Portland Community College | Portland, Oregon

This course builds on NRS 111, Foundations of Nursing in Chronic Illness I. Chronic Illness II expands the student’s knowledge related to family care giving, symptom management and end of life concepts. These concepts are a major focus and basis for nursing interventions with patients and families. Ethical issues related to advocacy, self-determination, and autonomy are explored. Complex skills associated with the assessment and management of concurrent illnesses and conditions are developed within the context of patient and family preferences and needs. Skills related to enhancing communication and collaboration as a member of an inter-professional team and across health care settings are further explored. Exemplars include patients with chronic mental illness and addictions as well as other chronic conditions and disabilities affecting functional status and family relationships. The course includes classroom and clinical learning experiences. 

Prerequisites: Completion of First year of Nursing Curriculum: NRS 110; NRS 111; NRS 112; NRS 230,231,232, 233

By the end of the course, the student will be able to:
1.conduct a health assessment that is in-depth, evidence-based, family-centered, and both developmentally and culturally appropriate interpret health data, focusing on: functional issues associated with complexities of co-morbid conditions in relation to adl’s and iadl’s; manifestations of psychiatric diagnoses and their impact on client selfcare; psychosocial issues and the impact of the illness on  individual development and family function; the client’s personal, social and cultural interpretation of the meaning of the illness and the impact on the client’s family; capacity for and engagement in self care; and, opportunities for health behavior change.
2.develop and use evidence-based interventions, individualized to client and family needs, specifically to: establish meaningful relationships with clients/families; support client and family in development of capacity for self-health care management; address caregiver needs for preparedness,
predictability and enrichment; manage symptoms/manifestations for specific disorders;
3.incorporate measures to enhance quality of life in the plan of care by:facilitating client in personal definition of quality of life, and addressing client needs for preparedness, predictability and enrichment.
4.identify and use community resources to provide support for the client and family caregiving by:supporting the client in negotiating the health care system; and accessing appropriateness of resources in meeting the client/family needs, (e.g. Accessibility, financial feasibility, acceptability).
5.communicate, as appropriate, with all agencies involved in patient care to assure continuity of care across settings (e.g. Schools, day
care, adult foster care, etc.) By:negotiating with others to modify care; and advocating for clients.
6.support patients and families across the life-span who choose palliative care or are experiencing transitions at the end of life by: negotiating with others to develop or modify patient care;describing the epidemiology of dying: where, when, how people die; dying trajectories across the lifespan;using developmentally and culturally appropriate communication with patients and families at eol;using appropriate assessment techniques for individuals and families experiencing life threatening illness; and, assessing family capacity to provide care, caregiving strain, strengths, and resources.
7.analyze impact of health care delivery system issues, policy and financing on individual and family care by: comparing basic funding mechanisms for chronic illness; identifying decision-making issues for chronic care based on funding resources; and accessing appropriateness of resources in meeting
the client/family needs, (e.g. Accessibility, financial feasibility, acceptability).

Intended Outcomes for the course:

1. Conduct a health assessment that is in-depth, evidence-based, family-centered, and both developmentally and culturally appropriate. Interpret health data, focusing on:

• functional issues associated with complexities of co-morbid conditions in relation to ADLs and IADLs;
• manifestations of psychiatric diagnoses and their impact on patient self-care;
• psychosocial issues and the impact of the illness on individual development and family function;
• the patient’s personal, social and cultural interpretation of the meaning of the illness and the impact on the patient’s family;
• capacity for and engagement in self-care; and
• opportunities for health behavior change.

2. Applies evidence-based nursing practices in support of patient and family in self health care management across the lifespan to: 

• establish meaningful relationships with patients/families;
• support patient and family in development of self-health care management;
• address caregiver needs for preparedness and predictability with regards to the management of symptoms/manifestations for specific disorders; and
• assess family strengths and resources, caregiver role strain, and capacity to provide care.

3. Incorporate measures to enhance quality of life in the plan of care by:

• facilitating patient in developing their personal definition of quality of life; and
• addressing patient needs for preparedness and predictability.

4. Identify and use community resources to provide support for the patient and family caregiving by:

• supporting the patient in negotiating the health care settings;
• assessing appropriateness of resources in meeting the patient/family needs (e.g. accessibility, financial feasibility, acceptability); and
• developing inter-professional collaboration for the provision of care.

5. Communicate with agencies involved in patient care to assure continuity of care across settings (e.g. schools, day care, adult foster care, etc.) by:

• negotiating with others to modify care; and
• advocating for patients.

6. Utilize nursing- and interprofessional based-knowledge of death and dying trajectories to support patients/families across the lifespan who are experiencing transitions at the end of life

• describing the epidemiology of dying: where, when, how people die; dying trajectories across the lifespan;
• using developmentally and culturally appropriate communication with patients and families at EOL; and
• using appropriate assessment techniques for individuals and families experiencing life threatening illness.

7.  Analyze the impact of health care delivery system issues, policy and financing on individual and family health care needs for chronic illness and end of life care by:

• comparing basic funding mechanisms;
• identifying decision-making issues for chronic care based on funding resources;
• and assessing appropriateness of resources in meeting the patient/family needs (e.g. accessibility, financial feasibility, acceptability).

Discussion groups

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

Clinical performance evaluation

Papers/Project Rubrics
Multiple choice exams
Lab performance evaluation

Themes, Concepts & Issues:

Advocacy

Complexity in chronic illness

Symptom management

Self-management

Communication

Case management

Chronic mental illness

Substance abuse

End of life care

Ethical/Legal issues

Financing

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

Homelessness

Skills: This is not an exhaustive list but is a minimum skill set to be completed anytime throughout  NRS 221, NRS 222 or NRS 224

Intravenous Therapy and Regulation: Central lines

Central Line Intermittent IV Therapy via Secondary Infusion (piggyback)

PCA (patient controlled analgesia) pump

 Central Venous Access Devices

 Peripheral IV Direct Medications (IV push)

TPN administration and maintenance

Blood Administration

Chest Tube Maintenance

Telemetry: Cardiac Dysrhythmias  

Tracheostomy Care

Tracheostomy Suctioning

Post Mortem Care

Epidural maintenance (classroom theory)

Ventilator/ETT (classroom theory)

Code Roles

Code

Chronic Pain Advanced Interventions

Advanced Wound Care