COPYRIGHTS AND AMENDMENTS

COPYRIGHTS AND AMENDMENTS

All rights reserved. © 2016 Saudi Commission for Health Specialties.

This material may not be reproduced, displayed, modified, distributed, or used in any other manner without prior written permission of the Saudi Commission for Health Specialties, Riyadh, Kingdom of Saudi Arabia.

Any amendment to this document shall be approved by the Specialty Scientific Council and the Executive Council of the commission and shall be considered effective from the date the updated electronic version of this curriculum was published on the commission Web site, unless a different implementation date has been mentioned.

Correspondence: Saudi Commission for Health Specialties P.O. Box: 94656 Postal Code: 11614 Contact Center: 920019393

E-mail: [email protected] Website: www.scfhs.org.sa

Formatted and Designed by: Salem M Altamimi (SCFHS)/Manoj Thomas Varghese, CMT (SCFHS)

ii SAUDI CARDIAC NURSING DIPLOMA CURRICULUM TABLE OF CONTENTS

TABLE OF CONTENTS INTRODUCTION 1 GENERAL TRAINING REQUIREMENTS 3 PROGRAM OVERVIEW 4 PROGRAM OBJECTIVES 5 ADMISSION REQUIREMENTS 6 ADMISSION PROCESS 7 PROGRAM REQUIREMENTS 8 Vacations 8 Clinical competencies 8 TEACHING AND LEARNING METHODOLOGY 9 Case presentation guidelines 9 Clinical rotations in the hospital 10 Rotation guidelines 10 Rotation content 10 Methods of evaluation 11 Methods of assessment 11 Cognition 11 Clinical skills/Patient management 11 ON-LINE UNIVERSAL TOPICS 12 Universal Topics: First Year 12 Universal Topics: Second Year 15 EDUCATIONAL MODULES OF FIRST YEAR TRAINING 18 Module I: Foundational human anatomy and physiology of the cardiac system 18 Module II: Health promotion, prevention, and rehabilitation 19 Module III: Fundamentals of cardiac pathophysiology 20 Module IV: Cardiac nursing: Assessment, planning, and managing care 21 Module V: Cardiac pharmacology 22 Module VI: Ethics in nursing and dimensions of care 23 Module VII: Epidemiology 24 Module VIII: Biostatistics 25 EDUCATIONAL MODULES OF SECOND YEAR TRAINING 26 Module IX: Introduction to research and evidence-based practice 26 Module X: Advanced cardiac care nursing 26

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM iii TABLE OF CONTENTS

Module XI: ECG interpretation – Advanced 29 Module XII: Emotional and spiritual well-being 31 Module XIII: Evaluation of quality of care 31 Module XIV: Nursing informatics 32 Module XV: Leadership and management 33 Module XVI: Professional performance 34 ASSESSMENT 36 Continuous evaluation 36 Centralized examinations 36 Promotion examination 36 Final examinations 37 Certification 37 REFERENCES 38 RECOMMENDED READING 40 Textbooks 40 Journals 40 Web resources 40 APPENDICES 41 Appendix A 41 Appendix B 42 Appendix C 43 Appendix D 48 Appendix E 50 Appendix F 51 Appendix G 52 Appendix H 54 Appendix I 56 Appendix J 59 Appendix K 60 Appendix M 61 Appendix N 62 Appendix O 63 Appendix P 64 Appendix Q 67

iv SAUDI CARDIAC NURSING DIPLOMA CURRICULUM ACKNOWLEDGEMENTS The team’s dedication to and hard work in the completion of this program is clearly evident and highly appreciated. The team members’ expertise in the cardiac field has added to the wealth of knowledge in and the strength of the curriculum.

Thanks are also due to the Nursing Scientific Board Members for their valuable feedback and contributions. Special acknowledgment is offered to the Advanced Clinical Practice in Emergency Nursing and the Advanced Clinical Practice in Oncology Nursing programs, whose materials were used as primary references for structuring this program.

We would also like to express our appreciation to the Saudi Commission’s Continuous Training Committee members for their feedback and support throughout the development of this cardiac diploma program. We offer extra special thanks to Dr. Zubair Amin and Dr. Sami Al- Shammarri for their guidance in the modification of this program.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM v

INTRODUCTION

INTRODUCTION

Cardiac disease (CVD) remains globally the primary cause of death and defects among both men and women. In 2015, the American Heart Association’s (AHA) statistical update on heart disease and stroke declared that CVD was responsible for more than 31.9% of all deaths annually in the USA, claiming more lives than cancer and pneumonia. In Saudi Arabia, CVD accounts for 46% of deaths annually, making this the number one cause of death in the country across all age groups (World Health Organization (WHO), 2014). CVD is responsible for a substantial portion of the economic burden of health care in developed countries.

However, the incidence of CVD is decreasing, and is estimated to be potentially reduced even further by means of increased use of evidence-based medical and nursing interventions targeted at secondary prevention and the management of risks impacted by lifestyles and environmental factors (AHA, 2015).

Over the past 70 years, nurses have been integral members of care teams for patients with CVD in a wide variety of healthcare environments. Heart surgery began in 1944 with the first palliative procedure for “blue babies” (AHA, 2015). The first open heart surgery was performed in 1955 to repair a congenital defect. In the 1950s, nurses helped in developing specialized operating rooms for heart and lung surgery and cardiac catheterization laboratories (AHA, 2015).

As the science of cardiac nursing emerged, expectations of care increased among the public, patients, and healthcare professionals. Consequently, considering the challenges around CVD care and management, and the burden of keeping up with the heath care needs of Saudi Arabia’s young and growing population, such care is considered as a priority. The challenge is exacerbated by limitations in healthcare resources and workforce shortages in terms of physicians and nurses. This context provides an abundance of opportunities for cardiac nurses to contribute to the prevention and management of CVD. Given the limited number of health providers available to care for this expanding population, and the potential to utilize all members of a collaborative team to this end, it is essential for all to put the full scope of their education and qualification into practice in ensuring the health and wellbeing for all patients with CVD (AHA, 2015). Excellence in cardiac nursing requires advanced cardiac knowledge and skills with consideration of gender differences.

This document describes the curriculum of the Advanced Nursing Practice Program in Cardiac Specialization (Adult). This diploma has been created to enhance the ability of nurses to utilize evidence-based clinical judgment, to promote the dissemination of research findings, and to develop essential knowledge and skills. As an outcome of the program, nurses will be capable of delivering the highest possible quality of nursing care to meet patient’s needs in the cardiac field. Holistic patient centered care and culturally sensitive values are integral aspects of this training. Furthermore, this program will enable graduated registered nurses to deal competently with patients suffering from CVD by applying a range of competencies. These competencies reflect essential critical thinking skills, an advanced knowledge base, and a high standard of practice and professional performance during nursing care for this type of patient in Saudi Arabia.

Cardiac nurses are expected to deliver “exemplary practice,” by which they are required to perform their duties with high levels of inter-professional care, accountability, competence, and autonomy. Autonomy refers to both clinical and organizational autonomy and control over nursing practice. The autonomy of a professional nurse implies the right to exercise judgment in the healthcare team in accordance with the socially and legally granted freedom of the discipline.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 1 INTRODUCTION

To exercise judgment and take action in response to patient’s needs, cardiac nurses must demonstrate their commitment to life-long learning on the basis of on evidence-based research, which will result in the achievement of favorable outcomes in patient care and nursing practice. Recent research has shown the strong relationship between professional development and knowledge advancement among nurses and the quality of patient outcomes.

2 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM GENERAL TRAINING REQUIREMENTS

GENERAL TRAINING REQUIREMENTS

1) The trainee shall abide by the training regulations and obligations as set by the Saudi Commission for Health Specialties (SCFHS). 2) Training is a full-time commitment. The trainee shall be enrolled in full-time, continuous training for the entire duration of the program. 3) Training is to be conducted in institutions accredited for nursing training by the SCFHS. 4) Training will be comprehensive in terms of the specialties of cardiac nursing. 5) The trainee shall be actively involved in patient care with gradual progression of responsibility based on achieved competencies.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 3

PROGRAM OVERVIEW

PROGRAM OVERVIEW

This program is designed to provide an opportunity for professional nurses to develop skills in specialized practice and to upgrade their knowledge and clinical competencies for the area of cardiac nursing care based on current evidence-based practice and research standards. The program aims to prepare registered nurses to meet the health care needs of cardiac patients. The program is structured in a particular format to enable trainees to understand and apply the necessary knowledge, skills, and attitude to approach and understand current nursing issues, theories, and research in the field of cardiac nursing practice. The focus is on creating learning opportunities and exemplar case studies that contribute to quality practice environments.

The program of study aims to facilitate trainees’ personal and professional growth in cardiac nursing by enhancing their ability to think critically, to deal with adult patients with acute complex needs, to become experienced in utilizing human and material resources, and to utilize evidence-based research findings to support their clinical reasoning.

Upon completion of the program, the trainee will earn an Advanced Nursing Practice in Cardiac (Adult) Specialization. This program is offered under the supervision of the Saudi Commission of Health Specialties.

4 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM PROGRAM OBJECTIVES

PROGRAM OBJECTIVES

Upon the completion of the Advanced Nursing Practice in Cardiac (Adult) Specialization, the trainee will be able to 1) Integrate knowledge of nursing and health sciences in the care of patients with CVD; 2) Assess common risk factors that may adversely affect the physical and psychosocial well-being of adult patients with CVD; 3) Apply basic and advanced concepts in the provision of care for patients with CVD; 4) Utilize the nursing process in the care of patients with CVD; 5) Demonstrate interpersonal and psychomotor skills in implementing effective nursing care to patients with CVD; 6) Utilize critical thinking skills to improve health outcomes of patients with CVD; 7) Provide health education and counseling to patients with CVD; 8) Demonstrate the ability to manage sudden or acute deterioration in patients with CVD; 9) Apply infection control measures when caring for patients with CVD; 10) Conduct a research project in the area of cardiac care nursing; 11) Utilize an evidence-based approach in evaluating nursing practice within cardiac units; 12) apply the concept of quality improvement in evaluating nursing care; 13) manage ethical issues concerning the care of patients with CVD and their families in accordance with Saudi rules and regulations; and 14) Perform self-directed professional development activities.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 5 ADMISSION REQUIREMENTS

ADMISSION REQUIREMENTS

To be eligible to enroll in the program, the applicant must conform to the application requirements of the Saudi Council of Health Specialties, as well as: 1) Being a graduate with a Bachelor of Nursing (BSN) degree or equivalent; 2) Having completed the internship year; 3) Interviewing successfully; 4) Having a valid nursing license from the SCFHS; 5) Being prepared to study on full time basis; 6) Providing a letter from an employer allowing participation; and 7) Being physically fit.

6 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM ADMISSION PROCESS

ADMISSION PROCESS

1) All the required admission forms and certificates should be submitted electronically to the Commission’s Department of Medical Education & Postgraduate Studies for review and assessment. 2) Potential trainees will be considered in descending order based on their specialty preference and their total score in terms of the following predefined criteria set by the Executive Council:  50% allocated to the specialty comprehensive exam  30% allocated to the cumulative grade during the bachelor phase (GPA)  20% allocated to academic achievements 3) Preliminary acceptance letters will be issued by the Commission to all shortlisted applicants. 4) Applicants who are issued preliminary acceptance letters are requested to apply to any of the accredited training centers to secure a training position. 5) Once an applicant has secured a training position, s/he is required to register as a resident in the Commission before s/he may commence his/her training program. 6) Any applicant who withdraws after been shortlisted will be immediately replaced by an applicant on the waiting list prior to the start of the training program. 7) The preliminary (Commission) and final (Training Centre) admission processes are conducted using a matching system. 8) Fixed start and end dates of the admission process will be announced by the Commission. 9) A preliminary acceptance letter is valid only for the stated year and cannot be used in another year.

Note: Applicants with previous postgraduate training program may apply for advanced training positions in a Saudi Board Residency Program. The Scientific Councils have the right to accept such applicants into a higher residency level after a thorough review of their previous scientific program content and evaluation of their theoretical and practical performance. Each case will be presented individually to the Council, which will then decide the suitable level at which an applicant may join the program and/or be exempted from attending the Part 1 Exam. The Scientific Council requires Executive 1 Council approval to recommend equating more the 50% of the Saudi Board Program period.

1 For further information for Admission Requirements for Postgraduate Training Programs, refer to Saudi Board Specialties Application, Admission Criteria & Guideline Booklet, 2015, which may be accessed at http://www.scfhs.org.sa/en/MESPS/TrainingProgs/RegMechanism/Pages/default.aspx SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 7 PROGRAM REQUIREMENTS

PROGRAM REQUIREMENTS

In order to graduate from the Advanced Nursing Practice Program in Cardiac (Adult) Specialization, the trainee must fulfill the following requirements: 1) The required period for the completion of this program is not less than two calendar years. 2) The program consists of 44 weeks per calendar year, excluding examination weeks and annual vacations. A total of 88 weeks of training must be completed during the entire diploma study period. 3) A total of 48 hours of didactic and clinical hours must be completed every week. 4) Trainees may complete clinical rotations as an eight-hour shift per day, excluding a lunch break, or as a 12-hour shift, to complete a total of no more than 40 hours per week. 5) The language of instruction for the program is English.

Vacations 1) The trainee is entitled to annual leave of 30 days, in addition to a one-day leave for Eid. 2) Sick leave, maternity leave, and exceptional “emergency” leave for a period not exceeding 90 days shall be compensated for with an equivalent number of days before the trainee is awarded the Certificate of Training Completion. 2 3) Leave not utilized in due time within the year shall not be shifted to the following year. 4) The trainee may be granted special leave for scientific research purposes not exceeding seven days per training year to attend conferences, seminars, or workshop in the same field, provided the trainee presents proof of attendance at such an event. Such leave to attend an event shall be arranged with the program director no less than one month in advance.

Clinical competencies The Advanced Nursing Practice Program in Cardiac (Adult) Specialization comprises 16 modules addressing the education and training of nurses who will provide comprehensive cardiac nursing care to targeted patients. Each module covers a range of specific competencies. The clinical competencies in the program were adopted from Mosby’s online nursing skills database. Each trainee will be issued a username and a password to access Mosby’s Nursing Consult database. Each trainee is expected to perform an online competency test, the results of which will be monitored by an assigned clinical instructor. The clinical instructor will schedule a trainee for a competency check off in the nursing skills laboratory on the basis of the trainee’s score in the online test. The checklist in Appendix S is used as a tool to monitor a trainee’s competency check off.

2 For further information on leave, refer to article (6) in Rules of Procedure for Training of Saudi Board Specialties Booklet, 4th edition, 2012, which may be accessed at http://www.scfhs.org.sa/en/Reglations/Documents/Rules%20of%20Procedure%20for%20Training%20of%20Saudi%2 0Board%20Specialties.pdf 8 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM

TEACHING AND LEARNING METHODOLOGY

TEACHING AND LEARNING METHODOLOGY

A “constructive teaching” style and positive environment are encouraged within the program to enhance trainees’ learning experience and improve their retention of information. The program’s teaching and learning methodology includes to the following: 1) Interactive lectures and discussions 2) Computer assisted interactive instructional programs 3 3) Weekly reading assignments and the use of the SCFHS digital library. 4) Simulations 5) Clinical skills demonstrations 6) Self-directed learning and conferences 7) Purposeful patient clinical rounding discussion (with a multidisciplinary health care team) 8) Chart reviews 9) Group discussion of case studies 10) Clinical practicum with targeted preset learning outcomes

Clinical practicums will include: 1) Theory preceding related clinical assignments (as required); 2) Post clinical debriefing: one or two per week as required – individual work; development of nursing plans of care for selected patients; 3) Trainee log/reflective journal; 4) Preceptorship guided by SMART individualized objectives, for example,  Specific – What outcomes are we looking for?  Measurable – What are the indicators and what change is expected?  Achievable – Is the task feasible? Sufficient time and resources?  Relevant – Does meeting this objective create practical change?  Time-bound – What are the start and end dates?

Case presentation guidelines Each trainee will present a case study of a patient cared for in the clinical setting. Case presentation must include the patient’s past medical/surgical history, diagnosis, and treatment and nursing diagnosis with appropriate assessment findings and identification of optimal outcomes.

Presentations must be approximately 15 minutes in length, and the trainee is to facilitate post presentation discussion. Discussion must include a comparison of plans of care with the current American Association of Critical Care Nurses and Clinical Practice guidelines, and any other evidence- based practice (EBP) standards.

3 The SCFHS digital library provides instructors and trainees with access to a diverse range of electronic learning resources that offer full-text papers for evidence-based best practice, such as the Ovid Medical Collection, Mosby’s Nursing consult, LexiComp, PubMed Central Journal, and Up-to-date. The digital library can be accessed at http://www.scfhs.org.sa/eservices/ELibrary/Pages/default.aspx SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 9 TEACHING AND LEARNING METHODOLOGY

Clinical rotations in the hospital Cardiac care is complex and comprises stages, which may begin in the emergency room, outpatient clinic, or at home. Therefore, cardiac nursing care must be demonstrated in a range of contexts. A trainee in this program must experience as much CVD nursing care as possible cross all potential contexts, and rotation among contexts is designed to meet this goal. At the end of such rotation, a trainee should have acquired the knowledge, skills, and attitudes and demonstrate core competencies.

To this end, the recommended rotation plan must include clinical time in the following areas: 1) Adult cardiology outpatients 2) Diagnostic cardiac radiology examinations 3) Non-invasive cardiac lab 4) Invasive cardiac cath lab 5) Cardiac step down for one-day cardiac procedures 6) Recovery room post cardiac procedures 7) Emergency 8) Coronary care unit 9) Cardiac surgical intensive care unit 10) Intensive care unit (ICU) 11) Cardiac operating room

Rotation guidelines 1) Hospital rotations in the first two years are considered as one block and can be done in any sequence; therefore, any rotation can be taken at any time during the first two years after the introductory course. 2) Rotations including an inpatient setting should be done in inpatient and emergency departments. 3) In outpatient department (OPD) rotation, the trainee candidate should perform a minimum of eight clinics per week.

Note: If a training center has no required clinical rotation due to facility limitations or low case volumes, trainees may be referred to another accredited facility with the required clinical facility unit, with the prior approval and notification of SCFHS Nursing Board.

Rotation content The core content in terms of the knowledge and skills expected of cardiac nurses should be attained during appropriate hospital rotation, as described for each rotation.

10 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM TEACHING AND LEARNING METHODOLOGY

Methods of evaluation Attendance 10% Assignments 10% Clinical evaluation/OSCE 30% Quizzes 10% Final examination/Project 40%

Methods of assessment Cognition Multiple choice questions (MCQs) and extended matching items

Clinical skills/Patient management 4 1) Portfolio and logbook. 2) Case-based discussion.

4 Instructor and trainee must refer to the electronic logbook and instructions, logging in as a user at http://www.scfhs.org.sa/en/MESPS/TrainingProgs/ElectrobookCases/Pages/default.aspx. Also see, http://www.scfhs.org.sa/en/MESPS/TrainingProgs/ElectrobookCases/Pages/Instructions.aspx. To view a video tutorial, see www.youtube.com/watch?v=ZncCbDhehns www.scfhs.info/medical/Bmedical/login.php SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 11 ON-LINE UNIVERSAL TOPICS

ON-LINE UNIVERSAL TOPICS

These universal topics were developed by SCFHS as learning resources for trainees. The topics that are important for trainees either because they are very common or because they deal with important clinical conditions. Pre- and post-test MCQs are provided to aid learning and to ensure that trainees have learned the content. These MCQs are not meant to be used as assessment tools in the more conventional sense. Of course, conditions described in the universal topics may be assessed in various ways in other examinations.

Passing score: As stated above, these topics are meant to be learning resources. Pre- and post-test MCQs should be viewed as learning aids rather than examinations. However, to ensure that trainees have indeed reviewed these online lectures, a score of 60%-80% is required in the post-test MCQs as evidence of learning. Trainees may review the lectures as many times as required and then take the post-test. The duration of each topic is around 90 minutes.

Completion of the universal topics: The assigned topics should be completed within the allocated year. Trainees and mentors should take personal initiatives to complete the universal topics on time. If a trainee fails to complete the assigned universal topics within a given year due to unforeseen circumstances, s/he may be allowed to carry these over to following years. Trainees must, however, complete all the topics before attempting the final exit exam.

For this program, the Advanced Nursing Practice in Cardiac (Adult) Specialization, trainees are 5 expected to cover the selected online universal topics set out below, according to the given time line. The universal topics modules are streamlined in accordance with the program curriculum.

Important note for program coordinators and trainees: The universal topics as a whole include some objectives that are not within the scope of nurses, who are not required to complete these.

Universal Topics First Year Second Year Module 1: Introduction Module 4: Medical and Surgical Emergencies Module 3: Diabetes and Metabolic Disorders Module 5: Acute Care Module 7: Ethics and Healthcare

Universal Topics: First Year Module 1: Introduction 1) Safe drug prescribing 2) Hospital acquired infections (HAI) 3) Sepsis; Systemic inflammatory response syndrome (SIRS); disseminated intravascular coagulation (DIVC) 4) Antibiotic stewardship 5) Blood transfusion

5 Instructors and trainees must refer to the Saudi Commission for Health Specialties Online Universal Topics, which can be accessed at http://www.scfhs.org.sa/en/MESPS/Pages/UniversalTopics.aspx 12 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM ON-LINE UNIVERSAL TOPICS

Safe drug prescription: At the end of the learning unit, you should be able to: 1) Recognize the importance of safe drug prescribing in healthcare; 2) Describe the various adverse drug reactions with examples of commonly prescribed drugs that can cause such reactions; 3) Apply principles of drug-drug interactions, drug-disease interactions, and drug-food interactions in common situations; 4) Apply principles of prescribing drugs in special situations, such as renal failure and liver failure; 5) Apply principles of prescribing drugs in elderly and pediatric patients, and in pregnancy and lactation; 6) Promote evidence-based cost effective prescribing; and 7) Discuss the ethical and legal framework governing safe-drug prescribing in Saudi Arabia.

Healthcare-associated infections (HAI): At the end of the learning unit, you should be able to: 1) Discuss the epidemiology of HAI with special reference to HAI in Saudi Arabia; 2) Recognize HAI as one of the major emerging threats in healthcare; 3) Identify the common sources and presentation of HAI; 4) Describe the risk factors of common HAIs, such as ventilator associated pneumonia, methicillin resistant staphylococcus aureus (MRSA), central line associated bloodstream infection (CLABSI), and vancomycin resistant enterococcus (VRE); 5) Identify the role of healthcare workers in the prevention of HAI; 6) Determine appropriate pharmacological (e.g., selected antibiotic) and non-pharmacological (e.g., removal of indwelling catheter) measures in the treatment of HAI; and 7) Propose a plan to prevent HAI in the workplace.

Sepsis, SIRS, DIVC: At the end of the learning unit, you should be able to: 1) Explain the pathogenesis of sepsis, SIRS, and DIVC; 2) Identify patient-related and non-patient related predisposing factors of sepsis, SIRS, and DIVC; 3) Recognize a patient at risk of developing sepsis, SIRS, and DIVC; 4) Describe the complications of sepsis, SIRS, and DIVC; 5) Apply the principles of management of patients with sepsis, SIRS, and DIVC; and 6) Describe the prognosis of sepsis, SIRS, and DIVC.

Antibiotic stewardship: At the end of the learning unit, you should be able to: 1) Recognize antibiotic resistance as one of the most pressing public health threats globally; 2) Describe the mechanism of antibiotic resistance; 3) Determine the appropriate and inappropriate use of antibiotics; 4) Develop a plan for safe and proper antibiotic usage, including correct indications, duration, types of antibiotic, and discontinuation; and 5) Appraise local guidelines in the prevention of antibiotic resistance.

Blood transfusion: At the end of the learning unit, you should be able to: 1) Review the different components of blood products available for transfusion; 2) Recognize the indications and contraindications of blood product transfusion; 3) Discuss the benefits and risks of and the alternatives to transfusion; 4) Undertake consent for specific blood product transfusion; 5) Perform the steps necessary for safe transfusion;

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 13 ON-LINE UNIVERSAL TOPICS

6) Develop an understanding of the special precautions and procedures necessary during massive transfusions; and 7) Recognize transfusion associated reactions and provide immediate management.

Module 2: Diabetes and metabolic disorders 1) Recognition and management of diabetic emergencies 2) Management of diabetic complications 3) Comorbidities of obesity 4) Abnormal electrocardiogram (ECG)

Recognition and management of diabetic emergencies: At the end of the learning unit, you should be able to: 1) Describe the pathogenesis of common diabetic emergencies, including their complications; 2) Identify risk factors and groups of patients vulnerable to such emergencies; 3) Recognize a patient presenting with a diabetic emergency; 4) Institute immediate management; 5) Refer the patient to appropriate next level of care; and 6) Counsel patient and families to prevent such emergencies.

Management of diabetic complications: At the end of the Learning Unit, you should be able to: 1) Describe the pathogenesis of important complications of Type 2 diabetes mellitus; 2) Screen patients for such complications; 3) Provide preventive measures for such complications; 4) Treat such complications; and 5) Counsel patients and families with special emphasis on prevention.

Comorbidities of obesity: At the end of the learning unit, you should be able to 1) Screen patients for the presence of common and important comorbidities of obesity; 2) Manage obesity related comorbidities; and 3) Provide dietary and lifestyle advice for the prevention and management of obesity.

Abnormal ECG: At the end of the learning unit, you should be able to: 1) Recognize common and important ECG abnormalities; and 2) Institute immediate management, if necessary.

14 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM ON-LINE UNIVERSAL TOPICS

Universal Topics: Second Year Module 3: Medical and surgical emergencies 1) Management of acute chest pain 2) Management of acute breathlessness 3) Management of altered sensorium 4) Management of hypotension and hypertension 5) Management of upper gastrointestinal (GI) bleeding 6) Management of lower GI bleeding For all the above, at the end of the Learning Unit, you should be able to: 1) Triage and categorize patients; 2) Identify patients who need prompt medical and surgical attention; 3) Generate preliminary diagnoses based on history and physical examination; 4) Order and interpret urgent investigations; 5) Provide appropriate immediate management to patients; and 6) Refer patients to the next level of care, if needed.

Module 4: Acute care 1) Pre-operative assessment 2) Post-operative care 3) Acute pain management 4) Chronic pain management 5) Management of fluid in the hospitalized patient 6) Management of electrolyte imbalances

Pre-operative assessment: At the end of the learning unit, you should be able to: 1) Describe the basic principles of pre-operative assessment 2) Perform pre-operative assessment in an uncomplicated patient with special emphasis on (i) general health assessment, (ii) cardiorespiratory assessment, (iii) medications and medical advice assessment, (iv) drug allergy, and (v) pain relief needs; and 3) Categorize patients according to risks.

Postoperative care: At the end of the learning unit, you should be able to: 1) Devise a post-operative care plan, including monitoring of vitals, pain management, fluid management, medications, and laboratory investigations; 2) Hand over a patient properly to the appropriate facilities; 3) Describe the process of post-operative recovery in a patient; 4) Identify common post-operative complications; 5) Monitor patients for possible post-operative complications; and 6) Institute immediate management for post-operative complications.

Acute pain management: At the end of the learning unit, you should be able to: 1) Review the physiological basis of pain perception; 2) Proactively identify patients who might be in acute pain; 3) Assess a patient with acute pain;

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 15 ON-LINE UNIVERSAL TOPICS

4) Apply various pharmacological and non-pharmacological measures available for acute pain management; 5) Provide adequate pain relief for uncomplicated patients with acute pain; and 6) Identify and refer patients with acute pain who may benefit from specialized pain services.

Chronic pain management: At the end of the learning unit, you should be able to: 1) Review bio-psychosocial and physiological bases of chronic pain perception; 2) Discuss various pharmacological and non-pharmacological options available for chronic pain management; 3) Provide adequate pain relief for uncomplicated patients with chronic pain; and 4) Identify and refer patients with chronic pain who may benefit from specialized pain services.

Management of fluid in hospitalized patients: At the end of the learning unit, you should be able to 1) Review the physiological basis of water balance in the body; 2) Assess a patient for hydration status; 3) Recognize a patient with over- or under-hydration; 4) Order fluid therapy (oral as well as intravenous) for a hospitalized patient; and 5) Monitor fluid status and response to therapy through history, physical examination, and selected laboratory investigations.

Management of acid-base electrolyte imbalances: At the end of the learning unit, you should be able to: 1) Review the physiological basis of electrolyte and acid-base balance in the body; 2) Identify diseases and conditions that are likely to cause or be associated with acid-base and electrolyte imbalances; 3) Correct electrolyte and acid-base imbalances; 4) Perform careful calculations, checks, and other safety measures while correcting acid-base and electrolyte imbalances; and 5) Monitor response to therapy through history, physical examination, and selected laboratory investigations.

Module 5: Ethics and healthcare 1) Occupational hazards of health care workers (HCWs) 2) Evidence-based approach to smoking cessation 3) Patient advocacy 4) Ethical issues: transplantation/organ harvesting; withdrawal of care 5) Ethical issues: treatment refusal; patient autonomy 6) Role of doctors in death and dying

Occupation Hazards of HCWs: At the end of the learning unit, you should be able to: 1) Recognize common sources and risk factors of occupational hazards among HCWs; 2) Describe common occupational hazards in the workplace; 3) Develop familiarity with legal and regulatory frameworks governing occupational hazards among HCWs; 4) Develop a proactive attitude to promoting workplace safety; and

16 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM ON-LINE UNIVERSAL TOPICS

5) Protect yourself and colleagues against potential occupational hazards in the workplace.

Evidence-based approach to smoking cessation: At the end of the learning unit, you should be able to: 1) Describe the epidemiology of smoking and tobacco usage in Saudi Arabia; 2) Review the effects of smoking on the smoker and family members; 3) Effectively use pharmacological and non-pharmacological measures to treat tobacco usage and dependence; and 4) Effectively use pharmacological and non-pharmacological measures to treat tobacco usage and dependence among special population groups, such as pregnant women, adolescents, and patients with psychiatric disorders.

Patient advocacy: At the end of the learning unit, you should be able to: 1) Define patient advocacy; 2) Recognize patient advocacy as a core value governing medical practice; 3) Describe the role of patient advocates in the care of patients; 4) Develop a positive attitude towards patient advocacy; 5) Be a patient advocate in situations of conflict; and 6) Be familiar with local and national patient advocacy groups.

Ethical issues: transplantation/organ harvesting; withdrawal of care: At the end of the learning unit, you should be able to: 1) Apply key ethical and religious principles governing organ transplantation and withdrawal of care; 2) Be familiar with legal and regulatory guidelines regarding organ transplantation and withdrawal of care; 3) Counsel patients and families in the light of applicable ethical and religious principles; and 4) Guide patients and families to make informed decisions.

Ethical issues: treatment refusal; patient autonomy: At the end of the learning unit, you should be able to: 1) Predict situations in which a patient or family member is likely to decline prescribed treatment; 2) Describe the concept of the “rational adult” in the context of patient autonomy and treatment refusal; 3) Analyze key ethical, moral, and regulatory dilemmas in treatment refusal; 4) Recognize the importance of patient autonomy in the decision making process; and 5) Counsel patients and families declining medical treatment in the light of a patient’s best interests.

Role of doctors in death and dying: At the end of the learning unit, you should be able to: 1) Recognize the important role a doctor can play during a dying process; 2) Provide emotional as well as physical care to a dying patient and family; 3) Provide appropriate pain management in a dying patient; and 4) Identify suitable patients and refer them to palliative care services.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 17 EDUCATIONAL MODULES OF FIRST YEAR TRAINING

EDUCATIONAL MODULES OF FIRST YEAR TRAINING

Module I: Foundational human anatomy and physiology of the cardiac system Module Description This module is designed to provide an overview of the cardiac cycle, the cardiac conduction pathway, cardiac output, and the structure and function of the heart and its role in the cardiac system.

Learning Objectives By the end of this module, the trainee will be able to 1) describe the location of the heart; 2) describe the function of the pericardium; 3) identify the major vessels and chambers of the heart and describe the flow of blood through the heart; 4) identify the major valves of the heart and describe their functions; 5) describe the heart wall and explain the purpose of coronary circulation; 6) identify the events of the cardiac cycle; 7) describe the relationship between cardiac structures and their role in the cardiac cycle; 8) relate heart sounds to the events of the cardiac cycle; 9) describe the types of cardiac muscle cells; 10) identify the parts of the cardiac conduction pathway and their functions; 11) discuss cardiac conduction and its relationship to an ECG; 12) define stroke volume and cardiac output; 13) discuss the relationship between heart rate, stroke volume, and cardiac output; and 14) identify the factors that control cardiac output.

Module Content This module focuses mainly on the following: 1) Overview of the circulatory system 2) Size and location of the heart 3) Linings of the heart 4) Wall of the heart 5) Heart chambers and valves 6) Skeleton of the heart 7) Path of blood through the heart 8) Blood supply to the heart 9) Heart sounds 10) Cardiac conduction system 11) Paths of circulation 12) Pulmonary circuit 13) Systemic circuit 14) Arterial system:  Principal branches of the aorta  Arteries to the shoulder and upper limbs  Arteries to the pelvis and lower limbs 15) Venous system:  Veins from the brain, head, and neck  Veins from the upper limbs and shoulders

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 Veins from the abdominal and thoracic walls  Veins from the lower limbs and pelvis 16) Portal circulation 17) Histological structure of the heart and blood vessels

Competencies 1) Apply knowledge of anatomy and physiology in clinical practice and recognize the clinical manifestations of cardiac disease. 2) Conduct adult physical assessment.

Module II: Health promotion, prevention, and rehabilitation Module Description The content of this module includes learning about cardiac risk assessment and interventions to support prevention, as well as instruction about how such health priorities may be implemented in practice.

Learning Objectives By the end of this module, the trainee will be able to 1) Describe the burden of cardiac disease in the Kingdom of Saudi Arabia and around the world; 2) Demonstrate essential knowledge of modifiable, non-modifiable, novel, and emerging cardiac risk factors across the lifespan, and advances in genetic testing; 3) Describe primary and secondary prevention strategies at the population and individual level; 4) Describe individualized and family centered cardiac risk assessment; 5) Introduce the theory and principles of behavior change; 6) Describe interventions (population, individual, and family focused) to promote a healthy lifestyle and support adherence to prescribed medications; and 7) Describe clinical guidelines in practice.

Module Content This module focuses mainly on the following: 1) Describing the burden of CVD locally (in the Kingdom of Saudi Arabia) and globally 2) Identifying modifiable, non-modifiable, emerging, and novel CVD risk factors across the lifespan 3) Demonstrating knowledge and understanding of EBP prevention guidelines for the management of hypertension, tobacco smoking, dyslipidemia, diabetes and metabolic syndromes, and lifestyle 4) Outlining key theories and principles that underpin health behavior change and relevance to clinical practice and cardiac rehabilitation 5) Describing prevention interventions used to reduce CVD mortality and morbidity.

Competencies 1) Use effective interview skills to obtain patient history to identify cardiac risk factors. 2) Identify patients at risk for unnecessary hospitalization and readmission. 3) Educate the patient and family about the importance of risk factor management and support self-management of healthy lifestyle changes. SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 19 EDUCATIONAL MODULES OF FIRST YEAR TRAINING

4) Select appropriate prevention programs for implementation by multidisciplinary team. 5) Develop, document, and evaluate preventions plans. 6) Search for, appraise, and interpret published literature critically. 7) Display a non-judgmental attitude and respect for patient choice.

Module III: Fundamentals of cardiac pathophysiology Module Description This module includes content about pathophysiology and the physical manifestations of common cardiac conditions, as well as the recognition of normal and altered physiological parameters and their clinical significance.

Learning Objectives By the end of this module, the trainee will be able to: 1) Describe atherosclerotic disease and associated conditions, such as ischemic heart disease, and peripheral vascular disease; 2) Describe heart rhythm and conduction disorders, such as tachy/brady arrhythmia and conduction defects; 3) Describe structural abnormalities of the heart, such as congenital heart disease and valve disease; and 4) Describe heart muscle disorders, such as inflammatory, acute, and chronic heart failure.

Module Content This module focuses mainly on the following: 1) Pathophysiology and clinical manifestations 2) Recognizing clinical deterioration 3) Atherosclerotic disease  Coronary artery disease  Chronic stable angina pectoris  Acute coronary syndrome (ACS) (unstable angina pectoris and non-ST-segment elevation myocardial infarction)  ST-segment elevation myocardial infarction 4) Health rhythm and conduction 5) Basic electrophysiology:  Electrophysiology  Principles of electrocardiography  Intraventricular conduction defects  ECG changes in myocardial infarction 6) Structural abnormalities  Aortic disease: o Aortic aneurysm and aortic dissection  Acquired valvar heart disease: o Mitral and aortic insufficiency o Mitral and aortic stenosis  Atrial septal defect, ventricular septal defect, patent ductus arteriosus, coarctation of the aorta 7) Heart Muscle Disorders

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EDUCATIONAL MODULES OF FIRST YEAR TRAINING

 Infection and inflammatory heart disease: o Pericarditis o endocarditis o myocarditis  Heart failure

Competencies Refer to Appendix P.

Module IV: Cardiac nursing: Assessment, planning, and managing care Module Description The content covered in the initial trainee education will be further developed to focus upon care of patients living with cardiac conditions.

Learning Objectives By the end of this module, the trainee will be able to: 1) Demonstrate the ability to collect data in a systematic manner that accurately reflects the immediate condition or anticipated needs of the patient; 2) Determine the nursing diagnosis or health-related complaint from assessment data; 3) Identify expected nurse sensitive outcomes with patients, families, and other healthcare providers; 4) Demonstrate the ability to analyze data to plan care and attain defined outcomes for a range of cardiac disorders; and 5) Implement an evidence-based plan of care and coordinate care delivery and evaluation for patients with a range of cardiac disorders.

Module Content This module focuses mainly on the following: 1) Knowledge of how to collect cardiac health assessment data (by taking a cardiac history and focused physical assessment) and a review of life support skills 2) Diagnostic tests, including ECG/telemetry (non-invasive imaging, such as echocardiography, magnetic resonance imaging, computerized tomography, and nuclear imaging, as well as invasive imaging, such as cardiac cauterization and angiography) 3) Development, implementation, and evaluation of a nursing care plan using evidence-based clinical guidelines in practice with emphasis on nursing contribution 4) Knowledge of how to plan, implement, and evaluate a plan of care for a cardiac patient 5) Principles and the safe practice of non-invasive procedures 6) Key diagnostic tests and how to prepare the patient, family, and environment 7) Review of life support skills in line with relevant clinical guidelines 8) Relevant clinical guidelines and their implementation in practice.

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EDUCATIONAL MODULES OF FIRST YEAR TRAINING

Competencies Refer to Appendix P.

Module V: Cardiac pharmacology Module Description This module is designed to review, expand, and update the trainee’s knowledge of pharmacology and pharmacotherapeutics, specifically for cardiac medications utilized in cardiac patients.

Learning Objectives By the end of this module, the trainee will be able to: 1) Describe the pathophysiology of certain disease states and the rationale for the use of selected pharmacotherapy interventions; 2) Explain the pharmacology (mechanism of action, effects, pharmacokinetics, side effects, etc.) Of drugs considered for each disease; 3) Anticipate potential side effects, recognize adverse reactions, and discuss their management; 4) Compare and contrast dosage and forms of commonly used medications; 5) Correlate pharmacological responses to the type of drug therapy of various physical systems; 6) Apply arithmetic, including fractions, decimals, and conversion between systems of measurement, to calculate drug dosages accurately; 7) Appreciate the importance of applying legal and ethical standards in the preparation and administration of drugs in cardiac critical care areas; 8) Be familiar with critical principles of pharmacology as they relate to applications in nursing; 9) Compare and contrast dosage and forms of commonly used medications in critical care units; and 10) Communicate appropriate patient education information regarding drug therapy for a given disease.

Module Content This module focuses mainly on the following: 1) Orientation to pharmacology 2) Administration of medication  A review of arithmetic  Principles of medication administration  Preparation and administration of medication via various routes 3) Legal and ethical aspects of medication administration 4) Principles of drug action 5) Medication errors 6) The nursing process and pharmacology 7) Agents used in the treatment of ischemic heart disease 8) Agents used in the treatment of heart failure 9) Vasodilators and blood viscosity-reducing agents 10) Anti-dysrhythmics 11) Anti-hypertensives 12) Anti-platelets, anticoagulants, fibrinolytics, and blood components 13) Anti-hyperlipidemic drugs 14) Inotropes

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Competencies 1) Apply the principles and routes of drug administrations and storage forms. 2) Calculate appropriate dosage. 3) Administrate drugs safely and efficiently through a variety of routes. 4) Describe homodynamic formulas and normal values. 5) Demonstrate the specialized administration rates used in critical and emergency care. 6) Utilize the systems of drug dose and drug level measurements (units of measurement). 7) Apply basic precautions and safe drug administration. 8) Administer medication.

Module VI: Ethics in nursing and dimensions of care Learning Objectives At the end of this module, the trainee will be able to: 1) Examine the nature and role of ethical theories in guiding sound ethical decision making in workplace settings; 2) Discuss the ethical and legal context of professional nursing practice; 3) Examine key ethical issues occurring in nursing and related health care contexts; 4) Discuss processes for achieving desired moral outcomes in nursing and healthcare domains; 5) Analyze conflicting duties and rights inherent in moral dilemmas; 6) Discuss the impact of current issues related to health care delivery; 7) Use ethical reasoning to synthesize standards of practice, ethical principles, and legal/regulatory requirements in the resolution of ethical dilemmas; and 8) Discuss ethical issues relevant to traumatized patients.

Module Content This module focuses mainly on the following: 1) Introduction to moral and legal concepts 2) Credentials and licensing 3) Autonomy and paternalism 4) Life and death 5) Public health 6) Ethical issues related to emergency situations

Competencies 1) Demonstrate knowledge by identifying basic ethical principles related to trauma management in the Kingdom of Saudi Arabia. 2) Demonstrate knowledge by distinguishing between moral and legal concepts in relation to trauma diagnosis and treatment. 3) Demonstrate knowledge by identifying ethical and cultural life and death considerations applied in the Kingdom of Saudi Arabia. 4) Demonstrate knowledge by identifying common ethical dilemmas related to traumatized patients.

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Module VII: Epidemiology Learning Objectives At the end of this module, the trainee will be able to: 1) Describe the mechanisms and dynamics of disease transmission in populations and the risk factors that determine their distribution; 2) Calculate measures of morbidity, mortality, incidence, and prevalence; 3) Assess the validity and reliability of diagnostic and screening tests; 4) Explain the different mechanisms used to describe disease prognosis in quantitative terms for groups of patients; 5) Assess the efficacy of preventive and therapeutic measures via randomized trials; 6) Conduct epidemiological study designs (cohort, cross-sectional, retrospective, and prospective); 7) Differentiate between association and causation; 8) Identify potential bias, confounding factors, and interacting factors in an epidemiological study; 9) Explain the role of genetic and environmental factors in disease causation; 10) Apply epidemiologic methods to evaluate screening programs; 11) Identify sources of information on disease occurrence; and 12) Critique medical and health research studies.

Module Content This module focuses mainly on the following: 1) Definition of epidemiology and health 2) Dynamics of disease transmission 3) Infectious disease epidemiology 4) Measuring the occurrence of disease 5) Assessing the reliability and validity of diagnostic and screening tests 6) Assessing the efficacy of preventive and therapeutic measures through randomized trials 7) Cohort studies 8) Case control and cross-sectional studies 9) Estimating risk determining association 10) Estimating the potential for prevention 11) From association to causation: deriving inferences from epidemiologic studies 12) Bias, confounding factors, and interaction 13) Roles of genetic and environmental factors in disease causation 14) Ethical and professional issues in epidemiology

Competencies 1) Demonstrate knowledge by identifying basic principles in epidemiology. 2) Demonstrate knowledge by identifying the dynamics of disease transmission and occurrence of diseases. 3) Demonstrate knowledge by determining associations of diseases and estimating potential for disease prevention. 4) Demonstrate knowledge by identifying roles of genetic and other environmental factors that contribute to the causation and occurrence of diseases.

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Module VIII: Biostatistics Learning Objectives At the end of this module, the trainee will be able to: 1) Demonstrate familiarity with statistical terminology and the purpose of statistics; 2) Identify ways of organizing data; 3) Recognize measures of central tendency and variability; 4) Demonstrate an understanding of the analysis of statistical data within the research context; 5) Provide the necessary statistical background for analyzing data and drawing inferences from the analysis; and 6) Discuss the logic of hypothesis testing.

Module Content This module focuses mainly on the following: 1) Descriptive statistics, frequencies, shapes, and measures of central tendency 2) Univariate descriptive statistics, measures of variability, range of standard deviation scores within a distribution, Z scores, and standardized distribution 3) Bivariate descriptive statistics 4) Inferential statistics, probability, sampling distribution, and hypothesis testing 5) Power analysis, type I and type II errors, level of significance/critical regions, confidence intervals, one-tailed and two-tailed tests, and parametric tests 6) Bivariate inferential statistics, t tests for independent groups, paired t tests for dependent groups 7) ANOVA, between group and within group analysis, non-parametric tests, Chi square, tests for independence, bivariate inferential statistics, and Pearson’s r as an inferential statistic

Competencies 1) Demonstrate familiarity with the terminology listed in the module content. 2) Demonstrate the ability to organize data. 3) Apply measures of central tendency and variability. 4) Demonstrate the logic of hypothesis testing. 5) Demonstrate the ability to analyze data and draw inferences from the analysis. 6) Explain the role of statistical data within the research process.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 15 EDUCATIONAL MODULES OF SECOND YEAR TRAINING

EDUCATIONAL MODULES OF SECOND YEAR TRAINING

Module IX: Introduction to research and evidence-based practice Learning Objectives At the end of this module, the trainee will be able to: 1) Define the basic concepts of research methodology; 2) Describe the different research designs; 3) Describe the scientific process and its use in nursing research; 4) Develop a research proposal for a project; 5) Explain the steps of the research process in the proposal and/or conduct a circumscribed nursing research project; 6) Identify research problems in the literature review process related to nursing practice; 7) Compare and contrast research designs; 8) Discuss appropriate statistical techniques in data analysis; 9) Critique current studies of nursing practice; 10) Describe the utilization of research findings; 11) Define the historical perspective of ebp; and 12) Define and apply evidence-based nursing practice principles identified by nursing research.

Module Content This module focuses mainly on the following: 1) Overview of nursing research 2) Research methodology and process 3) Research design 4) Data collection and analysis 5) Evidence-based research and application

Competencies 1) Demonstrate familiarity with research terminology. 2) Demonstrate knowledge of research design. 3) Conduct a literature search using a range of resources (electronic and non-electronic). 4) Gather and interpret relevant data to make judgments. 5) Utilize evidence-based principles in applications of practice 6) Comprehend the application of a critical appraisal approach. 7) Critique journal articles. 8) Formulate a research proposal for a topic of interest within the cardiac field. 9) Design and implement a research project. 10) Compose a manuscript for publication.

Module X: Advanced cardiac care nursing Module Description This module focuses on further developing the specialty knowledge, skills, and professional behaviors required for advanced cardiac care nursing practice. It also provides specific knowledge to trainees regarding cardiac disorders and other diseases, giving detailed information about each illness, the physical and psychological status of patients, treatment modalities, admission and discharge planning, and rehabilitation programs. The reading of hemodynamic monitoring is covered in this module.

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Learning Objectives By the end of this module, the trainee will be able to 1) Understand the critical care environment; 2) Define different cardiac diseases and other diseases; 3) Identify the pathophysiological basis of the clinical manifestation of different cardiac and other diseases; 4) Identify signs and symptoms of different cardiac and other diseases; 5) Discuss the diagnostic tests used for patients with cardiac and other diseases; 6) Define expected outcomes of therapeutic management of different cardiac and other diseases; and 7) Describe common pathophysiological processes, etiology, and management involved in generalized shock.

Module Content This module focuses mainly on the following: 1) Introduction to the critical care environment roles and responsibilities  Scope of practice  Professionalism and ethics  Accountability  Professional relationships  Legal responsibility  Advanced practice role  Credentials  Professional development  Professional portfolios 2) Stressors in the critical care environment  Identifying stressors  Burn-out  Managing stress  Sensory deprivation  ICU stress reduction techniques  Patterns and routines  Team work  Acuity index 3) Ethical Dilemmas  Ethical concepts  Ethical theories  Framework for decision making  Brain death  Bioethics  Euthanasia 4) Time management  Staff assignments  Prioritization  Delegation 5) Crisis management  Communication skills  Family counseling

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 Framework for crisis management  Transcultural issues in death and dying  Grief counseling 6) Common problems in cardiac critical care  Psychosocial alteration  Sleep alteration  Nutrition alteration and management  Pain and pain management  Peri anesthesia management  Sedation assessment and management 7) Pacemakers and implantable defibrillators  Pacemakers  Implantable defibrillators 8) Hemodynamic monitoring  Arterial pressure monitoring  Central venous pressure monitoring  Pulmonary artery pressure monitoring  Cardiac output determination  Evaluation of oxygen delivery and demand balance 9) CVDs and management  Cardiomyopathies  Pulmonary hypertension  Hypertensive emergencies  Carotid artery disease  Venous thromboembolism  End-stage heart disease  Cardiac trauma  Cardiac tumor  Shock  Multi-organ dysfunctions 10) Cardiac Surgery  Trends in cardiac surgery  Preoperative assessment and preparation  Surgical techniques  Cardiac revascularization  Valvar heart surgery  Cardiac transplantation  Patient management  Psychological reaction to cardiac surgery  Evidence-based collaborative practice 11) Sudden cardiac death and cardiac arrest  Definition of sudden death  Pathophysiology and cause of sudden cardiac death  Management of sudden cardiac arrest

Competencies Refer to Appendix P.

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Module XI: ECG interpretation – Advanced Module Description This module provides the trainee the opportunity to advance his/her ECG interpretation skills in 12- and 15-Lead ECG recordings. Analysis will include ECGs in acute coronary syndromes, differentiating causes of ST change, and differential diagnosis of wide complex tachycardia. Miscellaneous ECG patterns will also be further explored, including Brugada syndrome, Wellens syndrome, Long QT syndromes, and pacemaker ECG interpretation. At this level, trainees are expected to complete advanced cardiac life support (ACLS) certification.

Learning Objectives By the end of this module, the trainee will be able to: 1) Describe normal cardiac anatomy and the flow of blood through the heart; 2) Identify the parts of the cardiac conduction system and their functions; 3) Describe the origin and spread of the electrical impulse through the heart; 4) Identify the waves and intervals of the cardiac cycle and state their normal values; 5) State the five steps of rhythm interpretation; 6) Describe pacemakers (coding, normal function, loss of capture, loss of sensing); 7) State the commonly used drugs and correct dosages used to treat each of the arrhythmias below; 8) Illustrate proper electrode and lead wire placement for a five and a 3 wire system to obtain lead v1 (or mcl1) and v6 (or mcl6); and 9) Identify the following arrhythmias from a rhythm strip:  Sinus rhythm, sinus bradycardia, sinus tachycardia, sinus arrhythmia, sinus arrest, sinus exit block  Premature atrial complexes, wandering atrial pacemaker, multifocal atrial tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, supra ventricular tachycardia (svt).  Junctional rhythm, accelerated junctional rhythm, junctional tachycardia, premature ventricular complexes, idioventricular rhythm, junctional tachycardia  Idioventricular rhythm, accelerated ventricular rhythm, ventricular tachycardia (vt), ventricular fibrillation, first degree atrioventricular (av) block, second degree av block (type i and type ii), high grade av block, third degree av block, asystole, right and left bundle branch block.

Module Content This module focuses mainly on the following: 1) Mechanisms of arrhythmias  Disorders of impulse generation  Disorders of impulse conduction  Reentry  Abnormal automaticity  Triggered activity 2) Advanced concepts in conduction system disease  Sinoatrial exit block and entrance block  AV node idiosyncrasies  The His bundle electrogram  Evaluating “trifascicular” block 3) Applying physiology to atrial arrhythmias

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 Distinguishing different types of atrial flutter  Advanced concepts in atrial fibrillation  Automatic versus reentry atrial tachycardia  “Triggered” atrial arrhythmias 4) Wide QRS tachycardia  Morphology of VT versus aberrant conduction  Detecting AV dissociation  Identifying “capture beats”  Pre-excited tachycardia 5) Pre-excitation (Wolff-Parkinson-White syndrome)  Physiological basis of pre-excitation  Location of accessory pathways  Relating 12-lead ECGs to pre-excitation  Arrhythmias seen due to accessory pathways  Other pre-excitation syndromes 6) Paroxysmal SVT  Common causes of PSVT  Identifying electrophysiological causes of PSVT  P-wave timing and PSVT mechanisms 7) Applying physiology to ventricular arrhythmias  Distinguishing automatic versus reentry VT  Identification of VT site of origin  Brugada syndrome 8) Idiopathic ventricular arrhythmias  “Idiopathic” ventricular arrhythmias  VT arising from right ventricular outflow tract  Arrhythmogenic right ventricular dysplasia/cardiomyopathy  Idiopathic left ventricular (Belhassen’s) tachycardia 9) Long QT Syndrome  Electrophysiological events of the cardiac cycle  Genetic basis of repolarization  Varieties of congenital long QT syndrome  “Torsades de pointes”  Drug-induced long QT syndrome 10) Introduction to pacemakers  Types of pacemakers  Identifying normal pacemaker function  Recognizing loss of capture  Problems with under sensing

Competencies Refer to Appendix P.

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Module XII: Emotional and spiritual well-being Module Description This module focuses on nursing interventions to enhance emotional and spiritual well-being in people with CVD.

Learning Objectives By the end of this module, the trainee will be able to: 1) Recognize the emotional impact that a cardiac diagnosis may have upon patients and their families; 2) Discuss the potential effect that different personality traits and associated negative emotions may have upon health related quality of life, compliance, and prognosis; and 3) Consider the significance of religion and spirituality as moderators of well-being in patients living with CVD and their families.

Module Content This module focuses mainly on the following: 1) Emotional and coping responses to a diagnosis of CVD 2) Quantifying the prevalence and incidence of negative emotional responses (e.g., stress, anxiety, depression, hostility, anger, and denial) and their impact on psychological adjustment and health related quality of life 3) Identification, screening, and outcome assessment tools designed to measure psychological status and health related quality of life 4) The role of religion/spirituality in psychological adjustment to CVD 5) Nursing interventions to support emotional and spiritual well-being 6) Relevant clinical guidelines and their implementation in clinical practice

Competencies 1) Demonstrate the ability to recognize and understand the emotions, needs, and concerns of patients and their families. 2) Use screening and assessment tools to assess emotions, coping, and health related quality of life in alignment with scope of practice. 3) Recognize when referral to a mental health professional is warranted. 4) Promote EBP by accessing and maintaining European Society of Cardiology guidelines and other high quality evidence to promote the emotional and spiritual well-being of those in your care.

Module XIII: Evaluation of quality of care Module Description This module supports learning process in terms of systems and organizational theories that underpin quality of care. The principles and practices of a quality improvement framework are applied to care processes in cardiac care settings to demonstrate the link between care processes and patient outcomes.

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Learning Objectives By the end of this module, the trainee will be able to: 1) Comprehend the issues around quality of care; 2) Define the measurement of quality indicators for nursing care; 3) Possess broad knowledge of factors that influence care coordination and successful transition throughout a patient’s journey; 4) Recognize the potential of emerging technologies for quality and safety in supportive care; and 5) Recognize the role of teamwork, communication, and the work environment in influencing patient safety.

Module Content This module focuses mainly on the following: 1) Key principles of risk assessment, patient safety, auditing and evaluation of adverse events, integrating care that includes interception of errors by other-near misses 2) Key features of systems and organizational theory as they relate to the design, delivery, and evaluation of health care delivery 3) Standards of care within the present organization and associated challenges 4) The role that technology can play in the provision of quality of care 5) Ways in which patients’ perspectives can be integrated into auditing and quality improvement efforts

Competencies 1) Identify, develop, and enhance activities that promote a culture of safety. 2) Adhere to evidence-based standards to ensure optimal care. 3) Initiate safety measures based on evidence-based guidelines. 4) Apply basic and advanced information technology skills to electronic medical records. 5) Apply relevant key indicators in quality care at the unit level. 6) Apply auditing and evaluation techniques to improve service design and implement quality care. 7) Participate in the development of new standards of care.

Module XIV: Nursing informatics Learning Objectives At the end of this module, the trainee will be able to: 1) Describe the foundation of nursing informatics as an emerging field in the nursing profession; 2) Identify key factors and legislative organizations that help shape nursing informatics; 3) Discuss evolving models and theories of informatics that define roles and competencies in nursing informatics; 4) Explain the implications of nursing informatics for nursing practice, administration, education, and research; 5) Demonstrate skills in the acquisition and retrieval of nursing information using health information systems within the institution and through the worldwide web and varied electronic resources; and 6) Apply approaches that safeguard data and information integrity while maintaining privacy and confidentiality.

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Module Content This module focuses mainly on the following: 1) Introduction and overview of nursing informatics 2) Nursing informatics goals, standards, and scope of practice 3) Nursing informatics competencies (i.e., computer literacy skills, informatics literacy skills, etc.) 4) Models and theories of informatics 5) Internet search engines and electronic databases and resources 6) Selection of health care information systems 7) System implementation, maintenance, and development 8) Data integrity, security, and confidentiality 9) Intranet, extranet, and network integration 10) Information technology in patient education 11) Integrating computers and information technology in nursing education and practice

Competencies 1) Assess the application of information and communication technology in management of patient related data. 2) Identify different models of computerized health care service electronic records. 3) Differentiate between models of health information management systems. 4) Analyze implications for healthcare delivery arising from telehealth and telemedicine. 5) Assess the impact of the information technology revolution on nursing practice. 6) Apply skills to access, create, store, and retrieve nursing related information from the worldwide web. 7) Demonstrate ways of integrating nursing informatics to areas of nursing administration, education, clinical practice, and research. 8) Utilize security regulations to safeguard patients’ and organizations’ data and information. 9) Understand ethical issues related to nursing informatics. 10) Assess the future of information technology and its impact on nursing practice.

Module XV: Leadership and management Learning Objectives At the end of this module, the trainee will be able to 1) Analyze the components of organizational structure and culture; 2) Apply theories of effective leadership and management within selected health care arenas; 3) Utilize the skills of the nursing process, critical thinking, ethical decision-making, communication, and therapeutic nursing intervention in managing the culturally competent and cost effective care of groups of patients across the wellness/illness continuum; 4) Collaborate with multidisciplinary health care team members in prioritizing and coordinating quality/cost effective healthcare; 5) Demonstrate leadership and management of a care-giving team comprised of individuals with varied cultural backgrounds and varied levels of clinical knowledge and competencies; 6) Utilize skills of inquiry and research as a means to enhance knowledge base, facilitate change, and improve quality of care; 7) Demonstrate professional accountability for effective leadership in nursing practice; and 8) Contribute to organizational strategic planning and its implementation at different levels within healthcare organizations.

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Module Content This module focuses mainly on the following: 1) Organizational structure and culture 2) Application of leadership and management theories 3) Organizational and personal mission, vision, and goals 4) Critical thinking, problem solving, and effective decision making 5) Quality and risk management 6) Budgeting, cost, care delivery models, and staffing 7) Communication, motivation, and team building 8) Change and conflict management 9) Role transition and delegation 10) Strategic planning and strategic management 11) Career planning

Competencies 1) Systems thinking 2) Time management 3) Information management 4) Human resources management (i.e., staffing and scheduling, resource allocations, etc.) 5) Financial management (cost analyses, budget forecasting, etc.) 6) Quality and risk management (quality plans, risk management models, etc.) 7) Change management and conflict resolution 8) Strategic planning 9) Strategic management 10) Career planning

Module XVI: Professional performance Learning Objectives At the end of this module, the trainee will be able to 1) Assume responsibility for personal professional development; 2) Initiate independent learning activities; 3) Provide care in an inter professional environment; 4) Advocate for the health and safety of patients; 5) Differentiate between effective versus ineffective communication; 6) Discuss the meaning of active listening; 7) Identify three skills necessary for active listening; 8) Describe ways in which patients and coworkers benefit when nurses communicate effectively; 9) Discuss the difference between “i” statements and “you” statements; and 10) Identify the skills required for therapeutic communication.

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Module Content This module focuses mainly on the following: 1) Sources of data for EBP 2) Education processes (teaching and learning principles) 3) Legal issues 4) Ethical issues 5) Patient advocacy 6) Quality assurance 7) Professional development 8) Multidisciplinary collaboration 9) Effective communication

Competencies 1) Communication with depressed patients 2) Therapeutic communication 3) Communication with anxious patients 4) Situation, background, assessment, and recommendation based communication

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ASSESSMENT

Overall, the evaluation and assessment of trainees is performed according to the Saudi Commission training and examination rules and regulations. Assessment comprises two parts:

1) Continuous evaluation 2) Centralized examinations

Continuous evaluation The main aim of the continuous evaluation process is to evaluate every aspect of a trainee’s performance during his/her presence at the training center. This process provides objective feedback obtained from those involved in the training process (i.e., the preceptor). Furthermore, this process involves the evaluation of interactive training activities, such as case studies and seminars. The components of the continuous evaluation process are as follows: 1) Feedback from the assigned preceptor: This feedback should be obtained and documented every month and as required (see Appendix E). 2) Feedback from the assigned clinical instructor: This feedback should be obtained and documented every month and as required (see Appendix F). 3) Feedback from the assigned head nurse/nurse manager: This feedback should be obtained every month and as required (see Appendix G). 4) Seminar evaluation: one group seminar will be completed in each training year. Seminar topics should be selected by the trainee and approved by the assigned clinical instructor and program director (see Appendix C). 5) Case study presentation: A case study of a patient cared for in the clinical setting. Case presentation should include the patient’s past medical/surgical history, diagnosis/treatment history, current medical/surgical diagnosis and nursing diagnosis with appropriate assessment findings, and current medical/nursing plans of care with identification of optimal outcomes. Presentations are to be approximately 15 minutes in length, with the trainee facilitating post presentation discussion. The case study evaluation form is to be completed and signed by the clinical instructor and the trainee (see Appendix J).

Centralized examinations This assessment component includes examinations conducted centrally by the SCFHS, namely: 1) Promotion examination 2) Final (end-of-program) examinations

Promotion examination This examination is held at the end of first year of the program. Successful completion of the examination enables the trainee to continue to the second training year of the program. The promotion examination consists of a written test. The main objective of this examination is to assess the theoretical knowledge and critical thinking skills of the trainee in relation to the topics and clinical experiences covered in the first training year. The examination format, including the number of items, eligibility, and passing scores are determined according to the Saudi Commission Examination Rules and Regulations. Exam details and blueprint is available on the Commission Website: www.scfhs.org.sa.

36 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM

ASSESSMENT

Final examinations The end-of-program examinations are comprehensive. The trainee is awarded his/her diploma certificate once s/he successfully completes the following final examinations: Final written examination This examination assesses the theoretical knowledge and critical thinking skills of the trainee in relation to the topics and clinical experience covered in the entire program. The examination format, including the number of items, eligibility, and passing scores are determined according to the Saudi Commission Examination Rules and Regulations. Exam details and blueprint is available on the Commission Website: www.scfhs.org.sa.

Final clinical examination An objective structured clinical examination (OSCE) is held in order to assess a trainee’s clinical skills, including data gathering, patient management, communication, and counseling skills. This examination includes a specific number of stations designed to assess the degree to which the training objectives have been achieved. The examination format, including the number of items, eligibility, and passing scores are determined according to the Saudi Commission Examination Rules and Regulations. Exam details and blueprint is available on the Commission Website: www.scfhs.org.sa.

Certification A certificate of completion will be issued when the trainee has successfully completed all training program requirements, including examinations and competencies. Trainees who complete these requirements successfully will receive Diploma certificate in "Cardiac Nursing".

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 37 REFERENCES

REFERENCES

1) Advanced Practice Clinical Nursing Diploma in Oncology, 1435/2014 2) Advanced Practice Clinical Nursing Diploma in Emergency, 1436/2015 3) Astin, F., Carroll, D. L., Ruppar, T., Uchmanowicz, I., Hinterbuchner, L., Kletsiou, E., Serafin, A., Ketchell, A., & Education Committee of the Council on Cardiovascular Nursing and Allied Professions, 2015. A core curriculum for the continuing professional development of nurses: European Society of Cardiology. European Journal of Cardiovascular Nursing, 14(3):190-7. doi: 10.1177/1474515115572048. 4) Blanchard, L., 2010. Pathophysiology for nurses. Delmar: M. Shaw. 5) Estes, M. E. Z., 2010. Health assessment and physical examination (2nd ed.). Delmar: Thomas Cengage. 6) Everett, A. D., & Lim. D. S. (eds.), 2007. Illustrated field guide to congenital heart disease and repair (2nd ed.). Charlottesville: Scientific Software Solutions. 7) Godwin, L., Marny, J., Patricia, A. P., Anne G. P., & Sheila, A. S., 2002. Mosby’s nursing skills: Intermediate. St. Louis: Mosby. 8) Gordis, L., 2014. Epidemiology. New York: W. B. Saunders Co. 9) Gravetter, F., & Wallnau, L., 2010. Essentials of statistics for the behavioral sciences. Belmont: Thomson Wadsworth.Gregory, J., 2011. Psychosocial education of nurses, the interpersonal dimension. Aldershot: Avebury. 10) Guido, G.W., 2010. Legal and ethical issues in nursing. London: Pearson. 11) Hardin, S, R., & Kaplow, R., 2010. Cardiac surgery essentials for critical care nursing. St. Louis: Elsevier. 12) Jacobson, C., Marzlin, K., & Webner, C., 2014. Cardiovascular nursing practice: A comprehensive resource manual and study guide for clinical nurses (2nd ed.). Burien: CNEA. 13) Kanu, C., & Eric, J., 2015. Cardiac drugs (2nd ed.). London: Jaypee Brothers Medical Publications. 14) Kee, J. L., Hayes, E. R., & McCuistion, L. E., 2014. Pharmacology: A nursing process approach (8th ed.). St. Louis: Saunders. 15) Marzlin, K. M., 2011. Cardiovascular nursing: A comprehensive overview (2nd ed.). 16) Melnyk, B., & Overholt, E., 2014. Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Amsterdam: Wolters Kluwer. 17) Morton, P. G., & Fontaine, D. K., 2012. Critical care nursing: A holistic approach (10th ed.). Ambler: Lippincott Williams & Wilkins. 18) Munro B. A., 2010. Statistical methods for health care research (6th ed.). Philadelphia: Lippincott Williams and Wilkins. 19) Polit, D. F., Beck, C., & Hungler, B., 2010. Essentials of nursing research: Methods, appraisal and utilization (5th ed.). Philadelphia: Lippincott Williams and Wilkins.

38 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

20) Regan, E., 2016. EKG interpretation made easy: A complete step-by-step guide to 12-lead EKG/ECG interpretation and arrhythmias. 21) Saudi Board of Family Medicine, 2014. Curriculum. 22) Saudi Commission Examination Rules and Regulations, available at http://www.scfhs.org.sa/en/MESPS/TrainingExams/RegulationBoard/Documents/General%20 Exam%20Rules%20and%20Regulations.pdf 23) Saudi Commission for Health Specialties Online Universal Topics, available at http://www.scfhs.org.sa/en/MESPS/Pages/UniversalTopics.aspx 24) Sole, M. L., Goldenberg Klein, D., & Moseley, M. J., 2012. Introduction to critical care nursing (6th ed.). St. Louis: Saunders. 25) Urden, L. D., Stacy, K. M., & Lough, M. E., 2013. Thelan’s critical care nursing: Diagnosis and management (7th ed.). St. Louis: Elsevier. 26) Wiegand, D. L., 2010. AACN procedure manual for critical care (6th ed.). St. Louis: Elsevier.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 39 RECOMMENDED READING

RECOMMENDED READING

Textbooks 1) Hardin, S, R., & Kaplow, R., 2010. Cardiac surgery essentials for critical care nursing. St. Louis: Elsevier. 2) Jacobson, C., Marzlin, K., & Webner, C., 2014. Cardiovascular nursing practice: A comprehensive resource manual and study guide for clinical nurses (2nd ed.). Burien: CNEA. 3) Urden. L. D., Stacy, K. M., & Lough, M. E., 2013. Thelan’s critical care nursing: Diagnosis and management (7th ed.). St. Louis: Elsevier . 4) Wiegand, D. L., 2010. AACN procedure manual for critical care (6th ed.). St. Louis: Elsevier.

Journals 1) Critical Care Nursing - http://ccn.aacnjournals.org/ 2) National Institutes of Health - http://gateway.nlm.nih.gov/gw/Cmd/

Web resources http://www.uptodate.com/contents/search

40 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

APPENDICES

Appendix A Didactic and Clinical Rotations (1st Year) Course Duration Theoretical hours Clinical hours Module I: * 6 weeks 96 hours 144 hours Foundational Human (2 days per week) (3 days per week) Anatomy and Physiology of Simulation, workshop, and clinical rotation the Cardiac System Module II: 5 weeks 80 hours 120 hours Health Promotion, (2 days per week) (3 days per week) Prevention, and Workshop, awareness day, and community Rehabilitation visits Module III: * 12 weeks 92 hours 384 hours Fundamentals of Cardiac (1 day per week) (4 days per week) Pathophysiology Simulation, workshop, and clinical rotation Module IV: 6 weeks 144 hours 96 hours Cardiac Nursing: (3 days per week) (2 days per week) Assessment, Planning, and Simulation, workshop, and clinical rotation Managing Care Module V: * 5 weeks 80 hours 120 hours Cardiac Pharmacology (2 days per week) (3 days per week) Simulation, workshop, and clinical rotation Modules VI: 6 weeks 48 hours 192 hours Ethics in Nursing & (1 day per week) (4 days per week) Dimensions of Care * Cardiac medical units Module VII: Epidemiology * 2 weeks 80 hours Computer lab and library (5 days per week)

Module VIII: Biostatistics * 2 weeks 80 hours Computer lab and library (5 days per week) Total 44 weeks 736 hours 1024 hours *These modules are didactic modules.

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 11 Appendix B Didactic and Clinical Rotations (2nd Year) Course Duration Theoretical hours Clinical hours 96 hours (3 days per week) Module IX: * Consolidate rotation in research area of Introduction to Research 64 hours interest and in areas that provide 4 weeks and Evidence-Based (2 days per week) resources for nursing research (e.g., Practice nursing researchers, biostatisticians, librarians) Module X: * 96 hours 384 hours (4 days per week) Advanced Cardiac Care 12 weeks (1 day per week) Cardiac medical and coronary care unit Nursing Module XI: 384 hours (4 days per week) 96 hours ECG Interpretation – 12 weeks Cardiac surgery unit, cardiac operating (1 day per week) Advanced room Module XII: 2 weeks 32 hours 48 hours (3 days per week) Emotional and Spiritual (2 days per week) Outpatient clinics and communities Well-Being Module XIII: * 4 weeks 32 hours 128 hours (4 days per week) Evaluation of the Quality (1 day per week) Clinical rotation of Care 96 hours (3 days per week) Module XIV: * 64 hours Rotations with nursing informatics staff 4 weeks Nursing Informatics (2 days per week) and/or working with healthcare informatics systems Module XV: Leadership 32 hours 128 hours (4 days per week) 4 weeks and Management* (1 day per week) Rotations with nurse managers 48 hours (3 days per week) Module XVI: 32 hours 2 weeks Rotation in cardiac specialty area of Professional Performance (2 days per week) interest Total 44 weeks 448 Hours 1312 Hours *These modules are didactic modules.

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Appendix C 6 Nursing Research Project Guidelines Under the guidance of an adviser, the trainee takes three credit hours for a research project and submits it to the adviser. The clinical research project falls under the supervision of a faculty member and employs the scientific process in analyzing a clinical problem or issues related to advanced nursing practice. Emphasis is on a project that has tangible application to the practice setting.

Learning Objectives At the end of this module, the trainee will be able to: 1) Demonstrate the ability to collect, analyze, synthesize, and evaluate information; 2) Formulate research questions on problems of clinical significance in advanced nursing practice; 3) Critically analyze and apply studies pertinent to patient care; 4) Interpret research findings and recommendations to patients, agencies, and health care professionals; and 5) Write a scholarly paper in a format suitable for professional publication.

Clinical research project guidelines Utilization Studies A trainee may conduct a research utilization project that is relevant to nursing. Examples include the design of clinical protocols for the implementation of previous research findings.

Pilot Studies A trainee may conduct a small-scale study as a foundation for future study, for example, a pilot study (based on a smaller sample or refined methodology), a descriptive survey of a group targeted for later study, an intervention study, or a study that establishes or extends the reliability and validity of a tool.

Replication Studies A trainee may conduct an exact or approximate replication (under similar conditions) of a study in order to extend the findings of previous research.

Advisor For each research project, one faculty member will function as advisor, who gives final approval for the trainee to register for the course, advises the trainee during implementation of the project, verifies that all requirements for the project and written report have been met, and submits the final course grade. Graduate faculty will assign faculty members to the role of advisor or reader.

6 Nursing research project guidelines are adopted from the McNeese State University College of Nursing Graduate Program 2012-2013, available at http://www.mcneese.edu SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 13 For preliminary approval (prior to registration for the project module) 1) Select an advisor for the project who has expertise or an interest in the area of your proposed clinical research 2) Provide a description of the project, including the following:  Problem statement  Purpose and objectives of the project  Significance of the project

Completion of the project module 1) Register for the project module assigned to an advisor. 2) Attend conferences with the advisor as recommended or requested. Submission of working drafts of the research report to the faculty advisor is recommended. 3) Submit copies of the written research report to the advisor.

Evaluation 1) Written research report 2) Completion of the clinical research project, as outlined.

Grading criteria The maximum score for this paper is 100 points (see the project assessment tool below). Each item is weighted in terms of its importance in fulfilling the purposes of the project.

44 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Research Project Assessment Tool Trainee: ID Number: Date: Specialty Area for Research: Program Director: Mark Obtained: Percentage: SCIENTIFIC NURSING RESEARCH 0 1 2 N/A Remark The title page includes the following: Topic Candidate’s name and surname Course name Timely submission /4 The table of contents includes the following: Headings/sub-headings Numbering of headings/sub-headings Page numbers indicate where the headings appear in the text. Headings/sub-headings correspond with those in text. /4 Introduction: The clinical problem to be researched is stated. Background information to the clinical problem is provided. The importance of conducting the research is stated. /6 Problem Statement: The problem statement is formulated either in question or declarative form. The problem statement includes the topic, target group, and setting. /4 Purpose and Objectives: The purpose of the intended research is stated. Measurable objectives are stated to support the purpose. /4 Definitions: The main concepts in the topic, problem statement, purpose, and objectives are defined. /2 Literature Review: The literature review is relevant to the research problem. Mainly primary sources are reviewed. The sources are up to date (not older than five years, except classical sources). The best/most relevant evidence has been collected to support the data. /8

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 15 In-text citations (Harvard method) are included to avoid plagiarism. /2 Research Design, Population, Sample, and Sampling: The selected research design is motivated. The research population is described. The research sample is described. The sampling method is described. /8 Ethical Considerations: A letter requesting permission to conduct the research in the relevant setting is included (as an Appendix). Evidence of informed consent from the patient(s) is presented (where applicable). Confidentiality of data is maintained. /6 Data Collection Method and Analysis: The data collection method is described. A structured questionnaire is included (where applicable). The reliability and validity of the data collection method/instrument are described. An appropriate data analysis method is selected (e.g., pie chart). /8 Discussion: A conclusion is drawn on the basis of the research findings. The strengths and weaknesses of the research project are briefly described. Recommendations are made for future research. /6 List of Sources: A detailed list of sources is included. The list of sources appears on a separate page. A variety of up to date sources are consulted. The sources correspond with the in-text citations. The sources are ordered alphabetically (according to author surname). The sources are not numbered. The appendices appear after the list of sources. /7 General: The research report is neat. The research steps flow systematically. The research report is free of spelling errors. The grammar is correct. Effort has clearly been made. The research report is submitted on time. /6

46 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

TOTAL: /75 Comments of program director: ______

Name of program director: ______

Signature: ______

Date: ______

Trainee name: ______

Signature: ______

Date: ______

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 17 Appendix D SCFHS Guidelines for Mentors Goals of mentorship 1) Guidance of trainees towards personal and professional development through continuous monitoring of progress 2) Early identification of both struggling and high achieving residents 3) Early detection of trainees at risk of emotional and psychological problems 4) Provision of career guidance

Roles of mentors The primary role of a mentor is to nurture a long-term professional relationship with his/her assigned trainees. The mentor is expected to provide an “academic home” for trainees so that they might feel comfortable sharing their experiences, expressing their concerns, and clarifying issues in a non- threatening environment. The mentor is expected to maintain confidentiality with regard to sensitive information about trainees.

The mentor is expected to make appropriate and timeous referral to the program director or department head if a problem arises requiring expertise or resources beyond his/her capacity. Example of such referral might include: 1) Serious academic problems, 2) Progressive deterioration of academic performance, 3) Potential mental or psychological issues, 4) Personal problems interfering with academic duties, 5) Professional misconduct, etc. Note that the following are NOT expected roles of a mentor: 6) Providing extra tutorials, lectures, or clinical sessions 7) Providing counseling for serious mental and psychological problems 8) Involvement in trainees’ personal matters 9) Providing financial or other material support

Roles of trainees 1) To submit a resume at the beginning of the relationship 2) To provide the mentor with short-term (one year) and long-term (two year) goals 3) To take primary responsibility in maintaining the relationship 4) To schedule four-weekly meetings with the mentor in a timely manner, avoiding requests for ad hoc meetings except in an emergency 5) To recognize self-learning as an essential element of specialty training 6) To report any major events to the mentor in a timely manner

Who can be a mentor? Any faculty member of consultant grade and above within the specialty program can be a mentor. No special training is required.

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Number of trainees per mentor As a guideline, each mentor should have no more than four to six trainees. As far as possible, trainees from both first and second years of training should be assigned, so that a senior trainee might guide a junior trainee.

Frequency and duration of engagement The recommended minimum frequency of trainee–mentor meetings is once every four weeks. Each meeting may take 30 minutes to an hour. It is preferable for each trainee to remain with the same mentor for the entirety of his/her training i.e., for two years.

Tasks during each meeting The following are suggested tasks to be completed during each meeting: 1) Discuss overall clinical experience of the trainee with particular attention to any concerns raised. 2) Review logbook or portfolio with the trainee to determine whether the trainee is on target for meeting training goals. 3) Revisit earlier concerns or unresolved issues, if any. 4) Explore any non-academic factors seriously interfering with training. 5) Document excerpts of the interaction in the logbook.

Mandatory reporting to program director or department head 1) Consecutive absence from three scheduled meetings without valid reason 2) Unprofessional behavior 3) Consistent underperformance despite counseling 4) Serious psychological, emotional, or health problems that may potentially lead to unsafe patient care 5) Any other serious mentor concern

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 19 Appendix E Advanced Practice Nursing Program in Cardiac (Adult) Specialization

Performance Assessment of the Trainee (To be completed by the preceptor7 upon completion of the clinical hours required monthly in the specialty)

Trainee name: ______

ID number: ______

Evaluation for the period from ______to ______

Performance indicators: Weak: 1 Fair: 2 Good: 3 Very good: 4 Excellent: 5

Skill Assessment Criteria 1 2 3 4 5 Demonstrates the ability to effectively assess, diagnose, plan, implement, and evaluate patient care Plans patient-specific care and uses care maps or clinical pathways (if appropriate) for the clinical setting Implements nursing interventions and makes individualized therapeutic decisions related to patients’ health condition and planned outcomes Demonstrates safe medication administration practice at all times Participates in formal and informal teaching/training Maintains professional behavior at all times Maintains complete documentation according to hospital policies Works collaboratively with the multidisciplinary team (preceptor, manager, physicians, etc.) in order to achieve training goals Requests assistance, support, and supervision appropriately as needed Shares goals/objectives with preceptor for each clinical day Shows initiative in identifying and articulating training needs Completes all responsibilities for care associated with designated patients each clinical day Demonstrates effective time management, organization in planning, and appropriate performance in nursing responsibilities Remains punctual and provides appropriate absence notification based on hospital policy Displays professional behavior and appearance (uniform and ID) Demonstrates accountability and responsibility for own practice Accepts constructive feedback Adheres to the code of ethics Maintains patient confidentiality at all times Demonstrates respect for cultural differences Total: /20 Comments of the preceptor:

7 Appendices E, F, and G are adopted from the Advanced Practice Clinical Nursing Diploma in Oncology, 2014. 50 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Preceptor name: ______

Signature: ______

Date: ______

Trainee name: ______

Signature: ______

Date: ______

Appendix F Advanced Practice Nursing Program in Cardiac (Adult) Specialization

Performance Assessment of the Trainee (To be completed by the clinical instructor on completion of the clinical hours required monthly in the specialty)

Trainee name: ______

ID number: ______

Evaluation for the period from ______to ______

Performance indicators: Weak: 1 Fair: 2 Good: 3 Very good: 4 Excellent: 5

Skill Assessment Criteria 1 2 3 4 5 Collects relevant patient information in order to form a comprehensive care plan Conducts a thorough physical assessment and document findings in the patient’s medical record according to organizational policies Identifies, based on assessment findings, appropriate patient outcomes Develops a comprehensive plan of care that will ensure continuity of care in collaboration with patients and their families Provides appropriate interventions based on the patient’s plan of care Adheres to safety standards/protocols as outlined in hospital policies and procedures Communicates with patients and families using therapeutic communication skills Evaluates patients’ progress based on planned outcomes and revises plan of care accordingly Is self-directing; assumes initiative and responsibility for own practice Develops plan of care for specific patient population as needed Accepts constructive criticism and uses suggestions for improvement Remains punctual and reports absence or sickness through the right channels according to hospital policies

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 51 Participates in staff and trainee education Turns in completed written assignments on time Cooperates with and supports other members of the health care team Adheres to the code of ethics Maintains patient confidentiality and privacy at all times Communicates effectively with the multidisciplinary team members Synthesizes appropriate research findings and incorporates them in practice Utilizes evidence-based practice in developing a patient’s plan of care Total: / 20 Comments of the preceptor: ______

Preceptor name: ______

Signature: ______

Date: ______

Trainee name: ______

Signature: ______

Date: ______

Appendix G Advanced Practice Nursing Program in Cardiac (Adult) Specialization

Performance Assessment of the Trainee (To be completed by the nurse manager on completion of the clinical hours required monthly in the specialty) Trainee name: ______ID number: ______Evaluation for the period from ______to ______Performance indicators: Weak: 1 Fair: 2 Good: 3 Very good: 4 Excellent: 5

Skill Assessment Criteria 1 2 3 4 5 Actively participates in departmental activities (meetings, education, etc.) Assists with development, updating, and implementation of clinical guidelines Proactively intervenes in challenging situations within the clinical setting Attends and actively participates in hospital committees as needed Adheres to relevant standards of care and follows hospital policies at all times Coordinates with other departments within the hospital to promote optimal continuity of care 52 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Serves as patient advocate in exploring other plans of care in collaboration with the multidisciplinary team members Accepts constructive criticism and uses suggestions for improvement Remains punctual and reports absence or sickness through the right channels according to hospital policies Participates in staff and trainee education Turns in completed written assignments on time Cooperates with and supports other members of the health care team Adheres to the code of ethics Maintains patient confidentiality and privacy at all times Communicates effectively with the multidisciplinary team members Utilizes evidence-based practice in developing the patient’s plan of care Total: / 16 Comments of nurse manager: ______

Nurse manager name: ______

Signature: ______

Date: ______

Trainee name: ______

Signature: ______

Date: ______

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 53 Appendix H Trainee’s Performance Assessment of the Preceptor This tool is to be used by a trainee to evaluate his/her preceptor’s performance during his/her clinical training. One evaluation form is to be completed for each preceptor and submitted to the program director, who is to discuss the evaluation feedback with the preceptor to facilitate improvement as appropriate.

Name of Trainee: Hospital name: Region: Preceptor name: Preceptor ID number: Date of training: From ______to ______Duration of training: Unit/area of training: Performance indicators: Weak: 1 Fair: 2 Good: 3 Very good: 4 Excellent: 5

Assessment Criteria 1 2 3 4 5 Assesses the trainee’s previous work, history, and experience Reviews the trainee’s learning plan and assists with goal setting Talks about how the trainee learns best (e.g., on-the-job training, independent study) Reviews and discusses important workplace documents together with the trainee (e.g., IPP, fire procedures) Provides guidance on how to complete commonly used workplace forms (e.g., patient care plans, medication sheets) Has the trainee practice patient care documentation; reviews with the trainee and provides feedback Suggests helpful learning resources for writing skills development (e.g., workbooks, training sessions) Asks the trainee to prepare for patient rounds by the multidisciplinary team, ensuring that enough time is allocated to preparation; reviews with the trainee and provides feedback Demonstrates effective oral communication skills for the trainee (e.g., invites the trainee to attend meeting led by the preceptor) Encourages the trainee to participate in activities that may enhance his/her oral communication skills (e.g., patient rounds, speaking with co-workers about particular patient issues, handling customer complaints); provides feedback Provides adequate supervision to ensure patient safety during difficult or new procedures Utilizes evidence-based practice in developing a patient’s plan of care

Discusses ways to improve hospital operations or policies; encourages the trainee to identify strengths and weaknesses of proposed ideas

Asks the trainee to talk about problem faced in the workplace; discusses possible solutions in terms of strengths and weaknesses

Encourages the trainee to participate in group activities (e.g., volunteering, working groups in the unit)

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Observes how the trainee interacts with others and provides feedback

Suggests learning opportunities to improve computer skills (e.g., training sessions)

Helps the trainee search the internet for information relevant to the workplace or a particular task/procedure/patient condition Provides daily feedback on the trainee’s progress and improvement opportunities Assists with development, updating, and implementation of clinical guidelines Proactively intervenes in challenging situations within the clinical setting Adheres to relevant standards of care and follows hospital policies at all times Serves as patient advocate in exploring alternative plans of care in collaboration with the multidisciplinary team members Adheres to the code of ethics Maintains patient confidentiality and privacy at all times Remains approachable and open to discussion Appears knowledgeable, informative, and coherent Remains available for teaching when required Acts as a positive role model Demonstrates cultural sensitivity in the workplace and during patient care Suggestions for improvement: ______

Trainee’s signature: ______

Date completed: ______

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 55

Appendix I Trainee’s Overall Evaluation of the Training Program This tool is to be used by the trainee to evaluate the program after each year of training. The evaluation feedback is to be discussed by the program director and program supervisory committee to identify improvement opportunities.

Program name: Hospital name: Region: Program director name: Date of program: From / / to / / Duration of program: Performance indicators: Weak: 1 Fair: 2 Good: 3 Very good: 4 Excellent: 5

Assessment Criteria 1 2 3 4 5

GENERAL INFORMATION: The program participants manual included all information I needed to 1 know about the program. 2 I had adequate knowledge about the program before it started. The overall program goals were clearly explained to me before the start 3 of the program. The knowledge to be gained during the course of the program was 4 introduced to me before the start of the program. The skills to be mastered during the program were explained to me 5 before it started. PROGRAM CURRICULUM: 6 The program content met its stated objectives. 7 I was satisfied with the quality of the content. 8 An appropriate amount of material was covered. 9 The activities in the program helped me achieve the stated objectives. The program materials were well designed and organized to aid 10 understanding. Instructional methodologies (case studies, examples, group work, etc.) 11 were used appropriately to aid the understanding of the subject. The structure of the program helped me acquire the required knowledge 12 to practice my specialty professionally. The structure of the program helped me develop the required skills to 13 practice my specialty competently. The structure of the program emphasized the concept of respect for 14 others. The structure of the program emphasized the concept of compassion for 15 others. The structure of the program emphasized the concept of patients’ 16 autonomy.

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REFERENCES

Learning opportunities to improve computer use skills (e.g., training 17 sessions) were suggested. The structure of the program emphasized the concept of patients’ 18 privacy rights. 19 The sequence of training was appropriate. During the course of the program, I was introduced to the required 20 elective activity (research/education, administrative training, or simulation). The program emphasized the “nursing expert” competency as stated in 21 the Mosby. 22 The training program introduced me to principles of patient safety. The training program introduced me to principles of healthcare quality 23 improvement. I was given an opportunity to participate in a patient safety or healthcare 24 quality project at my training center. 25 Required readings/texts were valuable. Readings, homework, and laboratories contributed to my appreciation 26 and understanding of the subject. FACULTY: 27 Instructors were well prepared for the course. Instructors facilitated the achievement of the program’s learning 28 objectives. 29 Instructors had an adequate level of communication skills. 30 Instructors used a variety of training methodologies. 31 Instructors were able to maintain an effective learning environment. 32 Instructors connected learning objectives to content. 33 Instructors cooperated with trainees. 34 Instructors motivated me to interact with other trainees. Instructors encouraged me to interact with employees/trainees from 35 other professions. 36 Instructors provided me with sufficient feedback about my learning. Instructors encouraged and guided me in participating in a patient safety 37 or healthcare quality project at my training center. 38 Instructors provided me with timely feedback. 39 Instructors demonstrated competence in their specialty. 40 Instructors used technology (audiovisuals) to enhance education. Instructors were adequately accessible to trainees during office hours or 41 after class. 42 Instructors were enthusiastic about teaching the program. 43 Instructors were dynamic and energetic in conducting the program. EVALUATION: 44 I was regularly supervised by my instructors and preceptors.

45 The level of evaluation was based on the expected level of competency.

46 The evaluation was based on measurable objectives. 47 I was made aware of the type of evaluation to be used. SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 57 48 I was made aware of the frequency of evaluation. 49 I was made aware of evaluation policies. 50 I was made aware of the mechanism of evaluation data collection. 51 I was made aware of my legal responsibilities. 52 I was made aware of education/training policies at my training center. 53 I was made aware of how to access policies at my training center. 54 I was made aware of the how to obtain educational resources. 55 I was evaluated based on the Mosby “nursing expert” competency. EXAMINATIONS: 56 Feedback on examinations/graded materials was valuable. 57 Methods of evaluating trainee work were fair and appropriate. Examinations/graded materials tested course content as emphasized by 58 instructors. 59 Access to the SCFHS online universal topics was adequate. PARTICIPANTS: 60 I was able to develop self-evaluation skills during the program. During the course of the program, I was given a chance to evaluate my 61 performance. 62 I was encouraged to develop my personal learning objectives. I developed a list of personal learning objectives to achieve during the 63 program. 64 I read the details of the program (manual and curriculum). 65 I understood the details of the program (manual and curriculum).

ENVIRONMENT:

66 I had convenient access to all training areas. I had convenient access to library services (including electronic 67 resources). The technologies that were used for training purposes were in working 68 order. 69 Overall, I am satisfied with the program design (curriculum). 70 Overall, I am satisfied with the program management. 71 Overall, I am satisfied with the program environment. 72 Overall, I am satisfied with the outcomes of the program. Suggestions for improvement: ______

Trainee’s signature: ______Date completed: ______

58 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Appendix J Case Based Discussion (CBD)

Trainee name: ______

Year 1 Year 2

Assessor name: ______

Date: ______Location: ______

ER OPD In-patient A&E New Follow up

Reason for clinical encounter: ______

Focus of clinical encounter: ______

Clinical assessment Management Record keeping Professionalism

Complexity of case: Low Average High Please rate the trainee against what you would expect of one in that year of training. Theme Unsatisfactory Satisfactory Superior Not Observed 1. Medical record keeping 1 2 3 4 5 6 7 8 9 N/O 2. History taking 1 2 3 4 5 6 7 8 9 N/O 3. Clinical findings and interpretation 1 2 3 4 5 6 7 8 9 N/O 4. Management plan 1 2 3 4 5 6 7 8 9 N/O 5. Follow-up and future planning 1 2 3 4 5 6 7 8 9 N/O 6. Professional qualities 1 2 3 4 5 6 7 8 9 N/O Overall clinical judgment 1 2 3 4 5 6 7 8 9 N/O Strengths: Suggestions for development:

Assessor satisfaction using CBD LOW 1 2 3 4 5 6 7 8 9 HIGH Trainee satisfaction using CBD LOW 1 2 3 4 5 6 7 8 9 HIGH

Time taken for discussion: ______min. Time taken for feedback: ______min

The trainee is to complete reflection on this CBD on the back of this form using Gibbs framework for reflection.

Assessor’s signature: ______Trainee’s signature: ______

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 59 Appendix K Direct Observation Procedure (DOP) Evaluation Form

Trainee name: ______

Year 1 Year 2

Assessor name: ______Date: ______Location: ______

ER OPD In-patient A&E New Follow up

Reason for clinical encounter: ______

Focus of clinical encounter: ______

Clinical assessment Management Record keeping Professionalism

Complexity of case: Low Average High

Please rate the trainee against what you would expect of one in that year of training.

Theme Unsatisfactory Satisfactory Superior Not Observed 1. Understanding indications, relative 1 2 3 4 5 6 7 8 9 n/o anatomy & technique 2. Obtaining informed consent 1 2 3 4 5 6 7 8 9 n/o 3. Pre-procedure preparation 1 2 3 4 5 6 7 8 9 n/o 4. Patient safety 1 2 3 4 5 6 7 8 9 n/o 5. Antiseptic technique 1 2 3 4 5 6 7 8 9 n/o 6. Technical ability 1 2 3 4 5 6 7 8 9 n/o 7. Seeking help where appropriate 1 2 3 4 5 6 7 8 9 n/o 8. Post procedure management 1 2 3 4 5 6 7 8 9 n/o 9. Communication skills 1 2 3 4 5 6 7 8 9 n/o 10. Professionalism 1 2 3 4 5 6 7 8 9 n/o Overall clinical judgment 1 2 3 4 5 6 7 8 9 n/o Strengths: Suggestions for development:

Assessor satisfaction using DOPS LOW 1 2 3 4 5 6 7 8 9 HIGH Trainee satisfaction using DOPS LOW 1 2 3 4 5 6 7 8 9 HIGH

60 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Time taken for discussion: ______min. Time taken for feedback: ______min

The trainee is to complete reflection on this DOP on the back of this form using Gibbs framework for reflection.

Assessor’s signature: ______Trainee’s signature: ______

Appendix M Trainee Reflection Form Description of the event:

Feelings and thoughts (self-awareness):

Conclusion:

Action plan:

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 11 Appendix N Logbook

NAME: ______

YEAR: ______

Date Patient data Clinical problem Management Learning points

62 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Appendix O LPRIF* Module L P R I F (Weight %) Foundational Human Anatomy and Physiology of 3 3 - 3 3 81 the Cardiac System - 3 3 Health Promotion, Prevention, and Rehabilitation 3 3 81

- 3 3 Fundamentals of Cardiac Pathophysiology 3 3 81

Cardiac Nursing: Assessment, Planning, and - 3 3 3 2 54 Managing Care - 3 3 Cardiac Pharmacology 3 3 81

Introduction to Research and Evidence-Based - 3 3 3 3 81 Practice - 3 Advanced Cardiac Care Nursing 3 2 3 54

- 3 81 ECG Interpretation – Advanced 3 3 3

- 2 3 54 Emotional and Spiritual Well-Being 3 2

Evaluation of the Quality of Care

- 2 3 54 Ethics in Nursing and Dimensions of Care 3 2

- 2 2 3 54 Epidemiology 3

- 2 2 3 54 Biostatistics 3

- 2 3 54 Nursing Leadership and Management 3 3

- 2 2 3 72 Nursing Informatics 6

- 2 2 3 72 Professional Performance 6

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 13 Appendix P Competency Checklist Assessment: Cardiac Assessment: Focused Assessment: General Survey Assessment: Head and Neck Assessment: Intake and Output Assessment: Musculoskeletal and Neurologic Assessment: Nutrition Screening Assessment: Orthostatic Vital Signs Assessment: Respiration Assessment: Thorax and Lungs Assessment: Abdomen, Genitalia, and Rectum Assessment: Visual Acuity Assessment: Wounds Blood and Fluid Pressure Infusers Blood and Fluid Warmers Blood Glucose Monitoring Blood Pressure (Systolic): Palpation Blood Pressure Measurement Education Blood Pressure: Lower Extremity Blood Pressure: Upper Extremity Blood Products Administration Blood Specimen Collection: Blood Cultures Atrial Electrogram Auto-PEEP Calculation Hand Washing and Hygiene Pain Assessment and Reassessment Wound Dressing Medication Administration Indwelling Catheterization TPN and Fat Emulsion Administration Enteral Feeding Blood and Blood Product Administration Peripheral IV Insertion NGT Insertion Central Parenteral Nutrition Feeding Tube: Small-Bore Insertion and Care Feeding Tube: Verification of Placement Feeding Tubes: PEG, Gastrostomy, and Jejunostomy Care Ambulation Aids: Patient Education Aquathermia and Heating Pads Aspiration Precautions Cardiac Monitor Setup and Lead Placement Perform 12 Lead ECG Electrocardiogram: Right Precordial and Left Posterior Leads Automated External Defibrillator (AED) Transcutaneous Cardiac Pacing External Defibrillation Cardioversion

64 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Alteplase for Acute Myocardial Infarction Tenecteplase for Acute Myocardial Infarction Alteplase for Pulmonary Embolism Arterial and Venous Sheath Removal Arterial-Venous Oxygen Calculations Apical Pulse Radial Pulse Pulse Measurement Education Lumbar Puncture: Advanced Practice Arterial Catheter Insertion (Assisting), Care, and Removal Arterial Catheter: Blood Sampling Arterial Pressure-Based Cardiac Output Monitoring Cardiac Output Measurement Central Venous Catheter Insertion Central Venous Catheter: Blood Sampling Central Venous Catheter: Removal Continuous ST-Segment Monitoring Central Venous Catheter: Site Care Chest Tube Insertion Chest Tube Removal Closed Drainage Systems Code Management Donation After Cardiac Death Endotracheal and Tracheostomy Tube Cuff Care Emergent Sternotomy and Internal Defibrillation Endotracheal Tube and Tracheostomy Tube: Oxygen Administration Endotracheal Tube Extubation and Tracheostomy Tube Decannulation Endotracheal Tube Intubation Endotracheal Tube: Skin and Oral Care External Jugular Venous Access Implantable Cardioverter-Defibrillator: Deactivation and Reactivation Implantable Cardioverter-Defibrillator: Emergency Management Implanted Venous Port: Access, De-access, and Care Intra-compartmental Pressure Measurement Intra-aortic Balloon Pump Management Mechanical Ventilation: Volume and Pressure Modes Mechanical Ventilation: Weaning Nasopharyngeal Airway Insertion Needle Thoracostomy: Advanced Practice Pacemaker Insertion Temporary Transvenous: Advanced Practice Preoperative Care Postoperative Care: Immediate Recovery Period Pacemaker: Assessment of Function Pacing: Epicardial Wire Removal Pacing: Temporary Transvenous and Epicardial Pericardial Catheter Management Pericardiocentesis Pulmonary Artery Catheter Insertion (Assisting) and Monitoring Pulmonary Artery Catheter: Mixed Venous Oxygen Saturation Sample Pulmonary Artery Catheter: Removal Pulmonary Artery Catheter SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 15 Pulsus Paradoxus Assessment Troubleshooting Streptokinase for Acute Myocardial Infarction Suctioning: Endotracheal and Tracheostomy Tube Thoracentesis Tracheostomy Tube: Care and Suctioning Ventricular Assist Devices Resuscitation Bag: Manual Self-Inflating in Mechanically Ventilated Patients Seizure Precautions Transesophageal Echocardiography Right Atrial and Central Venous Pressure Monitoring Ventilation: Noninvasive CPAP, BiPAP, and NIMV EVD and ICP Monitoring and Troubleshooting Restraint Application and Monitoring Organ Donation Grief Support for Patients and Family

66 SAUDI CARDIAC NURSING DIPLOMA CURRICULUM REFERENCES

Appendix Q l (Use Method

Method of Instruction Method of Evaluation Self-Assessment by Trainee eft) Validation of Competency Key: Key:

Done N Practi Needs C Date Initials on (Use E i v o nstruction nstruction e al

P = O = Observation (in m v l eft) e u of Instruction Instruction of p

e r

Protocol/Procedure clinical setting) a c ete

val tion tion

e R

Review RD = Return e u n v ation ation t i e Method Method E = Education Session Demonstration k w e /

S = Self Learning T = Written Test y

k on on

Package V = Verbal Review e y C = Clinical Practice D = Demonstration HOSPITAL ADMINISTRATIVE MANUAL – is aware of content and/or provides care according to the following protocols/procedures: 1. Informed consent for treatment

2. Verbal/telephone orders

3. Do Not Resuscitate

4. Medication administration: Adverse drug reaction (ADR) Reporting System 5. Health information system (HIS)

6. Emergency codes

7. Fire safety

8. International patient safety goals

9. Back safety

10. Infection control manual

NURSING PRACTICE MANUAL – is aware of content and/or provides care according to the following protocols/procedures: 1. Blood components: Administration

2. Nursing documentation

3. Falls: Risk identification and prevention management 4. Pressure ulcer

5. Medication administration system

6. Point of care testing

7. Report/handoff

Initials Signature Initials Signature Initials Signature

SAUDI CARDIAC NURSING DIPLOMA CURRICULUM 17