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护理计划与实施 I

发布时间:2012-6-18      来源:admin      阅读次数:6070

护理计划与实施Ⅰ

课程代码:1000126                      开课学院:HOPE护理学院

开课学期:春季                         授课对象:二年级学生

    分:4                           课程负责人:邹智杰(中国)

课程简介:

教学目的

课程结束时,学生能够:

  1. 讨论依据护理对象生理改变所作的护理。
  2. 提出对身体系统方面具体的生理改变不同的护理方案。
  3. 分析有心理改变的护理对象的适应性反应。
  4. 分析护理措施对解决护理对象的问题是否有效。
  5. 对护理对象进行宣教:讲解内容需适合每个人对健康、疾病、饮食、药物、治疗等方面的理解水平。
  6. 评估在以一个护理理论为根据的假设情况下所进行的护理实施。

主要教学内容

第一单元:对有遗传/慢性改变护对象的护理

第二单元:对有心理状态改变的护理对象的护理

第三单元:对有生理改变的护理对象的护理

第四单元:对有外科手术改变的护理对象的护理

具体内容和课程安排如下:

第一单元对有遗传性或有慢性改变的护理对象进行护理

单元概述:本单元分析决策的基本要素以及影响决策过程的各种因素,以提升学生在护理中的临床决策能力。学生要根据慢性病/遗传病患者的护理诊断为患者提供护理计划。

单元教学目标

本单元结束时,学生能:

1.讨论组成决策概念的要素。

2.分析影响决策过程的因素。

3.为有慢性生理状态改变的个案提供护理计划。

4.评估和分析患者及家庭对遗传/慢性病诊断的反应。

5.叙述个人和家庭的社区资源。

6.讨论遗传筛查和遗传咨询对家庭的重要性

目标1. 讨论组成决策概念的要素。(1学时,讲授、课堂讨论)

内容:

  1. 介绍本单元的教学目标,教学安排,学习要求,考核方法, 参考书目;
  2. 结合既往临床实习经验讨论组成决策概念的要素。

预习

1. 学生复习既往所学健康评估、基础护理、人类发展学、生理学、病理生理学、药理学的知识。

 

目标2. 分析影响决策过程的因素。(2学时,课堂讨论)

内容:

  1. 给学生提供几篇关于决策在护理中应用的文章,让学生任选一篇研读,之后进行分析和讨论。
  2. 分析和讨论影响护理行为的其他因素。

预习:

1. 学生完成老师提前布置的阅读任务。

作业:在临床实习中有意识的训练自己的临床决策能力,在第四周周日8pm前提交书面报告,汇报自己在临床上觉得最成功的一次临床决策。

 

目标3:根据有慢性/遗传状态改变个案的护理诊断提出恰当的护理计划(12学时,讲授、课堂讨论、模拟教学、个案学习、个案陈述报告)

内容:

  1. 介绍慢性/遗传病的定义。让学生列举既往见过或学过的慢性/遗传病。(1学时,讲授、课堂讨论)
  2. 慢性/遗传病的特点。其发病的危险因素、生活方式与慢性病的关系。(1学时,讲授、课堂讨论)
  3. 遗传/慢性病的发病机制、临床表现。(学生自学)
  4. 遗传/慢性病的护理问题及依据。(复习,学生自学)
  5. 遗传/慢性病各发展阶段的需要。(复习,学生自学)
  6. 遗传/慢性病的药物管理。讲解药物管理的概念及要点;提供4例慢性/遗传病例,让学生为个案进行模拟药物管理。(2学时,讲授、模拟教学)

预习:

1)学生按老师要求提前一周预习和复习模拟教学前需具备的知识和技能。

2)学生模拟教学活动前需完成一份完整的药物管理计划。

3)学生提前分配好模拟教学中的角色。

作业:对自己护理的病人进行药物管理,并书面报告药物管理的效果及心得体会。第三周周日8pm前提交到BB平台。

  1. 遗传/慢性病的营养需要、饮食管理。讲解药物管理的概念及要点;提供4例慢性/遗传病例,让学生为个案提供详细的营养指导方案。(2学时,讲授、个案学习)

预习:

1. 复习营养素的组成、膳食营养结构等营养方面知识。

2. 复习营养状态评估。

3. 阅读WHO在2006年发布的饮食、活动与健康报告。

作业:评估自己护理病人的营养状况并进行营养的指导,针对自己的病人营养状况书写一份详细的营养指导。第三周周日8pm前提交到BB平台。

  1. 制定一个对有遗传/慢性病改变的护理对象/家庭的综合的护理计划。这个计划是以身体评估、营养需求、药物、治疗等为基础。(3学时,个案陈述报告)

   提供10个慢性/遗传病例,采取自由选择的方式(组间不重复),以小组为单位,课后根据所提供的遗传/慢性个案,确定其护理诊断、讨论恰当的护理计划及具体措施,包括发展阶段需要、药物、饮食治疗以及其他必要措施。

1)学生分组:3人一组,每组选择1个案例。

2)课堂陈述和课堂讨论:每组给予15-20分钟时间,小组中每位学生均要参与陈述和讨论,时间可自行分配。课堂陈述内容包括遗传/慢性病患者的护理问题、护理措施、措施依据、护理计划。课堂讨论要求围绕议题阐述观点、或见解、或心得等,观点明确,论据充分。

  1. 实施上述制定的护理计划。由学生自由选择上述制定的护理计划中的2例,为个案进行模拟护理。(3学时,模拟教学)

预习:

1)学生按老师要求提前一周预习和复习模拟教学前需具备的知识和技能。

2)学生模拟教学活动前需完成一份完整的药物管理计划。

3)学生提前分配好模拟教学中的角色。

 

目标4. 评估和分析患者/家庭对遗传/慢性病诊断的反应。 (3学时,电影欣赏、课堂讨论)

内容:

1. 讨论护理对象对慢性病/遗传病诊断的反应。

2. 家庭对慢性病/遗传病诊断的反应

3. 慢性病/遗传病患者及其家庭成员的需要

4. 慢性病/遗传病患者的应对策略

选择1-2部电影,让学生观看后进行讨论。观看前列出上述讨论大纲。

预习:

1. 预习精神心理单元压力与应对部分的内容。

2. 复习马斯洛的需要层次论。

案例:

1. 小红,20岁,患有支气管扩张,因呼吸道感染入院治疗。

2. 老李,65岁,因头痛到门诊就诊,诊断为高血压。

3. 徐洋,12岁,刚诊断为糖尿病。

4. 李梅,6岁,因急性呼吸困难急诊入院,患有支气管哮喘。

5. 刘宏,18岁,患有血友病,因出血入院。

6. 易锦,40岁,新近诊断为获得性免疫缺陷综合症。

7. 高红,60岁,患有冠心病5年。

8. 杨敏,50岁,便血一月。诊断为消化道肿瘤。

9. 蒋怡,10岁,2周前感冒,新近诊断为肾病综合征。

10. 陈思,35岁,患有忧郁症,被发现有自杀倾向。

 

第二单元对有心理状态改变的服务对象的护理

单元描述

本单元的目的是解决与心理状态改变(包括精神疾病及心理健康)相关的护理概念。重点是关注服务对象的急性和慢性精神疾病及心理健康。探讨和实践适合于个体、家庭和团体的评估及干预护理策略以促进心理健康。

单元目标:

课程结束时,学生能够完成下列目标:

1.整合护理及相关学科的理论知识,发展与临床护理实践相关的内环境、人际关系及外环境的发展框架,促进心理健康与疾病预防;

2.阐明在精神心理护理中自我意识的重要性;

3.发展临床护理的判断及技巧为经历急性和慢性心理健康改变的服务对象提供直接的护理;

4.讨论应用于精神心理改变的护理对象的治疗方式;

5.为服务对象提供基于家庭及社区背景的与心理健康,心理疾病及寻求健康行为相关的健康教育及咨询;

6.与跨学科的健康照顾团队成员在计划与实施过程中建立合作关系,为服务对象提供最佳服务;

7.基于相应的理论(Peplau 人际关系理论)实施策略以建立治疗性护患关系;

8.识别可用于精神心理护理中的治疗性沟通技巧;分析治疗性沟通的过程,在为患有心理疾病的儿童、青少年、成人及其家庭提供照顾的过程中,治疗性运用自我。(Travelbee, 1971)

9.在同经历急性及慢性心理健康改变的服务对象互动的过程中以专业的护理标准及服务对象的权益为指导;

10.护理经历各种心理障碍的服务对象过程中,总结与诊断、护理照顾或治疗处理相关的研究发现;

11.识别所有年龄的护理对象无效应对行为模式;

12.叙述有心理改变的护理对象的无效应对模式;

课程安排

完成目标Ⅰ:目标1、6、7、8;(整体发展框架;照顾团队成员关系的建立;护患关系的建立;治疗性沟通)

第一周治疗性人际关系的建立及治疗性沟通(5学时)

预习:

1. 学生复习既往普通心理学及人类发展学相关知识,重点复习“沟通”部分的内容,了解各个年龄阶段护理对象的沟通特点。

  1. 回顾以往人际交往或临床实习过程中的沟通状况。

内容及教学方法:

第一讲3学时

  1. 介绍本单元的教学目标,教学安排,学习要求,考核方法, 参考书目;
  2. 治疗性沟通的重要性(共同回顾),相关概念(讲授);
  3. 治疗性沟通的相关理论:沟通回馈论,领域论,交流分析论(表演);
  4. 语言和非语言性沟通的区别;(观赏图片)
  5. 角色扮演:基于已设计好的2个情境,进行角色扮演。使用气球,将学生分成两组进行。接下来进行讨论:
    • 影响治疗性沟通的因素;
    • 治疗性沟通的原则;
    • 过程分析:鉴别治疗性沟通技巧及非治疗性沟通行为;
    • 探讨如何进行访谈过程记录;
    • 两个小组互相点评;
    • 总结治疗性沟通技巧及非治疗性沟通行为。
  6. 讨论沟通在护理程序中的应用

案例分析:刘先生因为胃部不适及头痛来诊所就诊。医生开了减轻胃痛的药物。几周之后,这种症状仍然持续,每一次医生都加大了药物的剂量。护士注意到刘先生一直在揉眼睛,于是便问他的视力是不是出现了问题,或者在其他方面出现了改变。1)还应该问哪些问题?2)刘先生是否还经历其他的一些问题?3)应该做哪些检查?4)最好的治疗措施是什么?5)沟通方式会发生哪些改变?

第二讲2学时

7.基于Peplau的护患人际互动框架讨论护士在精神心理领域的角色。

8. 比较治疗性人际关系及社会性人际关系(小组讨论)。

9. 讨论治疗性护患关系的特性。

10. 识别护患关系的目标。

11. 识别并讨论治疗性关系的关键要素,如何治疗性运用自我。

12. 描述治疗性人际关系的建立过程及与之相关护士的任务。(个案分析, 欣赏视频).

13. 讨论如何建立和谐的团队氛围,如何在多学科团队中与其他成员建立良好的关系(小组讨论,有效交接信息)。

作业:在临床实习中有意识的训练自己的沟通技能,促进治疗性护患关系的建立,在临床实习过程中按照SBAR模式交接班。识别并分析临床实习过程中的治疗性沟通技巧及非治疗性沟通行为,并在下次课堂汇报印象较深的方面。在第二周的周日晨8点提交一份基于SBAR的交班报告。

 

完成目标Ⅱ:目标1、2、3;(整体发展框架;自我意识;提供直接护理)

第二周模拟教学:如何促进自我意识的发展及如何实施精神心理护理程序(5学时)

预习:

  1. 精神疾病的诊断及分类(DSM-Ⅳ)
  2. 预习与精神心理护理程序相关的内容,包括评估、计划、实施与评价;
  3. 准备相应的症状学知识:感知觉障碍及思维障碍。
  4. 准备护理诊断相关知识(NANDA)
  5. 分析第一周临床实习过程中对精神疾病患者的看法。

内容及教学方法

第三讲3学时

 

Time

Procedure

Remarks

8:00

Arrived at Classroom

Make sure leave your cell-phone and any other video-taped tools in  your dormitory

8:05

  1. Discuss the importance of self-awareness in the nurse-client relationship.
  2. Empathy and sympathy.
  3. Discuss basic concepts of hearing voices.
  4. Discuss coping strategies to deal with hearing voices.

Review related knowledge

8:35

Group Discussion :

What your feelings toward to clients live with mental illness.

What about those who around you.

Identify own feelings

8:50

Form Small groups (1 hr: Mp3 player on)

Stage 1:

Group1: stay in room (30min)

Group2: Instructions to go outside (30min)

Stage 2:

Group2: stay in room (30min)

Group1: Instructions to go outside (30min)

Turn off Mp3 player

Those who go outside(around or on campus) have to communicate with other people (Not communicate with each other)

 

Patricia Deegan - Distressing Voices

9:50

Large Group Discussion

Evaluation

 

10:10

How could we be more empathy

 

作业:写下你在听录音期间的真实感受以及对你的启发,在第二周的周日晨8点提交

第四讲  2学时

安全及风险管理:如何处理意外事件——贯彻护理程序,实施整体护理

特定预习内容:

1. 学生按老师要求提前一周预习和复习模拟教学前需具备的知识和技能。(如何照顾一位精神分裂症患者,有药物副作用带来的风险。

2. 学生模拟教学活动利用概念图完成一份护理计划。

3. 学生提前分配好模拟教学中的角色。

模拟教学:

作业:对模拟情境中的主要问题进行分析。第三周周日8pm前提交到BB平台。

 

完成目标Ⅲ:目标2,10、11、12;(同理心;总结与诊断、护理照顾或治疗处理相关的研究发现;应对)

第三周应激管理(5学时)

预习:

  1. 准备与应激及应激管理相关基本概念的知识;
  2. 应激的心理适应过程;
  3. 心理防御机制;
  4. 检索至少三篇与应激相关的英文文章并仔细阅读;

内容及教学方法:

第五讲3学时

  1. 心理健康与心理疾病:一个动态演变的过程(讲授)
  2. 应激相关的基本概念:以小组形式由学生们解读
  3. 心理防御机制:案列分析,共12个案例,将学生分成三组,每组分析四个案例;
  4. 适应性的应对策略:小组活动,将学生分成三组,每组同学演示一种适应性的应对策略
  5. 非适应性的应对行为:案例分析,共三个案例,分析个案采取何种应对方式,如何进行干预。
  6. 文献阅读结果汇报

第六讲2学时

  1. 心理适应过程:焦虑及悲伤,基本概念(讲授)
  2. 案例分析: 焦虑的行为适应反应分成两个小组,分析所给案列中的护理对象的适应过程,主要集中与心理防御机制。
  3. 影片片段赏析:心理医生(Grief process),分析悲伤的反应过程、非适应性的反应方式及应对策略。
  4. 小组讨论:如何基于同理心,帮助服务对象采取适应性应对策略,缓解悲伤。

作业:回顾你以往生活经历中的重大应激性事件,并思考自身采取的应对方式。在下节课前简单汇报。

 

完成目标Ⅳ:目标1、3、4、9;(整体发展框架;临床护理的判断及技巧;治疗方式;专业标准)

第四周危机干预:与精神病例状态相关的危机及精神科的紧急事件(3学时)

预习:

  1. 准备与危机及危机管理相关的概念;
  2. 回顾以往的临床实习经历,总结精神科及普通病房中常见的意外事件与暴力行为;

内容及教学方法:

第七讲3学时

  1. 病房中的意外事件与暴力:引导性回顾总结
  2. 案例分析
    • 冲动暴力行为的危险因子评估
    • 暴力事件的预防及应对措施
    • 护理人员对暴力行为的心理反应及态度
    • 自杀风险评估
  3. 常见的家庭暴力;
  4. 家庭暴力防治现状;
  5. 家庭暴力发生时,如何处理。

第三单元对有生理改变的护理对象的护理

单元描述

本单元重点关注服务对象对生理改变及其引发的各种问题的适应,提供对有生理改变的服务对象的护理

单元目标

1.对由于妊娠引起的生理改变的服务对象的护理。

2.对由于分娩引起的生理改变的服务对象的护理。

3.新生儿的护理。

4.对由于衰老引起的生理改变的服务对象的护理。

5.对由于疾病引起生理改变的服务对象的护理。

6.对由于饮食引起生理改变的服务对象的护理

目标1  对由于妊娠引起的生理改变的护理对象所进行的护理(第一讲,3学时,讲授、课堂讨论、观看视频)

内容

  1. 介绍本单元的教学目标,教学安排,学习要求,考核方法, 参考书目;孕前准备:准妈妈身体/心理准备、家庭成员准备
  2. 提问和讲授怀孕生理改变,并观看视频
  3. 孕期常规不适的护理:分早、中、晚孕期
  4. 孕期的自我/家庭护理(重点)
  5. 产前检查
  6. 孕妇营养(可结合案例)

预习:学生预习关于孕妇生理改变、护理的知识

作业:查阅相关资料,分小组完成作业:孕期的胎教方法及如何胎教

 

目标2  对由于分娩引起的生理改变的护理对象所进行的护理(第二讲, 2学时,讲授,观看视频)

内容

  1. 分娩应考虑的重要因素:产道、子宫、产力、社会心理因素
  2. 分娩征兆、假临产、临产
  3. 为分娩做好准备的方法:身体锻炼、放松练习、呼吸技巧
  4. 分娩过程中孕妇及胎儿的生理改变
  5. 产程及其护理(重点):第四产程中注意对新生儿的护理(方法:讲座、影片)
  6. 产妇的生理改变(各系统)
  7. 产妇的心理适应:角色适应、产后抑郁、家庭社会支持的重要性
  8. 产妇的护理
  9. 产后营养
  10. 协助学习做称职父母:学习方法和时间、内容、评价学习效果
  11. 家庭健康的促进:兄妹的反应、性生活的恢复、避孕

预习

学生完成老师提前布置的阅读任务。

作业

  • 在产科实习的同学在临床实习中参与分娩过程的护理

2. 在产科实习的同学在第二周完成对一份产妇的营养计划,在下周周六晚上10点之前发到BB平台

 

目标3 新生儿及其护理(第三讲,3学时,讲授、观看视频、演示)

  • 新生儿出生时间的评估
  • 新生儿特征及评估
  • 新生儿常见健康问题及护理

   ⑴生产损伤:①软组织损伤;②头部损伤;③骨折;④神经损伤

⑵新生儿感染:

  • 新生儿营养(重点)
    1. 营养需要
    2. 母乳喂养和牛奶喂养
    3. 喂养程序(喂养时间、技巧)
  • 亲子关系的建立时间、方法
  • 产后对母亲、婴儿及家庭的社区护理(家庭访视、家庭护理)

预习:

  1. 新生儿护理相关知识
  2. 亲子关系建立的方法

作业:

  1. 在临床进行新生儿护理
  2. 在临床上进行亲子关系建立的宣教

 

目标2第四讲  模拟教学——分娩护理(2学时)

 

目标3 高危险性新生儿及其护理(第五讲, 3学时,讲授)

  1. 高危险性新生儿的定义及评估
  2. 早产儿及其护理

⑴早产儿原因

⑵早产儿生理特性:①外观特征:早产儿与足月儿身体外观特征的比较;②常见健康问题:肺部支气管发育不全,呼吸暂停体温不稳定等;③早产儿家庭及其护理(住院期间护理,居家照顾护理)

常见高危险性新生儿及其护理:

⑴高胆红素血症(讲解):定义及病因,医疗处置,护理(重点:照光新生儿护理措施,换血新生儿护理措施)

⑵呼吸窘迫症候群(自学)

⑶胎便吸入症候群(自学)

⑷新生儿败血症(自学)

⑸坏死性肠炎(自学)

⑹婴儿猝死症候群(自学)

预习:

  1. 儿科护理学的相关知识
  2. 临床上如何护理高胆红素血症的患儿

 

目标4对由于衰老引起的生理改变的护理对象所进行的护理—Ⅰ(第六讲,2学时,讲授,课堂活动)

  1. 衰老的引起的生理改变、心理改变
  2. 由衰老引出的问题及一般护理原则
    1. 生理健康问题:营养的需要;睡眠型态的改变
    2. 心理健康问题:忧郁、谵妄等
    3. 老年人相关议题:老年人用药问题;安全问题;自杀问题;其他老年人相关议题

3.  衰老对疾病预后及恢复的影响

4.  对临终病人及家庭的整体护理:与临终病人的沟通、临终病人的生理护理、家属的护理

(课堂活动:沟通)

预习:

  • 第22章,李和惠,林丽秋,黄玉琪,吴碧云,林贵满. 内外科护理学,第三版,台湾,华杏出版社,2010
  • 复习沟通的技巧

 

目标4 第七讲对由于衰老引起的生理改变的护理对象所进行的护理—Ⅱ(3学时)(讲授,小组讨论,个案学习)

  • 死亡与濒死的定义
  • 面对死亡的心理冲击
  • 濒死病人的护理:生理、心理
  • 个案护理:一例濒死病人的护理

预习:

1.第23章,李和惠,林丽秋,黄玉琪,吴碧云,林贵满. 内外科护理学,第三版,台湾,华杏出版社,2010 

2.提前给一例个案让学生准备护理要点

 

第四单元对有外科手术改变服务对象的护理

单元描述:本单元的目的是介绍与手术经历各部分的护理概念,关注有手术经历的服务对象及其家属在生理,心理和社会层面所受到的影响,并针对这些影响提出有效的护理措施,促进学生将理论知识和临床实践结合起来,更好得提供有质量的护理。

单元目标

经过外科手术单元的学习

1.学生能够掌握手术组成部分及相关护理特点

2.学生能够熟悉术中配合

3.学生能够掌握外科手术单元患者术后护理。

4.学生能够运用相关概念在制定个性化的整体护理计划。

课程安排

目标1:讨论手术经历的各种组成部分    所需课时13学时

1.1 掌握手术经历的各组成部分的护理特点

1.2 通过查阅文献提出更新的手术经历的患者护理

第一周:外科手术经历的组成部分--术前  5学时

● 课堂目标:

1.学生能够掌握手术经历的各组成部分的护理特点。

2. 学生能够掌握术前准备的重点。

3. 学生能够通过案例的引用熟悉甲状腺手术的护理特点。

4. 学生能够通过讨论和阅读术前准备的相关文章总结出腹部手术的术前准备特色。

第一讲:总论(3学时)

● 课堂安排:

1.介绍本单元教学目标,教学内容,教学方式,教学要求,参考书籍。

2.介绍手术的各种组成部分(术前、术中、术后的护理组成部分)。

3.以甲状腺手术为例介绍颈部手术的常见手术护理组成的具体内容。

4.布置学生需要预习与准备的重点内容。

复习内容:阅读英文参考资料480-499,进一步巩固课堂知识。

 预习内容:

肛管直肠手术患者术前术后护理的内容(英文参考资料1265-1279)。

  网络上查找阅读腹部手术患者胃肠道准备,呼吸道准备,心理准备,家庭准备等方面的文献。

第二讲:术前准备的讨论(2学时)

● 课堂安排:

1.分三组,针对病例后的问题进行讨论并陈述讨论结果。

2.总结腹部手术的术前准备特点。

3.学生分享所查阅到的文献信息。

● 课堂病例:

刘小姐是一位45岁的律师,身高165CM,体重45公斤,与丈夫长期两地分居,没有儿女。近两年来出现上腹部的疼痛,进食后3-4小时发作,服用抗酸药物可以缓解,进食后腹痛可以缓解,但近一个月来发作频繁,症状严重,胃镜视溃疡深大,溃疡底可见血管,医生建议一星期后进行胃大部切除术。

李先生是一位50岁的公务员,半月前自己在家洗澡时发现腹部包块进入医院就诊,经过诊断检查,确定为结肠肿块,性质不明,且发现大便有带血的情况,医生建议明天行开腹切除肿块并行病理检查确定。他自己独立抚养15岁的女儿,他的母亲因结肠癌去年去世。既往有20多年的吸烟史。

陈先生是一位21岁的在校大学生,晚上跟同学吃烧烤,喝酒,半夜肚子疼醒不能入睡,遂被同学送入急诊,急诊以“急性阑尾炎”收治,进行急诊手术切除感染的阑尾组织。

思考问题:

1.患者的手术属于哪种类型?

2.作为病区护士,你从现有资料上有哪些评估发现?

3.为了更好地进行术前准备,你认为还应该评估哪些内容?

4.请针对患者的情况提出2个主要的护理问题和合理的护理计划。

课后作业:请观赏美剧《私家医情》中的第六季23集,熟悉其中的手术室环境,术中配合等内容。

 

第二周:外科手术经历的组成部分--术中  3学时

● 课堂目标:

1.学生能够熟悉手术室环境及术中配合。

2.学生能够掌握不同麻醉方式病人的麻醉恢复期护理。

第三讲:术中护理(课时3)

● 课堂安排:

1.讨论影片中呈现的手术室环境,总结介绍手术室的构成,护理人员构成及各种护士职责。

2.介绍外科无菌技术原则。

3.介绍不同麻醉方式下的麻醉恢复期病人的护理。

4.介绍下次课程的内容,布置预习任务。

5.进行课堂测验。

下次课前复习内容:

1.健康评估中获取患者健康资料的基本方法。

2.护理学基础中的舒适的护理章节的内容。

预习内容:重症监护的相关知识(英文资料参考资料523-548)。

第二周:外科手术经历的组成部分--术后  2学时

● 课堂目标:

1.学生能够掌握术后病情观察的重点。

2.学生能够列出常见的促进患者舒适的护理措施。

第四讲:术后护理  病情观察及舒适的护理(课时2)

● 课堂安排:

1.回顾术后护理常规的组成部分。

2.介绍术后病情观察的主要内容。

3.复习体位的种类和外科手术的适用人群(串讲各系统手术术后的体位)。

4.布置下周预习内容。

预习内容:

1.在数据库中搜索与疼痛管理相关的文章并阅读,包括疼痛的评估工具,疼痛管理的措施,例如药物镇痛,舒缓护理等内容。

2.以腹部手术,开胸手术,泌尿系统手术为主预习伤口护理和引流管护理的内容(英文参考资料754-775,1174-1200,1569-1607)。

 

第三周:外科手术经历的组成部分--术后  3学时

● 课堂目标:

1.学生能够使用疼痛评估的基本工具。

2.学生能够掌握术后疼痛管理的相关策略。

3.学生能够掌握切口管理的护理措施。

4.学生能够掌握引流管护理的基本原则。

第五讲:术后疼痛管理和引流管护理(课时3)

● 课堂安排:

1.介绍术后疼痛管理的相关内容。     

2.介绍切口管理的基本原则。

3.介绍引流管的护理原则和特殊引流管的护理。

4.布置下次模拟课的相关内容,如角色分配,知识准备,相关问题准备等。

课后作业:

1.组织去中南医院宁养院进行参观学习。

2.在Blackboard平台上阅读指定的文章,结合临床实践,分享造口护理的相关知识。

目标2: 认识手术改变对护理对象、家人以及对两者在社会交往中所产生的影响。所需课时  2学时

2.1:略述手术经历有可能引起的护理对象生理以及心理上的障碍。

2.2:识别与手术经历有关的每一个生理与心理障碍的危险及影响因素。

2.3:叙述对每一个与手术经历有关的生理与心理障碍所进行的具体护理方法。

第三周:识别手术经历患者及其家庭所受的影响及对策2学时

● 课堂目标:

1. 学生能够识别手术改变对服务对象生理改变的影响及其因素。

2. 学生能够识别手术改变对服务对象及其家属的心理方面的影响,并提出有效的干预措施。

3. 学生能够识别手术改变对患者、家人以及两者在社会交往中所产生的影响。

第六讲:手术经历患者及其家庭所受的影响及对策

● 课堂安排:

1.介绍手术改变的相关概念(应激,焦虑,疼痛,自我形象紊乱)。

2.介绍手术改变对服务对象及其家属的生理,心理,社会适应等方面的影响。

3.讨论针对上述影响的相关护理措施。

4.完成课堂测验。

目标3:制定一个对经历手术改变护理对象的整体护理计划所需课时3学时

第四周:制定整体护理计划3学时

● 课堂目标:

1.学生能够结合前三周学习的知识进行护理计划的制定和实施。

2.学生能够提出临床实践和理论知识的差异性,并进行评判性思维,陈述出自己在临床中评判性思维的过程。

第七讲:模拟教学

● 课堂安排:

1.分两个小组以乳腺手术和截肢手术为例进行情景模拟  (2学时)

 模拟教学  请同学们结合前几周所学习的知识和预习的知识,对以下病例进行20分钟的讨论,提出主要的护理问题和有针对性的护理措施并实施,学生分为两组,模拟完毕后进行总结性的讨论。

模拟的病例:

A. 韩影,29岁,是一位药剂师。她的父亲是一位退休的钢铁工人。她是六个孩子中最大的。她的母亲8年前死于乳腺癌。韩影结婚两年,她和丈夫都和她的父亲、弟弟妹妹、关系亲密。韩影供一个弟弟上大学,对其他弟妹们也很大方。只要他们有需要,她总是慷慨解囊。

最近在自我检查乳房时,她发现一个小的触摸得到的肿快,皮肤有浅凹。乳房X线照片显示一可疑肿瘤,所以她入院作活组织检查,有可能进行乳房切除。手术前,她被教会怎样翻身、咳嗽、深呼吸、腿部和臂部运动以及可服用的止痛药。但是当她丈夫反复地说他知道她不会失去她的乳房时,她立刻就同意了。病理结果显示为恶性肿瘤,医生只好给她作了左乳房全切手术。请评估患者及其家庭的需要制定整体护理的策略和方法并实施,请选取最重要的2-3个方面的问题进行模拟。

B. 周凯,15岁,中学二年级学生。家中的独子,父母均在工厂上班,家庭月收入5000元。既往无疾病史和过敏史,爱好足球,性格开朗,成绩中等,一月后面临升学。放学途中遭遇车祸,导致左小腿粉碎性骨折,外固定架固定,腓骨内固定钢板,需住院观察一个月。

主要议题和应完成的问题:

(1)讨论手术经历对家庭成员和其他较亲密的人产生的影响和含义。

(2)识别手术经历对患者及其家庭的影响和所引起的需要。

(3)制定满足患者和家庭需要的整体护理的策略和方法。

2.学生通过对临床实习和理论知识的对比,提出问题并分享自己解决问题的方法。

作业:在blackboard上讨论模拟的感受及提出建议。

 

 

教学方法与手段

本课程采取小班授课,单元形式进行教学。教学方法包括讨论、学生讲述、个案研究、模拟教学、讲课、利用电影、录像片、录音带之类的音像资料。

考核方式:

评估的依据是圆满完成各单元的学习、积极参加课堂讨论和活动、历次课程考试成绩和期末测试。

1.    考勤          10%

2.    课堂表现      25%

3.    单元测验      40%

4.    多站考核      25%

   材:

1.Smeltzer S.C. & Bare B. (2004). Chronic Illness. Textbook of Medical-Surgical Nursing (10th edition). Lippincott Williams & Wilkins.

2.尤黎明,吴瑛.内科护理学.第三版.北京:人民卫生出版社,2005.

3.Townsend, M.C. (2006). Psychiatric-mental health nursing: Concepts of care in evidence based practice (5th ed.). Philadelphia: F.A. Davis.

4.萧淑贞,王纯娟,刘玉云等.精神科护理概论:基本概念及临床应用. 台北: 华杏出版股份有限公司, 2010. (Xiao Shuzhen, Wang Chunjuan, Liu Yuyun, et. al.. Psychiatric Nursing: Concept and Practice. Taipei: Farseeing Publishing Group,2010.)

5.高玉玲等. 精神科临床护理导引:精神科个案护理. 台北:华杏出版股份有限公司,2000.

6.Deitra L Lowdermilk & Shannon E. Perry, Maternity & women’s health care, 8 edition, an affiliate of Elsevier, 2004

7.Michele R. Davidson, Marcia L. London, Patria A. Wieland Ladewig. Olds’ maternal-newborn nursing & women’s health across the lifespan, 8th edition, Prenrice hall, 2008

8.郑修霞,夏海鸥. 妇产科护理学, 第四版, 人民卫生出版社, 2006

9.陈月枝编著,实用儿科护理,华杏出版股份有限公司,2004年出版

10.曹伟新,李乐之。外科护理学。第4版,北京,人民卫生出版社,2006。

11.湖南医科大学附属湘雅医院。病人标准护理计划(外科分册)。第1版,长沙,湖南科学技术出版社,2002。

12.吴在德,吴肇汉。外科学。第六版,北京,人民卫生出版社,2004

13.李和惠,林丽秋,黄玉琪,吴碧云,林贵满。内外科护理学,第三版,台湾,华杏出版社,2010。

 

参考书目:

第一单元

  1. Smeltzer S.C. & Bare B. (2004). Chronic Illness. Textbook of Medical-Surgical Nursing (10th edition). Lippincott Williams & Wilkins.
  2. http://www.rwjf.org
  3. 尤黎明,吴瑛.内科护理学.第三版.北京:人民卫生出版社,2005.
  4. 陆再英等.内科学.第七版.北京:人民卫生出版社,2008.
  5. http://www.who.int/chp/chronic_disease_report/part1/zh/index.html
  6. http://www.nihe.org.cn/
  7. http://www.tnbzy.com/default.html
  8. http://chinacdc.net/
  9. Brunner L.S. & Suddarth O.S. (1992). Textbook of Medical-Surgical Nursing (7th edition). Philadelphia: Lippincott, 1992
  10. 慢性非传染性疾病预防医学诊疗规范(试行).卫生部疾病控制司,2002.
  11. 中国慢性病报告.中华人民共和国卫生部疾病预防控制局,2006.
  12. Reinvention of Depression Instruments by Primary Care Clinicians. Baik SY.; Gonzales JJ.; Bowers B.J.; Anthony J.S.; Tidjani B.; Susman J.L. Reinvention of Depression Instruments. 2010, 8(3):224-230
  13. http://www.biomedcentral.com/1472-6963/10/95

http://www.implementationscience.com/content/5/1/43

第二单元

主要参考书籍

  1. Townsend, M.C. (2006). Psychiatric-mental health nursing: Concepts of care in evidence based practice (5th ed.). Philadelphia: F.A. Davis.
  2. 萧淑贞,王纯娟,刘玉云等.精神科护理概论:基本概念及临床应用. 台北: 华杏出版股份有限公司, 2010. (Xiao Shuzhen, Wang Chunjuan, Liu Yuyun, et. al.. Psychiatric Nursing: Concept and Practice. Taipei: Farseeing Publishing Group,2010.)
  3. 高玉玲等. 精神科临床护理导引:精神科个案护理. 台北:华杏出版股份有限公司,2000.
  4. American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
  5. American Psychiatric Association. (2000). Diagnosis and statistical manual of mental disorders, (Fourth Edition.-Text Revision.) Washington DC: Author.

其他参考书籍:

  1. Mary C T. Essentials of psychiatric mental health nursing, 3rd ed. Philadelphia: F.A. Davis Company, 2004.
  2. Katherine M F. Psychiatric nursing care plans, 4th ed. St. Louis: Mosby, 2003.
  3. Katherine M F, Patricia A. Psychiatric mental health nursing, 3rd ed. St. Louis: Mosby, 2003.
  4. Sheila L V. Psychiatric mental health nursing, 3rd ed. Philadelphia: Lippincott, 2004.
  5. Patricia D. Barry. Psychosocial Nursing, 3rd ed. Philadelphia: Lippincott, 1996.
  6. Rawlins Williams Beck. Metal Health Psychiatric Nursing-A Holistic-Cycle Approach, 3rd ed. St. Louis: Mosby, 1993.
  7. 沈渔邨. 精神病学. 第5版. 北京:人民卫生出版社, 2009.
  8. 姚树桥,孙树礼. 医学心理学. 第5版. 北京:人民卫生出版社, 2008.
  9. 李小妹.精神科护理学—护理双语教材.北京:人民卫生出版社, 2006.
  10. 李峥,王志英.临床护理学:认知/感知. 北京: 中国协和医科大学出版社, 2002.

第三单元

  1. Deitra L Lowdermilk & Shannon E. Perry, Maternity & women’s health care, 8 edition, an affiliate of Elsevier, 2004
  2. Michele R. Davidson, Marcia L. London, Patria A. Wieland Ladewig. Olds’ maternal-newborn nursing & women’s health across the lifespan, 8th edition, Prenrice hall, 2008
  3. 郑修霞,夏海鸥. 妇产科护理学, 第四版, 人民卫生出版社, 2006
  4. 陈月枝编著,实用儿科护理,华杏出版股份有限公司,2004年出版

5. 梁惠芳,林宝玉,林凤贞,等. 儿科护理学,华杏出版股份有限公司,2010年出版

6. 李和惠,林丽秋,黄玉琪,吴碧云,林贵满. 内外科护理学,第三版,台湾,华杏出版社,2010

  • 湖南医科大学附属湘雅医院,病人标准护理计划(内科分册), 第1版, 湖南科学技术出版社,2002

第四单元

1.    曹伟新,李乐之。外科护理学。第4版,北京,人民卫生出版社,2006。

2.    湖南医科大学附属湘雅医院。病人标准护理计划(外科分册)。第1版,长沙,湖南科学技术出版社,2002。

3.吴在德,吴肇汉。外科学。第六版,北京,人民卫生出版社,2004

4.李和惠,林丽秋,黄玉琪,吴碧云,林贵满。内外科护理学,第三版,台湾,华杏出版社,2010。

5. Smeltzer, S.C., Bare, B. G., Hinkle, J. L. Cheever, K. H. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 11th edition, Lippincott Williams & Wilkins 2008.

6.http://www.orlive.com

 

 

 

 

 

 

 

 

 

 

Nursing Planning and Implementation

Course Code: 1000126                    College: HOPE School of Nursing

Semester:Spring                         Intended Students: Sophomore

Credits: 4                               Instructor: Zou ZhijieChina

Course Content:

Course Objectives: At the end of the course, the student will be able to:

1.   Discuss the care to be given to clients based on physiological alterations.

2.   present alternatives of care for specific physiological based on body systems:

3.   Analyze adaptive responses of clients with psychological alterations.

4.   Evaluate care given to clients for its effect upon resolution of clients problem(s).

5.   Teach clients content appropriate to individual level of comprehension about personal health, disease, diet, medications, treatment, etc.

6.   Evaluate the implementation of care in given situations based upon nursing theory.major Teaching content:

Topic outline:

Module 1: Nursing care of the clients with Altered psychological status

Module2: Nursing care of the clients with Genetic /Chronic Alterations

Module3: Nursing care of the clients with physiological alterations from Disease, Diet and Deterioration

Module 4: Nursing care of the clients experiencing surgical Alterations

Module 1 nursing care of clients with genetic/chronic alterations

Module description:

Module 1 presents the elements of decision-making and various factors that influence the decision-making process. Nursing care based on nursing diagnosis for clients with genetic/chronic alterations is presented by students.

 

Module Objectives

At the end of the module the student will be able to:

1. Discuss elements of a conceptual framework for decision-making.

2. Analyze factors influencing the decision-making process.

3. Discuss appropriate nursing care for clients with chronic physical alterations.

4. Assess client/family response to the diagnosis of a genetic/chronic alteration.

5. Consider community resources for the individual and family with a chronic debilitating condition.

6. Discuss the importance of genetic screening and genetic counseling for families.

Objectives 1:Discuss elements of a conceptual framework for decision-making.

(1 class hour;Lecture and discussion)

Contents:

1.   Introduce the objectives, schedule, requirement, evaluation, and references of this module.

2.   What are the major elements of the decision-making process? Discuss them according to the students’ clinical experiences.

Pre-class preparation:

1. The students should review the knowledge of health assessment, fundamental of nursing, human development, physiology, pathophysiology, pharmacology.

 

Objectives 2: Analyze factors influencing the decision-making process.

(2 class hours; Discussion)

Contents:

1.   Analyze one current article from a nursing journal in which decision-making has been demonstrated.

2.   Identify factors that influenced nursing actions.

Pre-class preparation:

1. The students should read the article before the class.

Assignment: the students need to improve their ability of decision making during the practice. They need to turn in the written report of the most success decision making during the four weeks practice before 8pm of the fourth Sunday each shift.

 

Objectives 3:Discuss appropriate nursing care based nursing diagnosis for clients with genetic/chronic alterations.

Contents:

1.   The definition of genetic/chronic illness. Let the students list the name of genetic/chronic illness they met or know. (1 class hours; Lecture and Discussion)

2.   Risk factors and relationship between lifestyle and genetic/chronic illness. (1 class hours; Lecture and Discussion)

3.   The mechanism and manifestation of genetic/chronic illness. (Review, Self-learning)

4.   Nursing diagnosis and scientific rationale. (Review, Self-learning)

5.   The developmental needs in vary stages of genetic/chronic illness. (Review, Self-learning)

6.   Medications management of patients with genetic/chronic illness. Give the students the concept of medication management. Then give 4 case scenarios to the students and let them do medication management on SimMan. (2 class hours; Lecture and Simulation activity)

Pre-class preparation:

1) The students should review the required knowledge and skills before the simulation activity.

2) The students should to finish a detailed medication management plan before the simulation activity.

3) The students need to make sure their roles before the simulation activity.

Assignment: the students help the patient to do medication management. Report the results and experience to the teacher by written before 8pm of the third Sunday of each shift.

 

7.   Nutritional needs and diet management of patients with genetic/chronic illness. Give the students 4 cases. Let the students practice to make a detail nutritional instruction. (2 class hours; Lecture and Case Study)

Pre-class preparation:

1) The students should review the required knowledge and skills before the simulation activity.

2) The students should to finish a detailed medication management plan before the simulation activity.

3) The students need to read the report of diet, activity, and health by WHO before the class.

Assignment: the students need to assess the nutrition of the patient and give the patient diet instruction. Turn in the detailed nutrition instruction before 8pm of the third Sunday of each shift.

8.   Develop a comprehensive nursing plan for client/families experiencing chronic illness / disability based upon assessment, nutritional needs, medications, therapies, etc. (3 class hours; Case presentation)

Give 10 genetic/chronic alteration cases. Divide the students into 5 groups. Each group chooses 1 case free. Each group needs to discuss and make the nursing plan as teamwork before the class. Then each group has 15 min to do presentation. After the presentation, the teacher will hold a discussion among the students. 

1) Divide the students into 5 groups. Each group can choose one case.

2) Students presentation and discussion in class: 15-20 minutes are given to each group; every student should take part in presentation and discussion. The content includes nursing problems in nursing client with a genetic/chronic alteration, nursing plan and scientific rationale. Discussion in class needs students to present options based on topic. The option should be clear and rationale is enough.

9.   Let the students choose 2 of above nursing plans by themselves. Then let them implement their nursing plans on SimMan. (3 class hours; Simulation activity)

Pre-class preparation:

1) The students should review the required knowledge and skills before the simulation activity.

2) The students should to finish a detailed medication management plan before the simulation activity.

3) The students need to make sure their roles before the simulation activity.

Objectives 4:Assess client/family response to the diagnosis of genetic/chronic alterations.

(3 class hours; Multimedia teaching and Discussion)

Contents:

1. Discuss client response to the diagnosis of genetic/chronic alteration.

2. Discuss family response to the diagnosis of genetic/chronic alteration.

3. Discuss the client /family needs to nursing care, social resource, and others.

4. Discuss the coping strategy that client/family can apply.

Choose 1-2 movies and let the students watch. Give them the outline of the discussion and let them discuss after they watch the movies.

 

Pre-class preparation:

1. The students should read the knowledge of stress and coping of psychological alteration module.

2. The students should review Maslow’s need theory.

 

Case study:

1. Xiao Hong (age 20) with bronchiectasis is admitted to the hospital for treatment of respiratory infection.

2. Lao Li (age 65) came to the clinic because of headache. He is diagnosed with hypertension.

3. Xu Yang (age 12) is newly diagnosed with diabetes.

4. Li Mei (age 6) came to the emergency room in acute respiratory distress. She was diagnosed with asthma.

5. Liu Hong (age 18) is admitted to the hospital because of a bleeding episode resulting from hemophilia.

6. Yi Jin (age 40) is newly diagnosed with acquired immune deficiency syndrome.

7. Gao Hong (age 60) has been diagnosed with Coronary Heart Disease for 5 years.

8. Yang Min (age 50) had blood in his stool for one month. He was diagnosed with gastrointestinal cancer.

9. Jiang Yi (age 10) is diagnosed with nephritic syndrome. He got a cold two week ago.

10. Chen Si (age 35) is found to have suicidal tendency. She was diagnosed with depression.

Module 2  Nursing care of the patient with psychological alternations

Module description:

This Module is designed to address nursing concepts related to altered psychological status (psychiatric and mental health). The focus is on clients with acute and chronic psychiatric disorders and their mental health. Nursing strategies that are appropriate for assessment and intervention with individuals, families, and groups to facilitate optimal holistic health especially mental health will be discussed and practiced.

 

Module Objectives

By the completion of this course, the student will achieve the following objectives related to the care of persons with psychosocial disorders:

1. Integrate theoretical knowledge from nursing and related disciplines, in the development of a framework for clinical nursing practice that addresses intrapersonal, interpersonal, and extrapersonal influences on mental health promotion and illness prevention.

2. Articulate the importance of self-awareness in mental health nursing.

3. Formulate clinical nursing judgments and skills in providing direct care to clients experiencing acute and chronic alterations in mental health.

4. Discuss treatment modalities utilized with clients who are experiencing alternations in mental health.

5. Educate and counsel clients within the context of the family and group about mental health, mental illness, and health-seeking behaviors.

6. Develop collaborative relationships with members of the interdisciplinary health care team in planning and implementing optimal client care.

7. Implementing strategies based on corresponding theories (Peplau, therapeutic interpersonal process) to develop the therapeutic nurse-patient relationship.

8. Identify the types of therapeutic communication applicable to mental health nursing. Analyze the processes of therapeutic communication and therapeutic use of self with children, adolescents, adults and families experiencing mental health concerns(Travelbee, 1971).

9. Utilize professional nursing standards and clients rights as guidelines for interacting with clients experiencing acute and chronic alterations in mental health.

10. Summarize relevant research findings related to the diagnosis, nursing care, or modalities of treatment of clients experiencing a variety of psychosocial disorders.

11. Identify ineffective coping behavioral patterns in clients of all ages.

12. Relate patterns of ineffective coping in clients with psychological alternations.

Corresponding objectives : objective 1678(Holistic framework; building interdisciplinary relationship; therapeutic nurse-patient relationship; therapeutic communication)

Week 1. Relationship Development and Therapeutic Communication (Class 5 hr)

Pre-class preparation

1. Review the knowledge of General Psychology and human development; pay more attention to basic concepts of communication and the communication characteristics of all ages

2. Review past experience of interpersonal relationship building during social activities and clinic practice.

Contents and teaching strategies:

Lecture Ⅰ3hr

1. Introduce the objectives, schedule, requirement, evaluation, and references of this module.

2. The importance of therapeutic communication (discuss together), basic concepts (lecture).

3. Theories of therapeutic communication: feedback theory, territoriality theory, transactional analysis (demonstrate by students).

4. Differentiate between verbal and nonverbal communication (observing photos)

5. Role play based on 2 designed scenarios (divided into 2 groups-use balloons), and then discuss following items:

1)   Identify factors that influence communication

2)   Principles of therapeutic communication

3)   Process analysis: identify therapeutic communication techniques and non-therapeutic communication behavior.

4)   How to do process record.

5)   Mutually evaluate.

6)   Conclude therapeutic communication skills and non-therapeutic communication behaviors.

6. Discuss “Communication in Nursing Process”

Case study:Mr. Liu comes to the clinic complaining of upset stomach and headache.  The doctor orders medication to calm the stomach.  After several weeks, the problems persist, each time the doctor increases the dose of medication. The nurse notices that Mr. Liu seems to be rubbing his eyes, and asks if he is having any problems with vision or other changes. A) What other questions might be asked? B) What other problems might Mr. Liu is experiencing?  C) What diagnostic tests might be done?  D) What might the best treatment be? E) How might the patterns of communication change?

Lecture Ⅱ2hr

7. Discuss the role of psychiatric nurse based on the Peplau’s Nurse-Patient Relationship framework.

8. Compare therapeutic relationship to social relationship (group discussion)

9. Discuss the dynamics of a therapeutic nurse-client relationship.

10. Identify goals of the nurse-client relationship.

11. Identify and discuss essential conditions for a therapeutic relationship to occur, therapeutic use of self.

12. Describe the phases of relationship development and the tasks associated with each phase. (case study, videos if possible).

13. Describe how to develop comfort teamwork atmosphere, how to build interdisciplinary relationship (group discussion,SBAR ).

Assignments: the students need to improve their ability of therapeutic communication during clinic practice. They need to identify and analyze therapeutic communication skills and non-therapeutic communication behaviors, and report the impressed ones during the next class. Submit a written shift exchange report into BB before 8pm of second Sunday each shift.

Corresponding objectives : objective 123(Holistic framework; promote self-awareness;formulate clinical nursing judgments and skills in providing direct care)

Week2.  Simulation: The Nursing Process in Psychiatric/Mental Health Nursing and How to promote self-awareness (Class 5 hr)

Pre-class preparation

1. Prepare the knowledge of Diagnosis and statistical manual of mental disorders, (Fourth Edition.-Text Revision.)

2. Prepare Nursing Process related knowledge, including assessment, diagnosis, planning, implementation and evaluation.

3. Prepare the knowledge about psychopathology: disturbance of perception (auditory hallucination) and disturbance of thought

4. Review: Nursing Diagnoses approved by NANDA

5. Identify and analyze your views on clients with mental illness and the feelings during care.

Contents and teaching strategies

Lecture 3hr  Distress hearing voices-how our clients feeling about the world

 

Time

Procedure

Remarks

8:00

Arrived at Classroom

Make sure leave your cell-phone and any other video-taped tools in  your dormitory

8:05

  1. Discuss the importance of self-awareness in the nurse-client relationship.
  2. Empathy and sympathy.
  3. Discuss basic concepts of hearing voices.
  4. Discuss coping strategies to deal with hearing voices.

Review related knowledge

8:35

Group Discussion :

What your feelings toward to clients live with mental illness.

What about those who around you.

Identify own feelings

8:50

Form Small groups (1 hr: Mp3 player on)

Stage 1:

Group1: stay in room (30min)

Group2: Instructions to go outside (30min)

Stage 2:

Group2: stay in room (30min)

Group1: Instructions to go outside (30min)

Turn off Mp3 player

Those who go outside(around or on campus) have to communicate with other people (Not communicate with each other)

 

Patricia Deegan - Distressing Voices

9:50

Large Group Discussion

Evaluation

 

10:10

How could we be more empathy

 

Assignments:write down your feeling during suffering from the hearing voices, submit before 8pm of second Sunday each shift.

Lecture 2hr 

Safety and risk management: Deal with unexpected events-more than mental illness

Specific Pre-class preparation:

1. The students should review the required knowledge and skills before the simulation activity. (e.g. how to care for clients with Sch;risks stem from drug side effects)

2. Utilize concept map finish a nursing care plan before the simulation activity.

3. The students need to make sure their roles before the simulation activity.

Simulation:

Introductory learning:  regular risks stem from psychopathology and psychiatric emergences.

Objective:

  1. Emphasize somatic problems among clients with mental illness.
  2. medication management: how to identify and manage side effects
  3. how to deal with unexpected event

Scenario:  a 22-year-old woman with Sch, use chlorpromazine 2 weeks, risk for postural hypotension.

Arrangement: students divided into 2 groups, simulate in the scenario in sequence and debriefing separately.

Assignment: Identify and analyze the major problems during simulation and submit into BB before 8pm of the third Sunday of each shift.

Corresponding objectives : objective 2,10,11,12;(empathy, Summarize relevant research findings related to the diagnosis, nursing care, or modalities of treatment;Coping)

Week 3.  Stress management (Class 5 hr)

Pre-class preparation

1. Prepare knowledge of basic concepts of stress and stress management.

2. Psychological adaptation to stress

3. Literature review: at least 3 English papers(the latest 3 years)referring to stress management and read in detail. Reading and then report in class room as 3 groups.

Contents and teaching strategies:

Lecture 3hr

1. Mental health and mental illness: the dynamic process (lecture)

2. Basic concepts of stress and stress management (analyze by students as groups)

3. Defensive mechanism: Case study, 12 cases (briefly described), students analyze as 3 groups. 4 cases each group.

4. Adaptive coping strategies: students demonstrate strategies as 3 groups (encourage role play).

5. Non-adaptive coping behaviors: case study as 3 groups. Analyze the coping style of individuals in case, how to intervention.

6. Literature report: Comments of literature reading

Lecture 2hr

  1. Psychological adaptation to stress:anxiety and grief, basic concepts(lecture)
  2. Cases study: Behavioral adaptation responses to anxiety, students identify and analyze adaptation responses, pay more attention to defense mechanism. 
  3. fragments of movies:The Shrink,Identify adaptive grief responses and coping strategy.
  4. Group discussion, how to help clients coping adaptive based on emphasy , and how to identify and record self-awareness, and relieve negative emotion.

Assignments:Review major stressor you once experienced, and thinking how you deal with them, submits into BB before 8pm of the Third Sunday of each shift. Students will be encouraged to sharing during the next Class.

 

 Corresponding objectives : objective 1,3,4,9;(Holistic framework; promote self-awareness;formulate clinical nursing judgments and skills in providing direct care,treatment modalities,Utilize professional nursing standards and clients rights as guidelines)

Week 4.  Crisis intervention: Crises reflecting psychopathology and Psychiatric emergencies (Class 3 hr)

Pre-class preparation

1. Prepare knowledge of basic concepts of Crisis and crisis management.

2. Review past clinic experience; conclude popular unexpected and violence events in psychiatric as well as general ward.

Contents and teaching strategies:

Lecture 3hr

1. Unexpected risks and violence in ward: Guided review and conclusion

2. Case study:

1) Violence risk factors assessment

2) Prevention and coping

3) Nurses’ psychological responses and attitude.

4) Suicide assessment.

3. Domestic violence or abuse: physical battering, psychological or emotional abuse and destruction of property or pets, sexual violence

4. Current Prevention and management

5. How to deal with domestic violence.

Module 3 Nursing Care of Clients with Physiological Alterations from

Disease, Diet, and Deterioration

Module description:

This module is designed to address nursing concepts related to physiological alterations. The focus is method and caring that help clients adapt their physiological alterations.

 

Module Objectives:

At the end of the module, the student will be able to:

1.    Discuss appropriate nursing care based on nursing diagnosis for clients with physiological alterations of pregnancy.

2.    Discuss appropriate nursing care based on nursing diagnosis for clients with physiological alterations of childbearing.

3.    Nursing care for newborn.

4.    Nursing care for clients with physiological alteration related to general aging.

5.    Nursing care based on nursing diagnosis for clients with physiological alterations from selected diseases.

6.    Nursing care for clients with physiological alterations related to dietary imbalances.

Objective 1:Nursing care based on nursing diagnosis for clients with physiological alterations of pregnancy (Lecture 1,3 hours,methods:lecture, discussion, watch the radio )

Contents:

1. Introduce the objectives, schedule, requirement, evaluation, and references of this module.

2. physical and psychological changes of pregnancy (question and lecture )(watch the radio )

3. method of relieving the common discomforts of pregnancy

4. promotion of self-care during pregnancy (focus on this item )

5.prenatal examination

6. maternal nutrition

Pre-class preparation: The students should read the article before the class

Assignment: antenatal training methods and how to do -- search the materials , finish the assignment by group

Objective 2:  Nursing care based on nursing diagnosis for clients with physiological alterations of childbearing (Lecture 2, 2 hours, method:lecture, watch the radio )

Contents:

1.    critical factors in labor

2.    threatened labor,  false labor, in labor

3.    methods of childbirth preparation

4.    physiology changes of pregnancy and fetal during labor

5.    Stage of labor and birth, nursing care during the different stages of labor

6.    postpartum physical adaptations

7.    postpartum psychological adaptation

8.    nursing care for maternal comfort and well-being, rest and activity

9.    postpartum nutrition

10.  promotion of maternal comfort and well-being

11.  promotion of family wellness and shared parenting

Pre-class preparation:The students should read the article before the class.

Assignment:

1. Students practicing in Obstetric department should take once the nursing care for the pregnancy during the whole process of labor and birth

2. Finish the a nutrition plan for the women in clinic, submit the report to BB plat before 10pm of the second week

Objective 3: Newborns and their care (lecture 3, 3 hours, method: lecture, watch the radio, Demonstration )

1.Timing of Newborn Assessments

2.Neonatal characteristics and assessment

3.Nursing care for Common health problems

   ⑴birth injury: ①soft tissue injury; ②head injury; ③fracture; ④nerve injury  ⑵neonatal infections:

4.Newborn nutrition

(1)    nutritional needs

(2)    choice of feeding: breast versus milk

(3)    feeding process

5.The establishment of parent-child relationship : time, methods

6.Community-based nursing care for mothers, infants and families

pre-class preparation:

1.    the basic knowledge on newborn,

2.    how to establish a good parent-child relationship

Assignment:

1.    provide caring for the newborn

2.    provide the guidance on how to establish a good parent-child relationship

Objective 2:Simulation Teaching – nursing care of childbearing (Lecture 4,2 hours)

Objective 3 :  Nursing care for The Newborn at high risk  (Lecture 5, 3 hours, 讲授)

1.the definition and assessment of High-risk newborns

2.nursing care for premature infant

⑴reason for premature

⑵physiological characteristics of premature infant

3.Common high-risk newborns and their care:

⑴hyperbilirubinemia: Definitions and causes, medical management, nursing (focus: nursing newborn phototherapy, exchange transfusion newborn care measures)

⑵respiratory distress syndrome (self learning )

⑶meconium aspiration syndrome (self learning )

⑷neonatal sepsis (self learning )

⑸necrotizing enterocolitis (self learning )

⑹sudden infant death syndrome (self learning )

Pre-class prepare:

1.    the related knowledge in the book of nursing care for child

2.    observe how to provide caring for newborn with  hyperbilirubinemia

Objective 4 :Nursing care for clients with physiological alteration related to general aging —Ⅰ(lecture 6,2 hours, methods: lecture, activeity )

1.    physiological changes and psychological changes of clients for general aging

2.    the principles of nursing care for the issue of aging:

(1) physical health issues: nutrition needs; sleep pattern changes

(2) mental health problems: depression, delirium, etc.

(3) issues related to the elderly: medication; security issues; suicide; other issues related to the elderly

3.  Effects of aging on disease prognosis and recovery

4.  The holistic hospice care for terminal patient and family: (Classroom Activities: Communication)

Pre-class prepare:

1.第22章,李和惠,林丽秋,黄玉琪,吴碧云,林贵满. 内外科护理学,第三版,台湾,华杏出版社,2010  read chapter 22 in a book

2.Review communication skills

 

Objective 4 : Nursing care for clients with physiological alteration related to general aging — Ⅱ(Lecture 7, 3 hours, methods: lecture, discussion, case study)

3.The definition of death and dying

4.The psychological impact of death

5.nursing care for terminal patient

6.case study: terminal patient

Pre-class prepare:

1.第23章,李和惠,林丽秋,黄玉琪,吴碧云,林贵满. 内外科护理学,第三版,台湾,华杏出版社,2010  read chapter 23 in a book

2.provide a case for students to prepare how to take care of the client and family

Module 4 Nursing Care of the Patient Experiencing Surgical Alterations

Module description:

This module is to introduce the main concepts in patients with surgical experience. Identify the main influence on the patients and their families physiologically and psychologically. And make nursing care plans for the patients with surgery and make some interventions.

Objectives

At the end of the course ,the student will be able to:

1. Discuss and commend the components of surgery and its related nursing characteristics.

2. Familiar with collaboration in the surgery.

3. Master the preoperative and postoperative nursing in surgery.

4. Utilize related concepts in formulating holistic nursing plan.

 

Course arrangement

Objective 1:

Discuss the components of surgery and its related nursing characteristics.

Week 1: components of surgical nursing

Class objectives

  • Students can master three components in surgery experience.
  • Students can master nursing characteristic through the case study-thyroid surgery
  • Students can command the preoperative preparation.

Class arrangement

Introduction (3hours)

1. Introduce objectives, contents, teaching methods, requirement, references.

2. Introduce components of surgery (concept in surgery, surgical indications, pre-, intro-, postoperative nursing)

3. Discuss the components in nursing care of patients with thyroid surgery and summarize the main contents in taking care of patients with neck surgery

4. Assign the contents to preview

Preoperative preparation 2hours

1. introduce conventional practice of preoperative preparation

2. illustrate anorectal surgery to explain preoperative preparation of abdominal surgery

3. Provide literatures related with preoperative preparation to students

Assignment: view Private Practice season 6 episode 23, to familiar with the environment in OR and collaboration in surgery.

Objective 2: recognize the collaboration in surgery

Week 2intraoperative nursing (5hours)

Class objectives

1. Students can familiar with the environment in OR and collaboration in surgery

2. Students can sum up and classify nursing care in patients with different type of anesthesia

Class arrangement

collaboration in surgery and anesthesia nursing (3hours)

1. Discuss the environment of OR in episode, conclude the composition of the OR, explain the composition, roles and responsibilities of nurses.

2. Introduce the principles of surgical aseptic technique.

3. Illustrate abdominal surgery and cesarean section to explain the anesthesia nursing

4. Group discussion of nursing care of different type of anesthesia

5. Introduce class activity next class and assign work to preview.

Class activity(2hours)

Simulation—taking care of patients with rectal carcinoma and appendicitis

Assignment: preview injury and the application of analgesic drugs. Gather related regulation of managing the using of analgesic drugs.

Objective 3

 command main concepts of postoperative nursing

Week 3: Postoperative nursing (5hours)

Class objectives

1. Students can master the emphasis of monitoring after surgery.

2. Students can list the regular interventions to improve patients’ comfort.

3. Students can give up personal plans of pain management regarding to cases.

Class arrangement

Postoperative nursing (1) Introduction and monitoring

1. Review the components of postoperative nursing.

2.Illustrate patients with burn to introduce the monitoring condition.

Postoperative nursing (2) Comfort-position, pain management (2hours)

1. Introduce the different type of positions in different types of surgery.

2. Introduce the concepts in pain management.

3. Illustrate gastric cancer to introduce pain management.

4. Make plans to promote comfort in patients with gastric cancer

Assignment: organize students to visit the hospice unit in Zhongnan Hospital and preview related contents of hepatobiliary and thoracic surgery.

Utilize related concepts in formulating holistic nursing plan

Week 4 Postoperative nursing(5hours)

Class objectives

1. Students can master nursing intervention of incision management

2. Students can familiar with nursing intervention of colostomy in duodenal surgery

3. Students can grasp the basic rules of taking care of drainage tube

4. Students can utilize the basic principles mentioned last week and this week to make nursing plan for patient with abdominal surgery and thoracic surgery

Class Arrangement

Postoperative nursing (3) Incision and drainage tubes management (3hours)

1. Introduce basic principles of taking care of

2. Introduce colostomy nursing through duodenal surgery.

3. Introduce basic principles of taking care of drainage tubes through abdominal surgery and thoracic surgery.

Assignment: Integrate knowledge mentioned before to make a nursing plan for cases.

 

Teaching methods and approaches: The course will utilize a modular approach in small-size class to instruction. Teaching methods will include discussion, student presentations, case studies, scenario simulation, lecture and audio-visual materials such as films, video, and audio tapes.

 

Course Evaluation:

Evaluation will be based upon satisfactory completion of modules, active participation in classroom discussions, and course examinations including a comprehensive final test and quiz.

1. Attendance        10%

2. Class Performance  25%

3. Quiz             40%

4. Final test         25%

 

Textbook:

  

1.Smeltzer S.C. & Bare B. (2004). Chronic Illness. Textbook of Medical-Surgical Nursing (10th edition). Lippincott Williams & Wilkins.

2.尤黎明,吴瑛.内科护理学.第三版.北京:人民卫生出版社,2005.

3.Townsend, M.C. (2006). Psychiatric-mental health nursing: Concepts of care in evidence based practice (5th ed.). Philadelphia: F.A. Davis.

4.萧淑贞,王纯娟,刘玉云等.精神科护理概论:基本概念及临床应用. 台北: 华杏出版股份有限公司, 2010. (Xiao Shuzhen, Wang Chunjuan, Liu Yuyun, et. al.. Psychiatric Nursing: Concept and Practice. Taipei: Farseeing Publishing Group,2010.)

5.高玉玲等. 精神科临床护理导引:精神科个案护理. 台北:华杏出版股份有限公司,2000.

6.Deitra L Lowdermilk & Shannon E. Perry, Maternity & women’s health care, 8 edition, an affiliate of Elsevier, 2004

7.Michele R. Davidson, Marcia L. London, Patria A. Wieland Ladewig. Olds’ maternal-newborn nursing & women’s health across the lifespan, 8th edition, Prenrice hall, 2008

8.郑修霞,夏海鸥. 妇产科护理学, 第四版, 人民卫生出版社, 2006

9.陈月枝编著,实用儿科护理,华杏出版股份有限公司,2004年出版

10.曹伟新,李乐之。外科护理学。第4版,北京,人民卫生出版社,2006。

11.湖南医科大学附属湘雅医院。病人标准护理计划(外科分册)。第1版,长沙,湖南科学技术出版社,2002。

12.吴在德,吴肇汉。外科学。第六版,北京,人民卫生出版社,2004

13.李和惠,林丽秋,黄玉琪,吴碧云,林贵满。内外科护理学,第三版,台湾,华杏出版社,2010。

 

List of Recommended References:

Module 1

  1. Smeltzer S.C. & Bare B. (2004). Chronic Illness. Textbook of Medical-Surgical Nursing (10th edition). Lippincott Williams & Wilkins.
  2. http://www.rwjf.org
  3. 尤黎明,吴瑛.内科护理学.第三版.北京:人民卫生出版社,2005.
  4. 陆再英等.内科学.第七版.北京:人民卫生出版社,2008.
  5. http://www.who.int/chp/chronic_disease_report/part1/zh/index.html
  6. http://www.nihe.org.cn/
  7. http://www.tnbzy.com/default.html
  8. http://chinacdc.net/
  9. Brunner L.S. & Suddarth O.S. (1992). Textbook of Medical-Surgical Nursing (7th edition). Philadelphia: Lippincott, 1992
  10. 慢性非传染性疾病预防医学诊疗规范(试行).卫生部疾病控制司,2002.
  11. 中国慢性病报告.中华人民共和国卫生部疾病预防控制局,2006.
  12. Reinvention of Depression Instruments by Primary Care Clinicians. Baik SY.; Gonzales JJ.; Bowers B.J.; Anthony J.S.; Tidjani B.; Susman J.L. Reinvention of Depression Instruments. 2010, 8(3):224-230
  13. http://www.biomedcentral.com/1472-6963/10/95

http://www.implementationscience.com/content/5/1/43

Module 2

  1. Townsend, M.C. (2006). Psychiatric-mental health nursing: Concepts of care in evidence based practice (5th ed.). Philadelphia: F.A. Davis.
  2. 萧淑贞,王纯娟,刘玉云等.精神科护理概论:基本概念及临床应用. 台北: 华杏出版股份有限公司, 2010. (Xiao Shuzhen, Wang Chunjuan, Liu Yuyun, et. al.. Psychiatric Nursing: Concept and Practice. Taipei: Farseeing Publishing Group,2010.)
  3. 高玉玲等. 精神科临床护理导引:精神科个案护理. 台北:华杏出版股份有限公司,2000.
  4. American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
  5. American Psychiatric Association. (2000). Diagnosis and statistical manual of mental disorders, (Fourth Edition.-Text Revision.) Washington DC: Author.
  6. Mary C T. Essentials of psychiatric mental health nursing, 3rd ed. Philadelphia: F.A. Davis Company, 2004.
  7. Katherine M F. Psychiatric nursing care plans, 4th ed. St. Louis: Mosby, 2003.
  8. Katherine M F, Patricia A. Psychiatric mental health nursing, 3rd ed. St. Louis: Mosby, 2003.
  9. Sheila L V. Psychiatric mental health nursing, 3rd ed. Philadelphia: Lippincott, 2004.
  10. Patricia D. Barry. Psychosocial Nursing, 3rd ed. Philadelphia: Lippincott, 1996.
  11. Rawlins Williams Beck. Metal Health Psychiatric Nursing-A Holistic-Cycle Approach, 3rd ed. St. Louis: Mosby, 1993.
  12. 沈渔邨. 精神病学. 第5版. 北京:人民卫生出版社, 2009.
  13. 姚树桥,孙树礼. 医学心理学. 第5版. 北京:人民卫生出版社, 2008.
  14. 李小妹.精神科护理学—护理双语教材.北京:人民卫生出版社, 2006.
  15. 李峥,王志英.临床护理学:认知/感知. 北京: 中国协和医科大学出版社, 2002.

Module 3

  1. Deitra L Lowdermilk & Shannon E. Perry, Maternity & women’s health care, 8 edition, an affiliate of Elsevier, 2004
  2. Michele R. Davidson, Marcia L. London, Patria A. Wieland Ladewig. Olds’ maternal-newborn nursing & women’s health across the lifespan, 8th edition, Prenrice hall, 2008
  3. 郑修霞,夏海鸥. 妇产科护理学, 第四版, 人民卫生出版社, 2006
  4. 陈月枝编著,实用儿科护理,华杏出版股份有限公司,2004年出版

5. 梁惠芳,林宝玉,林凤贞,等. 儿科护理学,华杏出版股份有限公司,2010年出版

6. 李和惠,林丽秋,黄玉琪,吴碧云,林贵满. 内外科护理学,第三版,台湾,华杏出版社,2010

  • 湖南医科大学附属湘雅医院,病人标准护理计划(内科分册), 第1版, 湖南科学技术出版社,2002

Module 4

1.    曹伟新,李乐之。外科护理学。第4版,北京,人民卫生出版社,2006。

2.    湖南医科大学附属湘雅医院。病人标准护理计划(外科分册)。第1版,长沙,湖南科学技术出版社,2002。

3.吴在德,吴肇汉。外科学。第六版,北京,人民卫生出版社,2004

4.李和惠,林丽秋,黄玉琪,吴碧云,林贵满。内外科护理学,第三版,台湾,华杏出版社,2010。

5. Smeltzer, S.C., Bare, B. G., Hinkle, J. L. Cheever, K. H. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 11th edition, Lippincott Williams & Wilkins 2008.

6.http://www.orlive.com

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