92442 Complex Nursing Care: Medical Surgical
Warning: The information on this page is indicative. The subject outline for a
particular session, location and mode of offering is the authoritative source
of all information about the subject for that offering. Required texts, recommended texts and references in particular are likely to change. Students will be provided with a subject outline once they enrol in the subject.
Subject handbook information prior to 2025 is available in the Archives.
Credit points: 6 cp
Subject level:
Undergraduate
Result type: Grade and marksRequisite(s): (90 credit points of completed study in spk(s): C10122 Bachelor of Nursing OR 90 credit points of completed study in spk(s): C10123 Bachelor of Nursing Bachelor of International Studies OR 90 credit points of completed study in spk(s): C10351 Bachelor of Nursing Bachelor of Creative Intelligence and Innovation) AND (92438 Medical Surgical Nursing OR 92322 Medical Surgical Nursing OR 92450 Medical Surgical Nursing (Graduate Entry) OR 92454 Medical Surgical Nursing)
Description
This subject builds on skills introduced in 92438 Medical Surgical Nursing and 92437 Nursing Care of the Older Person to extend students' abilities to practise in a range of more complex medical–surgical contexts. Through the use of simulation, students are provided opportunities to work in small nursing teams to make autonomous decisions on caring for patients with complex health conditions. The importance of comprehensive health assessment is particularly emphasised along with well-targeted nursing interventions, appropriately planned nursing care and the application of best evidence to practice. Particular attention is paid to recognising and responding to the clinically deteriorating patient. Learning experiences drawing on the National Safety and Quality Health Service Standards: Second Edition (ACSQHC 2018) and the Essentials of Care program (NSW Health: Nursing and Midwifery Office 2014) focus on providing safe and effective care to individuals and families. At all times during this subject nursing practice is considered in an interprofessional framework. Students also have the opportunity to reflect on their practice and determine self-identified learning needs appropriate to the subject's focus.
Subject learning objectives (SLOs)
| A. | Demonstrate the role and responsibilities of the registered nurse in maintaining and managing patient safety and quality care for medical-surgical patients in acute care settings (RN Standards for Practice 1-7). |
|---|---|
| B. | Collect and interpret comprehensive patient assessment data, as the basis to formulate plans of care and undertake increasingly complex nursing activities to meet the specific health care needs of the medical-surgical patient (RN Standards for Practice 4, 5, 6). |
| C. | Integrate relevant scholarly evidence, drawn from nursing and other professionals, and utilise this evidence base to inform a solutions oriented approach to plan, explain and justify the provision of individualised, complex nursing care for particular patient groups (RN Standards for Practice 1, 4, 5, 6, 7). |
| D. | Reflect and appraise the appropriateness of the medical-surgical patient’s planned nursing care and demonstrate the ability to revise appropriately (RN Standards for Practice 5, 6, 7). |
| E. | Develop effective relationships with patients, significant others and members of the inter-professional health care team, facilitated by the ability to communicate effectively in English in the clinical environment (RN Standards for Practice 2, 3). |
| F. | Evaluate their own learning and developmental needs in order to maintain and further develop their capacity for safe practice (RN Standards for Practice 3, 6). |
Course intended learning outcomes (CILOs)
This subject also contributes specifically to the following graduate attributes:
- Embody a professional disposition committed to excellence, equity and sustainability (1.0)
- Accept professional accountability and responsibility for quality and safe care concomitant with scope of practice (1.4)
- Engage in person-centred care that is appropriately sensitive to the needs of individuals, families and communities (2.0)
- Communicate and collaborate effectively and respectfully with diverse groups (3.0)
- Inquire critically to assess a body of evidence to inform practice (4.0)
- Comply with intellectual academic writing practices and use information ethically, legally and respectfully (4.4)
- Competently apply knowledge and skills to ensure safe and effective nursing practice (5.0)
- Demonstrate competence in clinical judgment, technical abilities and the skills expected of a new graduate nurse and meet or exceed the requirements of the Australian Health Practitioner Regulation Agency for registration as a nurse (5.1)
Teaching and learning strategies
In this subject, you will participate in a range of teaching and learning strategies that are designed to encourage you to collaboratively engage with fellow students in the nursing care of adults admitted to tertiary-care facilities with acutely deteriorating medical-surgical conditions.
Lectures
Lectures in this subject are designed to engage students and enable them to clarify complex descriptions and terminology that are developed in the laboratory classes.
Preparatory activities
Each week information and resources related to the week’s topics and laboratory session are available in UTSOnline. These activity resources vary but may include policy documents, video clips or pre-readings. The activities are integral to the subject and selected to prepare students for the lab session and support students getting the most benefit from the laboratory sessions by actively engaging in their learning. The laboratory sessions, many based on case scenarios, are practice focused and collaborative, and incorporate simulation based learning activities. The time required for these activities should be 3 hours preparation per week of attended labs.
There will be time in each lab session for discussion and formative feedback on the weekly activities.
Laboratory Classes
In laboratory classes students work in small teams and take roles as team leader, RN or patient. The team leader will coordinate nursing care activities and the RN(s) roles will primarily deliver the care required. Students will rotate roles each week. Students will receive tutor feedback on the activities they engage with during each lab class. In addition, each week there will be group debief/discussion to conclude each session to consolidate learning. Students are encouraged to reflect on their own skills, knowledge and understanding across the session in order that areas for their own development can be addressed.
Case Studies
Case studies are used to assist students explore health related scenarios. Cases depict patients and their families in clinical situations. Working in small groups, students use these scenarios to learn concepts, interpret information, form clinical judgements and develop individualised care solutions. Critical thinking is developed through analysis, interpretation of and reflection on issues or situations.
Clinical skills, communication and simulation
Students participate in clinical laboratory sessions that focus on integration of key concepts and skills. In these sessions, students learn more advanced skills and develop mastery of a range of previously taught nursing skills, including assessment, nursing interventions and simulation activities. Simulation activities are practical learning experiences designed to give students exposure to a comprehensive range of scenarios that may be encountered in practice. Activities include the use of audio-visual aids, interactive-computer programs and clinical equipment set-ups with mannequins, teaching staff or the students role playing patients. These practice scenarios incorporate the development of professional communication skills including professional and therapeutic communication required for nursing practice. The needs of students for whom English is an additional language will be taken into account.
Oral presentations
In class, formative presentations enable students to practice formulating and delivering a comprehensive handover and apply their knowledge of assessment data and its implications in planning care. Students receive feedback from peers and teachers not only on their knowledge of a subject area, but also their ability to communicate their thoughts, and relevant information in a clear, coherent, and confident manner.
Information Technologies
Information technologies will be used by students to access relevant evidence based guidelines related to health assessment and health promotion in addition to resources suitable for encouraging patient participation in health management.
Academic Writing
Demonstrating information literacy and technology skills, students search and synthesise the professional literature to complete written assessment items. Students comply with academic writing practices and use information ethically, legally and respectfully.
Clinical Placement
In this subject students complete 160 hours of clinical placement. Placements are provided in a range of healthcare facilities in mostly metropolitan locations. Students provide nursing care within their scope of practice alongside multidisciplinary teams to develop and consolidate their knowledge, skills and attributes relevant to the clinical field.
All clinical placements are managed under the UTS Internships Management Policy and students must comply and act in accordance with the Student Rules, the Student Rights and Responsibilities Policy and the Equity, Inclusion and Respect Policy.
Content (topics)
Clinical-based laboratories and simulation: Health assessment tools, including comprehensive physical assessment (neurological, respiratory, cardiovascular, renal, integumentary, musculoskeletal systems). Risk assessments including assessment related to possible deterioration/ complications. Calling for a clinical review/medical emergency team (MET). Total patient care (coordination and provision of care) for patients with complex care needs; health care team collaboration; nursing care delegation.
Advanced complex wound care: Negative pressure wound therapy; complicated non-healing wound care, including caring for wounds colonised with multi-resistant bacteria.
Assessment and management of the deteriorating patient (theoretical and practical aspects): Shock; hypovolemia; complications related to traumatic injury; caring for a patient with neurological deterioration post head injury; caring for the surgical patient with significant co-morbidities and postoperative complications. Advanced life support (ALS) principles and algorithms; cardio-pulmonary resuscitation; using the AED; 12-lead electrocardiogram (ECG) and rhythm interpretation.
Medication: Special needs of drugs administered through central venous access devices; clinical judgement with complex multiple drug dosing; complexities with polypharmacy.
Fluid and nutritional requirements of medical-surgical patients: Enteral and parenteral nutritional support; electrolyte and fluid balance disturbances and management.
Professional and interpersonal practice: Teamwork: including, individuals and understanding roles relationships of different team members, and the principles of management and delegation. Communication and developing therapeutic relationships.
Activity sets/key skills addressed in this subject:
Personal care: Assisted ambulation. Hygiene: bed making, hygiene: shower/bath, hygiene: bed bath, hygiene: oral care. Skin integrity: positioning, skin integrity: assessment, skin integrity: pressure area care. Nutrition and feeding, feeding a dependent patient, enteral feeding. Elimination: continence management, elimination: indwelling catheter care, elimination: bowel care
Clinical communication and documentation: Therapeutic communication: admission, clinical handover, care planning, recording vital signs, recording fluid intake/output. Communicating clinical reasoning, interprofessional communication, using and maintaining patient records. Delegation of nursing care, negotiating care with patient/client and families, discharge planning, managing a group of patients/clients
Clinical assessment and monitoring: Vital signs: TPR & BP, recording fluid input and output. Physical assessment: weight, height, BMI, using a stethoscope, pain assessment, respiratory assessment, pulse oximetry, cardiovascular assessment, basic cardiac rhythm recognition, cardiac monitoring: lead attachment, cardiac monitoring: 12 lead ECG, neurological assessment, blood glucose monitoring, haematological results, neurovascular assessment, abdominal assessment, nutritional assessment, cognitive assessment, recognition of the deteriorating patient, comprehensive health assessment, assessment of Fluid balance, arterial blood gas interpretation, ward urinalysis. Pre-operative and post-operative assessment.
Clinical interventions and management: Advanced life support. Wound care: aseptic non-touch technique, wound care: dry dressing, wound care: removal of sutures/staples, wound care: care of drains, wound care: swabbing for culture, wound care: non-healing wounds, wound care: negative pressure, wound care: packing wounds. Oxygen therapy, deep breathing and coughing exercises, chest drain / UWSD management. Care of the unconscious patient, airway management: artificial airways, airway management: suctioning. Pre-operative and post-operative education. Urinary catheterisation, care of the dying/deceased person
Privacy and dignity: Respectful care, confidentiality, cultural and transcultural care. Care of the dying/deceased person
Promoting self-management: Discharge planning. Health education & health promotion
Risk and safety: Infection prevention and control, hand hygiene, hand washing for invasive procedures, gowning and gloving. Risk assessment, inclduing manual handling, falls prevention, safe use of physical and chemical restraints
Medications, intravenous therapy and blood products: Safe checking, administration, documentation and disposal of medications. Medication calculations. Other non-parental medications, intramuscular injections, subcutaneous injections, subcutaneous infusions, oral medication administration, intravenous therapy, intravenous therapy calculations, intravenous injections, patient controlled analgesia (PCA), parenteral nutrition, central venous access devices (CVAD), blood product administration
Assessment
Assessment task 1: Medication calculation test
| Intent: | The purpose of this assessment is for students to demonstrate competency in performing medication calculations. |
|---|---|
| Objective(s): | This assessment task addresses subject learning objective(s): A and F This assessment task contributes to the development of graduate attribute(s): 1.4 and 5.1 |
| Type: | Quiz/test |
| Groupwork: | Individual |
| Weight: | 20% |
| Length: | 30 minutes |
| Criteria: | See Canvas for further details. |
Assessment task 2: Patient case study
| Intent: | The purpose of this assignment is for students to demonstrate their ability to effectively plan person centred, evidence based, holistic care for complex medical-surgical patients. Students will need to demonstrate the utilisation of patient assessment data, policies, current guidelines and the literature to inform a plan of patient care. Using the plan of care they develop, students are to explore in detail, two of the actual or potential patient problems identified in the plan of care. Students will have the opportunity to evaluate patient assessment data in order to determine the health care needs of complex medical surgical patients and identify appropriate nursing care interventions. Students will apply the relevant evidence base and/or policy/guidelines to generate rationales for care. Students need to also demonstrate their understanding of how the effectiveness of each intervention would be determined. The assessment will contribute to student learning as follows:
|
|---|---|
| Objective(s): | This assessment task addresses subject learning objective(s): A, B, C and D This assessment task contributes to the development of graduate attribute(s): 1.0, 2.0, 4.0, 4.4 and 5.0 |
| Type: | Report |
| Groupwork: | Individual |
| Weight: | 50% |
| Length: | 1500 words (+/- 10%) report |
| Criteria: | Please see Canvas for further details. |
Assessment task 3: Final quiz
| Intent: | The aim of this assessment is to consolidate student knowledge and understanding about the management of medical and surgical patients and person-centred care by applying this knowledge and understanding in a revision test |
|---|---|
| Objective(s): | This assessment task addresses subject learning objective(s): A, B, D and F This assessment task contributes to the development of graduate attribute(s): 1.0, 4.0 and 5.0 |
| Type: | Quiz/test |
| Groupwork: | Individual |
| Weight: | 30% |
| Criteria: | See Canvas for further details. |
Assessment task 4: Clinical placement
| Intent: | The clinical placement provides students with the opportunity to practice and consolidate their clinical skills and apply their knowledge in the clinical setting. Feedback from clinicians and clinical facilitators will support and reinforce student learning and development of confidence in their practice. Reflection on and in practice is encouraged to enhance personal development. |
|---|---|
| Objective(s): | This assessment task addresses subject learning objective(s): A, B, C, D, E and F This assessment task contributes to the development of graduate attribute(s): 1.0, 2.0, 3.0, 4.0 and 5.0 |
| Type: | Laboratory/practical |
| Groupwork: | Individual |
| Weight: | Mandatory task that does not contribute to subject mark |
| Length: | 160 hours |
Required texts
Brown, D., Edwards, H., Buckley, T., Aitken, R., Plowman, E. (Eds). (2019). Lewis's medical-surgical nursing: assessment and management of clinical problems, 5th ANZ ed. Sydney. Elsevier.
Tollefson, J. & Hillman, E. (2021). Clinical psychomotor skills: assessment tools for nurses, 8th edition, South Melbourne, Australia. Cengage Learning.
Recommended texts
LeMone, P. et al (Eds). (2020). LeMone and Burke’s: Medical Surgical Nursing: Critical Thinking for Person-Centred Care and Skills in Clinical Nursing. 4th ed. Melbourne, Australia: Pearson Australia.
References
The National Health Priority Areas InitiativeAustralian Commission on Safety and Quality in Healthcare (ACSQHC) 2022, National safety and quality health service (NSQHS) standards, Second Edition, Sydney. Available at: https://www.safetyandquality.gov.au/
Australian Institute of Health and Welfare, National health priority areas, viewed 10 February, 2023, https://www.aihw.gov.au/reports/health-care-quality-performance/national-health-priority-areas-first-report/background
Nursing and Midwifery Board of Australia (NMBA) 2016, Registered nurse standards for practice, Available at: Nursing Midwifery Board
Other resources
UTS Student Centre
Building 10
Monday to Friday: 9am - 5pm
Tel: 1300 ASK UTS (1300 275 887)
Details for student centres: www.uts.edu.au/current-students/contacts/general-contacts
For other resources/ information refer to the Faculty of Health website (www.uts.edu.au/about/faculty-health) and Canvas at: https://canvas.uts.edu.au/.
UTS Library
The Library has a wide range of resources, facilities and services to support you including textbooks, subject readings, health literature databases, workshops and bookable study rooms. There is also a team of librarians to help you with your questions available via online chat, phone and in person. W: https://www.lib.uts.edu.au/, Facebook: utslibrary, Twitter: @utslibrary Tel: (02) 9514 3666.
Improve your academic and English language skills
Marks for all assessment tasks such as assignments and examinations are given not only for what you write but also for how you write. If you would like the opportunity to improve your academic and English language skills, make an appointment with the HELPS (Higher Education Language & Presentation Support) Service in Student Services.
HELPS (Higher Education Language & Presentation Support)
HELPS provides assistance with English language proficiency and academic language. Students who need to develop their written and/or spoken English should make use of the free services offered by HELPS, including academic language workshops, vacation intensive courses, drop-in consultations, individual appointments and Conversations@UTS (www.ssu.uts.edu.au/helps). HELPS staff are also available for drop-in consultations at the UTS Library. Phone (02) 9514 9733.
Please see www.uts.edu.au for additional information on other resources provided to students by UTS.
The Accessibility and Financial Assistance Service
The Accessibility Service can support students with disabilities, medical or mental health conditions, including temporary injuries (e.g., broken limbs). The Accessibility Service works with Academic Liaison Officers in each Faculty to provide ‘reasonable adjustments’ such as exam provisions, assistive technology, requests and strategies for managing your studies alongside your health condition. If you’re unsure whether you need assistance, we recommend getting in touch early and we can provide advice on how our service can assist you. Make an appointment with an Accessibility Consultant (AC) on +61 2 9514 1177 or Accessibility@uts.edu.au.
The Financial Assistance Service can assist you with financial aspects of life at university, including Centrelink information, tax returns and budgeting, interest-free student loans and grants to assist with course-related costs. Check eligibility and apply online and make an appointment on +61 2 9514 1177 or Financial.assistance@uts.edu.au.