Portland Community College | Portland, Oregon

Course Description:

This course introduces assessment and common interventions (including technical procedures) for patients with chronic illnesses common across the life span in multiple ethnic groups. The patient’s and family’s “lived experience” of the condition is explored. Clinical practice guidelines and research evidence are used to guide clinical judgments in care of individuals with chronic conditions. Multidisciplinary team roles and responsibilities are explored in the context of delivering safe, high quality health care to individuals with chronic conditions (includes practical and legal aspects of delegation). Cultural, ethical, legal and health care delivery issues are explored through case scenarios and clinical practice.  Case exemplars include children with asthma, adolescents with a mood disorder, adults with type 2 diabetes, and older adults with dementia.  The course includes classroom and clinical learning experiences.

Prerequisite: NRS 110:

Prerequisites or Co-requisites: NRS 230 or 231 and NRS 232 or 233

1. Conduct a health assessment that is family-centered and both developmentally and culturally     appropriate and interpret, and use the resulting health data focusing on:

• mental and functional status, ADLs and IADLs,
• coping/adaptive strategies used by client/family,
• lived experiences of chronic illness, including recognition of stigma and its impact on

                vulnerability and maintaining health,

• impact of condition on family functioning, and
• specific lab value interpretation and medication concerns such as polypharmacy.

2. Provide safe and effective, developmentally and culturally appropriate care to clients with chronic illness including:

• safely and effectively assisting clients with ADLs & IADLs,
• identifying and providing for comfort needs (physical and emotional),
•  teaching clients/families about interventions for managing symptoms such as chronic pain and fatigue,
• teaching clients about self-assessment and self-management in highly prevalent chronic conditions such as (but not limited to)  congestive heart failure, dementia, type 2 diabetes, depression, and
• addressing basic questions about prognosis of illness.

3. Develop and implement a family-centered plan of care for a client with a chronic illness that incorporates evidence-based intervention strategies, assessment data, child and family developmental considerations, and demonstrates a deep understanding of the client’s perspective and illness experience within the framework of exacerbation, trajectory, and plateau.

4. Apply ANA Code of Ethics in the care of persons with a chronic illness or disability.
5. Identify roles and functions of members of the health care team in order to provide care for the chronically ill.
6. Use therapeutic communication skills in the development of therapeutic relationships with clients and families.
7. Recognize potential legal and ethical issues related to client autonomy across the lifespan in at risk populations.

Intended Outcomes for the course:

1.  Conduct a health assessment that is patient-centered and family-centered and both developmentally and culturally appropriate, interpret, and use the resulting health data, focusing on:

a.mental and functional status, ADLs and IADLs,

b.coping/adaptive strategies used by patient/family,

c.lived experience of chronic illness, including recognition of stigma and its impact on vulnerability and maintaining health ,

d.impact of condition on family functioning, and

e.specific lab value interpretation and medication concerns such as polypharmacy.

2.  Provide safe and effective, developmentally and culturally appropriate care to patients with chronic illness including:

a.safely and effectively assisting patients with ADLs & IADLs,

b.identifying and providing for comfort needs (physical and emotional),

c.teaching patients/families about interventions for managing symptoms such as chronic pain, fatigue,

d.teaching patients about self-assessment and self-management in highly prevalent chronic conditions,  such as (but not limited to) congestive heart failure, dementia, type 2 diabetes, and depression, and obesity.

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

4.  Apply ANA Code of Ethics and nursing values in the care of persons with a chronic illness or disability.

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

6.  Use therapeutic communication skills in the development of therapeutic relationships with patients and families.

7.  Recognize potential legal and ethical issues related to patient autonomy across the lifespan in at risk populations. 

Discussion groups

Required Readings
Clinical evaluation
Project/Papers
Multiple choice exams
Lab performance evaluation

Clinical performance evaluation

Papers/Project Rubrics

Multiple choice exams
Lab performance evaluation

Themes, Concepts & Issues:

Quality of life

Ethical/legal considerations

Family structure and functions

Care and planning

Case management

Symptom management

Care coordination

Documentation

Evidence-based best practices, e.g., core measures and National Patient Safety Goals (NPSG)

Skills: This is not an exhaustive list but is a minimum skill set to be completed anytime throughout  NRS 110, NRS 111 or NRS 112

Principles of Infection control & PPE

Handwashing

Isolation technique

 Body mechanics

 Client/environment safety, bed making Vital signs & SpO2 (pulse oximetry)

Height & Weight Basic ‘head to toe’ physical assessment

Health History interviewing (across the lifespan)

Client hygiene

Client Skin Care & Pressure Ulcer Prevention

Safe patient handling: positioning, transfers & mobilizing

Client range of motion

Client’s ADLs, mobility, fall risk

Nutrition and elimination procedures, I&O

Pain Assessment & Management: Acute & Chronic

Nursing Documentation

Capillary Blood Glucose Measurement

Diabetic Care (skin, foot, oral, illness, eyes)

 Intramuscular Injection sites

Subcutaneous and Intradermal Injections sites

Insulin preparation/injection

Medication calculation

Medication administration: Topical (skin, ear, eye, rectal), Oral, Inhaled

Intravenous Therapy and Regulation – Peripheral

Peripheral Intermittent IV Therapy via Secondary Infusion (piggyback)

Peripheral saline lock flush

NGT insertion and maintenance

Postpartum/newborn assessment

Sterile Technique

Perioperative Care – Pre/Post Suture, Staple, & Clip removal

Wound Care Drains: JP, Hemovac, Penrose,T-tube

Urinary Catheter insertion, maintenance and removal

Bladder Scan