Foundations of Nursing in Chronic Illness I

Course Number:
NRS 111
Transcript Title:
Foundations of Nursing in Chronic Illness I
Created:
Aug 15, 2022
Updated:
May 17, 2024
Total Credits:
6
Lecture Hours:
20
Lecture / Lab Hours:
20
Lab Hours:
90
Satisfies Cultural Literacy requirement:
No
Satisfies General Education requirement:
No
Grading Options
A-F
Default Grading Options
A-F
Repeats available for credit:
0
Prerequisites

Corequisites: NRS 235, NRS 238

Course Description

Expands on assessment and common interventions with the focus on patients with common chronic illnesses across the life span in multiple ethnic groups. Explores the patient’s and family’s “lived experience” of the condition. Applies clinical practice guidelines and research evidence to guide clinical judgments in the care of individuals with chronic conditions. Explores multidisciplinary team roles and responsibilities in the context of delivering safe, high-quality health care to individuals with chronic conditions (includes practical and legal aspects of delegation). Examines cultural, ethical, legal, and health care delivery issues through case scenarios and clinical practice. Includes classroom and clinical learning experiences. Practices selected core nursing skills as part of the clinical portion. Corequisites: NRS 235, NRS 238.

Course Outcomes

Upon successful completion of this course, students will be able to:

  1. Perform a comprehensive health assessment that prioritizes patient- family- centered care, integrates developmental and cultural sensitivities and effectively utilizes the derived data for interpretation and action.
  2. Identify and use safe, effective, developmental, and patient care preference interventions for patients with chronic illness.
  3. Develop, implement, and evaluate a patient-centered plan of care for a patient with a chronic illness that incorporates assessment data, patient care preference, evidence-based intervention strategies, patient developmental/cognitive considerations, and demonstrates a deep understanding of the patient’s perspective and illness experience within the framework of exacerbation, trajectory, and plateau.
  4. Identify the ANA Code of Ethics and nursing values in the care of persons with a chronic illness.
  5. Identify roles and functions of members of the health care team to provide care for the chronically ill.
  6. Identify and utilize therapeutic communication skills in the development of therapeutic relationships with patients and their support system.
  7. Recognize potential legal and ethical issues related to patient care across the lifespan.

Suggested Outcome Assessment Strategies

The determination of assessment strategies is generally left to the discretion of the instructor. Here are some strategies that you might consider when designing your course: writings (journals, self-reflections, pre writing exercises, essays), quizzes, tests, midterm and final exams, group projects, presentations (in person, videos, etc), self-assessments, experimentations, lab reports, peer critiques, responses (to texts, podcasts, videos, films, etc), student generated questions, Escape Room, interviews, and/or portfolios.

Department suggestions: Clinical evaluation, Papers, Multiple choice exams, Lab performance evaluation, Group Case Study, Patient Teaching Project

Course Activities and Design

The determination of teaching strategies used in the delivery of outcomes is generally left to the discretion of the instructor. Here are some strategies that you might consider when designing your course: lecture, small group/forum discussion, flipped classroom, dyads, oral presentation, role play, simulation scenarios, group projects, service learning projects, hands-on lab, peer review/workshops, cooperative learning (jigsaw, fishbowl), inquiry based instruction, differentiated instruction (learning centers), graphic organizers, etc.

Course Content

Outcome #1: Perform a comprehensive health assessment that prioritizes patient- family- centered care, integrates developmental and cultural sensitivities and effectively utilizes the derived data for interpretation and action.

  • mental and functional status, ADLs and IADLs,
  • coping/adaptive strategies used by patient/family,
  • lived experience of chronic illness, including recognition of stigma and its impact on vulnerability, and maintaining health,
  • impact of the condition on family functioning, and
  • specific lab value interpretation and medication concerns such as polypharmacy.

Outcome #2: Identify and use safe, effective, developmental, and patient care preference interventions for patients with chronic illness, including:

  • safely and effectively assisting patients with ADLs & IADLs,
  • identifying and providing for comfort needs (physical and emotional),
  • teaching patients/families about interventions for managing symptoms, and;
  • teaching patients about self-assessment and self-management in highly prevalent chronic conditions.

Focus on Chronic illness

  • Asthma 
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Hypertension
  • Coronary Heart Disease
  • Heart Failure
  • Post-acute stroke
  • Alzheimer’s and other dementias
  • Parkinson’s Disease
  • Multiple sclerosis
  • Arthritis
  • Osteoporosis
  • Post-trauma chronic alterations e.g., spinal cord injuries
  • Diabetes mellitus - Type I & II
  • Obesity

Outcome #3: Develop, implement, and evaluate a patient-centered plan of care for a patient with a chronic illness that incorporates assessment data, patient care preference, evidence-based intervention strategies, patient developmental/cognitive considerations, and demonstrates a deep understanding of the patient’s perspective and illness experience within the framework of exacerbation, trajectory, and plateau.

  • Multidimensional aspects of chronicity, including aspects of health promotion and quality of life
  • Body image, stigma, social isolation, chronicity vs. acute illness
  • Illness differentiated from disabling condition
  • Progressive & stable conditions, including transitions across the lived experience
  • Concepts of medication administration
    • Medication reconciliation
    • Polypharmacy
  • Health disparities
  • Family coping, adaptation, caregiver burden/stress
  • Family members with special health care needs
  • Planning within the patient, family context
  • Case Management/Coordination
  • Implications of the environment in the delivery of care
  • Use of health care system or resources
  • Community resources
  • Care assignment
  • Age and culturally sensitive health teaching
  • Wellness and health promotion activities
  • Assessment and skills to teach individuals with low health literacy

Outcome #4: Identify the ANA Code of Ethics and nursing values in the care of persons with a chronic illness.

Reflect on how each provision of the ANA Code of Ethics relates to the care of persons with chronic illnesses.

  • This reflection should include how the principles of the code guide nursing practices in promoting dignity, respect, and ethical treatment for those with long-term health conditions.

Explore Key Nursing Values in Chronic Illness Care:

  • Explore and discuss key nursing values such as compassion, respect for patient autonomy, and commitment to patient well-being.
  • Consider how these values are applied in the context of chronic illness care, emphasizing their importance in maintaining patient dignity and fostering a therapeutic nurse-patient relationship.

Discuss Ethical Resolutions Using the ANA Code of Ethics:

  • Using the ANA Code of Ethics as a guide, discuss potential resolutions for ethical dilemmas faced by patients with chronic illnesses.
  • This activity should involve identifying common ethical challenges in chronic illness care and brainstorming strategies for resolution that align with ethical standards and patient-centered care.

Participate in Mock Ethical Rounds or Discussions:

  • Simulate real-life scenarios to apply the ANA Code of Ethics, explore various perspectives, and develop skills in ethical decision-making and communication.
  • Engage in mock ethical rounds or discussions to deepen understanding of ethical issues in chronic illness care.

Outcome #5: Identify roles and functions of members of the health care team in order to provide care for the chronically ill.

Review the roles and responsibility of:

  • Care Provider- medical specialist.
  • Family member
  • Home Health Aid
  • Home Health Nurse
  • Hospice Nurse
  • Social worker
  • Care Giver
  • Spiritual support

Outcome #6: Identify and utilize therapeutic communication skills in the development of therapeutic relationships with patients and their support system.

Professional interactions:

  • Techniques of interviewing
  • Confidentiality
  • Legal responsibility to report
  • Professional Boundaries

Outcome #7: Recognize potential legal and ethical issues related to patient care across the lifespan.

  • Pain management with medications and alternative treatment.
  • Health care decision making - health care team vs family rights.
  • Legal age of consent
  • Health care providers legal responsibility regarding “end of life” documents.
  • Death with Dignity- assisted suicide and Oregon Law

Suggested Texts and Materials

  • Makic, M. B. F. & Martinez-Kratz, M. (2023). Nursing diagnosis handbook: An evidence-based guide to planning care (13th ed.). St. Louis, MO: Elsevier. 
  • Treas, L. S., Wilkinson, J. M., Barnett, K. L., & Smith, M. H. (2018). Basic nursing: Thinking, doing, and caring (3rd ed.). Philadelphia, PA: F. A. Davis.

Department Notes

  • See OCNE Megacase List and Minimum Skill Set by end of Year 1 List
  • See OCNE universal CCOG for additional information on course content