Advanced Nursing Skills

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Class
VNSG 2331

Application of advanced level nursing skills and competencies in a variety of health care settings utilizing the nursing process as a problem-solving tool. CIP Code Description: 51.3901 VNSG 2331 (Licensed Practical/Vocational Nurse Training) 96 hours, 3 credit hours.

Course Learning Objectives

Demonstrate safe and competent advanced nursing skills; implement the steps in the nursing process and describe how each step relates to nursing care; and discuss the implementation of advanced nursing skills in a variety of health care settings. (WECM, 2014)

 Identify underlying principles of each specific skill in a given unit of instruction.

1. Identify nursing responsibilities related to safety with medication administration

2. Explain patient needs related to respiratory interventions. 

  3. Broaden understanding of physical assessment. 

  1. Demonstrate understanding of intravenous therapy procedures. 
    1. Demonstrate an understanding of underlying scientific and/or ethical principles in performance of skills.
      1. Demonstrate application of oxygen administration devices. 
      2. Demonstrate ability to maintain a patent airway 
      3. Demonstrate performance of tracheostomy care. 
      4. Discuss ethical concerns related to the performance of procedures. 
      5. Demonstrate safety with different routes in medication administration 
      6. Demonstrate ability to monitor and maintain IV sites 
    2. Organize a safe and effective method for demonstration of each skill in this course.
      1. Practice simulated skills in laboratory or classroom setting according to      Instruction. 
      1. Simulate clinical setting with use of laboratory equipment. 
      2. Use items from Nurse Practice Pack to facilitate learning of a skill. 
      3. View videos demonstrating the performance of selected skills. 
      4. Demonstrate each skill in the clinical setting prior to independent performance.

               D. Appraise his/her own performance of the advanced skills utilized in this course. 

           1. Verbalize complications or difficulties encountered during practice and performance of: 

a. Medication Administration 

                b. Respiratory procedures 

                c. Physical Assessment Skills Intravenous therapy procedures 

                d. Simulated care of chronic and acute care patients 

 

  1. Identify areas requiring assistance to master performance of skills. 
  2. Review practice videotaped skills as a form of remediation prior totesting. This will allow assessment of his/her own performance. 
  1. Develop communication skills for the health care setting. 
    1. Demonstrate usage of medical terminology. 
    2. Demonstrate ability to document on the medical record using nursing process. 
    3. Demonstrate ability to seek assistance as needed to complete skills. 
    4. Demonstrate ability to collaborate with patients and family as well as other members of the healthcare team. 
  2. Demonstrate basic physical assessment skills. 
    1. Demonstrate performance of head to toe assessment. 
    2. Demonstrate performance of focused assessment
    3. Performance of selected diagnostic tests. Implement the nursing process to plan patient care.
    4.  List the components of the nursing process. 

5. Understand the rationale for the selected nursing diagnoses. 

6. Write a patient goal under the direct supervision of the RN and evaluate outcomes. 

7. Formulate a plan of care with the assistance of the RN based on identified patient needs. 

  1. Demonstrate proper techniques for medication administration using various routes. 
    1. Utilize the six rights of drug administration 
    2. List various routes by which a drug may be given 
    3. Describe techniques unique to each medication route 
    4. State principles of medication preparation 
    5. Discuss nursing responsibilities before, during, and after drug administration 
    6. Participate in guided and independent practice in lab, keeping in mind the personal skills of effective communication, reasoning, problem solving, and self-management 
  2. Demonstrate effective documentation of medications on the MAR and on the client’s chart 
    1. Identify characteristics of the MAR 
      1. Describe techniques of documenting medication administration 
      2. Practice proper techniques provided in the laboratory setting 
  3. Utilize knowledge to prevent medication errors 
    1. Identify common causes of errors 
      1. Develop plan for prevention of errors 
      2. Practice techniques for error free drug administration 
      3. Know how to appropriately intervene if a medication error occurs 

Differentiated Essential Competencies (DECs)  

http://www.bon.texas.gov/pdfs/differentiated_essential_competencies2010.pdf

Required Textbooks

Foundations and Adult Health Nursing 8th Ed. Cooper, K.& Gosnell, K. (2019)

Study Guide for Foundations in Adult Health Nursing 8th Ed.  Cooper, K & Gosnell, K. (2019) 

Advanced Nursing Skills Lab Manual:  Revised Fall 2019

Advanced Nursing Skills Lab Pack (Available in WC bookstore)

Stethoscope

SD Card

Evaluation Standards

Tests   (3 unit exams) = 35% of semester grade  

    1. No unit exams will be offered earlier than the scheduled date. 
    2. If absent for a unit exam, a make-up exam will be offered only when the student first returns to campus (regardless if the return to campus is not during the scheduled class time.)  The exam will be in an assigned area by the instructor on the day the student returns to campus.  It is the student’s responsibility to seek out the instructor for the makeup exam.
    3. Fifteen (15) points will automatically be deducted from the make-up exam score. 
    4. Make-up exams may be short answer, fill in the blank, essay, or matching. 
  2. Final Exam   (comprehensive) = 10% of semester grade 
  3. Assignments = 5% of semester grade  
    1. Assignments are to be submitted secured in a folder with the student’s name and mailbox number on the outside of the folder unless otherwise instructed.  It will be submitted to the designated area in the classroom at the beginning of the class period, unless otherwise instructed. 
    2. Papers will only be accepted late if the student is absent.  The assignment must be turned in on the student’s first arrival back on campus for any class.  15 points will automatically be deducted from the assignment grade. 
    3. It is the student’s responsibility to secure assignments if absent. 
    4. Assignments that are completed during class time may not be made up by the student. 
    5. All assignments are to be done independently unless otherwise instructed.
  4. Skill Performance (4)  =  50% of semester grade  
    1. Selected skills will be performed and graded during this course. 
      1. Medication Administration Maintaining A Patent Airway 
      2. IV Therapy 
    2. Skill performance and videotaping will be assigned during class time.  All students will be expected to be on campus during the scheduled class time.  An assignment will be given unless otherwise instructed. 
    3. If students are not present at the assigned time, they will be counted as absent and 15 points will be deducted from the highest obtainable grade.  It is the student’s responsibility to contact the instructor immediately on their return to Weatherford College (first day back at school) to set up the check off.  Failure to contact the instructor on the first day back to Weatherford College will result in a zero for the assigned check off. 
    4. Organization and time management skills are an integral component in the delivery of safe patient care.  Due to the nature of the healthcare profession, each vocational nursing student will be expected to complete the skills check off in the designated time.
    5. Videotaping guidelines are in the lab manual.  It is highly recommended that the student become familiar with the videotaping equipment before the testing date. Additional points will be deducted for failure to follow infection control guidelines, documentation guidelines, failure to follow skill overriders, and/or appropriate communication skills at the bedside. Successful completion of any skill performed in the skills lab does not authorize the student to perform the skill in the clinical setting without specific instructions from the clinical instructor.  
  5. Remediation  
    1. Any student that scores less than a 75 on any graded skill throughout the semester, will need remediation either with the skills instructor or clinical instructor. This remediation offered will be scheduled. However, if the student has an opportunity to perform the skill with their clinical instructor in the clinical setting, this could constitute remediation. 
    2. Students are required to bring their skills remediation form with their name and box number completed prior to performing the remediation.  This form can be located in the lab manual. Failure to show mastery of the skill by the 3rd attempt will result in an overall 25% reduction in the advanced nursing skill grade. 
  6. Attendance Two (2) class absences are allowed per semester.   Any absence over the allowed number will result in the final course grade being reduced 10% for each additional absence. Review student handbook in reference to attendance guidelines.
  7. Lab Practice  
    1. Lab time is to be used for practice or review.  Students are encouraged to use the lab manual for guidance during practice.  It is highly recommended that each student diligently practice all outlined skills for clinical preparation.  Students should review any available skills videos on the Canvas website prior to lab practice to help with comprehending how to perform the skill successfully. 
    2. Conduct in the nursing lab should be representative of behavior in the clinical setting. 
    3. All guidelines set forth are to be followed. 
    4. Students will be responsible for keeping an accurate record on their learning activity completion form found in the lab manual as well as their lab sign in sheet.  These forms must be turned in at the end of the semester. Final course grades will be calculated to the nearest whole number.  Students are responsible for reviewing grades and attendance on Canvas.  Instructors will not calculate grade averages.  Students should check the Canvas website routinely.

Failure to satisfactorily complete this course with a grade of 75 or higher prohibits the student from enrolling in the 3rd semester VN courses. If at any time during the semester difficulty is encountered, contact an instructor immediately.  Communicate your need for help as soon as possible so that assistance can be obtained.  If poor performance on tests, skills, homework or lab practice is detected, students may be contacted.  

Computer Use in Class:  

Students are permitted to use computers during class for note-taking and other class related work only.  Those using computers during class for work not related to this class, any social media sites, checking email, or “surfing the web” will be asked to turn off the computer and possibly leave the classroom for the remainder of the class period.  Work missed by the student if removed from the class, cannot be made up.  The student must adhere to the “accepted use” policy regarding electronic media and student code of conduct.

Evaluation

Percent

Final Exam

10%

Unit Exams

35%

Assignments

5%

Skills Checkoffs

50%

Total Evaluation

100%
Absences

Two absences are allowed for this course. More than two absences will result in a 10% final grade reduction for each additional absence. The clinical instructor and the assigned clinical agency should be notified prior to the beginning of the clinical shift if absent.   

Final course grades will be calculated to the nearest whole number.  Anything less than a 74.5 will be considered a failing grade.   

Clinical experiences may be scheduled between the hours of 5:30 A.M and 11:30 P.M. Times for clinical experiences will vary and may include 8 or 12- hour shifts. When in hospital clinical, the student will have thirty (30) minutes for lunch. Each student must ask permission from the instructor and the charge nurse if he/she wishes to leave the unit. The student is not allowed to leave the 20 clinical unit during the clinical shift, unless otherwise specified by the instructor, failure to do so will result in a section 1 (g) offense. Clinical during the first and second semesters are scheduled for 8-hr shifts, two days per week. Third semester clinical can be 8 or 12-hour shifts, two or three days per week. 3. Clinical experiences require students to travel to sites away from the college campus. Clinical sites include hospitals and other health care facilities in Mineral Wells, Stephenville, Weatherford, Willow Park, Millsap, Fort Worth as well as Decatur, Jacksboro, Granbury and Bridgeport. Other Locations may be used if deemed necessary for student learning. Students must be prepared to drive to any of these locations for clinical. 4. The nursing faculty will determine clinical assignments, depending upon the learning environment, availability of clinical resources and needs of the students. 

Instructional Methods

Guided clinical practice in a variety of settings:  acute care, long-term care, community clinics, physician offices, simulated activities, clinical conference and group discussion, and online resources.  Clinical Simulation, Basic and Advanced Nursing Skills may utilize low, moderate or high fidelity simulation types as defined by the Texas BON rule 214 and 215.    

Disabilities

ADA Statement:

Any student with a documented disability (e.g. learning, psychiatric, vision, hearing, etc.) may contact the Office on the Weatherford College Weatherford Campus to request reasonable accommodations. Phone: 817-598-6350 Office Location: Office Number 118 in the Student Services Building, upper floor. Physical Address: Weatherford College 225 College Park Drive Weatherford, TX.

Academic Integrity
Academic Integrity is fundamental to the educational mission of Weatherford College, and the College expects its students to maintain high standards of personal and scholarly conduct. Academic dishonesty of any kind will not be tolerated. Academic dishonesty includes, but is not limited to, cheating on an examination or other academic work, plagiarism, collusion, and the abuse of resource materials including unauthorized use of Generative AI. Departments may adopt discipline specific guidelines on Generative AI usage approved by the instructional dean. Any student who is demonstrated to have engaged in any of these activities will be subject to immediate disciplinary action in accordance with institutional procedures.
Hope Statement
Any student who faces challenges securing basic resources such as food, clothing, or housing and believes this may affect their performance in their course of study is urged to contact the Director of Student Resources, Dr. Deborah Cregger, for support at (817) 598-6444. Her office is on the first floor of Student Services. If the student prefers, they may contact their instructor, who can reach out on their behalf. Weatherford College also provides the Coyote Pantry. The Pantry maintains boxed and canned foods for students in need. The location of the Coyote Pantry is two blocks west of the Weatherford campus at the Baptist Student Ministry (118 E. Park Ave., Weatherford). Pantry hours are Mon-Thurs. 8:30 am-4:30 pm and Fri. 8.30 am-12:00 pm (817-599-6586).
SCANS

Essential Competencies (DECs) & Secretaries Commission of Achieving Necessary Skills  Differentiated (SCANS) will be aligned throughout the syllabus. Differientiated Essential Competencies of Graduates of Texas Vocational Nursing Educational programs and SCANS competencies can be accessed from Texas Board of Nursing.   SCANS information can be obtained from the document Identifying and Describing The Skills Required by Work published by The Secretary’s Commission on Achieving Necessary Work Skills.   

Texas Board of Nursing DECS     

I. Member of the Profession  

A. Function within the nurse’s legal scope of practice and in accordance with regulation and the policies and procedures of the employing health care institution or practice setting. B. Assume responsibility and accountability for the quality of nursing care provided to patients and their families. 

C. Contribute to activities that promote the development and practice of vocational nursing.  D. Demonstrate responsibility for continued competence in nursing practice, and develop insight through reflection, self-analysis, self-care, and lifelong learning.  

  1. Provider of Patient-Centered Care  
    1. Use clinical reasoning and knowledge based on the vocational nursing program of study and established evidence-based practice as the basis for decision-making in nursing practice. B. Assist in determining the physical and mental health status, needs, and preferences influenced by culture, spirituality, ethnicity, identity, and social diversity of patients and their families, and in interpreting health-related data based on knowledge derived from the vocational nursing program of study.  
      1. Report data to assist in the identification of problems and formulation of goals/outcomes and patient-centered plans of care in collaboration with patients, their families, and the interdisciplinary health care team. 
      2. Provide safe, compassionate, basic nursing care to assigned patients with predictable health care needs through a supervised, directed scope of practice.
      3. Implement aspects of the plan of care within legal, ethical, and regulatory parameters and in consideration of patient factors.
      4. Identify and report alterations in patient responses to therapeutic interventions in comparison to expected outcomes.
      5. Implement teaching plans for patients and their families with common health problems and well-defined health learning needs. 
      6. Assist in the coordination of human, information, and physical resources in providing care for assigned patients and their families.
  2. Patient Safety Advocate  
      1. Demonstrate knowledge of the Texas Nursing Practice Act and the Texas Board of Nursing Rules that emphasize safety, as well as all federal, state, and local government and accreditation organization safety requirements and standards.  
      2. Implement measures to promote quality and a safe environment for patients, self, and others.  
      3. Assist in the formulation of goals and outcomes to reduce patient risks.  
      4. Obtain instruction, supervision, or training as needed when implementing nursing procedures or practices. 
      5. Comply with mandatory reporting requirements of the Texas Nursing Practice Act.  F. Accept and make assignments that take into consideration patient safety and organizational policy.  
  3. Member of the Health Care Team 
    1. Communicate and collaborate in a timely manner with patients, their families, and the interdisciplinary health care team to assist in the planning, delivery, and coordination of patient-centered care to assigned patients.  
      1. Participate as an advocate in activities that focus on improving the health care of patients and their families.  
      2. Participate in the identification of patient needs for referral to resources that facilitate continuity of care, and ensure confidentiality. 
      3. Communicate patient data using technology to support decision-making to improve patient care.  
      4. Assign nursing activities to LVNs or unlicensed personnel based upon an analysis of patient or work place need.  
      5. Supervise nursing care by others for whom the nurse is responsible. 
      6. Assist health care teams during local or global health emergencies or pandemics to promote health and safety, and prevent disease.