Course Coordinator: Sindy Millington
Phone: +61 8 8222 4387
Email: sindy.millington@adelaide.edu.au

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

1	Demonstrate knowledge of the pathophysiological nature of disorders resulting in critical illness in a clinical based scenario.
2	Integrate advanced and integrated theoretical and clinical knowledge required for the, assessment and management of the complex critically ill patient
3	Demonstrate a systems approach to the assessment, monitoring and support of physiological function in the critically ill patient
4	Integrates care which is patient centred and embraces cultural diversity, individuality and experience
5	Demonstrate the ability to work as leaders in advanced practice roles within a collaborative multidisciplinary team
6	Evaluate and integrates the use of analytical enquiry and critical reflection into nursing practice, through contemporary issues, i.e. current evidence based guidelines, and consensus statements, in intensive care nursing.

In this course you should use the texts prescribed for Intensive Care I.

Choose one of the following:

Bersten, A & Soni, N (eds) 2009, Oh’s intensive care manual, 6th edn, Butterworth Heinemann Elsevier, Philadelphia.

Elliott, D, Aitken, L & Chaboyer, W (eds) 2007, ACCCN’s critical care nursing, Mosby Elsevier, Sydney.

Urden, L, Stacy, K & Lough, M (eds) 2010, Critical care nursing, diagnosis and management, 6th edn, Mosby Elsevier, St Louis (available as an electronic book from the University of Adelaide Library)

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.

Anatomy and Physiology
Saladin, KS 2010, Anatomy & physiology; the unity of form and function, 5th edn, McGraw Hill, Boston.
OR
Martini, FH 2006, Fundamentals of anatomy & physiology, 7th edn, Pearson, San-Francisco.

Pharmacology
Bryant, B & Knight, K 2007, Pharmacology for health professionals, 2nd edn, Elsevier, Sydney.
OR
Bullock, S, Manias, E 2011, Fundamentals of pharmacology, 6th edn, Pearson Education Australia, Frenchs Forest.

Haemodynamic Monitoring
Darovic, G (ed.) 2002, Hemodynamic monitoring, invasive and noninvasive clinical application, WB Saunders Co, Philadelphia.
OR
Pinksy MR (ed) 2004 Functional Haemodynamic Monitoring, Springer-Verlag, Berlin (available as an electronic book from the University of Adelaide Library)

Note: You are not required to buy the recommended texts. However, they provide valuable supplementary reading on various aspects of the material covered within this course and you are encouraged to have a look at them.

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.

This course will require the following resources:
1. Library
2. Clinical Skills Laboratory
3. Lecture / tutorial facilities
4. Pod casting facilities
5. Clinical equipment

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 or Royal Adelaide Hospital Campus, North Terrace. Lecture locations will be made available on the MyUni website.

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:
Advanced haemodynamic monitoring and management
Advanced Haemodynamic monitoring
PAC
PiCCO
Management of Haemodynamic instability
Hypertensive crises
Hypotension
Pharmacological management

Advanced management
Transportation of the complex ICU patient

Care of the patient with neurologic alterations
Physiological Principles
Neurological clinical assessment of raised ICP, diagnosis and monitoring
1. Angiography
2. CT
3. LP
4. ICP and EVD
Neurosurgical and Neurologic Disorders and Therapeutic Management
Management of ICH
5. Pharmacological management
Neuro surgical
6. TBI
7. Aneurysms
Neurological
GBS
Myasthenia Gravis

Care of the patient with renal failure
Physiological Principles
Renal Clinical Assessment and Diagnosis
Renal Disorders and therapeutic Management
Acute Renal Failure
ATN
Chronic Renal Failure
Renal Replacement Therapy
Dialysis

Care of the patient with cardiovascular surgical disorders
Cardiothoracic Surgery
IABP
Therapeutic Management
Vascular Surgery
Thoracic and abdominal aneurysms
Carotid endartectomy
Postoperative care

Care of the patient with gastrointestinal disorders
Physiological Principles
Clinical Assessment and Diagnosis
Gastrointestinal Disorders and Therapeutic Management
Acute gastrointestinal haemorrhage
Acute Pancreatitis
Fulminant Hepatic Failure
Pharmacological Management

Care of the patient with endocrine disorders
Physiological Principles
Clinical Assessment and Diagnosis
Endocrine Disorders and therapeutic Management
Neuroendocrinology of Stress and Critical Illness
Adrenal Gland Dysfunction
Adrenal crisis
8. Phaeochromocytoma
Antidiuretic Hormone Dysfunction
SIADH
DI
Emergencies for patients with Diabetes mellitus
Diabetic Ketoacidosis
Hyperglycaemic Hyperosmolar state
Thyroid Emergencies

Care of patients with haematological and oncological emergencies
Physiologic Principles of Coagulation and Fibrinolysis
Management of Massive Blood transfusion and Critical Bleeding
Haematological disorders and therapeutic management
DIC
Thrombocytopenia
Tumour Lysis Syndrome

Care of the patient with multisystem alterations
Shock
Hypovolaemic
Cardiogenic
Anaphylactic
Neurogenic
Severe Sepsis and septic shock
SIRS and MODS
Collaborative and therapeutic management
Pharmacology and haemodynamic profiles

Trauma
Mechanisms of Injury
Principles of Assessment and Management
Thoracic Trauma
Abdominal Trauma
Musculoskeletal injuries
Orthopaedic
Spinal
Complications of Multi trauma

Thermal injuries and disorders
Burns
Pathophysiology and aetiology
Classification and assessment
Therapeutic Management
Thermal disorders
Hypothermia
Hyperthermia

Brain death, organ donation and transplantation and End of life care
Physiology of Brain death
Assessment and diagnosis of brain death
Organ Donation Care of the Donor and Family
Organ Transplantation
End of Life care
Withdrawal of Life support
Caring for bereaved families

Poisoning and envenomation

Leadership
Workshop week 13

This course considers the pathophysiology of patient conditions requiring intensive care, as well as assessment, monitoring and therapeutics. Specifically topics considered will be:

Advanced Intensive Care
This session will cover some of the fundamental aspects of advanced care in the intensive care unit. One of the challenges for newly accredited intensive care nurses is the consideration of the legal, moral and ethical aspects of end of life decision making and end of life care. Students will be encouraged to discuss and review these issues and their role as a member of the multidisciplinary team.

The advanced practice skills of advanced airway and tracheostomy management will be discussed and demonstrated, highlighting the importance of planning, assessment and advanced skill acquisition in the areas of tracheostomy change, management and decannulation

Intrahospital patient transportation is another advanced skill in which the critical care nurse practices with minimal supervision or support. Familiarity with the patient, the equipment and the environment is essential to ensure safe patient management.

Haemodynamic Monitoring
This topic will consider the principles of haemodynamic monitoring as well as the details of specific cardiac output measurement modalities. The terminology relating to haemodynamic monitoring as well as indications for nursing management and possible complications will be considered. The accuracy and analysis of monitored parameters will also be examined. This session will build on knowledge gained in the introduction to haemodynamic monitoring in Critical Care Essentials

Critical Bleeding and Massive Blood Transfusion
The issues pertaining to the management of incidence of critical bleeding will be reviewed. Massive blood transfusion (MBT) will be discussed and the storage lesion of blood presented. The possible complications and the nursing care of patients following a critical bleeding event and MBT will be examined.

Intensive Care Management of the Trauma Management
This module describes the general principles of trauma management and then considers thoracic, abdominal, skeletal and spinal injuries management in an intensive care context.

Intensive Care of Patients with Multi system alterations – Shocked States
This topic will consider the factors resulting in cardiovascular instability. The pathophysiology of shock will be discussed in detail. The specialised nursing care and treatment of different forms of shock will also be presented.

Intensive Care Management of Patients post cardiovascular surgery

Vascular Surgery
Common types of vascular surgery that necessitate patient admission to intensive care and the particular nursing care required will be presented.

Cardiac Surgery/Intra-Aortic Balloon Counter pulsation
This topic will consider the common types of cardiac surgery and the post-operative nursing and medical management of such patients. The recognition and management of possible complications will also be considered. The intra-aortic balloon counter pulsation device, its indications, the nursing management and possible complications will be addressed.

Intensive Care Management of patients with neurosurgical / neurological disorders
This topic will consider the mechanisms of head injury as well as the assessment and management of patients during the acute phase. Non traumatic Neurosurgical presentations will also be discussed. Neurological monitoring, in particular neurological assessment, intracranial pressure monitoring, and the specialised nursing care of these patients will be addressed.

Brain Death, Organ Donation and caring for bereaved families
Brain death, its recognition, and the management of the brain dead patient will be considered. The nursing actions that may help support friends and relatives of the brain dead patient will also be discussed.

In this session the process of organ donation will be discussed. In particular, donor characteristics, evaluation of the recipient, and ICU management of a donor will be discussed. Review of the differences between a brain dead donor and a non-heart beating donor will be identified and the management critiqued

Ways in which the family and loved ones of the donor may be supported at this time will be explored.

Intensive Care of Patients in Renal Failure
This topic will consider the causes and pathophysiology of acute renal failure. The common treatment modalities will be compared and contrasted. The indications for, principles and the management of continuous renal replacement therapy will also be addressed. The specialised nursing care of patients with acute renal failure requiring continuous renal replacement therapy will be examined.

Care of patients with Haematological and Oncological emergencies
Haemostatic failures including coagulopathies are reviewed in this session. Normal coagulation, and the recognition and management of common disorders of coagulation such as Disseminated Intravascular Coagulopathy (DIC) will be considered. The specialised nursing care of patients with coagulation disorders will be presented

The complexities of caring for patients admitted to the intensive care unit with oncologic emergencies and the complex care required will be reviewed

Intensive Care of Patient’s with Endocrine Disorders
Endocrine derangements and disorders prevalent in the critically ill will be described including abnormalities in the functioning of the thyroid, parathyroid and adrenal glands. The nursing management and the resulting disorders and the impact on critical illness will be explored

Intensive Care of patients suffering toxicology / toxinology disorders
In this session the clinical features and possible treatment of common drug overdoses and poisoning will be presented.

In this session the general management of a patient who has suffered envenomation will be discussed. In particular, the first aid, initial in hospital care and ICU management. The physiological effects of envenomation by common Australian snakes and spiders will also be discussed.

Intensive Care of Patients with Thermal injuries and Disorders

Burns Trauma
This topic will consider the management of patients who have suffered burns trauma, in particular, the resuscitation of patients with burns and recognition of possible complications of burns. The specialised nursing care of patients with severe burns will also be discussed.

Hypo/Hyperthermia
This topic will consider the causes, clinical features, treatment and specialised nursing care in ICU of a patient with hyper or hypothermia.

Intensive Care of Patient’s with Gastrointestinal Disorders
In this session the pathophysiology of acute hepatic failure will be discussed. In particular the causes, clinical features, possible treatment and nursing care will be presented. Other significant gastrointestinal presentations to intensive care will also be reviewed including Severe Acute Pancreatitis and Gastrointestinal bleeding


CLINICAL SKILLS – Semester 2 ,2014

CLINICAL SKILLS

Airway

Assisting with a Percutaneous Tracheostomy

Changing a Tracheostomy Tube

Decannulation

Breathing

Commencing non-invasive ventilation*

Care of a Patient requiring Non-Invasive Ventilation*

Setup and management of a Ventilator Scavenging System

Circulation

Preparation and assisting in insertion of a Pulmonary Artery Catheter (PAC)

Care of a patient with a Pulmonary Artery Catheter

Measuring pulmonary artery wedge pressure

Measuring cardiac output by the Thermodilution Technique via a PAC

Removal of a Pulmonary Artery Catheter

Alternate Cardiac Output Monitoring Techniques

Management of a patient with an Intra-aortic Balloon Pump

Neurological

Caring for a patient with Intracranial Pressure Monitoring

Coordinating the turning of a patient with an Acute Spinal Injury

Renal

Measurement of intra-bladder pressure

Setting up continuous veno-venous haemodiafiltration/dialysis

Caring for a patient requiring continuous veno-venous haemodiafiltration

Transport

Transport of a critically ill patient within the hospital

Infection Control

Management of a patient with an infectious disease requiring isolation

Reflective Practice

Decannulation

Medical emergency

Infection control

Professional practice

Professional practice – Coroner

 

Assessment Task	Assessment Type	Weighting	Learning Outcome(s) being addressed
Part IA - Outline Part IB– Case Study	Formative Summative	0% 30%	1-3, 6
Pre-sighted Written Examination	Summative	35%	1-4
Structured Clinical Assessment	Summative	35%	1-4
Clinical Skills and Reflective Practice Diaries	Summative	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 2 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. Due Date: Week 13

Formative Assessment 1A - Case Study Plan and Search Strategy:
Due Date: Week 5 August
Weighting: 0%
Length: 500 words
This assessment is scheduled early in the semester to assist in the planning and development of your case study, so that you can receive feedback on your work before handing in your final assignment.

Topic
The case chosen must be relevant to the course content for Intensive Care II
Once you have selected a topic:
• Identify the topic and provide a brief paragraph which situates the topic, providing background, identifying the significance to critical care nursing and any limitations or boundaries of your intended work.
(This is designed to assist in the development of the introduction for your final case study).
• Provide a rough plan (in dot point form) of your case study identifying headings that demonstrate a logical sequence and structure for your proposed paper.
• Outline the key points to be discussed using the headings identified above and the issues to be critiqued.
(This is designed to assist in the development of the content of the paper ensuring the topic and significant issues are covered appropriately, and from a variety of perspectives).
• Describe the search strategy undertaken to identify preliminary references including key words and databases used.
(This is to ensure contemporary and reliable resources support your work).
• Provide a reference list containing 5 preliminary references on the topic which complies with the School of Nursing Student Handbook and Style Guide.
(This list will need to be expanded for your final case study).

A high academic writing standard is required with key points in text referenced appropriately.
Please ensure the patient's anonymity and confidentiality is maintained. The use and identification of a pseudonym is required. Work not complying with this guideline will be returned unmarked to the student.


Summative Assessment 1B – Case study:
Due Date: Week 9
Weighting: 30%
Length: 2000 words

Topic
Preamble
Case studies allow clinical episodes and practices to be articulated and explored. The case study should be about a patient you have cared for, relating actual events in which you were involved and critiquing the clinical events based upon the literature.
When writing the final case study the following points should be considered:
• the patient's diagnosis
• relevant past history
• nursing care
• treatment
• psychosocial aspects of care
• clinical progress and outcome
• discharge planning
• a critique of the care given.
The case study should summarise the nursing and medical treatment the patient received and then critique this in the light of current practice and knowledge.

The case study should be structured as an academic paper with the following sections:
• Introduction outlining the case study’s structure
• Body of text that covers the following areas:
     • presents the patient’s story—includes clinical presentation, diagnosis, any relevant history and pathophysiology of the patient’s condition
     • nursing assessment and discharge planning undertaken during the clinical admission to the relevant area
     • outlines the clinical progress of the patient, including interdisciplinary interventions (with an emphasis on nursing)
     • critiques the nursing management of the patient and interprets the outcomes of interventions, supported with relevant (and appropriate) literature
• Conclusion that summarises the patient case study.


Assessment 2 – Structured Clinical Assessment:
Due Date: Exam week TBC with clinical institution
Weighting: 30%
Length: 30 minutes

Topic
This practically based examination will test the student's ability to apply knowledge to practice. The examination will cover all skills and knowledge taught in Intensive Care II and will be approximately 30 minutes long. The Structured Clinical Assessment examination will be held during the first University Exam Week.

Procedure Guide
Time – 30 minutes for a 30% course weighting (6 unit course).
Course coordinators must be present at all assessments. The assessment team will consist of the course coordinator and a clinical titleholder from the student’s clinical workplace.
Structured Clinical Assessments should be conducted within student’s workplace.
A marking guide for the assessment will be developed that clearly identifies allocated points for specific answers.

Course coordinators need to clearly identify points within each question that constitute clinical safety. If the student fails to identify/demonstrate these points they will not have successfully completed this question.
Students who demonstrate unsafe practice during the structured clinical assessment will not have successfully completed the examination regardless of their overall mark. Students will be reassessed at the discretion of the course coordinator in the supplementary examination period.

Assessment 3 – Presighted Written Examination:
Due Date: Exam week TBC
Weighting: 30%
Length: 2 hours

Topic
The examination will consist of three long answer questions.
Students will be given five exam questions three weeks prior to the exam to use in revision. The exam will consist of three of these five 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 II.

Marking Guide – Examination
You should ensure that you comply with the directions for each question and that your writing is legible. For clarity, try to write your answers in a systematic and logical fashion

Assessments, unless otherwise stated in your Study guide, are to be submitted electronically via Assignments in MyUni 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.

An Assignment Coversheet must be submitted with each assessment. The coversheet should be the first page of your assessment. A word version of the Assignment Coversheet is available to download at www.health.adelaide.edu.au/nursing/students/resources. The Plagiarism Statement must be signed and dated for your assessment to be marked (please note the details stated on the Assignment Coversheet).

More information on avoiding Plagiarism is available at www.adelaide.edu.au/clpd/plagiarism/.
If you have difficulty submitting your assignment, you can call the MyUni helpdesk from 8am to 6pm 08 8303 3335.

Marking Guide – Case Study Plan and Search Strategy Formative Assessment

Structure and Writing Style

Structure • introduces/outlines/situates the topic of the case study • provides a clear justification for the case choice and its significance • The case study plan is structured in a logical sequence so that the content flows Writing style • the case study plan is written with clear sentence structure, clarity of argument and precision of expression and the spelling and grammar are correct.

Content/Critique

• the key points for the topic/issue have been identified • the proposed content has clear links to contemporary nursing practice • the student’s case study plan demonstrates an understanding of the significant issues surrounding the case. • the key points identified demonstrates the student has considered the topic from alternative perspectives

Search Strategy

• relevant databases and sources of evidence clearly identified in search strategy • key words / phrases clearly identified that are appropriate and relative to the search strategy and question • evidence of conduct of search with appropriate application of Boolean logic (‘and’, ‘or’, ‘not’) and search limiters

Referencing

• the referencing style used throughout the paper is congruent with the School’s Student Handbook and Style Guide • the reference list is accurate (i.e. no missing page numbers, volumes, correct title etc), complete (i.e. no references in the body of the paper are missing from the reference list) and consistent with the Student Handbook and Style Guide • the references cited are contemporary (i.e. less than 10 years old unless seminal papers)

Extension of time for assessment items
Up to one week
It is expected that all assessments will be submitted on or by the specified due date.

However, students may apply for an extension of time to submit an assessment, if they are experiencing difficulty. Applications for extension must be made to the Student Liaison Officer, in writing (e.g. email) prior to the due date lodgement of the assignment. Students must anticipate that it may take a few days to receive a reply. The grounds for granting an extension include health problems, compassionate reasons and other extenuating circumstances. Extensions will usually only be granted for a maximum of one week, but can be longer at the discretion of the Chairperson of the Postgraduate Learning and Teaching Sub-Committee if substantiated with evidence such as a medical certificate. Only original documents or certified copies of originals will be accepted.

You will be notified by email to your University of Adelaide student email account of the outcome of your application. If your extension is granted then it is your responsibility to keep in contact with the course coordinator and to hand in the assessment with a copy of the email (or other document) approving the extension.

Failure to submit an assessment item on time without an approved extension will incur a penalty as detailed under Late Submission of Work.

Longer than one week
The form for requesting an extension longer than one week can be downloaded from the School of Nursing web site www.health.adelaide.edu.au/nursing/students/resources/ or obtained from the administrative office in the School. Students should complete the form and submit it to the Student Liaison Officer, attaching any supporting documents. Only original documents or certified copies of the originals will be accepted. When an extension is granted, the extension request approved must be attached to the assessment item when it is submitted.

You will be notified by email to your University of Adelaide student email account of the outcome of your application. If your extension is granted then it is your responsibility to keep in contact with the course coordinator and to hand in the assignment with a copy of the email (or other document) approving the extension.

Failure to submit an assessment item on time without an approved extension will incur a penalty as detailed under Late Submission of Work.