2020-2021 Associate Degree Nursing

Bluegrass Community and Technical College Associate Degree Nursing Program

Student Handbook/Resource Manual Academic Year 2020-2021

Rev 8/12/18

Bluegrass Community and Technical College Associate Degree Nursing Program

PART 1 – GENERAL INFORMATION...... 4 Accreditation...... 5 Mission of BCTC...... 5 Vision...... 5 Values...... 5 Mission of the Associate Degree Nursing Program...... 7 Overview of the Nursing Program...... 7 Degree...... 7 Philosophy of the Associate Degree Nursing Program...... 7 Conceptual Framework...... 9 Conceptual Framework Design...... Error! Bookmark not defined. Technical Standards...... 12 Educational Competencies...... 13 Curriculum Sequence and Requirements...... 13 Descriptions of Courses/Nursing Courses...... 15 Structure of the Nursing Courses...... 15 Advising...... 15 Class Scheduling...... 14 Code of Student Conduct...... 14 Complaints/Grievances……………………………………………………………………………...…….....…...15 Family Educational Rights and Privacy Act...... 15 Student Organizations...... 16 Program Website...... 17 Student Support Services...... 17 Nursing Student Resources...... 18 Campus Laboratory...... 18 Media Center...... 18 Learning Resource Center...... 18 Tutoring Resources...... 18 Background Check...... 19 HIPAA...... 19 Graduation Audits...... 19 Application for a Degree...... 20 Approximate Costs Associated with the ADN Program...... 20 Intellectual Property/Taping of Lectures...... 21

Liability Insurance...... 21 Use of Electronic Devices...... 21 Class Attendance...... 21 Textbooks and Course Outlines...... 21 Course Outlines...... 22 Grading Scale...... 22 Medication Calculation Competency...... 22 Clinical Requirements...... 22 Overall Clinical Evaluation...... 22 Clinical Attendance...... 23 Clinical Skills...... 23 Immunizations/CPR...... 24 Dress Code/Uniform...... 24 Clinical Sites...... 25 Withdrawal from the ADN Program...... 25 Readmission to the ADN Program...... 26

PART II NURSING CONCEPT MAPS and CARE PLANS……………………………...……….27- 33

PART III NURSING DATA BASES (History and Physical Assessment Forms) ……………………..34

PART IV ESSENTIAL SKILLS AND CRITICAL CRITERIA...... 35

PART I – GENERAL INFORMATION

Bluegrass Community and Technical College Associate Degree Nursing Program

Accreditation

Bluegrass Community and Technical College is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools to award the associate degree. (Commission on Colleges at 1866 Southern Lane, Decatur, GA 30033-4097, phone 404.679.4500)

The Associate Degree Nursing Program holds national accreditation from the Accreditation Commission for Education in Nursing (formerly NLNAC), 3343 Peachtree Road NE, Suite 850, Atlanta, GA 30326, phone 404.975.5000, www.acenursing.org/

The Associate Degree Nursing Program is approved by the Kentucky Board of Nursing (312 Whittington Parkway, Suite 300, Louisville, KY 40222-5172, phone 502.329.7000, kbn.ky.gov).

Mission of BCTC

Bluegrass Community and Technical College (BCTC) transforms the Bluegrass Region—one student, one employer, and one community at a time. With students at the heart of our mission, BCTC supports student access, success, and completion of educational goals through comprehensive services, high-quality career and technical education for workforce skills, transfer education for baccalaureate degrees, and life skills development.

BCTC promotes cultural awareness and inclusion, critical thinking, and civic responsibility. Through excellence in teaching and learning and strong partnerships, BCTC supports regional economic vitality and quality of life as a member college of the Kentucky Community and Technical College System awarding associate degrees, diplomas, and certificates.

Vision

Bluegrass Community and Technical college aspires to teaching and learning excellence, student success, and creative solutions for educational, economic, and community challenges.

Values

As an organization that serves and learns, made up of students, faculty, and staff, and supported by boards, councils, and advisors, BCTC is guided by these core values:

Building Respect

• Authenticity - We act with integrity and uphold our commitments. • Inclusion - We empower students, faculty, and staff to create an inclusive culture through open access, shared experience, and mutual respect.

Communicating

• Meaningful Interaction - We value considerate and productive communication, empowered listening, and diversity of thought and expression. • Focus on Learning - We support lifelong learning through teaching and service that nurture emotional and intellectual growth to foster meaningful lives.

Transforming

• Innovation - We embrace challenges using new, creative, and flexible ideas and actions that seek improvements and support educational excellence. • Responsiveness - We assess needs, create partnerships, and take initiative to support the economic and cultural development of the communities we serve.

Creating Community

• Positive Environment - We embrace joy and celebration in our learning and working environment. • Collaboration - We cooperate toward common goals, striving to create positive results by being helpful, courteous, and kind.

Mission of the Associate Degree Nursing Program

In support of the BCTC’s mission of providing quality education and learning, the Associate Degree Nursing Program prepares program graduates to write the National Council Licensure Examination to become registered nurses. The program curriculum combines general education and nursing education and is accredited by the Accrediting Commission for Nursing Education (ACEN) and is approved by the Kentucky Board of Nursing. The program faculty support lifelong learning and workforce development through faculty efforts in continuing education and community service.

Overview of the Nursing Program

Consistent with the BCTC mission, the Associate Degree Nursing Program has a curriculum that combines general education and nursing education. Classroom lectures are held at the college and nursing faculty direct the learning of nursing practice in a variety of community settings. Classroom instruction is closely correlated with selected experiences in the health care facilities. Transportation to the facilities is the responsibility of each student.

The program prepares graduates to write the National Council Licensure Examination to become registered nurses, eligible to work in beginning level staff positions. The novice Associate Degree RN is most commonly employed in acute care and extended care facilities, but may work in such diverse sites as clinics, home health and physician’ offices. Responsibilities include, management of daily client care, evaluation of client’ physical and behavioral reactions to treatment through continual assessment, supervision of other health care workers, and identification and implementation of necessary client education.

Degree

Upon successful completion of the course of study, the graduate of the Bluegrass Community and Technical College Associate Degree Nursing Program will earn the Associate in Applied Science Degree.

Philosophy of the Associate Degree Nursing Program

The philosophy of the Associate Degree Nursing (ADN) program is congruent with the Kentucky Community and Technical College System (KCTCS) mission statement and is supported by the works of the National League for Nursing (NLN) Education Competencies and Quality and Safety Education in Nursing (QSEN).

The nursing faculty believe nursing is holistically evolving, blended with science, and the art of caring. Nursing demonstrates the provision of patient-centered care based on quality standards and evidence based practice through the inclusion of theoretical concepts.

Learning in an educational setting is enhanced by a teacher-student relationship and clearly defined student learning outcomes. The nurse educator’s responsibility is to structure and facilitate optimal conditions for critical thinking from simple to complex. The student brings to this relationship the willingness to learn and is accountable for his/her education.

The ADN graduate, having achieved the graduate outcomes is prepared to practice in a variety of settings with the parameters of individual knowledge and experience according to the standards of practice.

References: National League for Nursing. (2010). Outcomes and Competencies for Graduates of Practical/Vocations, Diploma, Associate Degree, Baccalaureate, Master’s, Practice Doctorate, and Research Doctorate Programs in Nursing. New York, NY: National League for Nursing.

Quality and Safety Education for Nurses (QSEN) Institute. (2018). QSEN Competencies. Retrieved from: http://qsen.org/competencies/pre-licensure-ksas/

Conceptual Framework

The conceptual model is a visual representation of the relationships among the core competencies essential to entry-level registered nursing practice. This model serves as a guide for curriculum development and instruction, which promotes the attainment of end of program student learning outcomes.

Teamwork and Collaboration

Patient Centered Evidence-based Care Practice

Human Nursing Flourishing Judgment

Professional Spirit of Identity Inquiry

Quality Informatics Improvement

Safety

References:

National League for Nursing. (2010). Outcomes and Competencies for Graduates of Practical/Vocations, Diploma, Associate Degree, Baccalaureate, Master’s, Practice Doctorate, and Research Doctorate Programs in Nursing. New York, NY: National League for Nursing.

Quality and Safety Education for Nurses (QSEN) Institute. (2018). QSEN Competencies. Retrieved from: http://qsen.org/competencies/pre-licensure-ksas/

KENTUCKY COMMUNITY AND TECHNICAL COLLEGE SYSTEM ASSOCIATE DEGREE NURSING

Operational Definitions

Core competencies in nursing education are those elements of Associate Degree Nursing that are essential to entry level registered nursing practice and are inherent of nursing practice. The National League for Nursing (NLN) Outcomes and Competencies for Graduates of Associate Degree Programs in nursing which serve as goals of nursing education for entry into nursing practice are defined as:

• Human Flourishing: “…an effort to achieve self-actualization and fulfillment within the context of a larger community of individuals, each with the right to pursue his or her own such efforts. ...Human flourishing encompasses the uniqueness, dignity, diversity, freedom, happiness, and holistic well-being of the individual within the larger family, community, and population.” (NLN, 2010, p.33)

• Nursing Judgement: encompassing “…critical thinking, clinical judgment, and integration of best evidence into practice. Nurses must employ these processes as they make decisions about clinical care, the development and application of research and the broader dissemination of insights and research findings to the community, and management and resource allocation.” (NLN, 2010, p.34) This process is driven by Maslow’s hierarchy of needs to assist in the prioritization of patient-centered care.

• Professional Identity: “… the internalization of core values and perspectives recognized as integral to the art and science of nursing. The nurse embraces these fundamental values in every aspect of practice while working to improve patient outcomes and promote the ideal of the nursing profession.” (NLN, 2010, p.35)

o Holistically Evolving: encompasses all mind-body-spirit interactions along the continuum of the human experience while providing care in a dynamic and progressive health care environment

• Spirit of Inquiry: “…a persistent sense of curiosity that informs both learning and practice. A nurse infused by a spirit of inquiry will raise questions, challenge traditional and existing practices, and seek creative approaches to problems.” (NLN, 2010, p.36)

Quality and Safety Education in Nursing (QSEN) competencies which were developed to prepare future nurses to have the knowledge, skills and attitudes necessary to continuously improve the quality and safety of healthcare are defined as:

• Patient-Centered Care: “Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs” (QSEN, 2018).

• Safety: “Minimizes risk of harm to patients and providers through both system effectiveness and individual performance” (QSEN, 2018).

• Informatics: “Use information and technology to communicate, manage knowledge, mitigate error, and support decision making” (QSEN, 2018).

• Teamwork and Collaboration: “Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care” (QSEN, 2018).

• Evidence-Based Practice: “Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care” (QSEN, 2018).

• Quality Improvement: “Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems” (QSEN, 2018).

Quality and Safety Education for Nurses (QSEN) Institute. (2018). QSEN Competencies. Retrieved from: http://qsen.org/competencies/pre-licensure-ksas/

Technical Standards

Nursing at the technical level involves the provision of direct care for individuals and is characterized by the application of verified knowledge in the skillful performance of nursing functions. Therefore, in order to be retained in the program all applicants should possess:

1) Sufficient visual acuity, such as is needed in the preparation and administration of medications, and for the observation necessary for patient assessment and nursing care.

2) Sufficient auditory perception to receive verbal communication from patients and members of the health care team and to assess health needs of people through the use of monitoring devices such as cardiac monitors, stethoscopes, IV infusion pumps, dopplers, fire alarms, etc.

3) Sufficient gross and fine motor coordination to respond promptly and to implement the nursing skills, including the manipulation of equipment, required in meeting health needs.

4) Sufficient communication skills (speech, reading, writing) to interact with individuals and to communicate their needs promptly and effectively, as may be necessary in the individual’s interest.

5) Sufficient intellectual and emotional functions to plan and implement care for individuals.

Students who need special accommodations to meet these standards should contact the Nursing Program Coordinator.

Educational Competencies

Technical Competencies: Associate Degree in Nursing Upon completion of this program, the graduate can: 1. Advocate for patients and families in ways that promote their self-determination, integrity, and ongoing growth as human beings (human flourishing). a. Incorporate culturally competent, individualized plans of care focusing on services and activities that promote independence, maintain or restore health, or support a peaceful death and advocate for access and quality of care for patients. b. Formulate teaching/learning processes to facilitate patients’ informed decision- making to support and achieve positive outcomes that demonstrates respect for diverse patients. 2. Formulate judgments in practice, substantiated with evidence, that integrate nursing science in the provision of safe, quality-care and promote the health of patients within a family and community context (nursing judgment). a. Utilize the nursing process as a basis for clinical judgment to optimize outcomes of care for the patient, family, and community. b. Establish and maintain effective/therapeutic communication in collaboration with patients, families, significant others, and members of the health care team. c. Manage the direct provision of nursing care through effective organizational skills, appropriate delegation, and supervision within the scope of practice. 3. Develop one’s role as a nurse in ways that reflect integrity, responsibility, ethical practice and an evolving identity as a nurse committed to evidence-based practice, caring, advocacy, and safe, quality care for diverse patients within a family and community context (professional identity). a. Employ principles of advocacy, quality and safety, healthcare policy, and cost effectiveness to improve healthcare outcomes. b. Exhibit professional behaviors/practice as defined by the ethical, legal, and regulatory frameworks of nursing. c. Incorporate the ability to ethically and responsibly integrate technology to skillfully locate, evaluate, use, create and communicate information to improve the quality and safety of patient care and the life and employability of graduates. 4. Consider the evidence that underlies clinical nursing practice to challenge the status quo, question underlying assumptions, and offer new insights to improve the quality of care for patients, families, and communities (spirit of inquiry). a. Interpret evidence-based literature/research for use in nursing practice. b. Exhibit continuous learning within the nursing profession.

Curriculum Sequence and Requirements

Effective fall 2019 Pre-Requisite to the Nursing Program: • CPR for Healthcare Providers • Proof of active status on the Medicaid Nurse Aide Registry or equivalency

Sequence Course Credits Pre-requisites Mathematics Quantitative Reasoning Course 3 at AA/AS Level Human Anatomy and Physiology I BIO 137 4 General Psychology PSY 110 3 Fall Semester – Year 1 Nursing Practice 1 NSG 101 9 Human Anatomy and Physiology II BIO 139 4 Spring Semester – Year 1 Medical Surgical Nursing 1 NSG 219 7 Behavioral Health Nursing NSG 212 3 Writing 1 ENG 101 3 Fall Semester – Year 2 Maternal Newborn Nursing NSG 211 3 Medical Surgical Nursing II NSG 229 7 **Transition to ADN NSG 195 4 Medical Microbiology BIO 225 4 Spring Semester – Year 2 Pediatric Nursing NSG 213 3 Medical Surgical Nursing III NSG 239 6 Heritage/Humanities Heritage/Humanities Course 3 Total Credit Hours 62 - 66 ** Taken by Licensed Practical Nurses who meet specific program requirements

In addition to the sequence of courses described, there are some special advising considerations that must be followed when students are considering pursuing the AAS degree in Nursing.

➢ Completion of the nursing program will meet the KCTCS graduate requirement of digital literacy. ➢ Students must demonstrate proof of active status on the Medicaid Nurse Aide Registry, or demonstrate equivalent experience within 1 year, of beginning nursing courses. ➢ A letter grade of “C” or higher is required for each nursing course, each biological/physical science course, and math course. ➢ Each course must be taken prior to or concurrent with the semester sequence in which the student is enrolled in nursing. ➢ Successful completion of each course in each semester is required before the student may progress to the next semester of the program. ➢ A cumulative GPA of 2.0 must be maintained. ➢ Failure to complete the outlined sequencing of the courses and curriculum will result in withdrawal from the nursing program.

Descriptions of Courses/Nursing Courses

A description of courses offered at Bluegrass Community and Technical College can be found online at https://kctcs.edu/education-training/course-catalog/2019-2020-kctcs-catalog.pdf or in a published copy of the catalog found in the Records Office. In addition, the description of nursing classes can be found online at the Associate Degree Nursing program website at https://bluegrass.kctcs.edu/education-training/programs/nursing/associate-degree- nursing/index.aspx

Structure of the Nursing Courses

All Nursing courses contain both lecture and clinical components. Didactic content is team taught, on both campuses by full time faculty. Campus labs are also taught by full time faculty. Clinical is taught by fulltime faculty and part time adjunct faculty.

As part of the clinical component of the course, students will have one hour per week in campus lab, where various skills are presented and then in small groups will be assigned an additional hour each week to practice the skill with faculty supervision. The student learning outcomes for the course are achieved through a variety of planned educational activities that are described in the course outline for each course. Students evaluate their progress as defined by these student outcomes

A team approach to teaching is the underlying foundation of all the nursing courses. The nursing faculty members in each course collaborate with the course leader to carry out the various activities of the course and to assist the students in meeting their learning outcomes

Advising

Bluegrass Community and Technical College provides quality academic advising to all students; however, students are ultimately responsible for knowing the requirements of their particular academic program, selecting courses that meet those requirements, monitoring their progress toward graduation, scheduling and keeping academic advising appointments, and being prepared for advising sessions.

Upon declaration of acceptance in a student’s SAS account, the student’s academic program plan will be changed to nursing. Each student will be assigned a nursing advisor. It is the student’s responsibility to schedule advising appointments during the assigned registration periods prior to registering for any classes.

Class Scheduling Students should follow the procedures outlined for online class registration in BCTC’s Schedule of Classes each semester. The website for online registration is https://bluegrass.kctcs.edu/education-training/class-schedules/index.aspx Information such as the academic calendar, how to register, tuition and fees, student email, Peoplesoft account access, dates and processes for add/drop, early withdrawal from class, and refund deadlines as well as final exam schedules can be retrieved from this site.

Code of Student Conduct

All rules and regulations set forth in the current edition of the KCTCS Code of Student Conduct will be followed in the ADN Program. It is the student’s responsibility to down load a current copy of the KCTCS Code of Student Conduct https://kctcs.edu/current-students/media/kctcs- student-code-of-conduct-revised-8-18.pdf

Complaints/Grievances If any student has concerns regarding their experience with the program, including but not limited to, grading policies, accommodations, etc., the student retains the right to pursue an informal and/or formal discrimination grievance. Students are encouraged to discuss any issues, problems, or difficulties promptly and candidly with the course leader of the nursing course in which they are enrolled. If the complaint is not resolved to the satisfaction of the student, the student should discuss their concerns with the program coordinator. If the complaint is not resolved to the satisfaction of the student after meeting with the program coordinator, the student should meet with the assistant dean. If the grievance is not resolved to the satisfaction of the student through the informal grievance procedure, the student may file a formal appeal according to the KCTCS Student Code of Conduct.

The Academic Ombud helps resolve academic disputes between students and faculty or administration. When a student is unable to resolve a grievance or complaint through usual means, the Ombud may be able to expedite the process or advise the student about the proper procedures to follow. Problems include, but are not limited to, violation of students’ academic rights, unfair teaching and grading practices, cheating and plagiarism, and discrimination and harassment. https://bluegrass.kctcs.edu/current-students/academic-resources/academic-ombuds.aspx

Family Educational Rights and Privacy Act

The Family Educational Rights and Privacy Act of 1974, commonly known as FERPA, or the Buckley Amendment, is a federal law governing the privacy of educational records. FERPA gives students five rights:

• The right to inspect and review educational records

• The right to seek the amendment of educational records • The right to consent to any disclosure of those records • The right to obtain a copy of the school's Student Records Policy • The right to file a complaint with the FERPA Office in Washington, D.C.

What is an Educational Record?

FERPA defines an educational record as: "Information about a student that is maintained by the university as part of the educational process."

The following are not considered educational records:

• Private notes of an individual faculty or staff member ("sole possession" records) • Campus police records • Medical records • Aggregate (statistical) data that contains no personally identifiable information about any student.

Be aware, though, that contents of an educational record may appear in a variety of forms, such as:

• A handwritten document • Computer file • Computer screen • Printout • Verbal Exchange

Directory Information

FERPA allows colleges and universities to classify part of the educational record as "directory information". Normally, schools may disclose directory information without the written consent of the student. Directory information includes:

• Name • Address (including email) • Telephone listing • Photographs • Date and place of birth • Major • Participation in officially recognized activities and sports • Weight and height of members of athletic teams • Dates of attendance • Degrees and awards achieved • Most recent previous educational institution attended by student

Suppressed Directory Information

Students have the right to require that directory information about them not be disclosed. To activate a privacy flag, a student must submit a request in writing to the Registrar's Office. Please note that students who request suppression of directory information usually do so for serious, even dangerous, circumstances. It is critical that their absolute privacy be protected in every situation. If a student has elected to suppress all directory information, the college will respond to all inquiries as follows:

"There is no information available for any student by that name."

Non-Directory Information

Non-Directory Information is any educational record not classified as directory information (this includes grades, social security number, GPA, etc...). This private information may not be released to anyone, including parents of the student, without written consent from the student. College staff may access this information only if they have a legitimate need to use it to fulfill official duties. There are some legitimate exceptions to this rule, however. Directory and non- directory information may be released without the student's consent in the following instances:

• Officials or faculty of the college who have a legitimate educational interest (need to know to fulfill official responsibilities) • Officials of other schools or school systems in which the student seeks to enroll • Certain Federal and State Education Authorities • Accrediting and University-approved testing agencies • Appropriate parties in connection with an emergency when the immediate health or safety of the student is threatened • Persons representing an officially-related judicial order or lawfully issued subpoena • Institutions from which the student is receiving financial aid

Student Organizations

In addition to academic success, BCTC strives to offer opportunities that enrich the college experience. We encourage you to find your passion and get connected to your campus community! Below are options to do just that: https://bluegrass.kctcs.edu/about/student- life/activities-organizations/index.aspx

Program Website

The Associate Degree Nursing Program’s website is the primary source of information for the program and may be accessed at: https://bluegrass.kctcs.edu/search.aspx?q=associate+degree+nursing

Student Support Services

The Disability Support Services (DSS) office at Bluegrass Community & Technical College provides a full range of services to more than 500 students each year who have disabilities. DSS goals are to ensure equal access and full participation for persons with disabilities in post- secondary education as outlined by Section 504 of the Rehabilitation Act of 1973.

To schedule an appointment with a Disability Support Services staff member on any BCTC campus, call (859) 246-6534, (859) 246-6753 TTY (Toll Free).

To contact a DSS staff member directly by phone or email, please see the college directory. Under "department", select "Student Affairs - Disability Support. https://bluegrass.kctcs.edu/about/student-life/accessibility-services/index.aspx

Campus Laboratory

The campus laboratory contains the supplies and equipment that are necessary to develop the psychomotor skills necessary to enter the clinical arena. Leestown and Lawrenceburg campus each has one full time nursing faculty responsible for coordinating the campus labs, skills practice and remediation schedules “Open” lab times and appointments to have individual assistance are available.

Learning Resource Center

The College is fortunate to have a library/learning resource center located in Building A, Room 112 at the Leestown Campus. The Learning Resource Center subscribes to several electronic nursing journals. Librarians are available to assist students with requests and needs. https://bluegrass.kctcs.edu/current-students/student-resources/library/contact-us.aspx

Background Check

All students in the ADN Program are required to submit a criminal background check as a prerequisite for clinical practice. Students who fail to submit to a background check will be ineligible for clinical placement. Those who do not pass the background check are afforded the opportunity to explain the circumstances surrounding the situation, but if the student is ineligible for clinical placement he/she will be given the opportunity to withdraw from the Program.

The criminal background check will include but is not limited to: Social Security Fraud; Criminal Background; Sex Offender Search; Abuse Registry; OIG Medicare Sanctioned List; Licensure, Certification and Designation.

Situations in which a person does not have a satisfactory background check will be reviewed by the program administrator on a case-by-case basis. Convictions involving the following crimes,

but not limited to these crimes may serve to disqualify a person from participating in required clinical learning experiences.

➢ Any felony, whether listed below or not ➢ Crimes involving drugs, including but not limited to unlawful possession or distribution ➢ Crimes of physical violence to include any type of abuse (child, spousal, or of the elderly), abduction such as kidnapping, manslaughter, murder, robbery, sexual crimes, possession of a restricted fire arm or any related weapons offenses, assault and battery ➢ Conviction of a misdemeanor related to abuse, neglect or exploitation

A private company approved to perform Criminal Background Checks will conduct the background check. The cost of the background check will be borne by the student.

HIPAA

The U.S. Department of Health and Human Services issued the Privacy Rule to implement the requirement of the Health Insurance and Portability Act of 1996 (HIPAA). This Privacy Rule addresses the use and disclosure of individuals’ protected health information. The goal of HIPAA is to assure that individuals’ health information is properly protected while allowing necessary access to health care providers directly involved in their care. All students are required to complete HIPAA training prior to beginning their first clinical rotation. HIPAA training instructions will be provided to each student. Students not meeting this requirement will not be allowed to attend clinical in the clinical facility. Any HIPAA violation could result in a substantial fine as well as subsequent dismissal from the program.

Graduation Audits

It is the student’s ultimate responsibility to assure that (s)he is taking the correct courses to progress to graduation.

Students are advised to see a nursing faculty each semester to be certain that their courses meet the requirements. At the time of the graduation audit, a student may be precluded from graduation because (s)he does not meet the curriculum requirements.

Application for a Degree

The graduation ceremony takes place at the conclusion of the spring semester. Students must file an application for a May degree (Associate in Applied Science) by the date published in the academic calendar which can be retrieved at https://bluegrass.kctcs.edu/current- students/academic-resources/graduation.aspx

Approximate Costs Associated with the ADN Program

Faculty want students to know the costs associated with entering school each year. This is a list of approximate costs associated with entering and completing the Associate Degree Nursing program at Bluegrass Community and Technical College. All costs are subject to change without notice.

Approximate Costs to Students

ITEM COST 1. Tuition - per semester (Kentucky resident) $174 per credit hour plus (as of fall 2020) $8.00 per credit hour student fee 2. Uniforms and Accessories Approx.$175.00 3. Nursing Books $1100.00 - $1200.00 4. Laptop for testing $300 – 800.00 (Chrome notebooks not allowed) 5. CPR for Health-Care Providers or Red $ 50.00 Cross CPR for the Professional Rescuer* 6. MMR (2)* See Health Care Provider 7. TB Skin Test (PPD)* or Quantiferon See Health Care Provider 8. Hepatitis B Series* See Health Care Provider 9. Varivax Series or Titer* See Health Care Provider 10. Influenza vaccination $25.00 11. Tdap vaccination $80.00 12. Liability Insurance* Included in tuition fee 13. Castlebranch account (Background check, $100.00 drug screen and immunization tracker) 14. Nursing Skill pack $50.00 – 150.00 each semester 15. Examsoft testing software $78.00 annually in fall semester 16. ATI resource including Live Review course $589.50 for 1st semester/ 559.50 remaining semester

(* Validation of each of these items is due by the first day of class. (Some facilities have additional immunization requirements that must be met in order to participate in clinical activities at the site.)

APPROXIMATE FOURTH SEMESTER EXPENSES

Fourth semester expenses include graduation fees, license application, Nursing pin, photograph/class picture and pinning ceremony. Pinning ceremony expenses are usually collected and utilized by class consensus. They include, decorations, venue rental, and refreshments, etc.

Intellectual Property/Taping of Lectures

Class lectures are the intellectual property of the lecturer and are protected by copyright law. Students may not tape lectures for distribution or distribute transcripts of lectures. Student may, with instructor permission, record lecture for personal use.

Liability Insurance

Students are billed for limited professional liability insurance with their tuition bill each fall and spring semester when they are enrolled in the Nursing Program. Payment is included in fees for classes and is non-refundable.

Use of Electronic Devices and laptops

All students are required to purchase a hand held wireless device in order to download required e-resources which will be used in the clinical setting. During lecture all communication devices must be in “silent” mode. Laptops are used at the Leestown campus to take course exams.

Class Attendance

Lecture attendance is expected for the entire class time. Students must inform the Course Leader if they will miss an exam. If an exam is missed due to an excused absence, the points for that exam will be evenly distributed over the completed exams. For example, if the course has 4 exams worth 100 points each for a total of 400 points. A missed exam will result in a total of 3 exams calculated for the total 400 exam points. This policy does not apply to the HESI or the Final Exam – both of those are mandatory.

Textbooks and Course Outlines

Each course has a required set of texts and materials to support the educational learning objectives. The required and recommended texts and materials are identified in the course outline. The texts are selected by the faculty members with input from students.

Course Outlines

The course outline is reviewed and updated on a regular basis to determine currency and appropriate reflection of learning objectives to support student outcomes for the course. The course outlines are organized to reflect the conceptual framework of the program and the sequence of educational outcomes related to achievement of overall program outcomes.

In each course outline, there will be the description of the course, and the pre-requisites will be listed. Next, the course outline will specify the course objectives the students will achieve for successful completion of the course. To facilitate learning in the course, the course is divided into units. Each unit will have overall objectives that direct the learning outcomes for that unit. Finally, there will be learning activities to help the student achieve the content and clinical objectives

Grading Scale

The final grade will be determined according to the following scale:

A = 90 - 100% B = 83 - 89 C = 77 - 82 D = 67 - 76 E = below 67%

A letter grade of C, satisfactory evaluation of course skills, satisfactory performance in the clinical area according to the Clinical Performance Review Evaluation Tool. Final grades of .50 will be rounded up. For example, a final grade of 76.50 will be recorded as a 77%

Medication Calculation Competency

Students must successfully complete a dosage calculation exam (90% correct) after a maximum of three (3) attempts. Students not meeting this requirement will be dismissed from the program.

Clinical Requirements

Overall Clinical Evaluation

Students will be evaluated in the clinical area according to established criteria (see Clinical Performance Review Evaluation Tool). A student must earn a satisfactory in the clinical area as documented on the Clinical Performance Review Evaluation Tool provided in the outline of each nursing course with a clinical component. This includes satisfactory demonstration of the essential nursing skills designated in the course.

The following criteria will form the guidelines for the student's performance in all client-care situations:

1. The problem-solving approach will be used. 2. The client must not be placed in physical jeopardy. 3. The client must not be placed in emotional jeopardy. 4. The principles of medical asepsis must be maintained at all times. 5. The student must perform in an ethical and professional manner.

Clinical evaluation of the Preceptorship will be completed by the faculty member in collaboration with the preceptor.

Should a student fail to comply with any of these guidelines at any time during the provision of care in a clinical setting, the clinical faculty will report the performance of the student to both the Course Leader and Program Coordinator. After consultation with the course faculty and Program Coordinator, an unsatisfactory grade in clinical performance may be assigned to the student at that time. Students who have been assigned an unsatisfactory grade in clinical performance will not be allowed to return to the clinical setting for client care and a letter grade of E will be assigned for the course.

Adherence to the criteria for Student Guidelines for Professional Appearance is required. Students are advised that working the night before clinical may jeopardize safe nursing care. Students will be sent home for having an unprofessional appearance or exhibiting any signs of fatigue. At the discretion of the faculty, a student may be required to change clinical groups.

Students are responsible for their own follow-up care in the event of any "on-the-job" injury such as a needle stick. Hospital workman's compensation does not cover students during their learning experience. Students must notify their instructor immediately of any injury or incident regarding self or patient in the clinical setting.

Clinical Attendance

Clinical Laboratory: Attendance is essential in order for students to achieve the clinical objectives of the curriculum. In case of an absence in the clinical area, each student must personally notify faculty prior to the absence. Tardiness will affect clinical evaluation and may result in unsatisfactory clinical performance. Students should notify the clinical faculty in case of tardiness prior to the assigned clinical time. In the event of a clinical absence, arrangements will be made by the course leader for a make-up. The student is accountable for achievement of the clinical objectives.

Campus Laboratory: Attendance and promptness in campus laboratory are also required. Each hour of absence in the campus lab is equivalent to one (1) hour clinical laboratory absence. Any absences from campus lab or skills practice must be made up.

Clinical Skills

Each student must demonstrate satisfactory performance of the nursing skills according to critical criteria designated in the course outline of each course. Additionally, students are expected to maintain competency in previously learned skills. Referral to the lab for a previously learned skill will constitute an instructor intervention. Any student who receives an unsatisfactory evaluation on a new skill or previously learned skill must remediate with laboratory faculty and will be evaluated a second and final time by a different faculty member designated by the course leader. Failure to obtain a satisfactory evaluation on the second performance indicates the student is unsafe to practice nursing, resulting in an unsatisfactory

grade for clinical performance as specified in the syllabus of each nursing course. All critical criteria and essential skills are located in Part V of this manual.

Immunizations/CPR Requirements

Students enrolled in the Nursing Program must submit evidence of immunizations as required by the clinical agencies. Students may access this information on the Nursing Program’s website at https://bluegrass.kctcs.edu/education-training/programs/nursing/associate-degree- nursing/associate-degree-nursing-program-immunization-information/index.aspx

Dress Code/Uniform

Uniforms may be purchased anywhere that have the required style and color that matches the criteria. If in doubt, get faculty approval before removing labels.

UNIFORM:

BCTC Patch: The patch is positioned on the left sleeve of the lab jacket and uniform sleeve, approximately 2 inches below the shoulder seam. Patches are available in the bookstore Pants: Must be straight legged, without cuffs. No Capri pants and no sweats or low (cargo type) pockets. Shoes: Clean, black leather, closed toe. Only to be worn for clinical experiences.

Name Pin: Name pins are available from the bookstore. They must be ordered at least two weeks in advance. The pin includes your first and last name and indicates that you are a student nurse. Hair: Clean and neat. Must be tied back or pinned up and off the collar. Only plain barrettes may be used, without ornamentation. Nails: Clean and neatly trimmed, with the length even with the ends of fingertips. No artificial nails, nail polish of any type, or nail jewelry may be worn. Jewelry: You must have a watch with a second hand. Only one pair of small stud type earrings in the lower lobe of the ear is permitted. Some agencies will permit wedding bands. No other jewelry is permitted, including visible body piercings. Accessories: Bandage scissors, ball-point pen with black ink, small note pad, and stethoscope. Jackets: Jackets are not to be worn while providing direct patient care. Jackets are worn to and from clinical. Other: No tobacco products. No chewing gum. All tattoos must be covered. If needed, students are allowed to wear a clean, solid white (no logo), short-sleeved, t-shirt under their top.

Clinical Sites

A variety of clinical settings is used to facilitate the student learning outcomes. Some regularly used agencies include:

➢ Bluegrass Regional Psychiatric Services, Eastern State Hospital ➢ Cardinal Hill Rehabilitation ➢ Central Baptist Hospital ➢ Ephraim McDowell Hospital ➢ Frankfort Public Health Department ➢ Frankfort Regional Medical Center ➢ Georgetown Community Hospital ➢ Good Samaritan Hospital/ University of Kentucky ➢ James B. Haggin Memorial Hospital ➢ Clark Regional Medical Center ➢ Pattie A. Clay Regional Medical Center ➢ Ridge Behavioral Health System ➢ Rockcastle Hospital and Respiratory Care Center, Inc ➢ Kentucky One Health; Saint Joseph Healthcare System ➢ University of Kentucky Medical Center ➢ Veteran Administration Hospital

In addition to these sites, the Associate Degree Nursing Program has Memoranda of Agreement with several long-term care facilities, ancillary facilities, and community health agencies. Students are expected to provide their own transportation to the clinical site. All agencies require some form of orientation to their facility and in addition, have specific immunization requirements, CPR certification, HIPAA compliance orientation and Criminal background checks. Sites are evaluated annually for accreditation and whether they are appropriate to meet program learning outcomes.

Withdrawal from the ADN Program

Students who wish to withdraw from the ADN Program must adhere to the guidelines specified in the academic calendar as well as those published in the course syllabus. Each student who wishes to withdraw must arrange for a conference with the Program Coordinator prior to withdrawal.

Readmission to the ADN Program

A student who withdraws from a nursing course or earns lower than a grade of ‘C’ in the course or any biological science course will be dropped from the Associate Degree Nursing Program. Students who wish to apply for readmission will have to apply two months prior to the start of classes as published in the BCTC Schedule of Classes. Readmission will be dependent upon available resources and meeting criteria for admissions. Two letters of faculty support, at least one from a full time faculty, must be submitted with the application. These letters should be addressed to the program coordinator.

Part II – Concept Maps and Care Plans

Nursing Concept Map Grading Rubric

Description: Satisfactory (S): 18-24 with no points in the 1 or 2 point columns. Needs Improvement (NI): 12-17, or any score with points in the 1 or 2 point columns. Unsatisfactory (U): <12

Satisfactory Needs improvement < 2 areas Needs improvement > 2 areas Unsatisfactory Assessment 4 3 2 1 data • Adequate subjective and objective • Inadequate assessment data • Minimal assessment data • Irrelevant assessment data assessment data • Incomplete CC • Missing cc • Assessment data doesn’t support nursing • Recorded client’s chief • Assessment data not grouped • Assessment data not grouped diagnosis complaint/reason for seeking healthcare appropriately in one category appropriately in two categories • Assessment data not grouped appropriately • Assessment data grouped appropriately. in > two categories

Identified 4 3 2 1 nursing • Accurate NANDA approved nursing • One incorrect NANDA nursing • Two incorrect NANDA nursing diagnosis • > 2 incorrect NANDA nursing diagnosis diagnosis diagnosis diagnosis • Missed two nursing diagnosis • Missed > 2 nursing diagnosis • Identified all possible nursing diagnosis • Missing one nursing diagnosis • Two nursing diagnosis not prioritized • > 2 nursing diagnosis not prioritized • Accurate prioritizing of nursing diagnosis • One nursing diagnosis not correctly correctly • Medical diagnosis, medications, prioritized correctly • Missing many elements of supporting • Minimal supporting data interventions, diagnostic testing, lab • Missing some elements of data work supports nursing supporting data diagnosis(supporting data) Planning/ 4 3 2 1 outcomes • Appropriate and measurable outcomes • Inaccurate outcome • Two inaccurate outcomes • Outcomes are inaccurate and not for two nursing diagnosis • Outcome not measurable • Two outcomes not measurable measurable Intervention 4 3 2 1 s • Identified all possible nursing • Missing 1 or 2 nursing • Missed 3 nursing interventions • Missed > 3 interventions for both interventions for two nursing diagnosis interventions. • 2 or 3 nursing interventions not • > 3 nursing interventions not individualized • individualized • 1 or 2 nursing interventions not individualized individualized Evaluation 4 3 2 1 • Documented appropriate patient • Inaccurate response for 1 – 2 • Inaccurate response for 3-4 • Inaccurate response for > 4 interventions response to each nursing intervention interventions interventions • Accurate overall evaluation of client’s • Inaccurate overall evaluation of • Inaccurate overall evaluation of two progress towards outcome for each one outcome. outcomes. nursing diagnosis Analyze 4 3 2 1 relationships • Accurately documented all relationships • Missed one relationship between • Missed two relationships between • Relationships between diagnosis not made between nursing diagnosis diagnosis diagnosis

BLUEGRASS COMMUNITY & TECHNICAL COLLEGE ASSOCIATE DEGREE NURSING PROGRAM

GUIDELINES FOR GRADING OF CONCEPT MAPS/NURSING CARE PLANS

"S" = Satisfactory "NI" = Needs Improvement "U" - Unsatisfactory

I. Assessment

A. Demonstrates collection and organization of data from a variety of sources in order to evaluate the health status of a client in preparation for forming a nursing diagnosis.

B. Grading criteria 1. Records data in an organized and systematic manner. 2. Includes all data necessary to formulate an accurate nursing diagnosis and to plan safe care (creates a foundation for subsequent phases of the nursing process). a. Includes accurate objective and subjective data. b. Utilizes all available sources: chart, physical assessment, nursing history, interview, etc. 3. Documents assessment of all of the client's Basic Human Needs (those covered to-date in lecture).

II. Nursing Diagnosis

A. Written as a statement that describes an actual or potential client response to a health problem. 1. Is not a restatement of the medical diagnosis. 2. Reflects analysis and interpretation of assessment data. 3. Reflects evidence of the student's beginning ability to prioritize client needs.

B. Grading criteria 1. Identifies/labels Basic Human Need to which the nursing diagnosis relates. 2. Correctly states diagnosis according to NANDA classification system. 3. Considers all available data. 4. Is written as a statement of the problem and an identification of its etiology. a. Uses terminology "related to" rather than "due to" ("due to" implies cause.) b. Is a statement of only one problem. 5. Is specific and brief.

III. Planning

Goal/Outcome A. Written as a statement of client behaviors or responses that the nurse anticipates should result from nursing care. 1. Relates directly to the nursing diagnosis. 2. Has one goal/outcome per diagnosis.

B. Grading criteria 1. Is client centered. 2. Is specific and includes a time frame. 3. Is observable and/or measurable. 4. Includes a subject plus a verb plus criteria of performance. Example: Client will ambulate the length of the hallway unassisted by 1100 on 10/15.

Plans/Interventions A. Lists nursing strategies or actions selected to assist the client to meet the established goals and expected outcomes.

B. Grading criteria 1. Are realistic from client and student perspectives. a. Are within student's ability to implement and appropriate for individual client. b. Are consistent with client's overall plan of care. 2. Are individualized to client. 3. Are specific and concise: WHO will do WHAT, WHERE, WHEN, HOW and HOW MUCH. 4. Are utilized to provide safe and therapeutic care. 5. Are inclusive. a. Include independent, interdependent, and dependent actions/orders. b. Include at least 4 interventions for promoting achievement of each goal 6. Must include "in your own words" rationale for selecting nursing intervention which is based on accurate, documentable scientific principles. 7. Prioritizes plans in order of importance.

IV. Implementation

A. Indicates initiation of nursing interventions to achieve the goals and expected outcomes. 1. Relates directly to the plans, goal/outcome, nursing diagnosis, and assessment data base. 2. Is not a repeat of the plan; does not include everything the student did that day. 3. Includes further data collection (reassessment) appropriate for the fundamental student's current level of expertise.

B. Grading criteria 1. Explains what the student, client, family, etc. did to facilitate implementation of the plan. 2. Includes how the plans were carried out. 3. Includes client response: words, actions, VS, etc.

V. Evaluation

A. Measures client's response to nursing actions and progress toward achieving designated goal/outcome. 1. Includes reassessment at a fundamental level. a. Reflects gathering of additional or new data. b. Compares gathered data with the outcomes and makes a judgment about client's progress toward achievement of desired outcomes. 2. Relates directly back to goal/outcome - not the plan or implementation.

B. Grading criteria 1. Evaluates and documents the goal/outcome as being met, partially met, or unmet. 2. Documents why the goal/outcome was met, partially met, or unmet. 3. Indicates re-planning or modification/revision of plans, if necessary.

PART IV ESSENTIAL SKILLS/CRITICAL CRITERIA

KENTUCKY COMMUNITY AND TECHNICAL COLLEGE SYSTEM ASSOCIATE DEGREE NURSING – MODULAR TRACK

ESSENTIAL SKILLS - CRITICAL CRITERIA

NURSING 101 – NURSING PRACTICE I

In addition to the critical criteria identified for each skill, the following will be used in the evaluation of the student’s performance:

*Denotes individual faculty check-off.

*General Principles 1. Personal protective equipment must be utilized and appropriate medical asepsis must be maintained at all time 2. Correct supplies/equipment must be assembled and organized 3. Client instruction must be provided 4. The client must not be placed in physical jeopardy 5. The client must not be placed in emotional jeopardy 6. Pertinent information must be reported and/or documented *Safety Practices 1. Verifies care/order for client 2. Performs hand hygiene before and after preforming any client care or handling supplies 3. Verifies facility policy and procedure and assembles appropriate equipment/supplies 4. Consults manufacturer’s recommendations when equipment is involved 5. Knocks on the client’s door 6. Identifies client using two identifiers 7. Notes overall condition of the client 8. Explains procedure to the client and provides for privacy 9. Elevates bed to promote good body mechanics 10. Dons PPE if indicated 11. Upon completion, lowers bed, applies side rails according to the client’s care plan, places call system within reach 12. If any abnormal findings are present, reports findings to charge nurse immediately

which jeopardizes the emotional or physical well-being of the client will result in an unsatisfactory grade for the skill.

*Standard Precautions 1. Standard Precautions: Tier One: to be used with all clients a) Verifies rationale for standard precaution: Tier 1 b) Identifies, dons, & doffs the appropriate PPE c) Performs hand hygiene prior to don and doff PPE d) Documents and reports pertinent observations and findings

2. Standard Precautions: Tier Two Transmission Based Precautions: Precautions used with specific types of clients (airborne, droplet, contact) a) Verifies rationale for standard precaution: Tier 2 b) Identifies, dons, & doffs the appropriate PPE for each type of Tier 2 precaution c) Performs hand hygiene prior to don and doff PPE d) Documents and reports pertinent observations and findings

* Physical Assessment Health History 1. Demographics – Name, address, sex, age, birth date, marital status or significant other, religion, race, education, occupation, hobbies, and significant life events 2. Health History - Smoking, heart disease, alcohol use, drug use or abuse, surgeries, injuries, childhood diseases, immunizations, hypertension, diabetes, arthritis, seizures, cancer, emotional problems, transfusions, drug/food allergies, perception of health/illness, lifestyle, hygiene, eating habits, health practices 3. Family Medical History - Includes history of heart disease, substance abuse, diabetes, arthritis, cancer, emotional problems 4. Current Situation - Chief complaint, reason for seeking help 5. History of the Present Illness – Location and duration of the present problem, aggravating/alleviating factors, associated symptoms, effect on lifestyle, coping measures, review of body systems 6. Medications - Prescribed, occasional, over the counter, and herbals Vital Sign Evaluation 1. Verbalizes factors affecting vital signs of the older adult 2. Verbalizes effects of ethnicity, activity/exercise, and body structure on the vital signs of an adult 3. Verbalizes situations when vital signs are to be measured 4. Identifies which elements of the vital signs that can be delegated to the UAP and when the licensed nurse needs to perform the vital signs Temperature 1. Verbalizes normal range/s of temperature for the adult client 2. Determines route of temperature measurement based on client condition 3. Demonstrates temperature measurement using a variety of devices: electronic thermometer: axillary, rectally, tympanic, temporal artery

4. Verbalizes general physiological processes that create heat production or heat loss which result in temperature variations 5. Identifies independent nursing interventions that affect thermoregulation 6. Documents temperature measurement including additional collaborative assessment data if present (flushing, warm skin, diaphoresis, etc.)

Peripheral Pulse 1. Verbalizes normal range/s of pulses for the adult client 2. Obtains heart rate (pulse) based on assessment needs including rate, rhythm, strength and equality; temporal, carotid, apical, brachial, radial, ulnar, femoral, popliteal, posterior tibial, dorsal pedis 3. Verbalizes factors influencing pulse rate 4. Verbalizes alterations in pulse rate (for example: bradycardia, tachycardia) 5. Verbalizes that in the event of a dysrhythmia (regularly irregular or irregularly irregular), the student would reassess the pulse by performing an apical pulse 6. Reports any unanticipated irregularities immediately 7. Documents findings utilizing descriptive medical terminology (for example, bounding, thready, 0-4 scale, and equality)

Vital Signs - Respiration 1. Assesses respiration as to rate, depth, and rhythm 2. Identifies alterations in breathing patterns (bradypnea, tachypnea, hyperpnea, apnea, dyspnea, hyperventilation, hypoventilation, Cheyne-Stokes, Kussmaul’s, Biot’s) 3. Verbalizes acceptable ranges of respiratory rate 4. Verbalizes factors that may affect character of respirations 5. Documents findings utilizing descriptive medical terminology Vital Signs – Blood Pressure 1. Identifies preferred method of obtaining blood pressure based on client condition (i.e. manual or electronic) 2. Selects appropriate cuff size for the area to be utilized (upper arm, forearm, thigh, etc.) and states rationale for adequate cuff measurement and placement 3. Selects site of blood pressure measurement as determined by the client’s condition and the rationale for the blood pressure measurement (i.e. B/P abnormalities, presence of casts, etc.) 4. After positioning client and placing cuff, locates pulsation of artery and places bell/diaphragm of stethoscope on the pulse 5. While inflating the cuff, raises the gauge reading of the manometer 30 mm Hg above the anticipated systolic pressure 6. Decreases cuff pressure gradually and smoothly, noting on the manometer the point at which the first sound is heard 7. Recognizes the muffling of sound if present 8. Notes on the manometer when the last distinct sound is heard 9. Verbalizes presence of Korotkoff sounds during auscultation of the blood pressure if distinct

10. If recheck is necessary, waits 30-60 seconds 11. Repositions and retakes according to client needs 12. Documents blood pressure measurement and reports any unexpected readings immediately

Pulse Oximetry 1. Identifies situations when pulse oximetry is indicated 2. Demonstrates or verbalizes sites to measure pulse oximetry (forehead, earlobe, bridge of the nose, digits) 3. Uses appropriate probe to obtain reading 4. Documents pulse oximetry with any collaborating assessment features, if present, such as cyanosis of the lips and mucous membrane. Functional Assessment (Inspection, Auscultation, & Light Palpation) 1. Appearance - Stage of growth and development, general health, striking features, height, weight, vital signs, behavior, posture, grooming, hygiene, communication 2. Skin – Color, consistency, temperature, turgor, integrity, texture, lesions, mucous membranes 3. Hair – Color, texture, amount, distribution, presence or absence of parasites 4. Nails – Color, texture, shape, size 5. Neurologic – Pupil reaction and size, gait and balance 6. Musculoskeletal – Range of Motion, gait, tone, posture 7. Cardiovascular – Heart rate and rhythm, central and peripheral pulses, temperature, edema 8. Respiratory – Rate, rhythm, depth, effort quality, expansion, cough, breath sounds, sputum, nasal patency 9. Gastrointestinal – Abdominal contour, bowel sounds, nausea, vomiting, ostomy type and care, fecal frequency, consistency, presence of blood 10. Genitourinary – Urine color, character, amount, odor, consistency, ostomy, external genitalia, appearance and patency of the anus 11. Reproductive – Last menstrual period, menopause, breast exam, pap & pelvic, prostate exam, testicular exam

*Administration of Medications 1. Verifies healthcare provider’s written order for medications 2. Prepares medication based on six rights: right drug, right dose, right time, right route, right client (uses two identifiers), right documentation. 3. Provides adjunctive assessment and interventions as indicated; including but not limited to verifying allergies, clinical indications, etc. 4. Administers medication according to six rights, including electronic bedside verification where available 5. Documents time, medication, dose, and route 6. Evaluates drug response and effectiveness

Oral 1. Does not alter extended released or enteric coated medications

2. Remains with client until medication is taken 3. Examines for pocketing prior to leaving the client Topical 1. Prepares area for medication 2. Applies with applicator or with gloved finger as indicated 3. Covers with dressing as indicated 4. Maintains anatomical position to allow absorption or distribution Injections 1. Uses sterile technique 2. Positions or restrains as indicated 3. Using anatomical landmarks, locates and names acceptable sites for injection 4. Selects and cleanses site for injection 5. Maintains skin contact with selected site with non-dominant hand 6. Inserts needle with bevel up if indicated, at the correct angle: 90 degree angle for intramuscular, 45 to 90 degree angle as indicated for subcutaneous, 15 degree angle for intradermal 7. Stabilizes syringe 8. Injects medication slowly and at an even rate of speed 9. Uses Z-Track method, if indicated, for IM injections 10. Withdraws needle quickly 11. Applies pressure or bandage to site unless contraindicated

Intramuscular Sites 1. Ventrogluteal 2. Vastus lateralis 3. Deltoid

Subcutaneous Sites 1. Outer aspect of upper arm 2. Anterior thigh 3. Abdomen two inches at or below the umbilicus

Note: Unless otherwise indicated by the medication’s manufacturer recommendation

Intradermal Sites 1. Inner forearm 2. Scapular region for allergy testing

*Teaching – Learning 1. Assesses client's knowledge of subject and readiness to learn 2. Reviews goals of session with client 3. Assembles materials and prepares the environment 4. Implements teaching plan, using appropriate content 5. Obtains evaluative feedback from client (summarizes content taught) 6. Evaluates effectiveness of session and documents

Breast Self-Examination 1. Explains best time to perform breast self-exam 2. Demonstrates visual inspection of breast before mirror 3. Demonstrates breast examination (standing and lying down) 4. Checks nipples and palpates axillae (circular, vertical, and wedge method) 5. Provides instructions for follow up with health care provider to clients with abnormal findings

Testicular Self-Examination 1. States time for examination 2. Demonstrates palpation technique 3. Identifies testes and epididymis 4. Provides instructions for follow up with health care provider to clients with abnormal findings

Perioperative Concepts 1. Documents client's understanding of surgical procedure and expected outcome 2. Explains legal forms and procedures to be completed prior to surgery 3. States reasons for and demonstrates to client how to move, perform leg exercises, and Coughing/deep breathing exercises 4. Clarifies clients' concerns related to postoperative pain and its control 5. Explains and completes preoperative assessment 6. Explains and conducts postoperative assessment 7. Evaluates achievement of identified outcomes

*Surgical Asepsis 1. Prevents anything that is not sterile from coming in contact with that which is sterile 2. Prepares a sterile field maintaining visual contact at all times 3. Avoids reaching across the sterile field with unsterile objects 4. Dons sterile gloves avoiding contamination

Dressings 1. Uses clean gloves to remove and discard soiled dressing 2. Assesses wound and/or dressing for appearance, drains, drainage, and odor 3. Uses sterile technique, cleanses wound from area of least to most contamination, using one swab for each stroke 4. Applies and secures dry sterile dressing

5. Cleanses urinary meatus: Female - Maintains exposure, uses anterior/posterior strokes; Male - Exposes meatus and straightens urethra, cleanses using circular motion from meatus downward 6. Uses the uncontaminated hand, inserts lubricated catheter into the urethra and obtains urine 7. Replaces foreskin over glans for the male client 8. Inflates balloon completely if using Foley catheter 9. Stabilizes tubing according to facility policy and procedure

Heat Application 1. Gathers specific equipment for type of dry/moist heat application as ordered 2. Selects proper temperature (100-115° F) or uses appropriate distance above area exposed (18-24 inches) 3. Provides protective covering when applicable 4. Applies to specific area and checks frequently

NOTE: If using commercial devices, follows the manufacturer's instructions for use

Cold Application 1. Fills container 1/2 to 2/3 capacity with chipped or cracked ice 2. Expels air and closes securely 3. Dries bag and tests for leakage 4. Provides protective covering 5. Applies to specified area and checks frequently

NOTE: If using commercial devices, follows the manufacturer's instruction for use

*I.V. Maintenance and Termination Assessment Verifies order for I.V. fluids and prescribed rate 1. Assesses site for patency and complications (infection, phlebitis, infiltration ), reporting abnormalities 2. Documents findings Termination 1. Stops flow 2. Removes intravenous device 3. Assesses site. Inspects and assures device is intact 4. Applies pressure and applicable dressing

Oxygen Administration 1. Removes articles which can produce a spark or open flame 2. Places “Oxygen in Use” signs in view according to facility policy and procedure 3. Provides for humidification of oxygen (per facility policy and procedure) 4. Sets, adjusts and maintains oxygen flow at prescribed rate 5. Secures and maintains integrity of devices used for flow of oxygen

6. Observes skin condition under delivery device frequently to prevent pressure injuries to skin

Glucose Monitoring 1. Assembles equipment and supplies 2. Calibrates equipment and performs control per facility policy and procedure 3. Selects and prepares puncture site 4. Obtains blood specimen on reagent strip 5. Processes strip according to manufacturer's instructions 6. Verbalizes expected peripheral glucose levels for adult 7. Follows facility protocol for critical values 8. Measures and documents blood glucose

Enemas 1. Verifies order for enema 2. Selects appropriate equipment for client 3. Prepares correct amount of solution assuring correct temperature 4. Drapes and positions client 5. Expels air from tubing 6. Lubricates tip 7. Inserts colon tube appropriate distance into rectum: Adult 3-4 inches (7-10 cm) 8. Holds container no higher than 12-18 inches (30-45 cm) above anus and releases clamp 9. Observes client during procedure 10. Assists client to toilet or places on bedpan 11. Documents type of enema, amount, return, and client response

NOTE: If using commercially prepared enema, follows manufacturer's instructions for use

Basic Care and Comfort 1. Evaluates environmental comfort: (room temperature, cleanliness and orderliness, bed/linens, environmental stimulation)

Therapeutic communication 1. Employs various communication techniques in communicating with consideration to lifespan, culture, sociocultural influences 2. Uses elements of professional communication

Rest and sleep 1. Assesses environment for rest & sleep according to the client’s preferences 2. Implements nursing interventions conducive to rest and sleep

Pain Management 1. Assesses pain including scale, description and effective relief measures 2. Verbalizes independent nursing interventions to address pain

3. Evaluates interventions 4. Provides adjunctive pain medication measures (pharmaceuticals), when indicated

Activity & Mobility 1. Assesses ability to perform ADLs and implement measures to maintain mobility 2. Assesses for use of assistive devices and implement measures to compensate for impairment 3. Identifies safety issues that impair activity and/or mobility

Application of Soft/Medical Physical Restraints 1. Verbalizes that restraints are only employed to ensure the safety of the client or other clients when less restrictive interventions have proven to be are ineffective, only on the written order of a qualified provider. 2. Verbalizes alternative methods that can be utilized to avoid restraints (weight and motion sensors, alarms on doors, etc.) 3. Reviews provider’s order for type of restraint including type, purpose, location and tie or duration of restraint 4. Implements and applies according facility policy and in accordance with regulatory agencies 5. Verbalizes safety checks and interventions for restraints: belt, extremity (ankle or wrist), mitten, elbow 6. Assesses for proper placement including skin integrity, pulses, skin temperature, color, and sensation of restrained body part 7. Identifies which elements of soft restraints can be delegated to the UAP 8. Removes restraint at least every 2 hours or more frequently or according to facility policy 9. Documents behaviors before restraint was applied, reasons for restraint, type, location, client understanding of restraint, prior attempts to use alternatives methods of behavior modification, evaluation time, interventions during the restraint episode, and client response

Measuring & Evaluating Intake and Output 1. Assembles appropriate measuring container(s) 2. Measures amount of fluid intake in appropriate unit of measurement 3. Measures amount of fluid output in appropriate unit of measurement 4. Verbalizes normal intake and output for the average adult client 5. Verbalizes various routes and sources of intake 6. Verbalizes various routes and sources of output 7. Identifies which elements of I & O tasks can be delegated to the UAP 8. Reports inappropriate intake and output 9. Develops a 24-hour intake plan to ensure accurate and sufficient quantity of fluid for the average adult 10. Documents intake and output data including client preferences according to facility policy

Assessing, Evaluating, and Facilitating Nutrition Needs 1. Assesses client’s ability to chew and swallow and collaborates findings to the health care team 2. Prioritizes safety needs and assignment of personnel to feed client based on assessment 3. Identifies which clients can be fed by the UAP and which clients need to be fed by licensed staff 4. Prepares client and environment 5. Verifies food on tray with prescribed diet 6. Assists client as necessary 7. Documents food and fluid intake including any special occurrences, and client response

*Management of Care 1. Provides care for one client experiencing dysfunctional health patterns 2. Documents assessment of individual needs and establishes nursing care priorities based on individual needs 3. Constructs a plan to implement nursing care to meet individual needs of the assigned client 4. Utilizes professional communications skills with verbal, non-verbal and written communications and ISBARR appropriate to the situation 5. Evaluates effectiveness of nursing care of assigned client

REFERENCE

Hockenberry, M. J. Wilson, D., & Rodgers, C. C. (2016). Wong’s essentials of pediatric nursing. St. Louis, MO: Elsevier.

Ignatavicius, D. & Workman, L. M. (2016). Medical-surgical nursing: Patient-centered collaborative care. St. Louis, MO: Elsevier

Jarvis, C. (2016). Physical examination & health assessment. St. Louis, MO: Elsevier.

National Council of State Boards of Nursing. (2016). NCLEX-RN Detailed Test Plan. Retrieved from https://www.ncsbn.org/testplans.htm

Phillips, L & Gorski, L. (2014). Manual of I. V. therapeutics: Evidence-based practice for infusion therapy. Philadelphia, PA: F. A. Davis.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2016). Fundamentals of Nursing. St Louis, MO: Elsevier.

Ricci, S. S. (2016). Essentials of maternity, newborn, and women’s health nursing. Philadelphia, PA: Wolters Kluwer.

The Joint Commission. (2016). National patient safety goals. Retrieved from https://www.jointcommission.org/standards_information/npsgs.aspx

Townsend, M. (2014). Psychiatric mental health nursing: Concepts of care in evidence- based practice. Philadelphia, PA: F. A. Davis.

Varcarolis, E. (2017). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care. St. Louis, MO: Elsevier.

ESSENTIAL SKILLS - CRITICAL CRITERIA NURSING 195 – TRANSITION TO ADN NURSING 199 – ACCELERATED TRANSITION: PN – ADN BRIDGE In addition to the critical criteria identified for each skill, the following will be used in the evaluation of the student’s performance:

*Denotes individual faculty check-off.

*General Principles 1. Personal protective equipment must be utilized and appropriate medical asepsis must be maintained at all time. 2. Correct supplies/equipment must be assembled and organized 3. Client instruction must be provided 4. The client must not be placed in physical jeopardy 5. The client must not be placed in emotional jeopardy 6. Pertinent information must be reported and/or documented *Safety Practices 1. Verifies care/order for client 2. Performs hand hygiene before and after preforming any client care or handling supplies 3. Verifies facility policy and procedure and assembles appropriate equipment/supplies 4. Consults manufacturer’s recommendations when equipment is involved 5. Knocks on the client’s door 6. Identifies client using two identifiers 7. Notes overall condition of the client 8. Explains procedure to the client and provides for privacy 9. Elevates bed to promote good body mechanics 10. Dons PPE if indicated 11. Upon completion, lowers bed, applies side rails according to the client’s care plan, places call system within reach 12. If any abnormal findings are present, reports findings to charge nurse immediately

Focused Abdominal Assessment 1. Inquire about current bowel and bladder habits, previous history, and recent changes 2. Obtains vital signs and reviews health history 3. Places client in the supine position 4. Inspects the abdomen for contour, symmetry, condition of the skin, abnormal pulsations or movement, and notes the position, shape, and color of the umbilicus 5. Auscultates the abdomen before palpation to assess bowel and vascular sounds in all four quadrants 6. Using light palpation, palpate all four quadrants of the abdomen, assessing for tenderness, distention, masses, and aortic pulsation 7. Document and report pertinent findings

Focused Integumentary Assessment 1. Inquires about current skin condition, previous history, and recent changes 2. Obtains vital signs and reviews health history 3. Places the client in a sitting or supine position 4. Assesses all visible aspects of the skin noting the color, moisture, temperature, texture, turgor, and vascularity 5. Assesses for lesions or masses on the skin 6. Assesses the scalp and hair for general condition, distribution, presence or absence of parasites 7. Assesses nails for color, condition, hygiene, while palpating for any tenderness in the nail bed or nail structure 8. Assesses mucous membranes for color, moisture, and general health 9. Documents and reports pertinent findings

2. Standard Precautions: Tier Two Transmission Based Precautions: Precautions used with specific types of clients (Airborne, Droplet, Contact) a) Verifies rationale for standard precaution: Tier 2

b) Identifies, dons, & doffs the appropriate PPE for each type of Tier 2 precaution c) Performs hand hygiene prior to don and doff PPE d) Documents and reports pertinent observations and findings

* Physical Assessment

Health History 1. Demographics – Name, address, sex, age, birth date, marital status or significant other, religion, race, education, occupation, hobbies, and significant life events 2. Health History - Smoking, heart disease, alcohol use, drug use or abuse, surgeries, injuries, childhood diseases, immunizations, hypertension, diabetes, arthritis, seizures, cancer, emotional problems, transfusions, drug/food allergies, perception of health/illness, lifestyle, hygiene, eating habits, health practices 3. Family Medical History - Includes history of heart disease, substance abuse, diabetes, arthritis, cancer, emotional problems 4. Current Situation - Chief complaint, reason for seeking help 5. History of the Present Illness – Location and duration of the present problem, aggravating/alleviating factors, associated symptoms, effect on lifestyle, coping measures, review of body systems 6. Medications - Prescribed, occasional, over the counter, and herbals

Vital Sign Evaluation 1. Verbalizes factors affecting vital signs of the older adult 2. Verbalizes effects of ethnicity, activity/exercise, and body structure on the vital signs of an adult 3. Verbalizes situations when vital signs are to be measured 4. Identifies which elements of the vital signs that can be delegated to the UAP and when the licensed nurse needs to perform the vital signs Temperature 1. Verbalizes normal range/s of temperature for the adult client 2. Determines route of temperature measurement based on client condition: electronic thermometer: axillary, rectally, tympanic, temporal artery 3. Demonstrates temperature measurement using a variety of devices 4. Verbalizes general physiological processes that create heat production or heat loss which result in temperature variations 5. Identifies independent nursing interventions that affect thermoregulation 6. Documents temperature measurement including additional collaborative assessment data if present (flushing, warm skin, diaphoresis, etc.)

3. Verbalizes factors influencing pulse rate 4. Verbalizes alterations in pulse rate (for example: bradycardia, tachycardia) 5. Verbalizes that in the event of a dysrhythmia (regularly irregular or irregularly irregular), the student would reassess the pulse by performing an apical pulse 6. Reports any unanticipated irregularities immediately 7. Documents findings utilizing descriptive medical terminology (for example, bounding, thready, 0-4 scale, and equality)

Vital Signs – Blood Pressure 1. Identifies preferred method of obtaining blood pressure based on client condition (i.e. manual or electronic) 2. Selects appropriate cuff size for the area to be utilized (upper arm, forearm, thigh, etc.) and states rationale for adequate cuff measurement and placemen 3. Selects site of blood pressure measurement as determined by the client’s condition and the rationale for the blood pressure measurement (i.e. B/P abnormalities presence of casts, etc.) 4. After positioning client and placing cuff, locates pulsation of artery and places bell/diaphragm of stethoscope on the pulse 5. While inflating the cuff, raises the gauge reading of the manometer 30 mm Hg above the anticipated systolic pressure 6. Decreases cuff pressure gradually and smoothly, noting on the manometer the point at which the first sound is heard 7. Recognizes the muffling of sound if present 8. Notes on the manometer when the last distinct sound is heard 9. Verbalizes presence of Korotkoff sounds during auscultation of the blood pressure if distinct 10. If recheck is necessary, waits 30-60 seconds 11. Repositions and retakes according to client needs 12. Documents blood pressure measurement and reports any unexpected readings immediately

4. Documents pulse oximetry with any collaborating assessment features if present such as cyanosis of the lips and mucous membrane

Functional Assessment (Inspection, Auscultation, & Light Palpation) 1. Appearance - Stage of growth and development, general health, striking features, height, weight, vital signs, behavior, posture, grooming, hygiene, communication 2. Skin – Color, consistency, temperature, turgor, integrity, texture, lesions, mucous membranes 3. Hair – Color, texture, amount, distribution, presence or absence of parasites 4. Nails – Color, texture, shape, size 5. Neurologic – Pupil reaction and size, gait and balance 6. Musculoskeletal – Range of Motion, gait, tone, posture 7. Cardiovascular – Heart rate and Rhythm, central and peripheral pulses, temperature, edema 8. Respiratory – Rate, rhythm, depth, effort quality, expansion, cough, breath sounds, sputum, nasal patency 9. Gastrointestinal – Abdominal contour, bowel sounds, nausea, vomiting, ostomy type and care, fecal frequency, consistency, presence of blood 10. Genitourinary – Urine color, character, amount, odor, consistency, ostomy, external genitalia, appearance and patency of the anus 11. Reproductive – Last menstrual period, menopause, breast exam, pap & pelvic, prostate exam, testicular exam

*Administration of Medications 1. Verifies healthcare provider’s written order for medications 2. Prepares medication based on six rights: right drug, right dose, right time, right route, right client (uses two identifiers), right documentation 3. Provides adjunctive assessment and interventions as indicated, including but not limited to verifying allergies, clinical indications, etc. 4. Administers medication according to six rights, including electronic bedside verification where available 5. Documents time, medication, dose, and route 6. Evaluates drug response and effectiveness

Oral 1. Does not alter extended released or enteric coated medications 2. Remains with client until medication is taken 3. Examines for pocketing prior to leaving the client

Topical 1. Prepares area for medication 2. Applies with applicator or with gloved finger as indicated 3. Covers with dressing as indicated 4. Maintains anatomical position to allow absorption or distribution

Injections

1. Uses sterile technique 2. Positions or restrains as indicated 3. Using anatomical landmarks, locates and names acceptable sites for injection 4. Selects and cleanses site for injection 5. Maintains skin contact with selected site with non-dominant hand 6. Inserts needle with bevel up if indicated, at the correct angle:90 degree angle for intramuscular, 45 to 90 degree angle as indicated for subcutaneous, 15 degree angle for intradermal 7. Stabilizes syringe 8. Injects medication slowly and at an even rate of speed 9. Uses Z-Track method, if indicated, for IM injections 10. Withdraws needle quickly 11. Applies pressure or bandage to site unless contraindicated

Intramuscular Sites 1. Ventrogluteal 2. Vastus lateralis 3. Deltoid

Subcutaneous Sites 1. Outer aspect of upper arm 2. Anterior thigh 3. Abdomen two inches at or below the umbilicus

Note: Unless otherwise indicated by the medication’s manufacturer recommendation

Intradermal Sites 1. Inner forearm 2. Scapular region for allergy testing

Perioperative Concepts 1. Documents client's understanding of surgical procedure and expected outcome 2. Explains legal forms and procedures to be completed prior to surgery 3. States reasons for and demonstrates to client how to move, perform leg exercises, and coughing/deep breathing exercises 4. Clarifies clients' concerns related to postoperative pain and its control 5. Explains and completes preoperative assessment 6. Explains and conducts postoperative assessment 7. Evaluates achievement of identified outcomes

Catheterization 1. Cleanses perineal area 2. Determines comfortable position and drapes for exposure 3. Opens catheter kit and applies sterile drape if appropriate 4. Organizes supplies using sterile technique 5. Cleanses urinary meatus: Female - maintains exposure, uses anterior/posterior strokes; Male - exposes meatus and straightens urethra, cleanses using circular motion from meatus downward 6. Uses the uncontaminated hand, inserts lubricated catheter into the urethra and obtains urine 7. Replaces foreskin over glans for the male client 8. Inflates balloon completely if using Foley catheter 9. Stabilizes tubing according to facility policy and procedure

NOTE: If using commercial devices, follows the manufacturer's instructions for use

NOTE: If using commercial devices, follows the manufacturer's instruction for use

Termination 1. Stops flow 2. Removes intravenous device 3. Assesses site; inspects and assures device is intact 4. Applies pressure and applicable dressing

Oxygen Administration 1. Removes articles which can produce a spark or open flame 2. Places “Oxygen in Use” signs in view according to facility policy and procedure 3. Provides for humidification of oxygen (per facility policy and procedure). 4. Sets, adjusts, and maintains oxygen flow at prescribed rate 5. Secures and maintains integrity of devices used for flow of oxygen 6. Observes skin condition under delivery device frequently to prevent pressure injuries to skin

6. Verbalizes expected peripheral glucose levels for adult 7. Follows facility protocol for critical values 8. Measures and documents blood glucose

NOTE: If using commercially prepared enema, follows manufacturer's instructions for use

Basic Care and Comfort 1. Evaluates environmental comfort: (room temperature, cleanliness and orderliness, bed/linens, environmental stimulation)

Therapeutic communication 1. Employs various communication techniques in communicating with consideration to lifespan, culture, sociocultural influences 2. Uses elements of professional communication

Rest and sleep 1. Assesses environment for rest & sleep according to the client’s preferences 2. Implements nursing interventions conducive to rest and sleep

Pain Management 1. Assesses pain including scale, description and effective relief measures 2. Verbalizes independent nursing interventions to address pain 3. Evaluates interventions 4. Provides adjunctive pain medication measures (pharmaceuticals) when indicated

Application of Soft/Medical Physical Restraints 1. Verbalizes that restraints are only employed to ensure the safety of the client or other clients when less restrictive interventions have proven to be are ineffective, only on the written order of a qualified provider 2. Verbalizes alternative methods that can be utilized to avoid restraints (weight and motion sensors, alarms on doors, etc.) 3. Reviews provider’s order for type of restraint including type, purpose, location, tie, or duration of restraint 4. Implemented and applied according facility policy and in accordance with regulatory agencies 5. Verbalizes safety checks and interventions for restraints: (belt, extremity, mitten, elbow) 6. Assess for proper placement including skin integrity, pulses, skin temperature, color, and sensation of restrained body part 7. Identifies which elements of soft restraints can be delegated to the UAP 8. Removes restraint at least every 2 hours or more frequently or according to facility policy 9. Documents behaviors before restraint was applied, reasons for restraint, type, location, client understanding of restraint, prior attempts to use alternatives methods of behavior modification, evaluation time, interventions during the restraint episode, and client response

Measuring & Evaluating Intake and Output 1. Assembles appropriate measuring container(s) 2. Measures amount of fluid intake in appropriate unit of measurement 3. Measures amount of fluid output in appropriate unit of measurement 4. Verbalizes normal intake and output for the average adult client 5. Verbalizes various routes and sources of intake 6. Verbalizes various routes and sources of output 7. Identifies which elements of I & O tasks can be delegated to the UAP 8. Reports inappropriate intake and output 9. Develops a 24- hour intake plan to ensure accurate and sufficient quantity of fluid for the average adult 10. Documents intake and output data including client preferences according to facility policy

7. Documents food and fluid intake including any special occurrences, and client response

*Intravenous Therapy - IV (Fluids and Medications)

Initiation 1. Correctly assembles intravenous system 2. Expels air from tubing 3. Applies tourniquet when appropriate 4. Selects appropriate vein 5. Releases tourniquet 6. Prepares site 7. Reapplies tourniquet when appropriate and distends vein 8. Inserts needle/catheter in vein 9. Releases tourniquet 10. Removes stylet using safety feature 11. Connects tubing to intravenous device, while stabilizing catheter 12. Initiates IV flow to maintain patency of line 13. Secures intravenous device to skin 14. Applies sterile dressing 15. Regulates and maintains intravenous flow at prescribed rate 16. Documents procedure

Obtaining Blood Specimens via Peripheral IV (Performed only upon initiation of IV Site) 1. Verifies the order and amount of specimen needed 2. Selects appropriate collection devices 3. Correctly initiates IV Access and withdraws blood from catheter, amount required for specimen 4. Connects Saline Lock Device 5. Flushes IV System with Normal Saline 6. Initiates infusion if continuous I.V.F. is ordered 7. Applies sterile transparent dressing to site 8. Correctly labels and prepares specimens for transport to the lab 9. Correctly documents procedure 10. Provides on-going monitoring

Intravenous Medication 1. Prepares medication based on six rights 2. Verifies pharmacological compatibility 3. Assesses site; verifies patency and placement of intravenous device 4. Administers intravenous medication at appropriate rate (I.V. piggyback/additives, I.V. 5. push medications 6. Provides adjunctive assessment and interventions as indicated 7. Maintains patency of intravenous device 8. Documents medications given

Infusion Devices 1. Set up infusion 2. Inserts IV tubing into infusion device 3. Sets required rate 4. Initiates infusion 5. Monitors infusion and documents

Central Line Dressing 1. Wears mask and instructs client on head position (or places a mask on the client) 2. Uses clean gloves to remove the soiled dressing toward catheter insertion 3. Discards soiled dressing 4. Assesses site and/or dressing for appearance and drainage 5. Cleans site in circular motion from catheter site to outer areas 6. Applies and secures air occlusive sterile dressing per facility policy and procedure 7. Follows the manufacturer's instructions for use of products

*Gastrointestinal Intubation 1. Positions client appropriately 2. Performs focused abdominal assessment 3. Measures tube for placement in stomach 4. Inserts lubricated tube into oral or nasal orifice 5. Advances tube to pre-determine distance and stabilizes 6. Verifies placement of tube in stomach per facility policy and procedure (check pH or obtains X-Ray) 7. Secures tube

Lavage 1. Positions client appropriately 2. Verifies placement of tube per facility policy and procedure 3. Instills solution 4. Aspirates fluid 5. Measures and assesses return

*Suctioning (Gastric) 1. Verifies placement per facility policy and procedure 2. Connects tubing to appropriate suctioning device 3. Selects correct vacuum setting 4. Measures and assesses return

*Teaching – Learning 1. Assesses client's knowledge of subject and readiness to learn 2. Reviews goals of session with client 3. Assembles materials and prepares the environment 4. Implements teaching plan, using appropriate content 5. Obtains evaluative feedback from client 6. Summarizes content taught 7. Evaluates effectiveness of session and documents

Chronic Disease Self Care 1. Recognizes strengths and weaknesses 2. Encourages verbalization of anxiety and concerns 3. Identifies support systems 4. Identifies community resources 5. Verbalizes importance of adherence to medical regime Ostomy Care 1. Demonstrates proper appliance, maintenance, and removal 2. Maintains skin and stoma integrity 3. Demonstrates proper irrigation technique when applicable

*Management of Care 1. Applies the nursing process to clinical decision-making and the management of care for a minimum of two clients 2. Documents assessment of individual needs and establishes nursing care priorities based on the individual needs of a minimum of two clients 3. Constructs a plan and implements nursing care to meet individual needs of assigned clients 4. Utilizes inter-professional communications skills with verbal, non-verbal and written communications, ISBARR appropriate to the situation 5. Evaluates effectiveness of nursing care of assigned client