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Essay Instructions: discussion clearly articulates the nature of critical care nursing practice and the role of critical care nurse.This is evidenced by a concise description of a nurse-patient interaction, in which the nurse provided care to a critically ill patient; a discussion of the nurse's knowledge within this interaction and discussion/analysis of nurse's attributes and her role promoting the health of the criticall ill patient.
Comprehensive discussion of critically ill patient and their experience of critical illness. (Patient has just gone through open heart surgery having an MVR mitral valve replacement with tissue valve)This is evidenced by description of critically ill patient(ie pt is female 75 yrs,slender frame, past medical history- NIDDM, hyperlipidemia, cataract sx,pt is sedated, intubated, lying supine under warming blanket. arterial line , central line ,SL x2 to right forearm, swan catheter, cordis , chest tubes, foley catheter, all in situ. upon entry into CSICU pt has PRBC's , insulin, nitro, levophed, hydromorhone all infusing at different rates via differnt access lines(as mentioned above)This patient's heart rythmm is being externally A-V paced at 78bpm for underlying bradycardia. discussion to include overview of the patient as a person and an analysis of factors that support or hinder the nurse's ability to come to know the patient as a person.
Discussion reflects a comprehensive overview of the nurse-patient relationship and an analysis of the factors influencing this relatioship ie. trust. specific topics addressed include an overview of the nurse patient relationship as it was observed (Pt sedated from OR , nurse is talking and explaining to patient what she is doing even though pt sedated). An alaysis of the attributes, personal characteristics, and capacities of the nurse and the patient and their influence on the nurse-patient relationship, and the impact of the immediate environment on the nurse-patient relationship. (surrounding environment is CSICU cardiac surgery ICU- open area with 15 other beds)
personal reflection about visit to the csicu (very intense high paced, constant change with patient's condition as they are still very critical and highly unstable from just coming out of OR)How this may influence their own vision of themselves as a critical care nurse ( This experience makes me want to become a critical care nurse more than ever. I like the fast pace , utilizing critical care thinking, helping patients in a very serious, critical time in their life, etc.

Essay Instructions: This is a case study of a patient who is transfered from DEM to HDU, and you must prioritize the nursing care and give a rationale for it (basically from the moment of handover, step by step what happens and why).

I will upload the assigment task instuctions, some journals to be used as references, and some hand written ideas.

This case study is to be written specificaly about this patient.

The introduction should be along this lines: 'Mrs Margaret Cronin has been admitted to HDU following assessment in DEM. She has an irregular heart rate, history of hypertension and pneumonia and appears anxious on admission to the unit. She has been ordered drug therapy, blood transfusion, etc,etc'.

This example introduction sets the scene- gives a brief overview of the client and enables the reader to know the direction of the paper.

An example of a nursing priority would be: we've established that there is a problem with the amioderone maintenance dose. So after ABCD the drug error is top priority. You can discuss that you would turn off the medication as the order is incorrect, do the ABCD assessment and then come back to setting up revised medication order. Preferred infusion site for amiodaron is via CVC but Margaret has no CVC the infusion has been commenced via IVC. As such stopping for incorrect dose and restarting when dose corrected and CVC insitu would be ideal option.

Another consideration would be: In critical care RN will be documenting observations and fluid balance hourly. Any change in the client's condition needs to be documented as it happens- this can occur by recording your observations either in the progress notes or on the observation charts at the bed site.

Please remember that nurses do not Diagnose.

Please see file NURS 13124 critical care nursing for assessment instructions.

There are faxes for this order.

Essay Instructions: 1. Give an example of a time when you were under pressure? How did you respond at the time and afterwards? What may be examples of stressors experienced in Critical Care Nursing?

2. You are caring for a patient with sepsis. You notice that the patients? respiratory rate has increased to 30 breaths per minute and that they have become more hypotensive. Subsequently, they have a MEWS of 7. Describe your care priorities for this patient.

3. Can you think of a time you have made an error and received constructive feedback? What did you do with that .information and why was it important to your practice?

4. You are assisting a colleague who is known for their abrasive behaviour to insert a urinary catheter. Prior to insertion you notice that they have contaminated the tip of the catheter. Describe what you would do next.

Essay Instructions: C. Advanced Nursing Role Paper: (100 points - see separate guideline sheet)

The purpose of this assignment is to demonstrate the student’s ability to investigate, analyze, and synthesize information on a topic related to advanced nursing in the U.S. health care environment. The outcome of this assignment is to arrive at a rational and specific recommendation for a selected course of action. Students may wish to submit the paper for publication to a journal. Hence, a well developed and literature supported synthesis is strongly encouraged.

1. Select a topic related to advanced nursing and the objectives and content of the course that is of interest to the individual student.(This topic must be different than the topic the student selected for class presentation.)

2. Conduct a cursory search of available literature to get a view of what is available. (HINT: some topics are very cyclical and were popular for a brief time, so it may be necessary to go back in history to get several citations on a specific topic.)

3. When you have identified the topic you wish to explore and the perspective you wish to pursue, obtain the advice and counsel of the course instructor.

Use APA Manual (5th ed) format for paper. Papers will be kept to a 10 page limit.

Students will briefly present to the class the key findings and recommendations from their paper topic.

This paper explores the CNS and NP roles based on the historical background, current practice, and education. This paper also discusses the existing debate of the CNS versus NP roles based on presented literature, and provides the author’s conclusions on merging the CNS and NP roles.

separate guideline sheet
Advanced Nursing Role Paper
(Total Possible Points = 100)

A. Introduction: (10 pts. possible)
1. State the purpose of the paper and the general organization that the paper will follow.
2. Describe relevance of issue to advanced nursing

B. Body: (30 pts. possible)
1. Verify with authoritative literature the nature and extent of the issue.
2. Review current experts’ recommendations for nursing.
3. Review research literature related to issue.
4. Critically review some of the selected solutions to the issue.

C. Summary: (30 pts. possible)
1. Synthesize and summarize the information presented.
2. Provide the student’s recommendations for the professional practice of nursing.

D. References: (20 pts. possible)
1. Quality and source of references used.
2. Comprehensiveness of literature reviewed.

E. Form and Style: (10 pts. possible)
1. Use clear, organized progression in writing.
2. Use correct grammar, sentence structure, and APA citation style.
3. Keep to 10-page limit.

Sources

American Association of Colleges of Nursing. (1997). A vision of baccalaureate and graduate nursing education: The next decade. Retrieved November 21, 2007, from http://www.aacn.nche.edu/Publications/positions/vision.htm

Berger, A. M., Eilers, J. G., Pattrin, L., Rolf-Fixley, M., Pfeifer, B. A., Roggee, J. A., et al. (1996). Advanced practice roles for nurses in tomorrow's healthcare systems. Clinical Nurse Specialist , 10 (5), 250-255.

Cukr, P. L., Jones, S. L., Wilberger, M. E., Smith, R., & Stopper, C. (1998). The psychaitric clinical nurse specialist/nurse practitioner: An example of a combined role. Archives of Psychaitric Nursing , XII (6), 311-318.

Dunn, L. (1997). A literature review of advanced clinical nursing practice in the United States of America. Journal of Advanced Nursing , 25 (4), 814-819.

Elder, R., & Bullough, B. (1990). Nurse practitioners and clinical nurse specialists: Are the roles merging? Clinical Nurse Specialist , 4, 78-84.

Fenton, M. V., & Brykcynski, K. A. (1993). Qualitative distinction and similarities in the practice of clinical nurse specialists and nurse practitioners. Journal of Professional Nursing , 9, 313-326.

Lincoln, P. (2000). Comparing CNS and NP Role activities: A replication. Clinical Nurse Specialist , 14, 269-277.

Lindeke, L. L., Canedy, B. H., & Kay, M. M. (1997). A comparison of practice domains of clinical nurse specialists and nurse practitioners. Journal of Professional Nursing , 13, 281-287.

Mick, D. J., & Ackerman, M. H. (2000). Advanced practice nursing role delineation in acute and critical care: Application of the Strong Model of Advanced Practice. Heart & Lung , 29 (3), 210-221.

Quaal, S. J. (1999). Clinical nurse specialist: Role restructuring to advance practice registered nurse. Critical Care Nursing Quarterly , 21 (4), 37-49.

Roberts-Davis, M., & Susan, R. (2001). Clinical role clarification: Using the Delphi method to establis similarities and differences between Nurse Practitioners and Clinical Nurse Specialists. Journal of Clinical Nursing (10), 33-43.

Rose, S. B., All, A. C., & Gresham, D. (2003). Role preservation of the clinical nurse specialist and the nurse practitioner. The Internet Journal of Advance Nursing Practice , 5 (2).

Sarah, E. O.-W., & Roger, A. N. (2001). Comparing and contrasting the clinical nurse specialist and the advanced nurse practitioner roles. Journal of Nursing Management (9), 205-207.

Williams, C. A., & Valdeivieso, G. C. (1994). Advanced practice models: a comparison of the clinical nurse specialist and nurse practitioner activities. Clinical Nurse Specialist , 8, 311-318.

Wright, K. B. (1997). Advanced practice nursing: Merging the clinical nurse specialist and nurse practitioner roles. Gatroenterology Nursing , 20 (2), 57-60.

Zuzelo, P. R. (2003). Clinical nurse specialist practice-Spheres of Influence. Association of periOperative Registered Nurses , 77 (2), 361-372.


There are faxes for this order.