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Course Outline: Integrated Nursing Practice 1

Minimum Course Hours: 135

Course Description

Learners focus on the development of basic assessment and nursing care competencies and will apply nursing knowledge through the practice of clinical decision making, nursing assessments, and nursing interventions aimed at promoting the client’s health, independence, and comfort. Cultural safety, cultural humility, anti-racism, and trauma-informed practice, with a focus on Indigenous-specific anti-racism, are integrated into the learning. A variety of approaches, such as simulation, will help learners integrate theory from other Level 1 courses.

Prerequisites: Admission to the Practical Nursing Program; completion of Human Anatomy and Physiology for Practical Nurses or equivalent course with a minimum grade of 65%

Corequisites: Professional Communication 1; Professional Practice 1; Variations in Health 1; Health Promotion 1; Pharmacology 1

Learning Outcomes

Upon successful completion of this course, in the simulated learning environment the learner will be able to:

  1. Use the current British Columbia College of Nurses and Midwives (BCCNM) LPN Professional Standards, Practice Standards, and the Entry-Level Competencies to guide nursing practice.
    • 1.1 Perform basic holistic nursing assessments, interventions, and documentation in stable or predictable situations, using objective and non-stigmatizing language and a trauma-informed, culturally humble, culturally safe, and person-centred approach.
    • 1.2 Discuss evidence-informed practice and clinical practice guidelines that inform nursing practice.
    • 1.3 Identify ongoing educational and learning opportunities that will enhance nursing competence.
  2. Demonstrate clinical and personal care skills competently in nursing practice with healthy adults in stable or predictable situations as taught in the skills lab.
    • 2.1 Define nursing management.
    • 2.2 Use critical thinking, clinical judgment, and knowledge of holistic assessment to plan, implement, and evaluate care of clients in stable or predictable situations.
    • 2.3 Use decision support tools to assist with decision making and implementation of care.
    • 2.4 Practise safe medication administration.
  3. Collaborate with clients, the interprofessional health care team, peers, and faculty.
    • 3.1 Provide a caring environment for clients by connecting, sharing, and exploring with them in a collaborative relationship.
    • 3.2. Practise communication skills required to initiate, maintain, and conclude a therapeutic relationship with healthy adults.
  4. Provide care for clients that considers their physical, mental, emotional, spiritual, and cultural needs.
    • 4.1 Provide culturally safe, person‐centred care that is free from personal assumptions and that recognizes and respects diversity and the uniqueness of each individual.
    • 4.2 Identify one’s own values, biases, and assumptions as a self‐reflective, responsible, and accountable practitioner.

Course Concepts

Course outcomes will be met through examination and exploration of the following:

  • BCCNM Professional Standards, Practice Standards, and documents that guide scope of practice
  • Introduction to assessment: taking vital signs
  • Focused health assessment of healthy adults across the lifespan: chest, abdomen, peripheral vascular
  • Clinical decision making
  • Basic nursing interventions
  • Safety
  • Principles of asepsis
  • Standard precautions
  • Musculoskeletal injury prevention
  • Personal care
  • Mobility assistance
  • Prevention of complications of immobility
  • Urinary elimination
  • Digital stimulation and rectal disimpaction (see more information below)
  • Fecal elimination
  • Nutrition and assisting with eating and drinking
  • Simple wound management (clean technique)
  • Introduction to pain management (non‐pharmacological)
  • Medication administration
  • Principles of medication administration
  • Rectal and topical medication
  • Introduction to reporting and documentation
  • Self-assessment and meeting own learning needs
  • Introduction to nursing care delivery models
  • Cultural safety, cultural humility, and anti-racism
  • Diversity, equity, and inclusion

Digital Stimulation and Rectal Disimpaction

Ensure the physician’s orders are in place and follow decision support tools before providing digital stimulation or rectal disimpaction to a client. These skills cannot be delegated to unregulated care providers.

Digital Stimulation

Digital stimulation is a technique that is typically provided to a client with neurogenic (spastic/reflexic) bowel dysfunction. It is used to stimulate the bowel reflex and initiate a bowel movement.

  1. Place the client in their preferred position: on a commode chair or in Sims’ position.
  2. Gently insert a well-lubricated gloved finger 2.5–5 cm into rectum.
  3. Rotate finger in a circular motion for 10–30 seconds, maintaining contact with the rectal wall to trigger the bowel reflex and muscle contractions.
  4. Repeat every 5–10 minutes until there is no stool left in the lower bowel.

Note:

  • Always use plenty of lubricant.
  • Be gentle—pushing or rotating the finger too roughly can irritate or tear the lining of the rectum or anus.
  • Use caution—overstimulation can lead to an increase of incontinence and increased mucus production. This procedure should not take longer than one hour.

Rectal Disimpaction

Rectal disimpaction is a technique that is typically provided to a client with neurogenic (flaccid/areflexic) bowel dysfunction, and is used when a fecal mass is too large to be passed voluntarily.

  1. Take baseline vital signs and complete an abdominal assessment before starting procedure.
  2. Place client in Sims’ position with a waterproof pad under the buttocks. Keep a bedpan close to the client.
  3. Gently insert a lubricated gloved index finger into the rectum and advance slowly along the rectal wall toward the umbilicus.
  4. Gently massage around the fecal mass to loosen it; work the finger into the hardened mass.
  5. Work the feces downward, remove small pieces at a time, and dispose of them into the bedpan.
  6. Monitor the client for signs of distress and fatigue. Reassess vital signs as needed and stop the procedure if client’s heart rate drops significantly—continue to monitor for one hour post-procedure.
  7. Continue to remove feces and allow the client to rest at intervals.
  8. Following the procedure, reassess the abdomen, vital signs, and the client’s level of comfort.

Note:

  • This procedure will be uncomfortable for the client.
  • Be gentle and use plenty of lubricant.
  • Use caution. Excess manipulation of the rectal wall can cause irritation of the rectal mucosa, bleeding, perforation of the bowel wall, or stimulation of the vagus nerve, which results in reflex slowing of the heart rate.

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