Course Coordinator: Sindy Millington
Phone: +61 8 83132996
Email: sindy.millington@adelaide.edu.au

Student Liason Officer:
Phone: +61 8 8313 3596
Email: nursing.studentliaison@adelaide.edu.au

1	Demonstrate the provision of patient focussed integrated holistic care of the critically ill patient.
2	Appraise the pathophysiology of disease processes that can result in critical illness in a clinical based scenario.
3	Formulate an analysis of monitoring and assessment of critically ill patients in intensive care in a clinical based scenario
4	Integrate aspects of nursing theory and knowledge to actual clinical practice
5	Evaluate the use of analytical enquiry and critical reflection into nursing practice, through contemporary issues in intensive care nursing.
6	Integrates current evidence based guidelines, consensus statements, and attitudes astutely to ensure competent clinical practice in clinical based scenario.

Texts
The prescribed texts are integral to the course. Students are required to select one of the following critical care nursing texts:

Bersten, A & Soni, N (eds) 2013, Oh’s intensive care manual, E-book, Butterworth Heinemann Elsevier, Philadelphia.
or
Elliot, D, Aitken, L & Chaboyer, W (eds) 2015, ACCCN’s critical care nursing,E-book  Mosby Elsevier, Sydney.
and
Wesley K 2011 Huszar’s Basic dysrhythmias and acute coronary Syndromes: Interpretation and Management 4th edn, Mosby Elsevier, St Louis

Each week a chapter (or part thereof - please take note of page numbers) will be identified as essential preparatory reading.

Reader
The readings for this course are available electronically via MyUni.
Please note: it is your responsibility to organise printing should you prefer a hard copy of the reader.

Texts
Pharmacology
Bryant, B & Knights, K 2007, Pharmacology for Health Professionals, 2nd edn Mosby Elsevier, Sydney
or
Bullock, S & Manias E & Galbraith A 2011, Fundamentals of Pharmacology 6th edn, Pearson Education Australia, Frenchs Forest

Ventilation
Pilbeam, S.P & Cairo, J.M 2006, Mechanical Ventilation; Physiological and Clinical Applications, 4th edn, Mosby Elsevier, St Louis
or
Pierce, LNB 2007, Management of the Mechanically Ventilated Patient, 2nd edn, Saunders Elsevier, St Louis.

Anatomy and Physiology
Saladin, K.S 2010, Anatomy & Physiology, The unity of form and function 5th edn, McGraw Hill, Boston.
or
Martini F. H 2006, Fundamentals of Anatomy & Physiology 7th edn, Pearson, San Francisco.

Haemodynamic monitoring
Darovic, G 2002, Haemodynamic monitoring, invasive and non-invasive clinical application, 3rd edn, WB Saunders Co, Philadelphia
or 
Darovic GO 2004 Handbook of hemodynamic monitoring 2nd edn, Saunders, St Louis.

Note: You are not required to buy recommended texts. However, they provide valuable supplementary reading on various aspects of the material covered within this course

E-books
As a student at the University of Adelaide you also have free access to a large variety of quality electronic textbooks. These can be accessed online through the library website by entering the E-Journals A-Z link and selecting-books only.

MyUni
All students enrolled in a postgraduate coursework nursing program have access to the School of Nursing – Postgraduate Coursework Student Centre on MyUni. If you would like the opportunity to network with other students, you can use the Communication features in the site. This site will also feature information about the latest news and events at the School of Nursing.

Unified
http://unified.adelaide.edu.au/
UNIFIED is your one-stop shop for email, calendar, MyUni and Access Adelaide. It even allows you to search the Library.
UNIFIED is available to all active students; with a single login you can access your student systems and personal information through a central website. Login with your Student ID ("a1234567") and Password.

For more information, including easy to follow instructions visit https://unified.adelaide.edu.au/web/mycampus/home.

Library Resources
Help for Nursing Students
The University of Adelaide Library has a website to help nursing students use the library and its resource (www.library.adelaide.edu.au/guide/med/nursing).

Remote student library service
The University of Adelaide Library provides a document delivery and loans service to non-metropolitan students who do not visit a University of Adelaide campus to attend classes (www.adelaide.edu.au/library/docdel/external.html).

This course employs on campus delivery of material by a variety of teaching methods to promote learning. A mix of lectures including guest speakers, tutorials, practical skill demonstration and case study review will be incorporated into the sessions. Students will be challenged to develop and demonstrate critical thinking and problem solving skills.

Student participation and discussion will be expected in all sessions.

Lectures
Course lectures are on Wednesdays 8.30am to 1pm on the University of Adelaide  North Terrace. Lecture locations will be made available on the MyUni website. There will be Articulate storyline Lectures available on the MyUni home page as student preparation for some weeks, that students are required to review prior to attending class.

Reading
There are several recommended texts for this course and a reading list has been compiled and made available on MyUni. For each lecture, readings have been carefully chosen. All of these required and recommended readings have been selected to optimise your knowledge on the topic and so that they will continue to be of use to you after you graduate.

Clinical Practice and Skill Acquisition
This course supplements theoretical knowledge acquisition with field based learning. Students are required to complete clinical skills and work a minimum of 300 clinical hours in intensive care during this semester.

Lectures
The student is expected to attend Course lectures every Wednesday morning from 8:30 am to 1 pm on the University of Adelaide or Royal Adelaide Hospital Campus, North Terrace. Lecture locations will be made available on the MyUni website. Student participation and discussion will be expected in all sessions.

Readings
A reading list has been compiled for this course and will be made available through MyUni. Lecture and readings have been carefully chosen. All of these are required and recommended readings have been selected to optimise your knowledge on the topic and so that they will continue to be of use after you graduate.

Clinical Practice and Skills Acquisition
This course supplements theoretical knowledge with field based learning. Students are required to complete clinical skills and work a minimum of 300 clinical skills in intensive care during this semester.

The course content will include the following:

Care of the critically ill patient
Assessment of critical illness – SOFA / APACHE II P
sychosocial and cultural care
Concerns of the critically ill
Communication
Comfort
Pain Management and assessment
Sedation
Sedation management principles
Assessment and prevention of delirium
Nutrition
Family’s experience

Care of the patient with respiratory failure
Respiratory Physiology
Acute Respiratory failure

Respiratory Monitoring, Assessment and Diagnostics
CO2
FEV
VQ scans
CXR revisited
Acid base disorders
ABG analysis

Advanced Respiratory Management
Oxygen therapy and humidification
NIV
Ventilation principles and management

Common Respiratory Disorders Assessment and therapeutic Management
Pneumonia
Asthma
COPD

Complex Respiratory Disorders Assessment and Management (1st or Second Semester)
ARDS
Management of Pandemic Flu
Advanced ventilation techniques
Waveform analysis
APRV / Bilevel
ECMO

Care of the patient with cardiac failure
Cardiac Physiology and Electrophysiology
Heart Failure

Cardiac Monitoring and Assessment
Arrhythmias
Cardiac Pharmacology
Antiarrhythmics
Inotropes

Atrioventricular blocks and Pacing

12 lead ECG interpretation
BBB
Axis deviation
Differentiation of VT/ SVT
Non-cardiac ECG changes

Care of the patient with ACS
Assessment, diagnosis and therapeutic management
UA
STEMI
NSTEMI

Special populations in intensive care
Paediatrics/ Paediatric Emergencies
Obstetrics / Obstetric emergencies
Gerontological alterations
Mental Health

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This course considers the pathophysiology, assessment, monitoring and therapeutics associated with the broad discipline of intensive care nursing. Particular focus is given to the respiratory and cardiovascular management of this patient population. This course also addresses some of the clinical skills necessary for practice as a registered nurse in intensive care.

Specialty Intensive Care
Care of the critically ill patient
This session will focus on building the foundation knowledge of specialty intensive care practice. The importance of providing patient focussed individualised care will be emphasised. The characteristics of the intensive care patient population locally, nationally and internationally will be explored. Students will be introduced to clinical instruments used to describe patient acuity and discuss the needs of specific patient populations including bariatric, gerontologic and paediatric patients in adult intensive care units.

The fundamental aspects of nursing care will also be reviewed including:
•    Nutrition in the critically ill patient
•    Sedation and Delirium Management
•    Psychosocial aspects of care
•    Principles of Infection control
•    Pain Management


Care of the Patient with Respiratory Failure
Advanced Respiratory Physiology
The goals of this session are to provide strong foundation knowledge of advanced respiratory physiology.  This will enable the discussion of how these physical factors relate to critical illness and advanced respiratory therapeutics in future weeks. In particular there will be discussion of the control of respiration, the mechanics of breathing, factors influencing diffusion across the alveolar capillary membrane and the transport of oxygen and carbon dioxide. The physical gas laws which influence gas delivery and gas exchange will be reviewed and focus will be given to the concepts of respiration versus ventilation.

Acute Respiratory Failure
The clinical features of acute respiratory failure, pathophysiology and the clinical manifestations of hypoxaemia and hypercarbia will be discussed in this session.

Respiratory monitoring, assessment and diagnostics
This topic will consider the monitoring, assessment and specialised nursing care of patients with actual or potential respiratory failure. The assessment and analysis of observations and monitored parameters will be investigated. Focus will be given to the use of spirometry, end tidal carbon dioxide monitoring, chest x-rays and the assessment of acid base disorders. This topic will introduce the principles of acid base regulation. Students will be introduced to a systematic approach to arterial blood gas analysis as a component of the session.

Therapeutics: Advanced Respiratory Management
This topic will consider therapeutics used for respiratory failure in critically ill patients. The principles of oxygen therapy will be considered, with focus given to the importance of humidification and consideration of issues pertaining to the appropriate use of oxygen therapy. Basic and advanced airway management will be presented from techniques such as positioning of the patient, to the use of advanced airway management techniques such as endotracheal intubation. Comparisons between differences in managing the adult and paediatric airway will also be reviewed.

Therapeutics: principles of supported / assisted ventilation
Supported and assisted ventilation will be examined from non-invasive supportive techniques such as Continuous Positive Airway Pressure (CPAP) to therapies such as invasive, controlled ventilation. The issue of nursing management of patients receiving these therapies will be discussed, as well as physiological effects and possible complications.

Common Respiratory Disorders: Assessment and therapeutic management
Common causes of respiratory failure in critically ill patients such as pulmonary oedema, pneumonia, asthma, chronic obstructive airways disease, pulmonary embolus and pleural effusions will be considered. The specialised nursing care of such patients will also be discussed. Links to the evidence based practice guidelines pertaining to the management of these disorders will be made. This topic will also consider common disorders associated with the presentation of paediatric patients to the acute care setting.

Complex Respiratory Disorders: Assessment and therapeutic management
In this session students will have the opportunity to discuss clinical cases which demonstrate the pathophysiology, diagnosis, medical and nursing management of patients in the intensive care environment with advanced respiratory disorders. This session will focus on patients with Acute Respiratory Distress Syndrome, the management of patients with pandemic influenza and advanced ventilation and therapeutic techniques including Airway pressure release ventilation (APRV) or Bi-level ventilation and Extracorporeal Membrane Oxygenation (ECMO)


Care of the Patient with Cardiac Failure
Cardiac Physiology and Electrophysiology
This topic will consider the principles of advanced cardiac physiology and how these relate to critical illness and intensive care therapeutics. In particular the physiological control of blood pressure and factors influencing cardiac output and tissue perfusion will be discussed.In this session the electrochemical basis of cardiac function will be presented. The basic principles of electrocardiography (ECG) such as the specific properties of cardiac tissue, cardiac action potential and the events of the cardiac cycle will be discussed. In addition the fundamental laws of electrocardiography and how these laws relate to the 12 lead ECG and cardiac monitoring will be will be presented with particular emphasis on the application of Einthoven's Triangle, the Triaxial and Hexaxial Reference Systems.

Heart Failure
Acute heart failure in critically ill patients adds a complexity to patient management. Acute Decompensated Heart failure (ADHF) is the leading cause of hospitalisations for patients > 65 years. Accordingly this lecture will focus on the diagnosis and management of ADHF in the context of the critical care environment.

Cardiac monitoring, Assessment and Pharmacology
The possible causes of arrhythmias, and the treatment and nursing care of patients with particular arrhythmias will be discussed. Principles of pharmacological management including the use of anti-arrhythmics and inotropic therapies in critical illness will be reviewed. This topic will be presented in two sessions and provide an introduction to the use of positive inotropic agents and antiarrhythmics in critical illness.

Atrioventricular Blocks and Pacing
This session will describe the mechanism of formation, assessment and management of atrioventricular blocks. Students will gain an understanding of the different methods of providing cardiac pacing. They will be challenged to apply their knowledge of symptomatic bradycardia and AV blocks to the delivery of this treatment modality. Focus will be on initiation and assessment of the effectiveness of this treatment and the nursing responsibilities required for patient management.

12 Lead ECG Interpretation
The process for 12 Lead ECG interpretation will be reviewed.
Specific focus in the session will be given to:
•    Recognition of conduction delays on the ECG.
•    The definition and causes of bundle branch block will be considered.  In addition bi and trifascicular block will be considered. The clinical implications of these abnormalities will also be identified.
•    Determination of the mean QRS axis on ECG
•    In this session students will learn how to calculate the mean QRS axis on a 12 lead ECG. The causes of axis deviation and the clinical significance will also be discussed.
•    Differentiation of broad complex tachycardia
•    In this session students will learn some principles, which assist in the differentiation of broad complex supra-ventricular tachycardia (SVT) from ventricular tachycardia (VT).  
•    Non cardiac ECG changes
•    The effect major electrolyte imbalances, drugs, hypothermia and Central nervous system injury have on the electrocardiograph will be outlined.

Care of the patient with acute coronary syndromes
This session will consider the pathophysiology of unstable angina, non ST elevation myocardial infarction and ST elevation myocardial infarction. The clinical features manifested by patients suffering from these disorders will be presented and the diagnosis and differential diagnosis will be discussed. Students will learn how to recognise ECG changes associated with ischaemia and infarction. The Australian guidelines for the management of acute coronary syndromes will be discussed.


Special Populations in Intensive care
The final session for this semester will focus on the special needs of patient subgroups within the intensive care population. Specifically the management of paediatric patients in the adult intensive care environment, obstetric patients and patients with mental health or drug dependency concerns will be reviewed.

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Clinical Skills – Semester 1 2016

Airway

Endotracheal Tube Repositioning and Security

Performing an Endotracheal/Tracheostomy Tube Cuff Check

Performing Tracheal Suction via an Endotracheal / Tracheostomy Tube

Care of a patient with an Endotracheal tube or Tracheostomy Tube insitu

Breathing

Caring for a Patient with a Pleural Drain insitu

Arterial Blood Gas Sampling and Analysis

Chest X ray Interpretation

Commencing IPPV

Care of a Ventilator Dependent Patient

Care of a Patient following Extubation

Circulation

Care of a Patient on an Inotropic/Vasoactive Infusion

Recording and analysing a 12 Lead ECG

Caring for a patient with Temporary Pacing*

Equipment

Setting the Modes of the Unit Ventilator *

Changing Oxygen and Ventilator Circuits *

Assembly of Ventilators and Oxygen Circuits *

Reflective Practice Semester 1

Teamwork

Leadership

Intubation

ETT Security

Extubation

It is the teaching team's endeavour to have Small Group Discovery (SGDE) experiences for many of our tutorial based exercises during our face to face time with students. Groups will be allocated to work together on clinical scenarios and problems that will be explored for solutions/actions that reflect evidence based care, professional team work and best practice.

Assessment Task	Assessment Type	Weighting	Learning Outcome(s) being addressed
Synopsis Paper Presentation	Formative Summative	0% (Non-Graded Pass) 30%	5-6
Essay	Summative	30%	1-3, 6
Exam	Summative	40%	1-4
Clinical Skills and Reflective Practice Diaries		Pass/Fail	1, 3, 6

Clinical Skills and Reflective Practice Diaries Pass/ Fail
The assessment of skills will occur throughout the semester. Students will be assessed by the critical care registered nurses and clinical titleholders, with whom they work. Please refer to the information provided in the Clinical skills and Reflective Practice Diaries regarding skills assessment criteria.

It is essential that students, who do not have exposure to a particular skill, may be discussed with the coordinator within enough time to arrange for clinical experience/demonstration to occur. The Semester 1 component of the skills and reflective diaries must be completed by end of semester and presented for assessment. The diaries will be graded Pass or Fail.

Development of a teaching package (60%) of total course grade
This assessment will consist of 3 components a synopsis, background paper and presentation (15 minutes with 5 minute discussion)

Students will be required to choose a topic of interest from the course content and prepare a teaching package to present to junior nursing staff (GNP and nursing students) within their clinical area.

Synopsis Paper: The formative assessment will be the submission of a synopsis paper (1000 words maximum ) which outlines the intended content, key points for discussion, expected outcomes and strategies for presenting the material. Students will be required to identify appropriate preliminary resources on which further research and reading will be based. Students will receive written feedback on their proposed topic.
Due Date: Week 5.

Background Paper: The second component of the assessment will consist of a background (2000 words − 30%) paper in which the students will identify the topic, justify the relevance of the topic to clinical practice and provide a detailed review and critique of the topic and the principles for promoting adult learning. This piece will provide the foundation on which the presentation will be structured. This strategy enables students to receive written feedback on their understanding and review of the topic prior to presenting.
Due Date: Week 9.

Presentation: The third component of the assessment will be a 15 minute (with 5 minute for questions/discussion – 30%) presentation (2000 word equivalent)
The students will be required to develop and present a presentation which demonstrates an understanding of the topic and an ability to convey it succinctly which incorporating skills in information delivery and an understanding of adult learning principles.
Students will receive feedback on presentation style and understanding of the information
Due Date: Week 13.

Written Examination 2 hours (40%) of total course grade
This assessment will be given to review and address the course content of the semester. It will include multiple choice and short answer questions designed to ensure summative knowledge of the course material has been achieved
Due Date: Exam Week -to be advised on the MyUni website

Clinical Skills and Reflective Practice Diaries Pass/ Fail
Students will be required to achieve a level of “competent to practice independently” on a list of clinical skills integral to the course content and management of the intensive care patient. Students will be assessed by preceptors and Clinical titleholders within their institution for clinical competence. They will also receive a performance appraisal from this clinical support network at the completion of the semester. Due Date: Week 13

The skills checklist complies with the 2015 Australian College of Critical Care Nurses (ACCCN) competency standards for critical care nurses.


Assessment 1
Synopsis Paper : Formative assessment
Students are required to choose a topic of interest from the course content and prepare a teaching package aimed to the level of junior nursing staff (nursing graduates and nursing students) within their clinical area. Students will be required to present this topic in a 15 minute seminar to their fellow students for assessment, prior to presenting in the work environment.

Students will be required to identify appropriate preliminary resources on which further research and reading will be based. Students will receive written feedback on their proposed topic.

A list of potential topics and an example of a synopsis paper will be made available on myUni.
Due Date: Week 5.

Presentation
The students will be required to develop and present a presentation which demonstrates an understanding of the topic and an ability to convey it succinctly which incorporates skills in information delivery and an understanding of adult learning principles. Due Date: Week 13 to be advised on the MyUni website

Assessment 2
Essay
The essay must relate to the role of the nurse in current practice and identify how the topic being investigated improves patient care. Select one of the essay topics from the list outlined in the Study Guide. Due Date: Week 9.

Assessment 3
Examination
The examination will consist of a combination of multiple choice questions and short answer questions. Students will be expected to be able to analyse patient situations. The examination will be two hours in duration and will examine the theory taught in Intensive Care I.
Due Date: Exam Week -to be advised on the MyUni website.

Assessment 4
Clinical Skills and Reflective Practice Diaries
The assessment of skills will occur throughout the semester. Students will be assessed by the critical care registered nurses and clinical titleholders, with whom they work. Please refer to the information provided in the Clinical skills and Reflective Practice Diaries regarding skills assessment criteria. Due Date: Week 13

Assessments, unless otherwise stated in your Study guide, are to be submitted electronically via Assignments in MyUni (through Turnitin) on the due date identified in this Study guide. Instructions for assignment submission are available for all students under Tutorials at www.adelaide.edu.au/myuni/.

An assessment submitted via MyUni must be submitted as a .doc, .docx or .rtf file. If submitting a PowerPoint presentation for marking, the .ppt or .pptx must be submitted as .pdf file. It is also important to submit your file under your name, such as surname.firstname. MyUni stamps all the other details against your filename once you submit your assessment.

Late Submission of Work
All assessments should be submitted by the specified due date.
Late submission without an approved extension will be penalised at the rate of 10% of available marks for each day after the due date. Work submitted more than ten days after the due date may be returned unmarked. This action will be taken to prevent students who do get their work in on time being disadvantaged.

Word Limit
You are advised to comply with word limits. You are, of course, not expected to achieve exactly the required length and a 10% leeway on either side is acceptable. However, a penalty of 5% of available marks will apply for word limit in excess of the 10% leeway.

Presentation
Your written work must comply with the formatting and referencing indicated in the School Academic Manual. Marks will be lost for failing to do so.

Return of Assessments
Marked assignments and feedback will be returned via MyUni. For further information relating to assessment refer to the Assessment for Coursework Programs Policy.