NORTH CENTRAL TEXAS COLLEGE COURSE SYLLABUS RNSG 1462 CLINICAL NURSING II Fall 2020 Course Title: Clinical Nursing II Course Prefix & Number:  RNSG1462 Section Number:    Semester/Year: Spring 2020 Semester Credit Hours: 4 Lecture Hours:   Lab Hours: 192 Course Description: A health-related work-based learning experience that enables the student to apply specialized occupational theory, skills, and concepts. Direct supervision is provided by the clinical professional.    Course Prerequisite(s): Successful completion of the following courses with a grade of "C" or better. Anatomy and Physiology I Math Statistics Anatomy & Physiology II Microbiology RNSG1423 RNSG1261 RNSG1300 RNSG1219 Concurrent with: RNSG2404.  The student must have completed or be currently enrolled in ENG1301 Required or Recommended Course Materials: Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., &Camera, I. (2017). Medical-surgical Nursing: Assessment and Management of Clinical Problems, (10th Ed.). St. Louis, Missouri: Elsevier. Sim-Chart Textbooks used in previous semester. Access: Texas Nursing Practice Act www.bon.state.tx.us All ATI resources

 

INSTRUCTOR INFORMATION

Clinical Coordinator:	Emily Lewis, MSN RN
Campus/Office Location:	HSC Gainesville Campus 2428-F
Telephone Number:	940-668-7731 Ext. 4361
E-mail Address:	elewis@nctc.edu

 

 

Clinical Instructor:	Cindy Lutkenhaus MSN RN
Campus/Office Location:	HSC 2428-M
Telephone Number:	665-7731 ext 4364
E-mail Address:	calutkenhaus@nctc.edu

 

Clinical Instructor:	Cindy Hobbs, BSN RN
Campus/Office Location:	Office Hours: By appointment only
Telephone Number:	940-668-7731
E-mail Address:	chobbs@nctc.edu

 

STUDENT LEARNING OUTCOMES (From Academic Course Guide Manual/Workforce Education Course Manual/NCTC Catalog

At the successful completion of this course the student will be able to:

Apply the theory, concepts, and skills involving specialized materials, tools, equipment, procedures, regulations, laws, and interactions within and among political, economic, environmental, social, and legal systems associated with the occupation and the business/industry. Demonstrate legal and ethical behavior, safety practices, interpersonal and teamwork skills, and appropriate written and verbal communication skills using the terminology of the occupation and the business/industry.

 

Texas Board of Nursing Differentiated Essential Competencies

Upon successful completion of this course, the student will be able to act as a: 

I. Member of the Profession: Provide nursing care within the parameters of professional nursing knowledge, scope of practice, education, experience, and ethical/legal standards of care.

II. Provider of Patient-Centered Care: Proactively manage priorities in patient care and follow-up on clinical problems that warrant investigation with consideration of anticipated risks.

III. Patient Safety Advocate: Safely administer medications and treatments. Recognize and report unsafe practices.

IV. Member of the Health Care Team: Assist patients and their families to communicate needs to their support systems and to other health care professionals.

 

COVID-19

Due to the COVID-19 pandemic, changes may occur at any time which would result in changes to the syllabus. The NCTC nursing faculty reserves the right to make any changes necessary to the syllabus to ensure the student receives the highest quality educational experience.  In the event of changes resulting from COVID-19 your instructor will send out an addendum to the syllabus informing you of such changes.

 

North Central Texas College students should be aware that in the event of a college closure due to COVID-19, onsite classes will be converted to an online/remote format. Students should plan ahead to ensure they have access to the computer equipment (either PC, MAC, or tablet), webcam, and internet connectivity to continue their classes in an online/remote format. Please read all your official North Central Texas College student emails as the transition from onsite to online/remote might require a reorganization in your personal situation. Students will be granted a 72-hour transition and grace period. Online classes will continue as scheduled without disruption. Wear a mask, stay safe, and contact your Instructor as the situation arises. These policies and procedures were updated on July 30, 2020 and are subject to change.

 

Face Coverings: Per the North Central Texas College guidance on face coverings on campus, in the instructional setting, faculty and students must wear face coverings, such as masks or face shields. Students without coverings, or those who do not comply with the rules relating to face coverings, will not be able to participate in on-campus classroom activities. To request an exception to this requirement, students should contact the NCTC HR Office of Enrollment Management (ccove@nctc.edu). Failure to comply with the face coverings requirement may result in the Instructor directing the student to leave the classroom. Any student asked to leave the classroom may be referred to the student conduct officer. These policies and procedures were updated on July 30, 2020 and are subject to change.

 

Temporary COVID-19 Attendance Policy for Face-to-Face Meetings: We are facing an unprecedented situation in which all of us must be flexible and make prudent decisions in the best interest of our families, our campus, and our community. In light of this, North Central Texas College is temporarily establishing the requirement that faculty keep records of student attendance for face-to-face course meetings as well as a documented seating chart. In addition, students who are sick or need to quarantine should not attend classes. Students will not be required to provide formal documentation from a health care provider and will not be penalized for COVID-19 related absences when proper notification to campus health officials is made in accordance with the guidelines stated below.

 

Faculty will:

 

Notify students about important course information and delivery changes through Canvas and campus email.

 

Students should:

• Provide notification to campus officials (via NCTC Daily Health Check protocol through Canvas) if they have tested positive for COVID-19 or have to quarantine so we can confirm reported absence with instructors, monitor, and assist the campus community.
• Notify instructors in advance of the absence.
• Connect with that class through Webex if the class session is being transmitted in a hybrid fashion.
• Keep up with and/or make up missed classwork or assignments.
• Submit assignments digitally through Canvas or other means as announced by your instructor.
• Work with their instructors to reschedule exams, labs, and other critical academic activities described in the course syllabus.
• Check Canvas and campus email daily to receive important announcements pertaining to the course.

During this period, faculty with face-to-face meetings will establish assigned seating/work stations to facilitate roll-taking, and, if necessary, contact tracing. Additionally, we ask all members of the College community to be attentive to their health, and safeguard others, by following the CDC’s guideline to “stay home when you are sick.” You should stay home if you have symptoms. More information on what to do if you are sick is available at the CDC’s website.

Additional NCTC information is available at http://www.nctc.edu/coronavirus/index.html

 

 

GRADING CRITERIA

 

Clinical Performance: is based on evaluation of student performance.  See mid-term and final evaluation tools in the appendices.

 

***Clinical Points tool: Any infraction as listed on the clinical points tool will result in the assigned points taken from the mid-term or final evaluation grade.

 

Skills Check-offs - Skills check-off scores are based on a pass/fail system.  During the check-off the professor evaluating the student will be in the room to watch only.  There will be no opportunities to ask questions during the checkoffs.  The critical elements below must be performed with each check-off.  Failure to perform any portion of the critical elements will result in failure.  If students pass on the first attempt, they earn a 100% on that skill, 2^nd attempt will receive an 80% 3^rd attempt will receive a 60%.  Students have one week to practice and attempt the skill again. You must make an appointment with your clinical instructor for remediation and another opportunity to check-off.  There are three attempts at each skill.  Failure to successfully perform the skill on the 3rd attempt will result in failure of the course.  

**You must come to check-off prepared.  IF YOU LEAVE THE PATIENT ROOM WITHOUT FOLLOWING PROPER SAFETY PRECAUTIONS (LOWERING BED AND RAISING SIDE RAILS) YOU WILL AUTOMATICALLY FAIL THAT ATTEMPT AT YOUR CHECK-OFF!!!

 

Critical Elements of the Skills Check-off

The following actions are to be done prior to each procedure:

• Check medical record and physician’s order
• Gather supplies
• Introduce self to client
• Hand hygiene/use standard precautions
• Identify client using at least two identifiers
• Check for allergies
• Adherence to the rights for medication administration
• Provide client privacy
• Assess pain/ client comfort/readiness for procedure
• Explain procedure to client
• Positioning of client and caregiver for safety
• All sterile/clean procedures must be free from contamination.  If sterility is broken the attempt is automatically a failure 

After completion of each procedure, the following actions are to be done:

• Ensure client comfort and safety
• Remove used items using standard precautions/perform hand hygiene
• Assess clients’ response and understanding of procedure
• Complete and document appropriate teaching

 

Math Competency:  Dosage calculation modules are available on your ATI account.  Clinical Nursing II students are required to take a dosage and calculation test prior to going to the clinical site.   The student will have three opportunities to pass the test with a minimum score of 100%. The math exam will consist of 10 questions and the student will be allowed one 50 minutes to complete the exam. If the student is not successful on the first or second attempt, he/she will be required to seek remedial math instruction with their clinical instructor or the NCTC math lab and retake the math test within two weeks after the first math exam. Failure to pass the third math test with a minimum score of 100% will result in a clinical failure. If a student misses the math exam that missed exam will be considered a failed attempt.

 

Swift River Clinical Days Swift River is a virtual hospital designed to help students and master their skills of Prioritization, Delegation, and Sequential thinking.  Each week prior to going to the hospital setting you will be assigned a “clinical day” which will consist of 2-3 different assignments in Swift River.  Each assignment has a designated level of achievement (percentage).  Students will be allowed multiple attempts to achieve the level of achievement.  Completion of the assigned activities at the level of achievement by the due date will earn the student 100%.  Failure to reach the level of achievement by the due date will result in a zero for that clinical assignment. 

 

Patient Documentation

When at the hospital setting each student will fill out an ASSESSMENT AND PATIENT CARE RECORD and turn in complete with narrative documentation for 4 patients they have cared for during their clinical rotation.  These patients MUST be med-surg or ICU patients (NO ED, Women’s Services or patients in the OR or Outpatient Services).  Level II students will provide total patient care for two patients per day on the med-surg unit.  The assessment and patient care data will be documented in EHR Tutor and submitted on four of the patients cared for this semester.  Your clinical instructor will give you a course ID for your clinical EHR tutor course. EHR tutor assignments will be graded by the clinical instructor (see rubric in appendices). Failure to complete assigned ASSESSMENT AND PATIENT CARE RECORD and EHR tutor documentation by the due date as per the clinical instructor will result a zero on that assignment.

 

Performance Evaluation is a timed assessment of both cognitive and psychomotor skills.  A portion of this will be a computer-based evaluation of the student’s ability to assess, plan and document patient care.  Students will have 30 minutes to complete this portion.  Each student will be required to check-off on a randomly chosen nursing skill as part of the performance evaluation.  Students will have 30 minutes to complete this portion.  Failure to successfully pass that skills check off will result in the required remediation with the clinical instructor and checking off on ALL previously learned skills.  Failure to successfully perform all skills will result in failure of the course.  The student has three attempts. 

 

 

Assignments: All assignments listed in the syllabus as well as any additional written assignments given by the clinical instructor must be satisfactorily completed and submitted on or before the assigned due date to the clinical instructor in order to receive a grade on the assignment. Failure to complete and submit assignments by the due dates will result in the student receiving a zero (0) for the assignment. All assignments must be completed and submitted in order to pass the course.

 

Portfolios:  The student must have a portfolio consisting of all the evaluation forms, clinical competency forms, patient care and documentation forms, and clinical points tool that they will need to bring to clinical each day.  The contents of this portfolio will be submitted with the final evaluation and will be part of the student file. 

 

The numerical course grade, after points are deducted for absences and other infractions (see Clinical Points Tool), will be converted as follows:

                                                     Numerical Grade                           Letter Grade

                                                90 – 100                                           A

                                                81  -  89                                            B

                                                75  -  80                                            C

                                                66  -  74                                            D

                                                            65 and Below                                   F

 

***Clinical Points tool: Any infraction as listed on the clinical points tool will result in the assigned points taken from the mid-term or final evaluation grade. 

If a Clinical Warning is issued, the final clinical grade will be reduced by one

letter grade. 

 

 

 

 

 

 

 

 

# of Graded Course Elements	Graded Course Elements	Percentage or Point Values
	Clinical Performance	50%
		Point value per evaluation
1	Mid-term Evaluation	100
1	Final Evaluation	100
Total # of Assignments	Assignments	30%
4	Documentation Assignments	100
6	Swift River Clinical Days	100
5	Skills Checkoffs	100
	Performance Evaluation	20%
1	Performance Evaluation	100

 

Scheduled Assignments and Important Dates

Week 1- Clinical Course Orientation via WebEx (Course expectations, grading, and schedules).	Lab
	(Schedule TBA): Medication Check-off (PO, IM, SubQ)- You will receive your Sim-Chart patient assignment the night before the check off.  You are responsible for previewing the electronic health record of your patient and the medications due.  You will be determining which medications will be administered and which will be held.  You will be administering simulated medications in the skills lab utilizing barcode scanning
	On Your Own
	Review Dosage calculations from level 1, Complete the following modules in ATI: ATI Parenteral Medications Dosages by Weight Take the practice math exam in ATI - Due August 30th  ATI Maternal Newborn Practice A – Due August 30th
Week 2	Lab
	Urinary catheter practice Clinical Math Exam
	On Your Own
	Swift River: Week 2 Maternal Newborn Patient Care (Must Score 75%) – due September 6th Week 2 Clinical Dosage Calculations (Must Score 100%) – due September 6th ATI Maternal Newborn Practice B - Due September 6th
	Lab
Week 3	Urinary catheter check-off ATI Maternal-Newborn Proctored Assessment Clinical Math Exam Retake (If applicable)
	On Your Own
	Swift River:                                    Week 3 Med Surg (Must score 75%) – Due September 13th Week 3 Med Pass (Must Score 85%) – Due September 13th
Week 4	Lab
	Central line dressing and NG tube practice Clinical Math Exam Retake (If applicable) Simulation (see clinical groups for assigned day/time and the simulation group in canvas for more details)
	On Your Own
	ATI Nutrition Practice A & B- Due September 20th
	Lab
Week 5	Central line dressing and NG tube check-off ATI Nutrition Proctored Assessment
	On Your Own
	Swift River             Week 5 Math Refresher (Must Score 100%) Due September 27th             Week 5 Med Surg (Must Score 75%) – Due September 27th
	Lab
Week 6	IV insertion practice
	On Your Own
	ATI Fundamentals Practice A- Due October 4th Swift River             Week 6 Med Pass (Must Score 85%) – Due October 4th             Week 6 Pediatrics (Must Score 75%) – Due October 4th
	Lab
Week 7	IV check-off
	On Your Own
	ATI Fundamentals Practice B- Due October 11th Week 7 Med Pass (Must Score 85%) – Due October 11th Week 7 Med Surg (Must Score 75%) – Due October 11th
	Lab
Week 8	Level II Performance Evaluations ATI Fundamentals Proctored Assessment Tour of NTMC (TBA per clinical instructor) Mid-term evaluation
	On Your Own
	Completion of Simon Says Quiz for NTMC
Week 9-13	Hospital Clinicals @ NTMC Clinical Portfolios to be turned in on final clinical day
Week 14	Final Evaluations

 

**Please note these dates may be subject to change at the discretion of the clinical instructor.

Regular and punctual attendance is expected of all students in all classes for which they have registered.  All absences are unauthorized unless the student is absent due to illness or emergencies as determined by the instructor.  It is the student responsibility to provide documentation as to the emergency for approval and judgement by the faculty member.  Approved college sponsored activities are the only absences for which a student should not be held liable and only when provided by a college official ahead of the absence.  Valid reasons for absence, however, do not relieve the student of the responsibility for making up required work.  Students will not be allowed to make up an examination missed due to absence unless they have reasons acceptable to the instructor.  A student who is compelled to be absent when a test is given should petition the instructor, in advance if possible, for permission to postpone the exam.  Student will be dropped from a class by the Registrar upon recommendation of the instructor who feels the student has been justifiably absent or tardy a enough times to preclude meeting the course’s objectives.    Persistent, unjustified absences from classes or laboratories will be considered sufficient cause for College officials to drop a student from the rolls of the College. From Board Policy FC (LOCAL)

Students are expected to attend clinical on each assigned clinical day.  There should be no clinical absences.  If an untoward circumstance occurs and the student must miss a clinical day, points will be deducted on the Clinical Points Tool for each clinical day missed.  Any student missing more than 2 clinical days or clinical labs will have to schedule an appointment with the department chair and 1other faculty prior to the next clinical day.  The circumstances for the absences will be reviewed and the student may be dismissed from the program or be placed on a probationary contract stating that any further absences will result in dismissal from the program.  Two days of being tardy up to 30 minutes will be counted as 1 absence.  Tardiness of more than 30 minutes will be counted as an absence and points will be deducted. It is at the discretion of the clinical instructor for allowing the student to remain in clinical (even though points will be deducted) or be sent home.

 

Last day to withdraw from a course with a “W” November 2^nd.  

 

DISABILITY SERVICES The North Central Texas College (NCTC) Office for Students with Disabilities (OSD) is committed to assisting students with accommodations related to all disabilities, including COVID-19. Any student that feels they require accommodations related to COVID-19 are encouraged to contact the OSD office by email at kwsmith@nctc.edu and/or ysandmann@nctc.edu for a virtual intake session. As with all disability related accommodations, documentation is required, and reasonable accommodations are considered on a case-by-case basis.  North Central Texas College also has a CARES Team and a student can also request advising assistance by contacting cares.nctc.edu or counseling@nctc.edu for information and/or assistance related to special advising and/or counseling referrals.

 

If you feel you have needs for services that the institution provides, please reach out to either Wayne Smith (940) 498-6207 or Yvonne Sandman (940) 668-4321.  Alternative students may stop by Room 170 in Corinth or Room 110 in Gainesville.

http://www.nctc.edu/StudentServices/Disabilityservices.aspx

 

COURSE TYPE: WECM Course

Counseling and Testing staff offer a variety of services to current and prospective students, such as College 101, placement testing, academic advising and course registration, transfer assistance, and College Success seminars (Time Management, Study Skills, Test Anxiety, Choosing a Major, Learning Style Strategies, Career Exploration), and much more. 

http://www.nctc.edu/StudentServices/CounselingTesting.aspx

 

Student Success offers academic coaching, tutoring, including a Writing Center, a Math Lab, free 24/7 online tutoring through Grade Results and assist new students acclimate to college by providing computer lab services for prospective students.   First generation students can also participate in TRIO which offers specialized support services.

https://www.nctc.edu/student-services/trio-student-support-services/trio-application.html

 

Financial Aid offers financial resources for students that qualify, visit the financial aid offices for more information.  http://www.nctc.edu/FInancialAidHome.aspx

 

 

 

Students are expected to follow all rules and regulations found in the student handbook and published online.

http://nctc.smartcatalogiq.com/en/2016-2017/Catalog/North-Central-Texas-College-Student-Handbook

 

Scholastic dishonesty shall include, but is not limited to cheating, plagiarism, academic falsification, intellectual property dishonesty, academic dishonesty facilitation and collusion.  Faculty members may document and bring charges against a student who is engaged in or is suspected to be engaged in academic dishonesty.  See Student Handbook, “Student Rights & Responsibilities: Student Conduct.

http://nctc.smartcatalogiq.com/en/2016-2017/Catalog/North-Central-Texas-College-Student-Handbook/Section-II/Student-Rights-and-Responsibilities-Student-Conduct/Specific-Conduct-RegulationsRestrictions

 

See the ADN Student Handbook regarding specific policies regarding academic dishonesty. 

 

Please note: For students in this course who may have a criminal background, please be advised that the background could keep you from being licensed by the State of Texas.  If you have a question about your background and licensure, please speak with your faculty member or the department chair. You also have the right to request a criminal history evaluation letter from the applicable licensing agency.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendices

 

 

 

Therapeutic Nursing Interventions

Therapeutic Nursing Interventions are acts carried out by nurses to foster and enhance the well-being of patients based on relevant scientific findings that guide a holistic approach to health care.  At the Clinical I and Clinical II Level of clinical performance, students are expected to demonstrate competency of selected psychomotor skills.  By the end of Clinical III mastery of these basic skills is expected.  Additionally, at the Clinical III and IV Levels of clinical performance, students are expected to demonstrate cognitive knowledge of the theory for skills performance that requires critical decision making even though they may not be able to demonstrate clinical mastery.

 

	Clinical I		Clinical II and Transition	Clinical III	Clinical IV
Respiratory		Oxygen Therapy Nasal cannula Oxygen Mask Incentive spirometry	Pulse oximeter Oropharyngeal Suctioning Nasopharyngeal Suctioning	Suctioning: Artificial airway Tracheotomy care IPPB Chest Physiotherapy Chest Tubes	Mechanical Ventilation ET/tracheotomy
Medications		Oral/Topical/Buccal Injections SQ/IM Injections  Z  track/Intradermal	IV Piggyback	IV bolus Titrate dosage IVP	Emergency drugs
IV		Assess IV Site only	Start IV , DC IVs, DC Saline Locks Regulate IV flow rate Change IV & Central Line dressing Change IV tubing/solutions	IVPB TPN Pumps/ PCA Venous access devices	Blood/blood products transfusions
Wounds		Dressing change Hot/cold therapy Remove staples/sutures	Care of acute and chronic wounds		Emergency care/burns/trauma
Elimination		Enemas Douches Foley catheter	Ostomy care/irrigation NG tube (Insertion/Irrigation) Tube feedings/ Gastrostomy tube	Hemodialysis/peritoneal dialysis
V S		Temperature/ Pulse/ Respiration Blood Pressure	Pediatric Neonate	Neuro exam
Physical Assessment		Adult and Geriatric Patient	Pediatric and neonate Patient OB patient	5-lead EKG Interpretation	Emergency Assessment Intro to 12-lead EKG
Lab		I&O Specimen collection Finger stick blood sugar	CBC, Electrolytes, Platelets, BUN, Creatinine, PT, INR, PTT Urinalysis, Oxygen Saturation	ABGs Interpretation F & E
Mobility		ROM Transfer/ Positioning/ Ambulation TED hose/compression pump	Traction/Cast care		Rehabilitation
Basic Care		Bathing/Oral Care/Hair care/Shave Bed making/Feeding/Weight

 

 

 

 

 

North Central Texas College          Student Name: ___________________________

Associate Degree Nursing

Attempt #     1          2          3

Simulated Skills Check-Off # 1

 

MEDICATION ADMINISTRATION

Each student will be given a patient care situation that requires the performance of selected skills.   All skills will be evaluated by the instructor for over-riding areas of concern, ie. safety, communication, and asepsis as related to the patient care situation and the concept of the skill being performed.

 

CRITERIA
PRE-PROCEDURE:	Complete	Incomplete
The student: Checked the physician’s order for the 5 Rights of medication administration. Make sure each order is complete. Identified patient with at least 2 patient identifiers  Checked for medication allergies – also asked patient  Checked V/S and current lab values as indicated  Performed the checks of medication preparation properly  Checked expiration date on all medications to be administered
PROCEDURE:
The student: Introduced self and explained procedure to patient  Applied principles of infection control (handwashing, gloves, etc)  Positioned patient correctly  Completed the checks of medication preparation at bedside  Selected appropriate site (if applicable) Observed patient swallow medications (if applicable) Used proper technique
POST-PROCEDURE:
The Student: Was able to state actions, nursing implications, safe dose ranges, adverse, and side effects of meds to be administered  Provided patient teaching regarding med administration  Protected patient from injury: patient in safe and comfortable position, bed in low position, 2 side rails raised, call light within reach when leaving room  Completed documentation of procedure (6th right)
Performance:	Pass	Fail

                                                                

 Comments:

 

 

 

                                                                            

 

 

 

 

Evaluator Signature: ______________________________________        Date: ___________________

 

North Central Texas College                           Student Name: _____________________________

Associate Degree Nursing

Attempt #     1          2          3

Simulated Skills Check-Off # 2

URINARY CATHETERIZATION

All skills will be evaluated by the instructor for over-riding areas of concern, ie. safety, communication, and asepsis as related to the patient care situation and the concept of the skill being performed.   The format of the skills check-off will utilize the nursing process of assessment, planning, implementation, and evaluation. The skill must be completed correctly without instructor prompts.

 

 

CRITERIA
PRE-PROCEDURE:	Complete	Incomplete
The student: Checked physician’s orders for frequency and type of urinary catheter  Identified patient with at least 2 patient identifiers  Checked for latex, iodine, or shellfish allergies – also asked patient Gathered the appropriate equipment & checked expiration date
PROCEDURE:
The student: Introduced self and explained the procedure to the patient  Provided appropriate privacy for the patient  Applied principles of infection control (hand hygiene, gloves, etc)  Positioned patient & the bed properly for procedure  Cleaned patient properly before starting the procedure  Donned sterile gloves observing sterile technique outlined in textbook  Performed urinary catheterization of female & male patient, using sterile technique and correctly adhering to guidelines – including cleaning patient   Collect Sterile Urine Specimen  Drain Foley bag, measure and document output  Removed the Foley catheter using appropriate technique
POST-PROCEDURE:
The student: Protected patient from injury: patient in safe and comfortable position, bed in low position, 2 side rails raised, call light within reach when leaving room  Document procedure and patient’s response
Performance	Pass	Fail

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Evaluator Signature: ____________________________________________        Date: _________________

 

 

 

North Central Texas College                           Student Name: _____________________________

Associate Degree Nursing

Attempt #     1          2          3

Simulated Skills Check-Off # 3

Central Line Dressing

All skills will be evaluated by the instructor for over-riding areas of concern, ie. safety, communication, and asepsis as related to the patient care situation and the concept of the skill being performed.   The format of the skills check-off will utilize the nursing process of assessment, planning, implementation, and evaluation. The skill must be completed correctly without instructor prompts.

 

 

CRITERIA	Instructor Check-off
PRE-PROCEDURE:	Complete	Incomplete
The student: Checked physician orders for frequency and type of dressing Checked for patient allergies – also asked patient Identified patient with at least 2 patient identifiers Gathered the appropriate equipment & checked expiration dates
PROCEDURE:
The student: Provided privacy for patient Introduced self and explained procedure to patient Applied principles of infection control (hand washing, gloves, masking, etc) Positioned patient & the bed in proper position for procedure & safety Removed old dressing & exam gloves using proper technique Assessed insertion site Donned sterile gloves observing sterile technique outlined in text book Prepared sterile field / sterile supplies – including solution Cleaned central line site and performed sterile dressing change – including proper placement of biopatch, taping & labeling dressing
POST-PROCEDURE:
The student: Repositioned patient in a safe and comfortable position Protected patient from injury: bed in low position, 2 side rails raised, call light within reach when leaving the room Documented procedure and patient’s response
Performance	Pass	Fail

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Evaluator Signature: ____________________________________________        Date: _________________

 

 

 

North Central Texas College                           Student Name: _____________________________

Associate Degree Nursing

                                          

Attempt #     1          2          3

Simulated Skills Check-Off #4

 

NASOGASTRIC INTUBATION

 

Each student will be given a patient care situation that requires the performance of selected skills.   All skills will be evaluated by the instructor for over-riding areas of concern, i.e. safety, communication, and asepsis as related to the patient care situation and the concept of the skill being performed.   The format of the skills check-off will utilize the nursing process of assessment, planning, implementation, and evaluation.

 

 

CRITERIA	Instructor Check-off
PRE-PROCEDURE:	Complete	Incomplete
The student: Checked physician orders for frequency or contraindications  Checked for patient allergies – also asked patient  Identified patient with at least 2 patient identifiers Gathered the appropriate equipment – checked expiration dates
PROCEDURE:
The student: Introduced self and explained procedure to patient  Applied principles of infection control (handwashing, gloves, etc)  Positioned patient  Measured patient properly prior to placement  Preformed nasogastric intubation as outlined in the textbook without prompts  Took proper steps to check placement of nasogastric tube
POST-PROCEDURE:
The student: Protected patient from injury: bed in low position, 2 side rails raised, call light within reach when leaving the room  Documented procedure and patient’s response
Performance	Pass	Fail

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

Evaluator Signature: ________________________________________      Date: __________________

 

 

 

 

North Central Texas College                           Student Name: _____________________________

Associate Degree Nursing

Attempt #     1          2          3

Simulated Skills Check-Off # 5

 

MEDICATION ADMINISTRATION – Intravenous

Each student will be given a patient care situation that requires the performance of selected skills.   All skills will be evaluated by the instructor for over-riding areas of concern, i.e. safety, communication, and asepsis as related to the patient care situation and the concept of the skill being performed.  The format of the skills check-off will utilize the nursing process of assessment, planning, implementation, and evaluation.

 

CRITERIA	Instructor Check-off
PRE-PROCEDURE:	Complete	Incomplete
The student: Checked the physician’s order for the 5 Rights of medication administration. Make sure each order is complete.  Identified patient with at least 2 patient identifiers  Checked for medication allergies – also asked patient  Checked V/S and current lab values as indicated  Performed the 3 checks of medication preparation  Checked expiration date on all medications to be administered
PROCEDURE:
The student: Introduced self and explained procedure to patient  Applied principles of infection control (handwashing, gloves, etc)  Positioned patient correctly  Assessed injection site before administering injection  Completed checks of medication preparation Secure tourniquet properly Perform venipuncture Advance cathlette Activate safety mechanism and dispose of sharps properly Secure IV tubing or J-loop Remove tourniquet Initiate IV flow using pump
POST-PROCEDURE:
The Student: Was able to state actions, nursing considerations, safe dose ranges, adverse and side effects of meds to be administered  Provided patient teaching regarding medication(s)  Protected patient from injury: bed in low position, 2 side rails raised, call light within reach when leaving room  Completed documentation of procedure (6th right)
	Pass	Fail

Comments:

 

 

 

 

 

 

 

 

Evaluator Signature: ________________________________________      Date: __________________

 

ASSESSMENT AND PATIENT CARE RECORD

Date (s) of Care _______________Room #_____________

Pt. Info:  Age__________ Gender____________ Ethnicity____________Allergies: ______________________

Medical Diagnoses: _____________________________________________________________________________

Pertinent Medical History________________________________________________________________________

Height: _______Weight: ______________ Code Status:_______Fall Risk:______

Time	Temp	Pulse	Resp.	BP	Pain Rating (0-10)	IV Location & Intact?	IV Fluid & Rate	O2 Device & √Setting	O2 Sat

 

Time	Intake				Output
	Oral	IV	IVPB	Blood	Urine	BM	Emesis	Drains
Totals

 

Labs/DX tests	Pt’s Value	Medication	Category	Nsg Considerations
Hgb Hct RBC HbA1C WBC Platelets Na++ K+ Phos. Glucose BUN Creatinine BNP TROPONIN Liver enzymes PT/INR PTT Albumin UA   Doppler CXR XRay CT EF% Other__________

Instructions: Complete the following assessment of your pt. using your observation, interviewing and physical assessment skills. You must enter the information into EHR Tutor to be submitted per instructor’s instructions.

Head, Face, Neck Head, Face (head round and symmetrical normocephalic, microcephalic, macrocephalic, headache, symmetrical facial features, asymmetrical facial features Neck (full range of motion, limited range of motion, without swelling, trachea midline trachea shifted right, cervical lymph nodes palpable, thyroid visible, jugular vein distension) Comments	Integumentary Skin Color, (Appropriate for ethnicity, even distribution, pallor flushed, cyanosis, jaundice Skin Temperature/Condition (Intact, not intact- See skin comments, warm, hot, cold, cool, dry, diaphoretic, swelling) Skin Turgor (Recoils immediately, recoils slowly, tenting Skin Comments      Braden Scale Sensory perception              Moisture                Activity  Mobility Nutrition                Friction and shear               Total score
Eyes, Ears, Nose, Throat Eyes (Symmetrical, no drainage, denies pain, asymmetrical, exophthalmia, glasses, contacts, blind) Ears (Symmetrical  placement, no drainage, hearing intact, no pain, difficulty hearing, deaf, hearing aid) Nose, Throat (Oral mucosa moist and intact, oral mucosa dry, oral lesions, teeth missing, dentures, bad breath, deviated septum, nasal discharge, sinus pain, nose bleed, sore throat, throat red, tonsils red and swollen Comments:	Musculoskeletal RUE       LUE       RLE       LLE       (Full range of mobility, limited range of mobility, weakness, paralysis, contracted, amputation Musculoskeletal Comments Morse Fall Scale History of falling Secondary diagnosis           Ambulatory aid    IV/Saline Lock    Gait/Transferring Mental Status       Total      Select Risk level based on total score
Neurological group Level of Consciousness     Orientation (Oriented X4, oriented to person, oriented to place, oriented to time, oriented to situations/event, disoriented, unable to assess)   Cognitive (WDL, no short-term memory loss, short-term memory loss, appropriate for developmental age, inappropriate for developmental age, appropriate attention/concentration, poor attention/concentration, unable to assess   Speech   Pupil Response (Bilateral pupils reactive, bilateral pupils fixed (nonreactive), R pupil nonreactive, L pupil nonreactive, R pupil reacts sluggishly, L pupil reacts sluggishly, unable to assess Pupil size (mm)   left: right: Deep Tendon Reflexes LUE- RUE- LLE- RLE- Neurological Comments       Glasgow Coma Scale Best Eye Response              Best Verbal Response        Best Motor Response         Glasgow Total	Gastrointestinal Abdomen (WDL, Soft, nondistended, nontender, rigid, tender, distended, flat, rounded, ascites Bowel Sounds (Present in four quadrants, active, hypoactive, hyperactive, absent) Passing Flatus      Last Bowel Movement       GI Comments
Respiratory Resp. (Effort/Pattern, WDL, regular rhythm, bilaterally even and unlabored, irregular rhythm, labored, retractions, dyspnea with exertion, dyspnea, nasal flaring, tachypneic, bradypneic, kussmaul, apnea, Cheynes-Stokes Breath Sound, Comments Cough    Sputum  Resp. Interventions (Suction, chest physiotherapy, turn, cough and deep breathe, incentive spirometry) Intervention, Comments    Respiratory Airways/Drain (Endotracheal tube, tracheostomy tube nasal tube, oral tube, chest tube Airway/Drain, Comments Oxygen Source    (Oxygen rate and comments)
Cardiac (Cardiac Rhythm/Sounds  WDL, regular rhythm, normal rateS1 and S2 present, irregular rhythm, murmur, adventitious heart sounds (Describe in cardiac comments) Pacemaker, cardiac symptoms, none, peripheral edema-pitting, peripheral edema-nonpitting, palpitations, dizziness, syncope, chest pain Monitors/Telemetry?          Cardiac Comments	Genitourinary Urinary Symptoms (WDL, continent, voiding without discomfort, incontinent, bladder distention, burning, dysuria, oliguria, retention, polyuria, anuria Urine Color         Urine Characteristics (No odor, foul odor, clear, cloudy, mucous, purulent, sediment, blood clots, stones, unable to assess GU Comments    :
Peripheral Vascular RUE LUE RLE LLE  (WDLCapillary refill less than 3 secs, pulse is palpable and strong, no edema or pain, capillary refill greater than 3 secs, doppler used+1-weak pulse+2-moderate pulse+3-strong pulse+4-bounding pulse, no pulse, edema=+1 (mild pitting, slight indentation) edema=+2 (moderate pitting, indentation subsides rapidly) edema=+3 (deep pitting, indentation remains for short time) edema=+4 (very deep pitting, persistent) Pain (Describe in comments) Periph. Vasc. Comments	Pain Assessment (Pain location, numeric pain rating, pain rating-faces           Pain Relieved by (Medication, position, meds, cold, heat, rest, activity) Pain Comments

 

 

 

 

 

 

Nursing Diagnosis: ______________________________________________________________________________

 

_____________________________________________________________________________________________________

 

_____________________________________________________________________________________________________

 

Nursing Documentation - Narrative

Suggested focus for documentation- Focused assessment (based on the patient’s problem(s); Nutrition; Safety issues; Education given to patient; etc. 

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

 

 

EHR Tutor Documentation Rubric

Criteria	Points Possible	Points Earned
Admission
Chief Complaint Principal Problem or Diagnosis Other Problems or Diagnoses History of Present Illness/Injury Allergies	15	Point deduction for each item missing = 1
Orders
Medications Pertinent medications for current hospitalization Therapeutic effect, action, contraindications, adverse reactions, recommended dosages, and nursing interventions.	15	Point deduction for each item missing = 1
Results
Laboratory Tests ALL abnormal lab studies	10	Point deduction for each item missing = 1
Diagnostic Tests Must include significance, findings, or results	10	Point deduction for each item missing = 1
Flowsheets
Vital Signs Include vital signs and trends for the entire shift Assessment Include findings for entire head to toe (shift assessment) Include follow up assessments throughout the shift, daily care and intake and output Interventions Include IV site assessment and care, urinary catheter assessment and care, chest tubes and gastric tubes and hourly rounds throughout the shift.	25	Point deduction for each item missing = 2
Care Plan
Assessment (Must list assessment data related to the nursing diagnosis chosen.  Nursing Diagnosis: Two diagnoses: Must include actual or potential, related to, and evidenced by (if actual) (Must be NANDA) Outcomes/Planning - Must include 2 two short term and one long term as in example on the next page.  Must be specific and measurable.   Interventions – Must include two interventions for each outcome as in the example on the next page.	25	Point deduction for each item missing = 2
Total Points Earned	100

 

 

 

 

 

Assessment (pertinent information related to the nursing diagnosis)

Diagnosis (NANDA)

Outcomes/Planning (1 long-term 2 short-term)

Interventions (two for each outcome)

 

 

 

 

 

 

 

 

 

 

 

Clinical Points Tool

Infraction	Date	Point Deduction or Consequence	Student/Faculty Initials
HIPAA Violations		Clinical Failure
Unsafe Patient Care: Anything that places the patient at risk of harm/injury		Clinical Warning
Medication Error (Any of the 6 Rights)		-10
Any additional medication errors (Any of the 6 rights)		Clinical Warning
Failure to submit Assessment and Daily Care Record at the end of the clinical day. (M/S & ICU)		-10
Failure to complete EHR Tutor documentation (4 assignments)		-10
Failure to complete Sim Chart documentation in simulation		-10
Failure to use isolation / standard precautions		-10
Violating tobacco policy		Clinical Warning
Unprofessional appearance / behavior		-10
Failure to properly perform previously checked off skills		-10
Clinical Absence		-15
Tardy (up to 30 minutes late) >30 min is absent		-10
Failure to follow instructions of Clinical Instructor or primary nurse		-10

 

These points will be deducted from the mid-term and final evaluations.

 

**If a Clinical Warning is issued, the final clinical grade will be reduced by one letter grade. 

 

 

(Rating Code: 15=marginal, 18=fair, 20=satisfactory, 22=good, 25=excellent)

 

 

Mid Term Signatures                                                                                    Final Signatures

Student_______________Instructor________________________                         Student___________________Instructor___________________

Date/time                                                                                                                     Date/time

 

 

 

Student Name___________________________                                                      Clinical Instructor_______________________

Clinical II Performance Evaluation Rubric

Category	Novice	Advanced Beginner	Competent	Proficient	Expert
Photo 1	Multiple errors in both documentation and nursing interventions with rationales	Satisfactory but missing more than two important points of information.	Satisfactory but missing two points of important information	Satisfactory but missing one point of important information	Outstanding (all important points covered).
Points	10	12	15	18	20
Photo 2	Multiple errors in both documentation and nursing interventions with rationales	Satisfactory but missing more than two important points of information.	Satisfactory but missing two points of important information	Satisfactory but missing one point of important information	Outstanding (all important points covered).
Points	10	12	15	18	20
Photo 3	Multiple errors in both documentation and nursing interventions with rationales	Satisfactory but missing more than important points of information.	Satisfactory but missing two points of important information	Satisfactory but missing one point of important information	Outstanding (all important points covered).
Points	10	12	15	18	20
***If student receives a novice or advanced beginner on the below nursing skills they must remediate with their clinical instructor and repeat the check-off plus check-off on all previously learned skills.
Insulin Administration	Performs skill with prompts.	Performs skill with 1 or more mistakes that compromises patient safety.	Performs skill with 1 mistake that does not compromise patient safety	Performs skill competently, without prompts and without patient safety compromise but needs practice	Performs skill proficiently, without prompts, and without patient safety compromise.
Points	10	12	15	18	20
Nursing Skill	Performs skill with prompts	Performs skill with 1 or more mistakes that compromises patient safety.	Performs skill with 1 mistake that does not compromise patient safety	Performs skill competently, without prompts and without patient safety compromise but needs practice	Performs skill proficiently, without prompts, and without patient safety compromise.
Points	10	12	15	18	20
Points Earned
TOTAL (out of possible 100)

 

 

 

 

RNSG1462 Clinical Skills/Competencies

Clinical Skills/Competencies	Date:	Discuss Rationale	Identifies Impact on the Client	Explains Procedure to Client	Selects Equipment	Completes Procedure	Uses Appropriate Aseptic Technique	Interprets Client Response	Reports and Documents Results	Provides Appropriate Follow-up	Instructor/RN Initials
Pulse oximetry
Oropharyngeal/ Nasopharyngeal Suctioning
Start IV, DC IVs, IV Saline Locks Piggyback Regulate IV flow rate Change IV tubing/solutions
Change IV & Central Line dressing
Care of acute and chronic wounds
Pediatric Care
Neonate care
OB patient care
CBC, Platelets Interpretation
Electrolytes, BUN, Creatinine Interpretation
PT, INR, PTT Interpretation
Urinalysis Interpretation
Ostomy care/irrigation
NG tube (Insertion/Irrigation)
Tube feedings/
Gastrostomy tube
Traction/Cast care

 

 

 

 

 

Student Signature/Date_______________________________                                                             Instructor Signature/Date_________________________________

***Skills completed must be initialed by RN or clinical instructor the day they are performed. 

NORTH CENTRAL TEXAS COLLEGE

Clinical Site Medication Policy and Procedures

LEVEL - Clinical II and Transition Clinical

 

In order to maintain safety of the patient when students administer medications in contracted hospitals, the faculty at North Central Texas College ADN program has developed the following policies and procedures.

 

            Policy I

a.     The staff nurse has the final responsibility for patient's care.

b.     The clinical instructor or RN preceptor (instructor) has the final responsibility for student medication administration (supervision and delegation of experiences)

c.     This medication policy will be subject to the policy of the clinical facility.

 

Procedure:

 

The instructor will evaluate the student's assignment for the shift and assess patient, time factor, instructor availability and possible collaboration of a staff nurse. The instructor's decision to delegate the responsibility of medication supervision will be communicated directly to the staff and/or Charge Nurse.

 

The instructor's discretion will be used as to the student's readiness to do a skill involving medications. While North Central Texas College ADN program appreciates and values the collaboration of hospital staff nurses in this venture, it does not assume that staff nurses will comply. Collaboration will be sought when the instructor cannot be present and only by prior arrangement.  The nursing instructor will request communication concerning agency medication administration policy during student orientation.

 

            Policy II

When a staff nurse has agreed to supervise a student with the Clinical Instructor's discretionary permission, it is requested that the staff nurse check the poured medications for accuracy (the five rights) before the student can administer the medication to the patient. The student is to state the classification, purpose, common side effects, contraindications, and nursing implications of the medications(s) before administering to the patient. The student will document on the medication records and nursing notes ONLY medications they have administered; never prior to actually administering the medication to the patient.

 

            General procedures to be followed:

 

            I.          The students are permitted to administer the following routes of medication as noted in this policy. All medication administration by Clinical II students will be supervised. Clinical II students DO NOT administer IV push medications or any IV flush with heparin.

            1.  Oral medications may be given with direct supervision of a staff nurse with approval of the Clinical Instructor.

            2.  Intramuscular, subcutaneous, or intradermal medications may be given with supervision of a staff nurse with approval of the Clinical Instructor.

            3.  Medications by any other route including rectal, vaginal, sublingual, buccal, and topical may be given with supervision of a staff nurse with approval of the Clinical Instructor.