Nursing in Chronic Illness II and End-of-Life Care

Course Number:
NRS 221
Transcript Title:
Nursing in Chronic Illness II and End-of-Life Care
Created:
Aug 15, 2022
Updated:
Apr 29, 2024
Total Credits:
9
Lecture Hours:
40
Lecture / Lab Hours:
0
Lab Hours:
150
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

NRS 111

Course Description

Builds on NRS 111, Foundations of Nursing in Chronic Illness I. Expands the student’s clinical judgement related to chronic disease management, including symptom management, family care giving concerns, palliative care, and end of life concepts. Include patient focus in chronic physical and mental health conditions, disabilities affecting functional status, as well as issues impacting family relationships. Explores ethical issues related to advocacy, self-determination, and autonomy as well as diversity, equity and justice. Covers legal considerations related to nursing practice with chronic health populations, such as those at end-of-life and experiencing mental health disorders. Provides demonstrations of cognitive, affective, and psychomotor skills associated with the assessment and management of increasingly complex comorbidities within the context of patient and/or family centered care. Expands on the concepts of enhancing therapeutic communication and collaboration as a member of an interprofessional team and across health care settings. Includes classroom and clinical learning experiences. Prerequisite: NRS 111.

Course Outcomes

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

  1. Create a comprehensive culturally appropriate plan of care with patients experiencing chronic physical and mental health conditions, and disabilities affecting functional status and including issues impacting family relationships.
  2. Applies evidence-based nursing practices in support of patients experiencing chronic physical and mental health conditions, and disabilities affecting functional status to facilitate self-health care management across the lifespan.
  3. Incorporate measures to enhance quality of life for patients with chronic physical and mental health conditions, and disabilities affecting functional status in the plan of care.
  4. Identify appropriate community resources to provide support for patients, family and caregivers. This may include assistance in navigating health care settings and developing collaborative interprofessional relationships for the provision of care.
  5. Communicate with agencies when patients are experiencing transitions of care, promoting continuity by advocating for patients and collaborating with others to provide patient-centered care.
  6. Utilize nursing- and interprofessional-based knowledge of death and dying trajectories to support patients/families across the lifespan who are experiencing transitions towards the end of life.
  7. Analyze the impact of health care delivery system issues, policy, and financing on individual and family health care needs for chronic physical and mental health conditions, and end of life care.

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 performance evaluation, multiple choice exams, lab performance evaluation, project and participation evaluation, papers

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: Create a comprehensive culturally appropriate plan of care with patients experiencing chronic physical and mental health conditions, and disabilities affecting functional status and including issues impacting family relationships.

Concepts of Complex Chronic Illness: consider when developing a plan

  • Chronic illness trajectories
  • Co-morbidities – including acute exacerbations of chronic illnesses
  • Trauma-informed care
  • Adverse Childhood Experiences (ACEs)
  • Access to healthcare/community resources
  • Family-centered issues in care planning
  • Transitions to levels of care
  • Self-management
  • Psychosocial adjustment

Outcome #2: Applies evidence-based nursing practices in support of patients experiencing chronic physical and mental health conditions, and disabilities affecting functional status to facilitate self-health care management across the lifespan.

Symptom Management in Chronic Illness

  • Exploring common symptoms and developing interventions: fatigue, dyspnea, hypoxia, anxiety, depression, pain, agitation, GI effects
  • Patient quality of life issues
  • Mental status changes, including delirium
  • Interprofessional team communication

Case management and care coordination

  • Transitions across various settings of care
  • Continuity of care in complex situations (e.g., homelessness)
  • Care transitions, including anticipatory guidance
  • Access to care/resource stewardship
  • Understanding systems perspective of healthcare, patient navigation

Outcome #3: Incorporate measures to enhance quality of life for patients with chronic physical and mental health conditions, and disabilities affecting functional status in the plan of care.

  • describe the etiology, symptoms, experiences, and stigmas of those affected
  • therapeutic communication
  • facilitating patient centered care that is sensitive to the patient’s personal, social, cultural, and spiritual interpretation of illness and the impact on patient/family

Outcome #4: Identify appropriate community resources to provide support for patients, family and caregivers. This may include assistance in navigating health care settings and developing collaborative interprofessional relationships for the provision of care.

Health Care Systems and Financing

  • Analyze the impact of chronic illness on the U.S. health care system
  • Supplemental Security Income (SSI)
  • Centers for Medicare and Medicaid Services (CMS)
  • Current state and federal health care plans: Medicare, Medicaid/Oregon Health Plan
  • Coordinated Care Organizations (CCOs)
  • Triple/Quadruple Aim (IHI)

Outcome #5: Communicate with agencies when patients are experiencing transitions of care, promoting continuity by advocating for patients and collaborating with others to provide patient-centered care.

  • Intro to palliative and hospice care
  • Assessment of family capacity to provide care
  • Anticipatory care planning
  • Interprofessional symptom management, complementary therapies
  • Cultural, spiritual, and psychosocial issues
  • Developmental considerations
  • Communication
  • Loss, grief, and bereavement

Outcome #6: Utilize nursing- and interprofessional-based knowledge of death and dying trajectories to support patients/families across the lifespan who are experiencing transitions towards the end of life by:

  • describing the epidemiology of dying: where, when, how people die
  • using developmentally and culturally appropriate communication with patients and families experiencing serious chronic or end of life illnesses
  • incorporating palliative care approaches and symptom management interventions

Outcome #7: Analyze the impact of health care delivery system issues, policy, and financing on individual and family health care needs for chronic physical and mental health conditions, and end of life care,

  • comparing basic funding mechanisms
  • identifying decision-making issues for chronic care based on funding resources
  • assessing appropriateness of resources in meeting the patient/family needs

Suggested Texts and Materials

  • Lewis’s Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier. 
  • Nursing diagnosis handbook: An evidence-based guide to planning care (13th ed.). St. Louis, MO: Elsevier

Department Notes

See OCNE Megacase List and Minimum Skill Set by end of Year 2 List

See OCNE universal CCOG for additional information on course content