

urine
drainsI advance ca瑨e瑥r ano瑨er N.P


O.R cm ENLO

N in.F






18






INDWELLING CATHETERIZATION OF THE FEMALE URINARY BLADDER
(con’t)


S


NP



U


Inflate balloon with syringe of normal saline.





Tug gently on catheter after balloon is inflated.





Secure to upper thigh with Velcro leg strap or tape. Leave slack in catheter to allow
for leg movemen
ts. Attach catheter drainage bag

to bed.






Check that drainage tubing is not kinked and that movement of side rails does not
interfere with cathe
ter or drainage bag. Remove equipment and make patient
comfortable. Clean and dry perineal area, if necessary.






Wash your hands.





Document time of catheterization, amount of drainage, description of urine, and
patient’s response to procedure.






heyW

p = pa瑩sfac瑯ry;


乐 = 乥eds mrac瑩ce;


r = rnsa瑩sfac瑯ry


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature _____________________________________________


Comments:


19



SUCTIONING TH
E TRACHEOSTOMY


S


NP


U


Assess the need for suctioning, identify patient and explain procedure.





Gather equipment.





Wash your hands.





Provide for privacy.





Assist patient to semi
-
Fowler’s or Fowler’s position if conscious. An unconscious

pa瑩en琠should be placed in la瑥ral posi瑩on facing you.






qurn suc瑩on 瑯 appropria瑥 pressure Ewall uni琠NNM
-
NRM mm eg; por瑡ble uni琠NM
-
ㄵN
mm egF.






Place clean towel across patient’s chest. Don goggles, mask, and gown.





lpen s瑥rile suc瑩o
n ki琮


a. Place sterile drape across patient’s chest.


b. lpen s瑥rile saline con瑡iner and pour s瑥rile saline in瑯 i琮


c. mrepare ambu bag and preoxygena瑥 pa瑩en琠for several brea瑨s.


G
d. mu琠s瑥rile gloves on dominan琠hand and
clean glove on nondominan琠hand.


e. 䍯nnec琠s瑥rile suc瑩on ca瑨e瑥r 瑯 suc瑩on 瑵bing 瑨a琠is held wi瑨 uns瑥rile


gloved hand.

Gsery fmpor瑡n琠p瑥p





jois瑥n ca瑨e瑥r by dipping i琠in瑯 con瑡iner of s瑥rile saline.





oemove oxygen

delivery se瑵p wi瑨 uns瑥rile gloved hand.





rsing s瑥rile handI gen瑬y and quickly inser琠ca瑨e瑥r in瑯 瑲achea. 䅤vance abou琠NM
-
NO.R cm E4
-
R in.F or un瑩l pa瑩en琠coughs. ao no琠apply suc瑩on when inser瑩ng
ca瑨e瑥r.






䅰ply in瑥rmi瑴tn琠suc瑩on

by occluding v
-
por琠wi瑨 瑨umb of uns瑥rile gloved hand.
䝥n瑬y ro瑡瑥 ca瑨e瑥r wi瑨 瑨umb and index finger of s瑥rile gloved hand as 瑨e
ca瑨e瑥r is being wi瑨drawn. al 乏q allow suc瑩oning 瑯 con瑩nue for more 瑨an NM
seconds. bncourage pa瑩en琠瑯 cough

and deep brea瑨e be瑷een suc瑩oning. clush
ca瑨e瑥r wi瑨 saline and repea琠suc瑩oning as neededI allowing pa瑩en琠瑯 res琠for a琠
leas琠N minu瑥 be瑷een suc瑩oning.





then procedure is comple瑥dI 瑵rn off suc瑩on and disconnec琠ca瑨e瑥r from suc瑩on
瑵b
ing. oemove all equipmen琠and dispose according 瑯 agency policy. tash hands.
jake pa瑩en琠comfor瑡ble.


S


NP


U


20




SUCTIONING THE TRACHEOSTOMY (con’t.)





Document time, character and amount of secretions, and patient response to
procedure.









K
ey:

S = Satisfactory;


NP = Needs Practice;


U = Unsatisfactory


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature _____________________________________________


Comments:


21



CARE OF THE TRAC
HEOSTOMY



S


NP


U


Assess the need for tracheostomy care, identify patient and explain procedure.





Gather equipment.





Wash your hands.





Provide for privacy.





Open trach care kit and put on sterile gloves. The dominant hand will remain st
erile;
the nondominant hand will be clean.





With sterile gloved hand, separate basins; with the clean hand, pour hydrogen
peroxide in one basin and normal saline in the other basin.

Use agency policy





Unlock inner cannula by turning left about 90 d
egrees with the dominant hand, while
securing outer cannula on neck plate with other hand.






Gently pull the inner cannula slightly upward and outward. Place in sterile container of
hydrogen peroxide and allow to soak.






Clean the lumen and outer s
urface of the cannula with brush moistened with
hydrogen peroxide.






Rinse cannula thoroughly in basin filled with saline.





Dry clean cannula on sterile 4 x 4 gauze pad and pipe cleaner.





Replace inner cannula by grasping the outer flange of th
e cannula with
the non
-
dominant

hand while inserting the cannula with the
dominant

hand.






Lock the inner cannula by turning the lock to the right.





Clean around the stoma site with cotton tipped applicator sticks soaked in hydrogen
peroxide and sa
line.






Change the tracheostomy ties.





Make the patient comfortable.






22


CARE OF THE TRACHEOSTOMY (con’t)


S


NP


U


Remove all equipment and dispose according to agency policy. Wash hands. Make
patient comfortable.






Document time, appearan
ce of stoma, and patient response to procedure.





Key:

S = Satisfactory;


NP = Needs Practice;


U = Unsatisfactory


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature ______________________
_______________________


Comments:


23



MIXING REGULAR AND NPH INSULIN IN ONE SYRINGE


S


NP


U


Check medication order against original physician’s order.





䝡瑨er equipmen琠and wash your hands.





oo瑡瑥 乐e vial be瑷een palms 瑯 mix before wi瑨draw
al.





䍬eanse rubber 瑯ps of bo瑨 vials wi瑨 alcohol.





oemove cap from insulin syringe. fnjec琠air in瑯 乐e insulin vial. rse an amoun琠of air
equal 瑯 瑨e amoun琠of medica瑩on 瑯 be wi瑨drawn. ao no琠allow needle 瑯 瑯uch
medica瑩on in vial. oemove

needle.






fnjec琠air in瑯 regular insulin. rse an amoun琠of air equal 瑯 瑨e amoun琠of medica瑩on
瑯 be wi瑨drawn. ao no琠bubble air 瑨rough 瑨e medica瑩on.






fnver琠vial of regular insulin and aspira瑥 瑨e prescribed amoun琮 oemove needle from

al.

䍬ear all air un瑩l exac琠amoun琠is in syringe.






fnser琠needle in瑯 乐e insulin vialI inver琠i琬 and wi瑨draw prescribed amoun琮 oemove
needle from vial and cap 瑨e needle.






fden瑩fy pa瑩en琮





bxplain procedure 瑯 pa瑩en琮 mu琠on clean di
sposable gloves.





mrovide for privacy. pelec琠injec瑩on si瑥 and ensure 瑨a琠area is no琠瑥nder and is free
of lumps or nodules.






fns瑲uc琠pa瑩en琠瑯 assume posi瑩on appropria瑥 for si瑥 selec瑥d.


a. Outer aspect of upper arm: the patient’s

arm should be relaxed a琠side of


body.


b. 䅮瑥rior 瑨ighW 瑨e pa瑩en琠may si琠or lie wi瑨 leg relaxed.


c. 䅢domenW 瑨e pa瑩en琠may lie in 瑨e semi
-
recumben琠posi瑩on.


d. pcapular areaW 瑨e pa瑩en琠may be proneI on sideI or

in a si瑴tng posi瑩on.






24



MIXING REGULAR AND NPH INSULIN IN ONE SYRINGE


S


NP


U


Remove needle cap with nondominant hand, pulling it straight off.






Grasp and bunch area surrounding the injection site or spread skin at site.





Hold syringe
in dominant hand between the thumb and forefinger. Inject the needle
quickly.






After the needle is in place, release the tissue and immediately move your
nondominant hand to steady lower end of the syringe. Slide your dominant hand to
the tip of the b
arrel.






Inject medication slowly.





Quickly remove the needle.





Massage area with alcohol swab.





Do not recap used needle. Discard needle and syringe in appropriate receptacle.





Assist patient to position of comfort.





Wash your hand
s.





Document medication administration on medication administration record.





Evaluate patient response to medication within appropriate time frame.





Key:

S = Satisfactory;


NP = Needs Practice;


U = Unsatisfactory


Student’s Name ______________
____________________________________

Date ___________________


Instructor’s Signature _____________________________________________


Comments:


25



ADMINISTERING AN INTRAMUSCULAR INJECTION


S


NP


U


Check medication order.





Explain procedure, gather eq
uipment and wash your hands.





Withdraw medication from ampule or vial. Put on clean disposable gloves.





Identify patient.





Provide for privacy. Select injection site and ensure that area is not tender and is free
of lumps or nodules.






Inst
ruct patient to assume position appropriate for site selected.


a. Dorsogluteal: the patient may lie prone with toes pointing inward or on side


with upper leg flexed and placed in front of lower leg.


b. Ventrogluteal: the patient m
ay lie on back or side with hip and knee flexed.


c. Vastus lateralis: the patient may lie on back or assume a sitting position.


d. Deltoid: the patient may sit or lie with are relaxed position.






Clean area around injection site with a al
cohol swab. Use a firm, circular motion while
moving outward form injection site. Leave alcohol swab in clean area for reuse when
withdrawing needle.






Remove needle cap with nondominant hand, pulling it straight off.





Grasp and bunch area surround
ing the injection site or spread skin at site.





Hold syringe in dominant hand between the thumb and forefinger. Inject the needle
quickly at a 90 degree angle.






After the needle is in place, release the tissue and immediately move your
nondominant

hand to steady lower end of the syringe. Slide your dominant hand to
the tip of the barrel.






Aspirate by slowly pulling back on plunger to determine if needle is in vessel. If blood
is aspirated, discard needle, syringe, and medication, prepare a new

sterile setup and
inject another site. If no blood is aspirated, inject medication slowly.










26


ADMINISTERING AN INTRAMUSCULAR INJECTION (con’t)


S


NP


U


Quickly remove the needle.





Massage area with alcohol swab.





Do not recap used needl
e. Discard needle and syringe in appropriate receptacle.





Assist patient to position of comfort.





Wash your hands.





Document medication administration on medication administration record.





Evaluate patient response to medication within appr
opriate time frame.





Key:

S = Satisfactory;


NP = Needs Practice;


U = Unsatisfactory


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature _____________________________________________


Com
ments:


27



INTERMITTENT IV MEDICATION VIA EXISTING IV FLUIDS


S


NP


U


Gather equipment, check order and determine compatibility of medication and IVF.





Take equipment to bedside, identify patient and explain procedure.





Wash your hands.





Asse
ss IV site and proper functioning of IV.






Clamp secondary IV tubing, spike medication bag, open clamp, prime tubing and close
clamp.






Connect capped needleless cannula to secondary tubing using sterile technique.
Attach date label to tubing.






Hang medication bag on IV pole, positioning it higher than the primary IV fluid bag.





Swab injection port on the primary tubing that is closest to the primary fluid bag with
alcohol and insert the needleless cannula on the secondary tubing.






Ope
n clamp on secondary tubing and adjust flow rate on infusion pump according to
the recommended infusion rate.






Monitor patient response and infusion at periodic intervals.





Ensure infusion pump converts back to primary rate after medication infuse
d.





Wash your hands.





Document medication administration on medication administration record.





Evaluate patient’s response to medication.





heyW

p = pa瑩sfac瑯ry;


乐 = 乥eds mrac瑩ce;


r = rnsa瑩sfac瑯ry


Student’s Name ____________________
______________________________

Date ___________________

Instructor’s Signature _____________________________________________


Comments:


28



IV BOLUS MEDICATION VIA A PERIPHERAL INT


S


NP


U


Gather equipment, check order and prepare medication. Remove nee
dle from syringe
and attach needleless cannula to syringe using sterile technique.






Take equipment to bedside, identify patient and explain procedure.





Wash your hands.





Assess IV site and unclamp extension tubing.





Prime normal saline syr
inge to remove air.





Swab injection port with alcohol, insert needleless normal saline syringe, aspirate for
blood return and inject normal saline slowly while observing IV site for swelling.






Withdraw normal saline syringe and discard.





Swab
injection port with alcohol, insert medication syringe with needleless adapter
and inject medication at prescribed rate while observing IV site for swelling.






Withdraw medication syringe and discard.





Prime normal saline syringe to remove air.





Swab injection port with alcohol, insert needleless normal saline syringe, aspirate for
blood return and inject normal saline slowly while observing IV site for swelling.






Withdraw normal saline syringe and discard.





Clamp extension tubing.





Wash your hands.





Document medication administration on medication administration record.





Evaluate patient’s response to medication.





heyW

p = pa瑩sfac瑯ry;


乐 = 乥eds mrac瑩ce;


r = rnsa瑩sfac瑯ry


Student’s Name ___________________________
_______________________

Date ___________________


Instructor’s Signature _____________________________________________


Comments:


29



CHANGING THE CENTRAL INTRAVENOUS LINE DRESSING


S


NP


U


Assess the date of the last dressing change.






Gather equipm
ent, identify patient and explain procedure.





Wash your hands.





Place patient in the low
-
Fowler’s or supine position and instruct the patient to turn
head away from dressing si瑥.






mu琠your mask and clean gloves on.





oemove old dressingI o
bserve drainage and discard.





䅳sess inser瑩on si瑥 for signs of infec瑩on.




aiscard clean gloves. tash hands.

lpen s瑥rile dressing ki琠and pu琠on s瑥rile gloves.





䍬eanse inser瑩on si瑥 wi瑨 alcohol swab s瑩cks followed by be瑡dine swab s瑩ck.

_egin
a琠inser瑩on si瑥 and cleanse ou瑷ard using a circular mo瑩on.

rse agency policy.





䅰ply an瑩microbial oin瑭en琠瑯 inser瑩on si瑥 if agency policy.

pee agency policy.





ioop 瑨e ca瑨e瑥r and apply 瑥gaderm dressing.





oemove gloves and mas
k. 䅳sis琠瑨e pa瑩en琠瑯 a posi瑩on of comfor琮





䅰ply da瑥 label.





aispose of equipmen琠appropria瑥ly.





tash hands.





bvalua瑥 if 瑨e dressing is secure and ca瑨e瑥r is no琠under any 瑥nsion.





aocumen琠dressing change and appearance of
inser瑩on si瑥 in 瑨e nursing no瑥s.






heyW

p = pa瑩sfac瑯ry;


乐 = 乥eds mrac瑩ce;


r = rnsa瑩sfac瑯ry


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature ________________________________
_____________


Comments:


30



INTERMITTENT IV MEDICATION VIA UNUSED PORT OF TLC


S


NP


U


Check order. gather equipment, prepare medication.





Take equipment to bedside, identify patient and explain procedure.





Wash your hands.





Assess IV site.





Clamp IV tubing, spike medication bag, open clamp, prime tubing and close clamp.






Connect capped needleless cannula to tubing using sterile technique. Attach date label
to tubing.






Hang medication bag on IV pole.





Put clean gloves on.





Prime normal saline syringe and prime to remove air.





Swab appropriate injection port on TLC with alcohol and insert the needleless normal
saline syringe, release clamp on TLC tubing, aspirate for blood return and inject
normal saline slowly while o
bserving IV site.






Clamp extension tubing on TLC. Withdraw normal saline syringe and discard.






Swab appropriate injection port on TLC with alcohol and insert the needleless cannula
on medication tubing, release clamp on TLC extension tubing.






Open roller clamp on tubing and adjust flow rate on infusion pump according to the
recommended infusion rate.






Monitor patient response and infusion at periodic intervals.





When infusion is complete, reclamp the extension tubing on the TLC and c
lose the
roller clamp on the secondary medication tubing. Carefully recap the needleless
cannula on the medication tubing with sterile cap.






31


INTERMITTENT IV MEDICATION VIA UNUSED PORT OF TLC (con’t)


S


NP


U


Prime normal saline syringe and prime to

remove air.






Swab appropriate injection port on TLC with alcohol and insert the needleless normal
saline syringe, release clamp on TLC tubing and inject normal saline slowly while
observing IV site.






Clamp extension tubing on TLC. Withdraw norma
l saline syringe and discard.





Prime heparinized saline syringe to remove air. Use concentration according to agency
policy.





Swab appropriate injection port on TLC with alcohol and insert the needleless
heparinized saline syringe, release clamp on

TLC tubing and inject heparinized saline
slowly while observing IV site.






Clamp extension tubing on TLC. Withdraw heparinized saline syringe and discard.





Wash your hands.





Document medication administration on administration record.






Ev
aluate patient’s response to medication.





heyW

p = pa瑩sfac瑯ry;


乐 = 乥eds mrac瑩ce;


r = rnsa瑩sfac瑯ry


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature _____________________________
________________


Comments:


32




IRRIGATING UNUSED PORT OF A CENTRAL INTRAVENOUS CATHETER


S


NP


U


Assess need for irrigation and gather equipment.





Take equipment to bedside, identify patient and explain procedure.





Wash your hands.





Put on
clean gloves.





Prime normal saline syringe in tubex and prime to remove air.





Swab appropriate injection port on TLC with alcohol and insert the needleless normal
saline syringe, release clamp on TLC tubing and inject normal saline slowly while
obs
erving IV site.






Clamp extension tubing on TLC. Withdraw normal saline syringe and discard.





Prime heparinized saline syringe to remove air.





Swab appropriate injection port on TLC with alcohol and insert the needleless
heparinized saline syri
nge, release clamp on TLC tubing and inject heparinized saline
slowly while observing IV site.






Clamp extension tubing on TLC. Withdraw heparinized saline syringe and discard.





Wash your hands.





Document medication administration on administra
tion record.





Evaluate patient’s response to medication.





heyW

p = pa瑩sfac瑯ry;


乐 = 乥eds mrac瑩ce;


r = rnsa瑩sfac瑯ry


Student’s Name __________________________________________________

Date ___________________


Instructor’s Signature _________
____________________________________


Comments:


33





POLICIES/GUIDELINES


34

1
University of South Carolina Upstate

Mary Black School of Nursing

Associate Degree Program in Technical Nursing


Fall
2005

Addendum

SANU 202P Syllabus


Clinical Absences


It is im
portant all students remember the
Fall

2005

calendar does not allow time to build in a clinical makeup
day. Your clinical experience is extremely valuable and it is very important that each student attend clinical on
the days assigned. In case of emergenci
es the following policy will be used.


Please refer to Page 4, number 12, page 6, number 9, page 3
5

and

page 3
6

in your
Fall

2005

SANU 202P syllabus. The policies regarding clinical absences and clinical makeup days are clearly stated
in these pages
.
In a
ddition to these stated policies please be informed of the following explanation on how
clinical absences will be treated:


In the event a student misses
the first
clinical day, he/she is to meet with the clinical instructor the day they
return to school (
even if this day is for

another class
-

not

SANU 202P).

IF THE INSTRUCTOR IS NOT
AVAILABLE, CALL THE INSTRUCTOR
or call the

coor
d
inator

of SANU 202P.

The instructor will arrange a
clinical makeup day with another rotation of students in SANU 202P
with in 1

week
. Since each student’s
schedule is different, be aware that the makeup clinical day will mirror the missed

experience

in clinical
.



If for any reason the instructor is unable to arrange a clinical makeup day before the end of the
semester it is possi
ble that the student will be assigned a grade of Incomplete and not be able to
graduate in

December
.


Hopefully this problem will not occur and that all of you will remain healthy, your families will remain healthy
and problem free and your life remains
crisis


free. Please let me know if you have questions regarding the
above explanation.


I have read and understand the above explanation of the SANU 202P Clinical Absence Policy. If all of my other
grades and responsibilities for SANU 202P are satisfacto
ry and I have a 78 or better on my course work I
understand that if a clinical absence is not made up during the semester an Incomplete for SANU 202P will be
given and I will not be able to graduate in
December

2005.


______________________________



____
____________________

Name








Date



Students will read, sign and return to the instructor the first day of class. Please make a copy for your records
before turning in to the instructor.




1

File: Addendum SANU 202P Syllabus: Clinical Absences


35

POLICY FOR CLINICAL ABSENCES



Because attendance in clinical l
aboratories is extremely important and the number of days are limited, there
should be NO absences for clinical labs. The following guidelines will apply for clinical make
-
up in this course:


For the first absence, the student will complete a clinical make
-
up day at a
date designated by the
instructor

(as soon after the absence as possible)
. For the second absence, the student must complete
a clinical make
-
up paper. Any additional absences will result in an unsatisfactory grade in the course.


GUIDELINES FO
R CLINICAL MAKE
-
UP PAPER


In the event of a clinical absence, the student will consult with the clinical instructor regarding completion of
the following assignment. You will be given a clinical situation related to SANU 202P content. The

assignment must b
e completed as follows:



1.

Review of Literature (30 points)



Summarize current information from professional journals. Use at least four different articles



related to the situation. References must be included in the paper.



2.

Plan of Care (30 point
s)



Develop a plan of care for the patient in the clinical situation.



3.

Discussion of Ethical Issues (30 points)



Discuss the ethical issues that apply to the clinical situation. Support your conclusions with



documentation from at least two current
articles.




4.

Format (10 points)



The paper should adhere to logical and systematic format, correct grammatical construction,



clarity in presentation and proper order of all components (using headings and subheadings).



The paper will be typed and fo
llow APA format. The due date for the paper will be determined



by the instructor.


NOTE:

Papers not typed in APA format will NOT BE ACCEPTED. Paper should be 10
-
12 pages in
length.


36

REVISION OF POLICIES FOR ADN PROGRAM


NOTE:

These are revisions for spe
cific policies in your ADN Handbook. All other policies are

still in effect.


WRITTEN WORK:


All written course requirements must be submitted

as scheduled

or the student will receive an F in the
course. If no specific deadline is given, course requiremen
ts must be submitted by the last day of class/clinical.
For extenuating circumstances, where an extension may be needed, arrangements must be made prior to the
deadline for submission of paperwork. (See USCS Catalog)


Instructors are not responsible for pa
pers that are given to anyone other than the instructor.


Five (5) points will be taken off per day or any portion of the twenty
-
four hours on any late paper or
assignment to include Saturday, Sunday, and holidays.


CLINICAL PRACTICA:


Students who fail to

attend clinical evaluation conferences will receive a grade of F in the course or a
grade of I if arranged with the instructor prior to the assignment of an incomplete grade.



Students who miss a clinical practicum will be given a designated make up day
to attend a clinical lab
or write a make up paper. (See course requirements for make up requirements).


STATEMENT OF UNSAFE PRACTICE


Some examples of unsafe behaviors are as follows:


-
medicating a patient without the permission/supervision of instructor


-
medicating or performing a treatment without verifying the doctors order before completing the task


-
leaving an infant unattended


NOTE:

These are not all inclusive.


Effective Date:

August 1999


37

STATEMENT OF UNSAFE PRACTICE


The following student beh
aviors may be considered as unsafe practice:


1.

Failure to use the nursing process effectively, demonstrated by such behaviors as lack of knowledge


of the patient’s diagnosis, treatments, or medications; failure to follow safety precautions for patient


such as side rails, restraints, position of patient, acts of omission or commission, including utilization


of correct principles in implementation of skills, the documentation of care, and the administration


of medications.


2.

Failure to take nursing ac
tion when such action is essential to the health and safety of the patient.


3.

Performing nursing activities which are detrimental to the health and safety of the patient.


4.

Attending clinical laboratory while under the influence of alcohol or drugs.


5
.

Failure to recognize the influence of own attitudes, values, beliefs and behaviors on the care of


patients.


6.

Deliberately giving false or inaccurate information regarding nursing care.


7.

Failure to assume responsibility for completing nursing care
.


8.

Performing interventions without adequate preparation or needed supervision.


CONSEQUENCES OF UNSAFE PRACTICE


The consequences of unsafe behavior are determined by the nature of the behavior exhibited and the situation
in which it occurs.


1.

Unsafe

practice may result in immediate failure.


2.

Student may be sent home for the clinical day.


3.

Repeated unsafe behaviors or failure to correct unsafe behavior will result in failure. The student will


not be allowed to continue in the clinical area and
must withdraw from the course.


38






Guidelines for Student Experiences


Student Observational Guidelines


Guidelines for Assignments


39

UNIVERSITY OF SOUTH CAROLINA UPSTATE

ASSOCIATE DEGREE PROGRAM IN NURSING


SANU 202P

CLINICAL ROTATION OBSERVATIONAL EXPE
RIENCES


Each student in SANU 202P will have the opportunity to observe procedures in Endoscopy, Dialysis,
and Home Health at Spartanburg Regional Medical Center. Information regarding these assignments
is listed below:


SRMC Endoscopy Unit


(864) 560
-
6633



Time




0745
-
1245


Dress




USC Upstate ADN Uniform, Lab coat, Name pin


Activity




Observe procedures
and nursing responsibilities






Complete moderate sedation assignment


Contact Person


Joan Cadmus, RN, Charge Nurse


Directions



SRMC Out Patien
t Center 4
th

Floor. Use the front door


SRMC Dialysis Unit



(864) 560
-
6570



Time




0645
-
1000


Dress




USC Upstate ADN Uniform, Lab coat, Name pin


Activity




Observe procedures and nursing responsibilities






Complete Assessment of Dialysis Patient


Contact Person


Finula King, RN, Unit Manager


Home Health



(864) 560
-
3919



Time




0800
-
1245


Dress




USC Upstate ADN Uniform, Lab coat, Name pin


Activity




Observe an RN during home visits


nursing responsibilities






Obtain information for Ho
me Health paper


Contact Person


Phyllis Osbourn, RN, Educational Coordinator


Directions



SRMC Home Health






120 Heywood Avenue*1






Suite 300






Spartanburg, SC


*1

SRMC Home Health: Directions


I
-
585 to St. John Street (1 block before Main S
t.).


Left onto St. John St. Travel 1 block on St. John and turn left onto E. Main St. Follow


Main St. for 3 traffic lights and turn left onto Heywood Ave. Travel approximately 1 block.


The building is on the left. Home Health is at the back of the build
ing.



STUDENTS MUST BRING THEIR OWN CAR ON THE HOME HEALTH DAY. YOU WILL

FOLLOW THE NURSE TO PATIENTS’ HOME IN YOUR CAR. YOU ARE NOT ALLOWED

TO RIDE WITH THE NURSE IN THEIR CARE (INSURANCE AND LIABILITY ISSUES)



The student is responsible to maintain t
he confidentiality regarding all patient

information. Students are not allowed to use patient names or other data that will

in any way identify the patient on any written work.

40


GUIDELINES FOR WRITTEN HOME HEALTH ASSIGNMENTS


After making joint home vis
its with an experienced home health care nurse, the participant is expected to:


1.

Describe the process of the visit, i.e, preparations, organization, nurse/client interaction, etc.


2.

Discuss how the home health nurse observed functioned in relation to
the Standards of Home Health

Nursing Pra
ctice (address Standards I
-
VI) and Standards of Professional Performance (address
Standards I
-
VIII) See handouts.


3.

Assess the level of skilled care the client received and determine the appropriateness of the care


administered by addressing the following issues:



a.

Whether or not the complexity of the client’s need(s) required the knowledge and skill of a



registered nurse; explain why or why not.


b.

Cost effective measures the nurse would take in consideratio
n for this particular patient.


c.

Management principles the nurse would use in planning care for this particular patient.


4.

Identify one learning need of the client seen and develop a teaching plan; address actual and potential