1

Curriculum Design for Entrance Level Knowledge for Novice ICU Nurses

Elizabeth Greger

Grand Canyon University

Nur-648E Nursing Education Seminar 1I

Professor Rebecca Beck-Little

September 12, 2021

 2

Critical Care course for Senior Level BSN Nurses

Introduction

Many undergraduate nurses pursue jobs in specialty areas as their first job, but they are

unprepared for the increased level of knowledge necessary for specialized care units, such as

intensive care units (ICUs). Universities are limited on time and resources to provide advanced

education for specialty units, so hospitals require classes and precepted internships in an effort to

prepare novice nurses for independent care. Short classes that universities and hospitals offer

cover topics such as advanced assessment skills, advanced respiratory assessment and ventilator

functions, advanced cardiac life support (ACLS) for acute changes in patient condition, and

critical medications. This paper will outline what is included in an apprentice ICU class

curriculum: the course title and description, course outcomes, course outline, Quality and Safety

Education for Nurses (QSEN) competencies, course objectives, and knowledge assessment.

Course Preparation, Title, and Description

Nursing educators will sometimes offer courses they are experienced in, such as intensive

care. They use course mapping to help guide the preparation of course work because it aligns

program and course curricula to accreditation standards and national guidelines, which assures

the course content will be effective and beneficial for the student and their patient care (Norton

& Cantwell, 2018). Professional standards for curriculum development were derived from

several major nursing organizations in an effort to organize and recognize accredited nursing

curriculum (Neville-Norton & Cantwell, 2018). This course, Entrance Level Knowledge for

Novice ICU Nurses, will cover basic knowledge for nursing students in their senior year of their

undergraduate degree. The course outline will indicate the topics that will be covered, such as

advanced assessment skills, ventilator knowledge, cardiac rhythms requiring ACLS activation,
 3

and critical medications; and will include QSEN competencies of evidence-based practice (EBP)

and patient-centered care (PCC). Course outcomes will be determined for each topic to develop

learning objectives. The class topic will conclude with a short answer test to evaluate both the

students’ retention of knowledge and the effectiveness of the course. Course outcomes will be

aligned with learning objectives to determine any changes in future courses, but the course

should be successful with careful preparation.

Course Topics

Novice nurses entering the ICU can become overwhelmed when faced with the amount

of knowledge they lack to adequately care for critically ill patients. Broad topics, such as critical

assessment skills, respiratory assessment skills and ventilator knowledge, cardiac arrhythmias

that require ACLS activation, and critical medications (used in critical scenarios), will provide

insight into recognizing the most common skills and treatments.

Critical Assessment Skills

All ICU patients are continuously monitored on cardiac and hemodynamic monitors, but

acute situations in the ICU are inevitable and must be recognized quickly when time is of the

essence (Illuzzi & Gillespie, 2021). This course will provide instructions on how to do a quick,

systematic, step-by-step assessment that uses visual and physical assessment skills, and acute

management skills that can be applied to any situation (Illuzzi & Gillespie, 2021). Students will

learn about common critical events such as hypotension, respiratory distress, neurological

changes, and chest pain that will be treated with these assessment and management skills. Group

discussions and role play can be effective teaching strategies for this topic because they mimic

teamwork that occurs in the ICU (Illuzzi & Gillespie, 2021). A course outcome for the student
 4

would be to identify assessment steps for acute changes in the patient condition, and a learning

objective would be to learn the steps to recognize acute changes in the patient’s condition.

Advanced Respiratory Assessment and Ventilator Knowledge

One of the most common ICU treatments is the mechanical ventilator for respiratory

failure. This can be a particularly intimidating machine for novice nurses because of the

seriousness of its purpose. However, an increased level of knowledge and understanding can

bring confidence in providing care for the patient who requires its support in life threatening

situations. There are many different types of settings used for many different respiratory

conditions and illnesses. During this course, students will learn basic ventilator settings –

assisted control (AC), volume control (VC), pressure control (PC), and pressure support (PS) -

and the rational for their use – pneumonia, asthma, near drowning, and neurologically induced

respiratory failure (Holanda, 2021). As part of the new assessment skills learned during this

course, students will learn how to identify different ventilated breath sounds, assess laboratory

results (arterial blood gasses), and assess radiology films (chest x rays to assess endotracheal

tube (ETT) placement and pneumothorax) (Holanda, 2021). This course topic includes

assessment skills and hands-on care (suctioning the ETT and oral suctioning), as well as looking

at chest x-ray films, so an instructional video will be included for students to watch virtual skills

they will be required to do. Research has shown that video instruction and other integrated

technology modalities can support different student learning styles and effectively accomplish

course objectives (Wirihana, Craft, Christensen, & Bakon, 2017). Short answer test questions

will be asked when the student performs hands-on skills to assess the student’s knowledge and

basic ventilator skills. A course outcome for the student would be to identify one basic ventilator

mode and a corresponding patient condition and identify the ETT placement on an x-ray, and a
 5

learning objective would be for the student to learn basic ventilator modes and corresponding

patient conditions. Another course outcome would be for the student to perform a hands-on skill

(suctioning, recognizing the correct placement of the ETT on a chest x-ray, or identifying

auscultated lung sounds), and a related learning objective would be for the student to learn

hands-on skills (suctioning, identifying lung sounds, or recognizing correct placement of the

ETT on a chest x-ray).

Arrythmias That Require ACLS Activation

Another daunting situation in ICU care is cardiac arrythmias that require immediate

ACLS treatment. Being able to recognize changes in the patient’s electrocardiogram (ECG) is a

very necessary skill for novice nurses. This course will cover three categories of arrhythmias that

require immediate attention – pulseless rhythms, brady-arrhythmias, and tachy-arrythmias – and

the type of treatment for each one – electro-cardioversion or medication. This is another area that

video instruction will be effective because the students will be able to observe the arrythmia and

recognize the importance of activating ACLS protocols (and notifying the physician) to help give

the patient the best treatment. A course outcome for the student would be to identify an

arrhythmia from each category and identify the immediate treatment for each one, and a related

learning objective would be to learn the arrhythmias in each category and their corresponding

treatment protocols.

Critical Medications

The life of millions of patients admitted to an emergency room setting or critical care unit

is dependent upon the skill set and knowledge of the attending ICU nurse (Kviklyte, 2021).

Nurses must be able to quickly identify critical conditions – hypotension, lethal arrhythmias, or

respiratory failure - and the treatment that is necessary for optimal outcomes. During this course,
 6

nurses will be taught about common antiarrhythmics - Adenosine, Amiodarone, and Sotolol,

antihypotensives – Levophed (norepinephrine) and Epinephrine, and respiratory therapeutics –

bronchodilators (Albuterol) and corticosteroids (Kviklyte, 2021). They will learn the action of

each drug and the conditions they would treat. The students will be given a short answer test to

evaluate their understanding and the effectiveness of the course instruction. A course outcome

for the student would be to list a drug and its action for each condition, and a learning objective

would be to learn about different critical conditions and the medication used to treat them.

Quality and Safety Education for Nurses (QSEN) Competencies

When educators prepare curriculum for nursing students, they include competencies set

forth in the guidelines from the Quality and Safety Education in Nursing (QSEN) project. The

overall goal of the (QSEN) project is to ensure that all graduating nursing students develop the

relevant quality and safety competencies that prepare them for practice (Billings & Halstead,

2019). The QSEN original standards provide key concepts related to quality and safety that can

be used to create a framework to organize curricula (Billings & Halstead, 2019). QSEN faculty

used the Institute of Medicine competencies for nursing to define pre-licensure and graduate

quality and safety competencies for nursing and proposed targets for knowledge, skills, and

attitudes (KSA) to develop curriculum in nursing pre-licensure and graduate level programs

(QSEN Institute, 2021). Competencies include evidence-based practice, patient-centered care,

teamwork & collaboration, quality improvement, safety, and informatics. This paper will discuss

the first two.

Evidence-Based Practice (EBP)

Evidence based nursing practice is the conscientious, explicit, and judicious use of

information that is derived from theory and based on research to make decisions about patient
 7

care (QSEN Institute, 2021). Evidence-based practice is a problem-solving approach to the

delivery of health care that integrates the best evidence from studies and patient care data with

the bedside nurse and patient preferences and values (Mithiyane & Habedi, 2018). It begins by

recognizing a problem, asking a question in PICOT format, finding the best evidence for a

solution, critically appraising the evidence, integrating it into clinical practice, evaluating the

outcome, and disseminating the results to other professionals. Nurse educators and student nurses

who regularly use EBP have up-to-date information that improves the quality of care for patients

and fills the gap between research, theory, and practice (Mithiyane & Habedi, 2018). Educating

student nurses in the use of EBP will instill in them the value of EBP and provide the knowledge

and skills to continue its practice throughout their career. During this course, each topic will have

information that is obtained through research of current data that provides EBP and students will

be able to recognize its relevance to each topic. A short answer test will be given to assess their

knowledge. A course outcome for the student would be to identify an EBP for each topic, and a

learning objective would be for the student to learn how to recognize an EBP for each topic.

Patient-Centered Care

Patient-centered care (PCC) encourages active collaboration and shared decision-making

between patients, families, and providers to design and manage a customized and comprehensive

care plan for the patient (NEJM, 2017). Patient and family preferences, values, cultural

traditions, and socioeconomic conditions are respected; the right care is provided at the right

time and right place; and information is shared fully in a timely manner so patients and their

families can make informed decisions (NEJM, 2017). Goals of PCC are an increased trust

between providers and patients, as well as better patient outcomes (Stagno, Crapanzano, &

Schwartz, 2016). As part of this course, educators will teach how PCC involves an understanding
 8

of patients' perspectives of their illness and treatment, the impact that health and illness has on

the lives of patients, and the values and goals patients have for themselves, which encourages

patients and health care professionals to engage in a shared decision-making model of health

care. In the ICU, many times the patient is unconscious due to sedation, causing their family

(preferably the next of kin or medical power of attorney) to make decisions for them. Novice

nurses must be instructed in the intricacies and legalities of including the family members in

patient care decisions based on the patient’s wishes. A course outcome for the student will be to

identify one way to include the patient and their family in discussions concerning patient care

and a learning objective will be for the student to learn how to include the patient and their

family in discussions concerning their care.

Short Answer Test for Student and Course Evaluation

Short answer tests (SAT) are an assessment tool that can be used to examine nursing

students' knowledge, equip nursing students with the knowledge and critical thinking skills for

the clinical setting, meet nursing facility curricula learning outcomes, and evaluate expectations

for student educational success (Studen & Jefferies, 2018). A short answer test can measure the

level of understanding by how much information a student retrieves from memory (Studen &

Jefferies, 2018). When short answer tests are done following a face-to-face demonstration of

skills, it ensures that students develop the knowledge they will require for bedside care, such as

critical reasoning and making decisions (Studen & Jefferies, 2018). Most of the education during

this course will require the nurses to perform hands-on return demonstrations. They will perform

the skill and answer questions that would require a short answer to explain what they are doing

and its importance in patient care. This will serve several purposes – it will give students the

opportunity to practice new skills, educators will be able to evaluate the students’ learning, and
 9

the educators will be able to evaluate the effectiveness of their instructions by how well the

students perform the skill and learning objectives.

Conclusion

As shown in this paper, there are many things to consider when preparing an education

course. It takes time to organize, find the desired information based on evidence, and build

evaluation tools to evaluate the students and curriculum. Depending on the length of the class

and amount of material covered, several educators and preceptors can be included in the

organization of gathering the evidence, deciding on what to include, the test questions, and who

should teach which topic (based on their expertise). Students respond well when they know the

class has been prepared and presented in a professional manner.

 10

References

ACLS, (2021). Advanced cardiac life support, EKG rhythms and interpretation, https://acls-

algorithms.com/rhythms/

Billings, D. M., & Halstead, J. A. (2019). Teaching in nursing: A guide for faculty (6th ed.).

Saunders. ISBN-13: 9780323554725

Holanda, M.A., (2021). Basic modes of mechanical ventilation, Xlung, https://xlung.net/en/mv-

manual/basic-modes-of-mechanical-ventilation

Illuzzi E. & Gillespie M., (2021). Physical examination in the ICU. Oropello J.M., & Pastores

S.M., & Kvetan V(Eds.), Critical Care. McGraw Hill.

https://accessmedicine.mhmedical.com/content.aspx?

bookid=1944&sectionid=143515966

Kviklyte, G., (2021). Eight drugs every ICU nurse needs to know. Advanced Medical

Certification. https://advancedmedicalcertification.com/eight-drugs-every-nurse-needs-

know/

Mthiyane, G. N., & Habedi, D. S. (2018). The experiences of nurse educators in implementing

evidence-based practice in teaching and learning. Health SA Gesondheid Journal of

Interdisciplinary Health Sciences, 23, 1177. https://doi.org/10.4102/hsag.v23i0.1177

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917461/

NEJM, (2017). What is patient-centered care? New England Journal of Medicine, NEJM

Catalyst, https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559
 11

Neville-Norton, M., & Cantwell, S. (2018). Curriculum mapping in nursing education: A case

study for collaborative curriculum design and program quality assurance. Teaching and

Learning in Nursing, 14(2), 88–93.

https://doi-org.lopes.idm.oclc.org/10.1016/j.teln.2018.12.001

QSEN Institute, (2021). QSEN Institute competencies. QSEN Institute, Frances Payne Bolton

School of Nursing, Case Western Reserve University. https://qsen.org/competencies/

Stagno, S., Crapanzano, K., & Schwartz, A. (2016). Keeping the patient at the center: Teaching

about elements of patient-centered care. MedEdPORTAL: The Journal of Teaching and

Learning Resources, 12, 10500. https://doi.org/10.15766/mep_2374-8265.10500

Stunden, A., & Jefferies, D. (2018). The effectiveness of short answers test papers in evaluating

academic nursing programs: A review of the literature. Nurse Education in Practice, 33,

94–101. https://www-sciencedirect.com.lopes.idm.oclc.org/science/article/pii/

S1471595317307114?via%3Dihub

Wirihana, I., Craft, J., Christensen, M., & Bakon, S. (2017). A nursing education perspective on

the integration of video learning: A review of the literature. Singapore Nursing Journal,

44(1), 24–32. https://content.ebscohost.com/ContentServer.asp?

T=P&P=AN&K=124789970&S=R&D=ccm&EbscoContent=dGJyMNHX8kSep6840dv

uOLCmsEmeprBSrq

%2B4TbCWxWXS&ContentCustomer=dGJyMPGusUuxp7dOuePfgeyx43zxpwAA