NURS2040 Professional Practice 4 (PP4) Week 1 PDF

NURS2040 Professional Practice 4 (PP4) Week 1 Course Coordinators/Lecturers Freo: Dr Benjamin Hay & Marie Fielding Broome: Jane Livissianos NSW: Michelle De Leon ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowl...

NURS2040 Professional Practice 4 (PP4) Week 1 Course Coordinators/Lecturers Freo: Dr Benjamin Hay & Marie Fielding Broome: Jane Livissianos NSW: Michelle De Leon ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Fremantle Campus is located on Wadjuk Country, the Broome Campus on Yawuru Country and the Sydney Campus on Cadigal Country. My Background Critical Care Nurse – ICU -13 years Senior Lecturer – UNDA 13 years PhD 2018 HDR students- MPhil’s, PhD’s Research publications and conferences 2nd year Academic Advisor 2024 Personal notes Email: [email protected] LinkedIn: https://www.linkedin.com/in/benjamin-hay-39a41737/ Quotes… ‘You don’t go to university to be ‘satisfied’. You go to be profoundly challenged, unsettled, pushed and skilled in the hope that you might think differently and better when you graduate’. Phillip Darbyshire @Pdarbyshire Course Description Please have your course outline available for next few slides This course builds on the knowledge and skills developed in Nursing Practice 3. The clinical context of the course is caring for people across the lifespan experiencing complex health problems in both medical and surgical environments. The course will also examine issues impacting on an individual’s rehabilitation, education, and discharge planning. Students will relate to the Clinical Reasoning Cycle to guide their critical thinking, assessment and care planning. Students will also further develop their competence in medication and complex wound management. This Professional Practice experience builds on theoretical knowledge of pathophysiology and pharmacotherapeutics and nursing skills developed during Nursing Practice 3. Students further develop critical thinking skills and apply the Clinical Reasoning Cycle framework to the assessment and management of people undergoing surgery and those with complex health problems. This course will also engage students in the role of the nurse in patient education and discharge planning. Students must complete the nursing practice component successfully to qualify for practicum, which will occur consecutively at the end of the semester. Course learning outcomes On completion of this course, students should be able to achieve the following learning outcomes: 1. Apply therapeutic communication skills and a person-centred approach to client/patient assessment and care. 2. Execute a range of fundamental nursing assessments and skills. 3. Select and manage appropriate interventions. 4. Evaluate the efficacy of nursing care interventions. 5. Meet competency requirements as set down in the Professional Practice Record, including the ANSAT. 6. Apply a range of professional standards, principles, and processes. Pre-requisites This course builds on knowledge gained in Professional Practice 3 (PP3). You are ineligible to enrol in this course if you have not met the requirements for PP1, PP2 and PP3. There may be academic or financial penalties if you remain enrolled past the census dates. Financial census: Friday 16th August 2024 (end of week 4) Academic census: Friday 18th October 2024 (end of week 12) Please contact your year advisor or [email protected] if you are unsure if you meet the requirements for this course. If you have a Learning Access Plan (LAP) please email it to the course coordinators asap. https://www.notredame.edu.au/students/your- enrolment/calendars-and-timetables Academic team Course coordinators/Lecturers Dr Benjamin Hay Marie Fielding –Prac Fremantle NURS2040 - Professional Practice 4 Tutorials Labs Sarah Merlino Fiona McNamara Laura Petropoulos Laura Petropoulos Jenni Hogge-Mooney Mary Haydon Eunice Tan Paige Whyte Steph Duncan Karen Gillies Emily Griffin Mary Haydon Jessica Dantaz Nicola Horstmann Melissa Christensen Lucy Wright Jessica Dantaz Chelsea Reyniers Contact hours/Plan *50 hours theory contact & 200hrs Prac-different to other prac courses Lectures: Mondays (1 hour*); & 1 hour Prac lectures weeks 2, 7, & 10 (Fremantle). Tutorial: 2 hours per week on campus. Labs/simulated tutorial: 2 hours per week on campus. Readings/assessments/revision: see course outline. Note weekly reading page links to hard copy version of text- (see eBook headings and content to match) Please also: – Check for weekly announcements via Blackboard + emailed – Complete your allassessments – Undertake the weekly readings-less contact hours = more student responsibility to keep up to date Note- public holidays and self-directed learning -see weekly course schedule in course outline  Compulsory Interprofessional event with the School of Medicine/Physio: Survivors Teaching Students Date/time: 16th September 0830-0930am (week 8) AWST Via ZOOM -(mandatory attendance)-see BB links Topic: Survivors Teaching Students®(STS) program Background: A learning program that brings the faces and voices of ovarian cancer survivors and caregivers into the classrooms of medical, medical sciences, nursing and allied health students. Aims: to raise awareness of the symptoms of the disease amongst our future diagnosticians and contribute to their developing communications skills particularly in managing difficult conversations. Mandatory event: Please make a note of the above date/time for your calendars as a note a record of attendance will be applied- (attendance replaces the week 9 tutorial-see course outline) For more information, please see the below link: https://www.anzgog.org.au/inform/survivors-teaching-students/ Assessments Pro tips…. Overview of assessments see course outline for more details (*see separate Prac assessments) No. Assessment Weighting % Due Date* 1 Mid semester quiz 30% Week 4 (during your allocated tutorial) 2 Med+Safe calculation exam 10% Week 7 (during your allocated tutorial) -Need to achieve 100% Hurdle Task 1 3 Clinical Skills Exam (CSE) 20% Week 9 & 10 (during your allocated -Indwelling Catheter (IDC) simulation tutorial)-sign up –see blackboard Hurdle task 3 4 End of Semester Test 40% Week 10 tutorial (during your allocated tutorial) *Please see Prof Prac assessments during prac period –course outline *Students are responsible for checking the due dates of ALL assessment tasks (covered in week 2 Lecture- Marie Fielding Broome and R&R students- see Scott Stokes –tutor for study block updates Lecture – Week 1 | NURS2040 – Professional Practice 4 MED+SAFE updates… Now includes Practice assessment tab – unlimited practice of Assessment #20 Login: https://ilearn.kineoportal.com.au/index.jsp Blackboard and resources Tutorial and lab Pre-reading and prep important each week due to less contact time in lectures See Blackboard for weekly reading links- main texts for course are free access ebooks through the library –images hyperlinked Use resources/learning objectives as a study guide and for prep for assessments Resources include videos, eLearning opportunities, readings, hospital guidelines, evidenced based care guidelines, VR/360 videos, product guides e.g. PCA set up + troubleshooting; Chest drains, preop/post op considerations –read around the topics for your understanding and for yours and your patient's safety… Ask your tutors questions and respect their knowledge and experience Week 1: Learning objectives 1. Discuss various types of surgery according to degree of urgency, degree of risk and purpose. 2. Describe the phases of the perioperative period. 3. Identify essential aspects of preoperative assessment. 4. Identify nursing responsibilities in planning perioperative nursing care. 5. Describe essential preoperative teaching, including pain control, moving, leg exercises and coughing and deep-breathing exercises. 6. Describe essential aspects of preparing a person for surgery, including skin preparation. Pre-reading: Pre-reading: Ch 52 Ch 38-pp 953-968 Elective surgery across Australia- public hospitals 2022-2023 AIHW: https://www.aihw.gov.au/reports- data/myhospitals/sectors/elective- surgery Emergency vs Elective surgery: – Emergency surgery – unplanned surgical treatment of trauma or acute illness (usually through an emergency department). To preserve function or life of person e.g. control haemorrhage, or repair displayed fracture – Elective surgery – planned surgery to improve persons life. Common procedures include: cataract extraction, cystoscopy, hysterectomy, total knee or hip replacements, cholecystectomy and inguinal herniorrhaphy, plastic surgery. Surgical procedures classification, purpose and terms Accessed from: Berman, Audrey, et al. Kozier and Erb's Fundamentals of Nursing, Volumes 1-3, Pearson Education Australia, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/unda/detail.action?docID=6352557. Briefly discuss the three phases of perioperative nursing: preoperative, intraoperative, and postoperative. Possible procedure settings Inpatient: Operating theatres Day surgery unit Cardiac Catheter Lab/Angiogram suite/Interventional radiology Outpatient: Procedure room/suite e.g., Endoscopy Unit Ambulatory care unit Regardless of where the procedure takes place, nurses play an essential role in preparing the patient for surgery, caring for the patient during surgery, and facilitating the patient’s recovery after surgery.  The perioperative patient journey (1/2) Preoperative Intraoperative Postoperative Primary referral Operative decision Preadmission Admission to hospital Primary referrer Specialist PHQ and DPQ are Patient presents to Discussed on following slide (the patient’s GP) reviews reviewed by the hospital for will discuss patient. clinical screener and admission on the diagnosis with triaged for Pre- day of their surgery If surgery is decided, patient and decide Procedure / procedure. patient will be whether to refer to Preparation (PPP). referred to hospital Pre-procedure/ a specialist for surgery. PPP process ensures surgery preparation (surgeon) the patient is is completed. Specialist Non-surgical optimally prepared completes Patient is reviewed options should for their surgery / Recommendation by their procedural also be procedure and that for Admission anaesthetist. considered. hospital resources (RFA) and consent are efficiently form and coordinated. distributes Patient Health Questionnaire (PHQ), Discharge Planning Questionnaire (DPQ) to patient. Lecture – Week 1 | NURS2040 – Professional Practice 4 The perioperative patient journey (2/2) Intraoperative Postoperative During the surgery Recovery in hospital Primary referrer care / follow up Patient is wheeled into the When clinical protocol for Patient returns home and back in anaesthetic bay, information is discharge is satisfied, patient the care of their GP who will be checked and anaesthetic is is given information on post responsible for actions ongoing administered. surgery/procedure care and care as per the discharge pain management. summary. Patient is positioned and prepared for Emergency contact details GP is also the main point of provided. Patient provided surgery/procedure. A time out contact for addressing with follow up appointment is completed. concerns, complications or and further information as side-effects post-surgery. Procedure is undertaken. required. Anaesthetic is switched off and the patient is wheeled into PACU (recovery). Lecture – Week 1 | NURS2040 – Professional Practice 4 20 PREOP BAY OR HOLDING BAY Preoperative. Commences when the decision for surgery is made and ceases upon transfer to operating theatres. Periop Phase used for: assessing persons suitability for surgery, identify potential risk factors, education for patient on avoiding complications of surgery and anaesthesia, and plan to meet patients needs for safety and to recovery. ANAESTHETIC BAY / ROOM INTRAOPERATIVE Intraoperative. Begins when a patient enters the operating theatre and ends upon transfer to the Post Anaesthetic Care Unit (PACU). Intraoperative Phase: Starts when periop nurse hands over to the OT/Anaesthetic nurse. Safety is paramount and several checks and procedures are included. Includes administering of anesthetic, performing procedure. Closure of wounds on completion of procedure and reversal of anaesthetic is the transition to post op period. VR surgery Brain aneurysm POST-OPERATIVE Postoperative. Starts in PACU and ends on discharge or complete recovery from the intervention (in the community). Postoperative Phase: begins with handover of person from OT to staff in post anaesthesia care unit (PACU). Nurses assess airway, breathing, and circulatory parameters, including managing pain and nausea. For day surgery cases, PACU nurses teach and support patients and carers as they prepare for home. Preoperative nursing care in focus Today’s focus: the role of the nurse in pre-operative care is to identify patient needs and ensure adequate patient education and preparation prior to arrival in the operating theatre suite. Nursing assessment occurs in advance of surgery. Purpose: 1. Obtain the patient’s health information. 2. Provide and clarify information about the planned surgery, including anaesthesia. 3. Assess the patient’semotional state and readiness for surgery, including expectations about the surgical outcomes. Lecture – Week 1 | NURS2040 – Professional Practice 4 25  Patient interview: physiological & psychological factors Understanding of the surgical Current health status, procedure and the anaesthetic, including current medical including past anaesthetic conditions, demographics, experience. family history, and general fitness. Social habits e.g. smoking, alcohol and other substances. Previous and current medical conditions. Cultural and spiritual considerations. Previous surgery/hospitalisation. Ensure informed consent has been obtained. Ensure appropriate blood tests and other diagnostics Discharge planning e.g. have been completed. occupational therapist prep and equipment, post op instructions- Mental status and coping. wound care, lifting, pain, bathing, Current medication sexual activity, nutrition, (prescribed, non- elimination-opioid effects… prescribed and OTC) Opportunity for patients and their Allergies (drug, food, etc.) family members/carers to ask questions. 26 Presence of body piercings + Functional capacity –planning for removal post op care and recovery Lecture – Week 1 | NURS2040 – Professional Practice 4  Preoperative tests Lab work (samples below) Test Area Assessed Urinalysis Renal status, hydration, UTI & disease Chest x-ray Pulmonary disorders & cardiac enlargement Blood studies: RBC, WBC, Anaemia, immune status, infection Hb, Hct, Electrolytes Metabolic status, renal function, diuretic side effects Blood Gas Analysis (BGA’s), Pulmonary & metabolic function oximetry Prothrombin (INR) or Bleeding tendencies partial thromboplastin time Blood glucose Metabolic status, diabetes mellitus Creatinine Renal function Serum urea Renal function Electrocardiogram (ECG) Cardiac disease, electrolyte abnormalities Pulmonary function studies Pulmonary status Liver function tests Liver function Blood Type & cross- match Blood availability for replacement (elective surgery patients may have their own blood available) Lecture – Week 1 | NURS2040 – Professional Practice 4 (Brown, Edwards, Seaton, & Buckley, 2020)  Nursing management – Legal considerations and consent All required forms are signed and in the Surgeon is responsible for obtaining consent patient’s medical record – Nurse may obtain and witness the patient’s – Informed consent. signature. – Blood transfusion consent. – Verify patient has understanding. – Advance directives. – Permission may be withdrawn at any time. – Power of attorney. Medical emergency may override the need Consent for surgery – informed consent for consent. must include: Legally appointed guardian or family – Adequate disclosure. member may consent if the patient is: – Understanding and comprehension. – A minor. – Be given voluntarily. – Unconscious. – Mentally incompetent. Silence Kills- OT example 42 https://www.youtube.com/watch? v=G9j2SUlPirU  Preoperative patient information- Education and preventing complications Perioperative education and preventing complications: 5 aspects: Children- separation anxiety- 1. Information on surgery and sensory aspects- ‘what to expect’ –be open parents allowed into preop and to questions e.g. what will happen?, how will feel when I wake up?, PACU if able; teaching at what will they find?, how long will I be in hospital? developmental level e.g. 2. Psychosocial support- reduce anxiety-actively listen, clarify any doll/teddy with bandage, ID misperceptions band. 3. Staff roles and expectations- clarify roles- empowers person in what to expect – helps with sense of control and reduces anxiety Older adults: hearing issues; short term memory, post op 4. Skills training- moving safely post op; mobilization options; deep complications higher, functional breathing and coughing- important to do so without pain; splinting wound incisions with pillow or support when coughing, moving with needs, pressure area risks. devices e.g. IDC, NGT, chest drains; avoiding thrombi/emboli-e.g. DVT-no prolonged sitting, no crossing legs, importance of leg exercises and early mobilization, hydration, TEDS and/or compression devices; specific surgery expectations- cardiothoracic and physio; knee surgery etc. 5. Pain relief options and plan- discuss what may be expected and options for managing e.g. PCA, epidural, IV, IM, oral, etc Lecture – Week 1 | NURS2040 – Professional Practice 4 43  Preoperative patient information- Education and preventing complications-Case study example Your patient is an older semi-retired Italian farmer who was admitted to the coronary care unit (CCU) following a loss of consciousness from a severe bradycardic episode. He is currently on an important IV infusion of medication to maintain his pulse rate at a safe level and the medical plan is for a permanent pacemaker insertion this afternoon. When reviewing the patient, he states he doesn’t want the pacemaker and feels he doesn’t need it. He just wants to get back to the farm and is threatening to take his IV out himself... Critical thinking- What are your priorities of care? What other psychosocial issues could be at play that you may need to address? What other resources/staff could you draw on? Perioperative preparation Preoperative patient information-Preparation Surgical site- marked in preop bay by surgeon; preop wash as per hospital; hair is clipped not shaved; intraop- povidone/iodine and alcohol or chlorhexidine used as scrub into skin on site Checklists- (see samples in labs)- Patient ID- usually 2 on opposite limbs (wrist and leg) in case ID cut off during surgery Fasting- 6 hours food, clear fluids 2 hours –consider procedure and protocols e.g. Colonoscopy. Risks of dehydration, Nausea and vomiting, electrolyte imbalances Elimination- depends on procedure- abdominal/bowel surgery- emptying prior to surgery –laxatives and bowel prep. Not routine Consent- see previous slide. Includes blood transfusions Preop assessment findings- physical status notes, language issues, and other risks noted- e.g. bariatric patients- higher risks – wound healing, skin issues, respiratory issues, cardiac issues –prep equipment-bed, lifting devices, skin prep, preop antibiotic cover Allergies- drugs, food, soaps, latex, tapes-ID bands, stickers on charts Valuables- facility protocols-sent home ideally, rings covered in tape-note risk of swelling for procedures like mastectomy- lymph node dissection; piercings may need removal –risk could be accidently ripped out or burns from electrosurgery…. Theatre attire- cap, gown, OT underwear, hair tied back-no metal clips-pressure area risk, pad not tampon if menstruating Prothesis issues- bridges and dentures can cause issues with airway; glasses and hearing aids kept as long as possible, contact lenses removed, nail polish removed- affects O2 assessment, infection risks. TEDS/compression pumps- placed in preop-prevents DVT in moderate risk surgical patients BSL control for diabetics-note plan and if usual medications withheld. Goal is optimal range for healing Premedication if ordered- note only after consent completed-note premed is not routine-case by case basis. Patient safety-bed rails up, call bell, toileting prior, check what was withheld or given e.g. cardiac drugs, sedatives, atropine to reduce secretions Privacy and dignity maintained for patient- manual handling, site preparation Documentation checks and handover prep (see next slide sample)  Preoperative checklist Pre-reading: Ch 52, Checklist tips on pages 316 -318 Pre-reading: Ch 38-pp 955- 957-periop risk assessments Website: https://www.acorn.org.au/ Resources and links for perioperative nursing if interested in this speciality. We will be referring to the website next week (week 2) for specific perioperative nursing roles: https://www.acorn.org.au/perioperative-careers and https://www.acorn.org.au/index.cfm?display=963543 You can also link in for national and state membership for events and networking! E.g. ACORNWA https://www.acornwa.org.au/ and NSW https://www.ota.org.au/ International conference in Sydney! November 2024 https://www.acorn.org.au/acorn-2024-international- conference Tutorial and labs Review Blackboard for lessons plans- tutorial and labs Check pre-reading and review –note BB has PP slides and worksheets for tut and lab sessions Come prepared with access to worksheet and apps for drug guides –check access is working e.g. AUSDI: https://library.nd.edu.au/nursing/poc Check access to Med+Safe is working and email coordinator if any issues https://ilearn.kineoportal.com.au/index.jsp References (1/2) Agency for Clinical Innovation. (2016). Perioperative toolkit. https://aci.health.nsw.gov.au/ data/assets/pdf_file/0010/342685/ACI-Perioperative-toolkit.pdf Agency for Clinical Innovation. (2016). Preoperative fasting in NSW public hospitals. https://aci.health.nsw.gov.au/ data/assets/pdf_file/0006/299301/ACI-Key-principles-preoperative- fasting-NSW.pdf American Society of Anesthesiologists. (n.d.). Statement on ASA physical status classification system. Retrieved June 30, 2023, from https://www.asahq.org/standards-and- guidelines/statement-on-asa-physical-status-classification-system Australian Institute of Health and Welfare. (2021). Australia's hospitals at a glance: Hospital activity. Retrieved from https://www.aihw.gov.au/reports/hospitals/australias-hospitals-at-a- glance/contents/hospital-activity Brown, D., Edwards, H., Seaton, L., Buckley, T. (2020). Lewis’s medical-surgical nursing; assessment and management of clinical problems fifth edition. Sydney Australia, Elsevier. Hamlin, L. (Editor in chief), Richardson-Tench, M, & Davies, M (eds) (2009). Perioperative nursing: an introductory text. Chatswood, N.S.W: Mosby Elsevier. LeMone, P., Bauldoff, G., Gubrud-Howe, P., Carno, M., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K., Berry, K., & Carville, K. (2019). Lemone and burke's medical-surgical nursing: Critical thinking for person-centred care. Pearson Education Australia. The Australian College of Operating Room Nurses, (2014). ACORN standards for perioperative nursing, 2014-2015. Adelaide South Australia: the Australian College of Operating Room Nurses Ltd. The Joanna Briggs Institute, (2022). Pre operative preparation: Nursing Care. Recommended practice.. https://ovidsp.dc2.ovid. com/ovid-b/ovidweb.cgi 35 Lecture – Week 1 | NURS2040 – Professional Practice 4 Any Questions?