Course Title: Critical Care Nursing

Course Number: NUR 4333

Prerequisite:
Generic BSN students: Nursing 3320 Adult Health Nursing I Practicum
Post-Licensure students: none
Faculty: Melissa R. McDowell, MSN, RN, CCRN (Virtual Office Hours Tuesdays 2000 until 2200
and Thursdays 0800 until 1000. Available on Campus by Appointment)
Vincent Nursing-Physical Science Building, Room 134
E-mail: melissa.mcdowell@angelo.edu
Phone: (325) 212-6694
Course Description: Explores the interrelationship of human bio psychosocial dimensions of
critical care nursing and examines the theoretical basis and nursing process for alterations in
human functioning as consequences of critical illness and care. Grading will be pass or fail.
Course Objectives/Student Learning Outcomes Linked to Program Objectives: By the end of
the course, students will be able to:

1.

2.

3.

4.

5.

Course Objective/Student Learning Outcome

Prioritize, plan, and evaluate outcomes of care for the critically ill patient
with multiple complex, and/or life threatening stressors using health
data, evidence, clinical judgment, and patient preferences.
Integrate principles of safety and quality into research-based
interventions for adult patients and families with complex health needs
and unpredictable outcomes.
Deliver and coordinate compassionate, culturally, ethnically and patientcentered care based on evidence, guidelines, standards, and legal
statutes/regulations.
Analyze acute and critical illness or injury for the interrelationship of the
following factors: epidemiology, demographics, pathophysiology,
physical assessment, diagnostic tests, pharmacological interventions, EKG
interpretation, basic hemodynamic monitoring, nutritional measures,
and genomic competencies for clinical decision making.
Formulate patient and family centered goals that assist toward health
promotion, maintenance, and/or restoration.

6. Demonstrate collaboration and communication skills in advocacy actions

BSN Outcomes
1,2,3,4,5,6

2,3,4,6

1,2,3,4,5,6

1,2,3,4,5,6

1,2,3,4,5,6

including improvements in quality, safety and error prevention.

7. Interact with peers, colleagues and interdisciplinary health team
members to facilitate positive patient outcomes and a professional
clinical environment.
8. Demonstrate standards of moral, ethical, professional and legal conduct
in the critical care setting.

1,2,4,6
1,2,4,5,6
1,4,5,6

Clinical Requirements:
1. Maintain student liability insurance and current American Heart Association Health Care
Professional CPR certification.
2. Provide safe nursing care to adult clients within level of knowledge and nursing
skills.
3. Refer to the Angelo State University Undergraduate Nursing Handbook for the following:
Clinical Attire - regulations; general appearance
Behavior in Clinical Agency
Professional Conduct
Standards of Nursing Practice
Patient Client Confidentiality
Student absences
o In the event of extenuating circumstances preventing a student from attending a
clinical experience, the student will:
Notify the agency before scheduled time to report on duty
Notify the clinical instructor a minimum of one hour before scheduled
time to report on duty
Failure to call in will result in an unsatisfactory for that clinical day
o Students will be prepared for all clinical activities. The faculty has an obligation
to remove a student from the clinical setting if the student is not prepared.
Repeated behavior reflects failure to meet clinical objectives
o Students missing more than one day of clinical will result in reevaluation of a
students ability to meet course objectives and may result in an unsatisfactory
clinical grade.
Dosage Calculation Testing Policy
Policy on Exam Make-Up
Policy on Universal Precautions
Guidelines for Written Work
BON Declaratory Statement
All Guidelines for Referencing Materials
Policies Related To This Course: All students are required to follow the policies and procedures
presented in the Angelo State University Undergraduate Nursing Handbook.

Required Textbooks/Materials:
Text - Urden, L. D., Stacy, K. M., & Lough, M. E. (2013). Thelans critical care nursing:
Diagnosis and management (7th ed.). St. Louis: Mosby ISBN-10: 0323057489 | ISBN- 13:
978-0323057486
Materials Name tag, bandage scissors, watch, stethoscope, penlight, ASU uniform,
appropriate reference books, and appropriate clinical forms.
We recommend the use of a PDA.
Download and installation of Second Life Viewer software
Optional Textbooks/Materials:
Text- Mims, B. C. Toto, K. H.,Luecke, L. E., Roberts, M. K., Wilmouth, J. B., & Tyner, T. E.
(2004). Critical care skills (2nd ed.). Saunders ISBN-978-0-7216-0085-7
Teaching Strategies:
Web-based and asynchronous didactic modules
Case studies/clinical reasoning activities
Clinical practicum
Second Life interactive exercises/gaming
Written assignments
Web sites/references
Method of Assessing Learning Outcomes:
Assessment Activity

Course Objective
1,2,3,4,5,6
1,2,3,4,5,6,7,8
1,2,6,7,8
1,2,4,5,7
2,3,6,7,8
1,2,3,4,5,6,7,8

Case Study Assignment

Clinical Competency Performance
Clinical Assessment Tool
American Heart Association NIH Stroke Scale Test
Interdependent QSEN Competency Assignment
Discussion Board

Clinical Grading System: The grading system used in this course is P (Pass), F (Fail), NC* (No
Credit), or W (Withdrawn)
Case Study Assignment
Clinical Competency Performance/Clinical Assessment Tool
American Heart Association NIH Stroke Scale Test
Interdependent QSEN Competency Assignment

20%
20%
20%
20%

Discussion Board
20%
Practicum Hours: Students will spend 20 hours in clinical settings.
Attendance: In the event of extenuating circumstances preventing a student from attending a
clinical experience, the student will:
Notify the agency before scheduled time to report on duty.
Notify the clinical instructor a minimum of one hour before scheduled time to report on
duty.
Failure to call in will result in an UNSATISFACTORY for that clinical day.
Students missing one day of clinical will result in reevaluation of a students ability to meet
course objectives and may result in an unsatisfactory clinical grade. The instructor may assign
the student work to supplement the experience.
UNSATISFACTORY Clinical Performance: A student will be considered "Unsatisfactory" if
clinical experiences reflect negative performances, lack of preparation or absence.
Unsatisfactory incidents indicate that students may not be able to meet course requirements.
A student whose clinical practice is UNSATISFACTORY will be given (a) counseling, opportunities
for improvement, and/or remediation, and (b) a verbal and written warning. Faculty may
remove a student from the clinical setting for lack of preparation or other unsatisfactory
performance.
A pattern of three (3) clinical "unsatisfactories" may result in the student failing the clinical
portion of the course, and as a result, receive a failing grade for the course.
UNSAFE clinical performance: When direct patient care is part of the learning experience,
patient safety and well-being is of paramount concern. If a faculty member evaluates that a
student is unable to provide safe nursing care in accordance with Standards of Professional
Nursing Practice (BON, Nursing Practice Act, 2001), and if this deficit is such that it cannot be
remedied, the student will be removed from the clinical setting and will receive a grade of F
in the course.
Policy on Missed Assignments: There are no makeup assignments. If you miss an assignment,
you will receive a zero for the missed item. It is the students responsibility to notify the
respective clinical instructor if the student is unable to meet the assignment deadline 1 week
before the assigned deadline.
Student Conferences with Instructors are Required:
1. At mid-term and during the week before final exams for performance evaluation.
2. Excessive absences.
3. Repeated UNSATISFACTORY PERFORMANCE in clinical setting.

4. Any situation that is considered UNSAFE, which can result in immediate dismissal
from the nursing program.
Academic Honesty: Students must maintain complete honesty and integrity in classroom,
online and clinical learning experiences. Any student found guilty of any form of dishonesty in
academic work is subject to disciplinary action. See the following site on the ASU web page for
the ASU Academic Honor Code: http://www.angelo.edu/forms/pdf/honorcode5.pdf
Disability Statement: Students with disabilities must contact the Student Life and Student
Services Office to request any necessary academic accommodations. This student request
should be made early in the semester to allow time for appropriate arrangements.
Syllabus Changes: The instructor reserves the option to make changes as necessary to this
syllabus. If changes become necessary during this course, the instructor will notify students of
such changes, by email communication, class announcement, and/or via a course
announcement on Blackboard.
Student Evaluation of Course: Students are provided the opportunity, and are strongly
encouraged to participate in a course evaluation at the end of the semester.
Clinical Skills:
1. Endotracheal Tube Care
2. Tracheostomy Care
3. Ventilator Care
4. Nutritional Measures
5. Basic Hemodynamic Monitoring
6. SVO2 Monitoring
7. ECG Monitoring/12 Lead ECG Interpretation
8. Care of Patient with Intra-Aortic Pump
9. Care of Patient with Temporary Pacemaker
10. Care of Central Lines

CLINICAL EXPERIENCES OBJECTIVES

A.

GOAL: To provide opportunities for the student to gain knowledge and participate in
patient care.

B.

DEFINITION: The Nurse must possess good assessment skills and sound clinical knowledge
and be able to apply this knowledge.

C.

OBJECTIVES: The student will:

1.
2.

3.

4.

5.

6.

7.

D.

Become aware of the various aspects of nursing care as an interdisciplinary

component of patient care.
Identify the operation of the department, i.e.
a. Duties and functions of the various personnel
b. Equipment
c. Role-play with the interdisciplinary team using SBAR Communication
d. Use information and patient care technology to communicate effectively with
members of the healthcare team
Observe and/or assist with the use of treatments and therapeutic measures related
to the department.
a. Administer and document administration of medications in the critical
care environment
b. For assigned patients, compare observed practices with published
standards
Identify the needs for skills in assessment based on all body systems.
a. Perform patient assessment and evaluation of patients response to
pharmacological agents
Identify the skills needed in patient and family teaching.
a. Conduct basic genetic health screening
b. Address end-of-life decision making
Provide emotional support for the client, family members as needed.
a. Provide evidence-based, patient-centered end-of-life care to a dying
patient and their significant others.
Infection control
a. Reporting communicable diseases required
b. Universal Precautions

EVALUATION:
1.
2.

Onsite or Virtual Clinical Competency Evaluation/Clinical Assessment Tool

Case Study Assignment

3.

Interdependent QSEN Competency Assignment

ROLE OF RN DURING CARDIAC EMERGENCIES &
CARDIAC OR RESPIRATORY ARREST

SUBJECT:

Nursing Resuscitation and Cardiac Arrest Management

PURPOSE:

To provide the student with theoretical knowledge in performance of the

nursing interventions essential during a cardiac arrest in the practice of
professional nursing.

SUGGESTED
READING:
LEARNING
ACTIVITIES:

Skills Manual

Skills Performance
CPR for Health Care Professionals

VIEW:

Videos: Cardiac Emergencies and Cardiac Arrest

OBJECTIVES:

The student will be able to demonstrate basic understanding related to

the following assessment and psychomotor skills.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Assessment of need for and initiation of cardiopulmonary

resuscitation.
Utilization of the institutions mechanism of reporting a cardiac
arrest that summons appropriate help.
Know the location of and routine checking of Crash Cart with
emergency equipment and medications on your unit.
Recognize the role of the arrest team and leader and helping
facilitate the life sustaining interventions.
Identify the progression of resuscitative interventions until client is
stabilized and/or heroic measures are terminated.
Provide psychosocial comfort and understanding emotional support
to family members of arrest victim.
Identify the elements of Cardiac output.
Describe assessment of client with complaints of chest pain.
Recognize the role of the nurse in assessing the client with chest
pains.
Analyze signs and symptoms of myocardial infarction.

EVALUATION: Required current American Heart Association Health Care Professional.

Clinical Assessment Tool

Patient
________Patient name outside of room
________Wrist band: Name verified with patient and DOB
________Correct names/dates on whiteboard inside patient room

Tubes and Lines follow each line from patient to device, look at connections, amount
of room to move, secured in place, and labels
Oxygen
_______Nares any skin breakdown
_______Source flow rate______, ordered flow rate________
Feeding tubes (DH)
_______Nares any skin breakdown
_______Source label on bag________, dated_______
_______Irrigation set-up clean/dated________
Abdominal tubes
_______Type: G-tube (input) Biliary tube (output)
_______Site described in pathway_______, labeled________, bag attached_________

Chest tube
_______Site described in pathway_______, dressing intact________
_______Tubing no kinks_______, tight connections________
_______Pleurovac check fluid levels and movement of fluid in
________Suction chamber
________H2O chamber
________Drainage chamber
Drainage
Amount noted on chamber_______
Tracheostomy
_______Description of trach and size written on pathway
_______Suction catheters available in room
_______Extra trach tube available in room
_______Obturator in sight
_______Sterile water at bedside for trach care? Dated if opened__________

Foley
_______Date of original insertion noted on pathway
_______Tubing dependent and without loops
_______Drainage bag below level of bladder
IVs
_______Site inspect for redness, swelling, warmth, tenderness, drainage
_______Follow tubing to solution check connections________, label________
_______Solution Correct drug______, time_______, dose_______, route_______
Compare all of above to MAR/admin RX
_______Pump: Green light_______ Plugged in to wall socket________

Environment
_______Side rails necessary?
_______Bed in low position
_______Call light working and within reach
_______No obstacles/clutter at bedside or in route to bathroom
_______No obstacles in route to sink
_______No obstacles at bedside
_______Patient assistive devices within reach i.e. glasses, hearing aids
_______Correct date/nurse name on white board in patient room
_______Water pitcher or glass available and clean
_______Urinal at bedside
_______Bathroom or Bedside commode emptied
_______Trash receptacle available and within easy reach

Questions for patient and/or significant other (5 minute sit-down)

What would you like to see happen today?
How would you describe your hospitalization Is there anything that could be done to make it
better?
What should nursing students know about what its like being a patient in the intensive care unit?

Assessment Tool completed by_____________________

Case Study Assignment

Purpose: The purpose of this assignment is for evaluation of meeting course objectives.
Focus: The focus for this assignment is patient care, data collection, and evaluation of care
provided compared to evidence-based research.
Due Date: August 5, 2013. No exceptions.
Course Objective(s): 1, 2, 3, 4, 5, 6
Instructions During the clinical rotations, students will select an assignment which fits with
their interest in completing course objectives. The clinical objectives are to perform patient
care, gather data for the case study and the evaluation of care delivery.
The case study consists of six sections with very specific criteria that the student must include
to receive full credit. Required elements are included in each section description. Be thorough
in gathering information and document the reason for any missing elements.

Angelo State University - Department of Nursing

NUR 4333: Critical Care Nursing
Case Study Guidelines and Rubric
Criteria
I.

II.

III.

Introduction: Section consists of introducing/presenting

the patient. Required elements: Patient initials, date of
birth, age, race and gender, current ht & wt, BMI, and
date of admission.
Chief complaint: (why the pt came into the hospital) and
primary admitting diagnosis.
HPI: history of present illness (length of illness and signs
and symptoms on admission). Provide a detailed course
of illness and his or her present health state (are they
better, worse or the same).
Overview of patient: History, bio-psycho-social
assessments, diagnostic tests, pharmacological
interventions, EKG interpretation, hemodynamics,
nutritional measures, and genomic considerations.
Pathophysiology: Review pathophysiology of the
condition including etiologies, clinical manifestations,
expected outcomes, current research, demographics,
and relating this information to the assigned patient.

Possible
Points
10

20

30

Points Received

IV.

Plan of Care:
20
Part 1: Generate and discuss nursing diagnosis in
planning care for the patient.
Part 2: Priorities of care, plan, and evaluation of
outcomes

V.

VI.

Research-based Interventions: Evaluate the care this

patient received related to your research of the
condition.

References: Cite all references used in the paper. The

references must include at least one peer-reviewed
journal article. The article must be less than 5 years old,
and must be longer than 2 printed pages to count. Your
other references can be textbooks and internet sites. The
reference section must follow APA 6th edition format

Total

10

10

100

Limit your response to no more than 10 double-spaced pages with 1 margins all around. Use
12-point Times New Roman font. All of your work, except for the appendices, must be in type
written form for this assignment. Follow APA 6th edition for this paper. Please do not plagiarize,
as this is grounds for failure. As much as possible one should paraphrase (put into your own
words) when referencing sources. One may use quotes as appropriate. All papers are subject to
submission to http://safeassign.com/ to assess for plagiarism. Spelling, punctuation, and
grammar needs to be correct.
Point totals of 70 to 100 points equal Satisfactory performance on this assignment. Point
totals of 0 to 69.99 points will result in an Unsatisfactory performance. Unsatisfactory
assignments will be returned to the student for corrections. These assignments will be rescored
using the same scoring guidelines. The student may have the assignment rescored once.

Interdependent QSEN Competency Assignment

Purpose: The purpose of this assignment is to prepare students to actively participate as
collaborative partners in a transforming healthcare system.
Focus: The focus for this assignment is to apply real life healthcare problems in the critical care
setting to the Interdependent QSEN Competency Model. Students identify how an issue with
one competency is affected by other competencies for the creation of a quality improvement
plan.
Due Date: One week post last clinical rotation day. No exceptions.
Course Objective(s): 2, 3, 6, 7, 8
Instructions Prior to the Critical Care/ER rotations, students will do a library database
assignment looking at research recommendations and standards for the assigned competency
in those areas. Five or more peer-reviewed sources required for an APA formatted reference
list. Three must be journal articles.
During the clinical rotations, students will collaborate with peers and staff to identify
issues/situations illustrating use or lack of use of assigned competency in the critical care
setting. Students will collaboratively create a 10 slide PowerPoint presentation summarizing the
issues/situations and recommendations with an APA formatted reference list. The PowerPoint
presentation will be turned in to the instructor one week post the students last clinical
rotation. Post instructor approval, students will share the presentation with their peers in
Second Life (SL). Since access is not restricted on the virtual campus, no patient or facility
identifiers to be presented. **Maintain confidentiality, including HIPAA policy at all times.

Angelo State University - Department of Nursing

NUR 4321: Critical Care Nursing
Interdependent QSEN Competency Assignment Rubric

Criteria
1. Use library databases to review the
literature exploring one of the six QSEN
competencies. Include an APA
formatted reference list of 5 or more
peer-reviewed sources (Three must be
journal articles).
2. Collaborate with peers and staff to
identify issues/situations illustrating use
or lack of use of assigned competency in
the critical care setting.
3. Identify how the issue with the
competency is affected by other
competencies.
4. Identify how the issue may compromise
Safety and Quality Improvement; as well
as how competencies could be part of
the solution. Collaboratively formulate a
quality improvement plan.
5. Create a 10 slide PowerPoint
Presentation summarizing the
issues/situations and recommendations
with APA formatted reference list to
share with your peers in SL.
Total

Points
Possible

Evaluation

10

20

20

25

25

100

Please do not plagiarize, as this is grounds for failure. As much as possible one should
paraphrase (put into your own words) when referencing sources. One may use quotes as
appropriate. All papers are subject to submission to http://safeassign.com/ to assess for
plagiarism. Spelling, punctuation, and grammar needs to be correct.

Angelo State University

NUR 4333 Critical Care Nursing
Discussion Board Grading Rubric
Description: Online protocols include: -Postings should be evenly distributed during the
discussion period (not concentrated all on one day or at the beginning and/or end of the
period). -Postings should be a minimum of one short paragraph and a maximum of two
paragraphs. -Avoid postings that are limited to 'I agree' or 'great idea', etc. If you agree (or
disagree) with a posting then say why you agree by supporting your statement with concepts
from the readings or by bringing in a related example or experience. -Address the questions as
much as possible (don't let the discussion stray). -Try to use quotes from the article that
support your postings. Include page numbers when you do that. -Build on other responses to
create threads. -Bring in related prior knowledge (work experience, prior coursework, readings,
etc.) -Use proper etiquette (proper language, typing, etc.)
Course Objective(s): 1, 2,3,4,5,6,7,8

Exit

Excellent

Good

Average

Points Range: 9
(30%) - 10
(33.33%)

Points Range: 8
(26.67%) - 8
(26.67%)

Points Range: 6
Points Range: 0
(20%) - 7 (23.33%) (0%) - 5 (16.67%)

Timely Discussion
Contributions
5-6 postings well
distributed
throughout the
week
Feedback:
Responsiveness to
Discussion and
Points Range: 9
Demonstration of (30%) - 10
Knowledge and
(33.33%)
Understanding
Gained from
Very clear that
Assigned Reading readings were

Poor

4-6 postings
distributed
throughout the
week
Feedback:

3-6 postings
somewhat
distributed
Feedback:

Points Range: 8
(26.67%) - 8
(26.67%)

Points Range: 6
Points Range: 0
(20%) - 7 (23.33%) (0%) - 5 (16.67%)

Readings were
understood and

Postings have
questionable
relationship to

2-6 not distributed

throughout the
week
Feedback:

Not evident that

readings were
understood

Excellent
understood and
incorporated well
into responses
Feedback:

Good
Average
incorporated into reading material
responses
Feedback:
Feedback:

Points Range: 9
Points Range: 8
(30%) - 10
(26.67%) - 8
Adherence to On- (33.33%)
(26.67%)
Line Protocols
All on-line
1 online protocol
protocols followed not adhered to
Feedback:
Feedback:

Poor
and/or not
incorporated into
discussion
Feedback:

Points Range: 6
Points Range: 0
(20%) - 7 (23.33%) (0%) - 5 (16.67%)
2-3 online
protocols not
adhered to
Feedback:

4 or more online
protocols not
adhered to
Feedback: