Jordan University of Science & Technology



Jordan University of Science and Technology

Faculty of Nursing

Department of Adult Health

Semester 2007

Course Syllabus

|Course Information |

|Course Title | |

| |Acute Care Nursing, Advanced Practice II |

|Course Code |NUR 717 |

|Prerequisites |NUR 714 |

|Course Website |NA |

|Instructor |Dr. Ibtisam Al-Zaru RN, PhD |

| |Dr. Mohammed Said RN, DNS |

| |Dr. Issa Hweidi RN, PhD |

|Office Location |NI-L1 |

|Office Phone # |23716 |

|Office Hours |10-12 Sunday |

| |1-3 Monday |

|E-mail |ibtisam@just.edu.jo |

| |alkhalil@just.edu.jo |

| |hweidi@just.edu.jo |

|Teaching Assistant(s) |None |

|Course Description |

| This course focuses on critical analysis and utilization of nursing research and theories in providing advanced nursing care for acutely |

|ill adult clients and their families. Students originate nursing intervention strategies in partnership with clients and their families. |

|Interventions are based upon consideration of relevant research and theory. The processes of research critique and theory evaluation are |

|used to provide theory and evidence-based nursing care for clients and families experiencing selected acute health disruptions. In clinical |

|settings, students further refine acute care skills in their area of specialization (Oncology or Cardiopulmonary). Emphasis is on management|

|of complex problems in intermediate and critical settings with special focus on discharge planning in the student’s specialty area. The |

|clinical specialist roles focus on continuation of the advanced practice specialist, teaching, and research. Clinical specialist roles are |

|developed in a weekly 8-hour practicum accompanied by a 2-hour weekly clinical seminar. |

|Textbook |

|Title | |

|Author(s) | |

|Publisher | |

|Year | |

|Edition | |

|Book Website | |

|Other references |A list of required readings will be handed to students one week before each 2-hour class session. |

|Assessment |

|Assessment |Expected Due Date |Percentage |

|First Exam | | |

|Second Exam | | |

| | | |

|Assignments |Clinical Component |50% |

| | Clinical log, formative evaluation (Appendix 1) |20 |

| | Summative evaluation |20 |

| | Case presentation (Appendix 2) |10 |

| |Theory component |50% |

| | Lit. Review paper (appendix 3) |15 |

|Participation | Participation & Quizzes |10 |

|Final Exam | Final Exam |25 |

|Course Objectives |Percentage |

|1. Demonstrate proficiency in managing the care of the cutely ill adult, especially those with system specific |20% |

|disorders (cardiopulmonary and oncology). | |

|2. Integrate knowledge from the fields of nursing, pharmacology, oncology, pathophysiology and biopsychosocial |20% |

|sciences into specialty based practice for clients and their families adjusting to the stress of acute illness. | |

|3. Function as an educator to the acutely ill adults, their families, and other members of the health team. |15% |

|4. Develop proficiency in identifying the continuing physical, psychosocial and environmental needs of the care of |20% |

|the acutely ill and those with system specific disorders. | |

|5. Analyze current research related to the care of the acutely ill and those with system specific disorders |15% |

| 6. Function as a client advocate |10% |

|Teaching & Learning Methods |

|Group discussion, Clinical practicum |

|Seminar presentation |

|3. Individual counseling |

|Learning Outcomes: Upon successful completion of this course, students will be able to |

|Related Objective(s) | |Reference(s) |

|1 | |Chapter 2 and Handouts |

|1,2 | | |

|1-6 | | |

|3,4 | | |

|5,6 | | |

|6 | | |

|5 | | |

|Useful Resources |

| |

|Course Content |

|Week |Topics | |

|1 |Cardiopulmonary |Oncology |

|2 |Introduction |Introduction |

|3 |Writing for publications |Writing for publications |

|4 |CAD: Risk factors and atherosclerosis: Nursing implication |Prevention, early detection and staging |

|5 |Nursing health assessment and problems identification |Nursing implication for radiotherapy |

|6 |Nursing management of patients with angina |Nursing implication for chemotherapy |

|7 |Nursing management of patients with ST segment elevation MI |Nursing implication for biotherapy |

| |receiving Thrombolytics. | |

|8 |Nursing management of patients receiving invasive interventions |Nursing implication for surgery |

|9 |Nursing Management of MI patients receiving Conventional |Nursing implication for BMT |

| |therapeutic approach | |

|10 |Nursing management of patients with cardiac surgeries |Nursing implication for oncologic |

| | |emergencies |

|11 |Nursing management of patients with V. Tach. |Ethical, legal and professional issues in |

| | |oncology nursing |

|12 |Nursing management of patients with acute respiratory failure |The experience of cancer and survivorship |

|13 |Electrical therapy: Nursing implications |Symptom management |

|Additional Notes |

| |

|Class schedule: Cardiopulmonary Track |

| |

|WEEK 1: Introduction and orientation (cardiopulmonary and oncology track) |

| |

|WEEK 2: Writing for publications (cardiopulmonary and oncology track) |

|Objectives |

|1. Discuss the process of publication and reviewing |

|2. Discuss ethical issues related to participation |

|3. Develop understanding of strategies that facilitate publication |

|4. Identify the format of a typical Journal article |

|5. Prepare a manuscript for a specific, appropriate journal. |

| |

|Outline |

|Process of publication |

|Ethical issues related to publication |

|Strategies that promote writing for publication |

|A manuscript: Structure and organization |

| |

|Readings |

|Ch: 1. The typical format of a journal article.pp.3-16. |

| |

|Thomson, A. M. (2005). Writing for publication in this refereed journal. Midwifery, 21, 190-194. |

| |

|Endacott, R. (2005). Clinical research 6: Writing and research. 21, 258-261. |

| |

|Lewis, S. E. (2004). Ethical issues in the world of technical and professional writing: the classroom , the workplace and beyond. * |

| |

|Miracle, V. A. (2003). Writing for publication. You can do it. Dimension of Critical Care Nursing. 22 (1): 31-34. |

| |

|Plaisance, L. (2003). The write way to get published in a professional journal. Pain Management Nursing. 4(4): 165-170. |

| |

|Erlen, J. A. (2002). Writing for publication: Ethical considerations. Orthopedic Nursing. 21(6): 68-71.* |

| |

|King, C. R. (2001). Ethical issues in writing and publishing. Clinical Journal of Oncology Nursing. 5(3):19-23. |

| |

|Newell, R. (2001). Writing academic papers: a guide for prospective authors. Intensive and Critical Care Nursing. 17: 110-116. |

| |

|Mee, C. L. (2001). 10 lessons on writing for publication. Clinical Journal of Oncology Nursing. 5(3): 1-2. |

| |

|Rosenfeldt, F. L. et al. (2000). How to write a paper for publication. Heart, Lung and Circulation. 9: 82-87. |

| |

|Dexter, P. (2000). Tips for scholarly writing in nursing. Journal of Professional Nursing. 16(1): 6-12. |

| |

|WEEK 3: Coronary artery diseases, risk factors and atherosclerosis: Nursing implications |

|Objectives |

|1. Identify major risk factors that contribute to atherosclerosis and CAD. |

|2. Discuss how each factor contribute to atherosclerosis and CAD |

|3. Describe nursing intervention strategies for patients at increased risk for atherosclerosis and CAD. |

|4. Compare and contrast among theories of atherosclerosis. |

|Outline |

|Risk factors to CAD: |

|-Hypertension |

|-Smoking |

|-D M |

|-Blood lipids and cholesterol |

|-Other risk factors: age, gender, physical inactivity, stress and type A personality, body weight, and oral contraceptives. |

|-Strategies to manage major risk factors: Patient teaching and behavior modification, pharmacological and non-pharmacological intervention |

|strategies |

|-Theories of atherosclerosis |

| |

|Readings |

|Norhammar, A. (2004). Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of |

|coronary artery disease and benefits of revascularization. Journal of the American College of Cardiology, 43(4):585-591. |

| |

|Hugbs, S. (2003). Novel cardiovascular risk factors. Journal of Cardiovascular nursing. 18(2): 131-138. |

| |

|Fair, J. M. (2003). Cardiovascular risk factor modification Is it effective in older adults?. 18(3):161-168. |

| |

|Bertuzzi, M; Tavani, A, & Vecchi, C. (2003). Family history of ischemic heart disease and risk of acute myocardial infarction. Preventive medicine, |

|37:183-187. |

| |

|Allen, J. K. (2000). Cholesterol management: An opportunity for nurse case managers. Journal of Cardiovascular Nursing. 14(2): 50-58. |

| |

|Ch: 8. Risk factors and CAD. |

| |

| |

|WEEK 4: Health assessment and problems identification of CAD patients: Nursing implications |

|Objectives |

|1. Develop understanding of pathological alterations of CAD: angina, ST segment MI, and non-ST segment elevation MI. |

|2. Identify types of MI, Q-wave and non-Q-wave MI |

|3. Describe phases of MI. |

|4. Compare and contrast among subjective and objective indicators of angina and MI |

|5. Describe the most common diagnostic procedures of CAD, angina and myocardial |

|infarction |

|6. Discuss major complications of CAD, unstable angina and MI |

|Outline |

|Pathophysiological alterations of CAD, angina and MI |

|Types of MI |

|Phases of MI |

|Theories of atherosclerosis, atherosclerotic plaque, and coronary thrombus formation |

|Subjective and objective indicators of angina, non-ST segment elevation MI, and ST segment elevation MI. |

|Diagnostic procedures for CAD: ECG, echocardiogram, cardiac enzymes, cardiac catheterization, exercise stress test. |

| |

|Readings |

|Burke, L. E. (2003). Primary preventin in patients with a strong family history of coronary heart disease. Journal of Cardiovascular Nursing. 18(2):|

|139-143. |

| |

|Woon, V. C. & Lim, K. H. (2003). Acute myocardial infarction in the elderly the differences compared with the young. Singapore Medical Journal, |

|44(8):414-418. |

| |

|Collinson, P. O. & Stubbs, P. J. (2003). Are troponins confusing? Heart. 89: 1285-1297. |

| |

|Deaton, C. et al. (2001). Diagnostic strategies for women with suspected CAD. Journal of Cardiovascular Nursing. 15(3): 39-53. |

| |

|Doering, L. V. (1999). Pathophysiology of acute coronary syndromes leading to AMI. Journal of Cardiovascular Nursing. 13(3): 1-20. |

| |

|Milner, K. A. et al. (2001). Symptom predictors of acute coronary syndromes in younger and older patients. Nursing Research. 50(4):233-241. |

| |

|McSweenmy, J. C., Cody, M. & Crane, P. B. (2001). Do you know them when you see them? Women's prodromal and acute symptoms of MI. Journal of |

|Cardiovascular Nursing 15(3): 26-38. |

| |

|Haak, S. W. & Huether, S. E. (Ch 10). The person with myocardial infarction. |

| |

| |

|WEEK 5: Nursing Management of patients with angina |

|Objectives |

|1. Compare and contrast among different type of angina in terms of clinical |

|parameters |

|2. Distinguish between unstable angina and non-ST segment elevation MI |

|2. Identify physiological and psychological human responses to angina |

|3. Develop understanding of drug therapy used in management of angina in terms of action, side effects and nursing implications |

|4. Design a discharge plan for patients with angina, activity, risk factor modification and compliance. |

|Outline |

|-Type of angina: |

|Stable, Variant, Unstable; clinical indicators |

|- Differences between unstable angina and non-ST segment elevation MI |

|-Common drug therapy: |

|Nitrates, B blockers, Calcium channel blockers, Angiotensin Converting enzyme |

|inhibitor, Antiplatlets, Anti thrombin |

|-Physiological responses to angina |

|-Psychological responses |

|-Discharge plan and patient education |

| |

|Readings |

|Grech, E. D. & Ramsdale, D. R. (2003). Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. British Medical |

|Journal. 326:1259-1261. |

| |

|Thadani, U. (2003). Management of stable angina-drugs, tents and devices for coronary bypass surgery. Global health care, 67-71. |

| |

|Gil, M; Zarebinski, M & Adamus, J. (2002). Plasma fibrinogen and troponin I in acute coronary syndrome and stable angina. International journal of |

|Cardiology, 83:43-46. |

| |

|Nauer, K. A. (2001). Emergent treatment of cardiac ischemia. Topics in Emergency medicine. 23(1): 26-35. |

| |

|Manhapra, A. (2000). Treatment possibilities of unstable angina. British Medical |

| |

|Staniforth, A. D. (2001). Contemporary management of chronic stable angina. Drugs and aging. 18(2): 109-121. |

| |

|Zanger, D. R. (2000). Contemorary management of angina: Part 11. medical management of chronic stable angina. American Family Medicine. |

| |

| |

|Pollack, C. et al. (2001). 2000 ACC/AHA guidelines for the management of patients with unstable angina and non-ST segment elevation myocardial |

|infarction: A practical summary. Annals of Emergency Medicine. 38: 229-240. |

| |

|Haak, S. W. & Huether, S. E. (Ch 9). The person with angina. PP: 221-249. * |

| |

| |

|WEEK 6: Nursing management of ST-segment elevation MI patients receiving Thrombolytic Therapy |

|Objectives. |

|1. Review the phathophysiological mechanisms of thrombus formation |

|2. Identify the current thrombolytic agents used in clinical practice |

|3. Discuss the mechanism of action of each thrombolytic agent |

|4. Identify clinical indications for thrombolytics |

|5. Identify contraindications to thrombolytics, absolute and relative |

|6. Design an assessment protocol for MI patients’ pre-administration of thrombolytics |

|7. Design a protocol specific for theombolytics adminstration and MI patients’ management |

|8. Identify complications and side effects of thrombolytics |

|9. Identify clinical indicators of reperfusion as a result of thrombolytics |

|10. Discus delay to thrombolytics and the associated factors. |

|Outline |

|-Pathophysiological mechanism of coronary artery thrombus formation |

|-Thrombolytics: Streptokinase, tissue plasminogen activators |

|-Mechanisms of action of thrombolytics |

|-Indicatios for thrombolytics |

|-Contraindications for thrombolytics |

|-Pre-adminstration of thrombolytics assessment protocol |

|-Nursing protocol for managing MI patients receiving thrombolytics |

|-Complications of thrombolytics; side effects and nursing implications |

|-Clinical indicators of reperfusion |

|-Research based review of delay to reperfusion: patient, transportation, and hospital. |

| |

|Readings |

|Maniadakis, N; Kaitelidou, D..et.al. (2005). Economic evaluation of teatment strategies for patients suffering acute myocardial infarction in |

|greece. Hellenic Journal of Cardiology, 46:212-221. |

| |

|Fernandez-Aviles; et.al. (2004). Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute |

|myocardial infarction with ST- segment elevation (GRACIA-I): a randomized controlled trial, 364(18):1045-1053. |

| |

|Tendera, M. & Wojakowski, W. (2003). Role of antiplatelet drugs in the prevention of cardiovascular events. Thrombosis Research, 110:355-359. |

| |

|Kucia, A. & Zeitz, C. (2003). Failed reperfusion after thrombolytic therapy: recognition and management. 31(2):113-121. |

| |

|French, J.et.al. (2003). A score predicts failure of reperfusion after fibrinolytic therapy for acute myocardial infarction. American heart Journal,|

|145(3):508-514. |

|Meschia, J. et.al. (2002). Thrombolytic treatment of acute ischemic stroke. Mayo Clinical Project, 77:542-551. |

| |

|Ornato, J. P. (2002). Using fibrinolysis and antiplatelet in acute coronary syndrome: New therapies to restore blood flow. Journal of critical |

|Illness. . |

| |

|Wilkinson, J. et al. (2002). Interaction between arrival time and thrombolytic treatment in determining outcome of AMI. Heart. 88: 583-586. |

| |

|Estess, J. M. & Topol, E. J. (2002). Fibrinolytic treatment for elderly patients with AMI. Heart. 87: 308-311. |

| |

| |

|WEEK 7: Nursing management of patients with CAD receiving invasive interventions, PTCA/STENT/ Atheroectomy |

| |

|Objectives |

|1. Identify indications (characteristics of plaques) for PTCA and STENT |

|2. Discuss nursing management required pre-PTCA/STENT |

|3. Compare and contrast among different designs of STENT |

|3. Describe how PTCA/STENT dilate stenotic coronary arteries |

|4. Discuss immediate and long-term complications of PTCA/STENT |

|5. Compare among major revascularization interventional procedures in terms of outcomes. |

|6. Identify psychosocial human responses to PTCA/STENT |

|7. Design a nursing management protocol for immediate and long term care post-PTCA/STENT. |

| |

|Outline |

|-Definition of PTCA/STENT |

|-Indications for PTCA/STENT: clinical characteristics of atherosclerotic plaque |

|-Design of STENT |

|-Mechanism of action/dilatation of PTCA/STENT |

|-Immediate and long term complications of PTCA/STENT |

|-Psychosocial responses to PTCA/STENT |

|-Research based review about the outcomes of different revascularization interventional strategies. |

|-Pre-PTCA/STENT nursing management and education |

|-Post-PTCA/STENT nursing management |

|-Discharge plan for patients with CAD received PTCA/STENT |

| |

|Readings |

| |

|Kaufmann, B. et.al. (2005). Coronary stent infection: a rare but severe complication of percutaneous coronary intervention. Swiss med wkly, |

|153:483-487. |

| |

|Reid, M. & Cottrel, D. (2005). Nursing care of patients receiving intra-aortic balloon counterpulsation. Critical Care Nurse, 25(5):40-49. |

| |

|Grilli, R. & Taroni, F. (2004). Empirical assessment of the impact of drug-eluting stents on the rate of use of coronary revascularization |

|procedures. International Journal of technology Assessment in Health Care, 20930:356-360. |

| |

|Finet, G. et al. (2003). Mechanism of lumen enlargement with direct stenting versus predilatation stenting: Influence of remodeling and plaque |

|characteristics assessed by volumetric intracoronary ultrasound. Heart. 89: 84-90. |

| |

|Stone, G. W. et al. (2002). Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. The New England |

|Journal of Medicine. 346(13): 957-966. |

| |

|Al Suwaidi, J. et al. (2000). Coronary artery stents. JAMA. 284(14): 1828-1836. |

| |

| |

|WEEK 8: Nursing management of MI patients, conventional treatment approach |

| |

|Objectives |

|1. Compare and contrast among medical approaches of managing unstable angina, NON-ST segments elevation MI, and ST segment elevation MI. |

|2. Discuss patients' physiological and psychological responses that affect the size of infarct. |

|3. Discuss intervention strategies to manage pain and activity intolerance |

|4. Discuss intervention strategies to provide mental and physical rest |

|5. Develop understanding of oxygen and diet therapy for patients with MI |

|6. Develop understanding of drug therapy for MI and the related nursing implications |

|7. Discuss approaches to assess and monitor homodynamic status of MI patients |

|8. Identify complications of MI, and related medical and nursing management |

|9. Discuss non-drug approaches to manage MI, PTCA and CABG. |

|10. Design a discharge plan for MI patients including compliance to drug therapy, rehabilitation, and risk factors modification |

|Outline |

|-Medical approaches for management of Unstable angina, NON-ST segment elevation MI, and ST segment elevation MI. |

|-Increased myocardial workload: physiological and psychological responses to MI |

|-Hemodynamic monitoring |

|-Pain and activity intolerance: Nursing implications |

|-Physical and emotional rest: Nursing implications |

|-Oxygen and diet therapy: Nursing implications |

|-Drug therapy: Nursing implications |

|-Complications of MI: Nursing implications |

|-PTCA and CABG approaches to manage MI: Nursing implications |

|-Discharge plan for MI patients: Cardiac rehabilitation, compliance with medical therapy, and risk factors modifications. |

|Readings |

|Babuin, L. & Jaffe, A. (2005). Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ, 173(10):1191-1202. |

| |

|Bush, D. E. et.al. (2005). Post-myocardial infarction depression. Evidence Report/ Technology Assessment, 123.1-12. |

| |

|Hanna, I. & Wenger, N. (2005). Secondary prevention of coronary heart disease in elderly patients. American Academy of Family Physicians, |

|71:2289-2296. |

| |

|Gassner, L. et.al. (2003). Aerobic exercise and the post myocardial infarction patient: a review of the literature. Heart & Lung, 32:258-265. |

| |

|Karastanew, k. et.al. (2002). Monitoring of heparin treatment in patients with acute myocardial infarction. Trakya, oniversitesi tip Fakoltesi, |

|19(2):96-99. |

| |

| |

|Haak, S. W. & Huether, S. E. Ch: 10 the person with myocardial infarction. |

| |

| |

|WEEK 9: Nursing management of patients with cardiac surgeries, valve surgery and CABG. |

|Objectives |

|1. Compare and contrast pathophysiological alterations of valve stenoses and insufficiencies. |

|2. Identify indications for cardiac surgery |

|3. Describe the cardiopulmonary bypass process |

|4. Discuss assessment and intervention strategies pre-cardiac surgery |

|5. Relate post-operative pathophysiological alterations to cardiac surgery (bypass) |

|6. Discuss assessment and management principles post-cardiac surgery |

|7. Explain post-operative complications of cardiac surgery. |

|8. Discuss discharge and teaching plans for patients with CABG |

|Outline |

|Valvular diseases: |

|-Valve stenoses |

|-Valve insufficiencies |

|-Indications for cardiac surgeries |

|Valve surgery |

|Bypass process |

|Effects of cardiopulmonary bypass |

|Pre-operative management principles |

|-Nursing assessment |

|-Physiological Preparation |

|-Psychological preparation |

|Post-operative management principles |

|-pain |

|-Ventilatory support |

|-Cardiac output |

|-Hypo tension and hemodynamic |

|-Hypothermia related changes |

|-Chest drainage and bleeding |

|-hypothermia related changes |

|-Neurological changes |

|Major complications of cardiac surgery |

|-Altered fluid and electrolyte balance |

|-Decreased cardiac output, and dysrhythmias |

|-Decreased contractility |

|-Altered blood pressure |

|-Post-operative pain |

|-Postoperative bleeding |

|-Early cardiac tamponade |

|-Pulmonary dysfunction |

|-Neurological dysfunction |

|-Wound infection |

|-Sleep disturbances |

|-Thrombosis and embolism |

|Discharge preparation |

|-Patient education |

|-compliance |

| |

|Readings |

| |

|Kshettry, V. et.al. (2006). Complementary alternative medical therapies for heart surgery patients: feasibility, safety, and impact. The Society of |

|Thoracic Surgeons, 81:201-206. |

| |

|Fowler, V. et.al. (2005). Clinical predictors of major infections after cardiac surgery. Circulation, 112:358-365. |

| |

|Redeker, N. et.al. (2004). Patterns and predictors of sleep pattern disturbance after cardiac surgery. Research in Nursing & health, 27:217-224. |

| |

|Frantz, A. K. & Walters, J. (2001). Recovery from coronary bypass grafting at home: Is your nursing practice current?. Home Health Nurse, 19(7); |

|417-424. |

| |

|Nemec, L. D. & DiLucente, M. R. (2000). The effects of hypothermia on coronary artery bypass graft surgery. Critical Care Nursing, 23(1):72-80. |

| |

|Ch. 21, Cardiac surgery |

| |

| |

|WEEK 10: Nursing management of patients with Ventricular tachycardia |

|Objectives |

|1. Describe major life-threatening arrhythmias |

|2. Identify clinical and ECG indicators of V. Tach. |

|3. Differentiate between V. Tach and Suprventricular tachycardia |

|4. Explain emergency management of V. Tach and other arrhythmias. |

|5. Discuss intervention strategies for V. Tach and major arrhythmias. |

|6. Identify psychosocial responses to V. Tach. |

|7. Discuss teaching plan for patients with V. Tach., and ICDs/Pacemakers |

| |

|Outline |

|-Clinical indicators of major arrhythmias |

|-Electroradiographic indicators of arrhythmias |

|-Electrographic changes of arrhythmias |

|-Criteria for differentiating V Tach form SVT |

|Wellens criteria |

|Kindwall criteria |

|-Electrophysiological studies |

|-Medical management of V Tach and major arrythmias |

|Emergency intervention: nursing implications |

|Pharmacologic intervention: Nursing implications |

|Sugery: Nursing implications |

|Ablation: Nursing implications |

|ICDs/ Pacemaker: Nursing implications |

|-Psychological responses |

|-Discharge Planning and medication compliance |

|Readings |

|Rourke, S. et.al. (2004). Paroxysmal supraventricular tachcardia:improving diagnosis and management within the accident and emergency department. |

|Emerg med, 21:495-497. |

| |

|Matsushita, T. et.al. (2003). Limited predictive value of inducible sustained ventricular tachycardia for future occurrence of spontaneous |

|ventricular tachycardia in patients with CAD and relatively perceived cardiac function.36 (3):205-211. |

| |

|Pinter, A. & Dorian, P. (2001). Intravenous antiarrhythmic agents. Current Opinion in cardiology. 16(1): 17-22. |

| |

|Josephon, M. E. et al. (2000). The role of cardioverter-defibrillator for prevention of sudden cardiac death. Journal of Internal Medicine.133(11): |

|901-910. |

| |

| |

|WEEK 11: Nursing management of patients with |

|Acute Respiratory Failure/Respiratory Distress Syndrome |

| |

|Objectives |

|1. Define acute respiratory failure |

|2. Define respiratory distress syndrome |

|3. Develop understanding of the cardiopulmonary gas transport system |

|4. Relate pathophysiological mechanisms to major clinical indicators of RDS |

|5. Develop a nursing care plan for Individual with RDS including pharmacological and non-pharmacological interventions strategies |

|6. Compare and contrast conventional and new approaches of mechanical ventilation for patients with RDS. |

| |

|Outline |

|-The cardiopulmonary unit as a gas transport system |

|-ABG, read and interpret. |

|-ARF/RDS: Definitions and risk factors |

|-RDS, Pathophysiology, clinical parameters, and prognoses |

|-Nursing management |

|1. Ventilatory support, conventional and new approaches |

|2. Pharmacological management |

|3. Non-pharmacological management: |

|a. Respiratory management |

|b. Hemodynamic monitoring |

|c. Fluid management |

|d. Proper positioning |

|e. Endotracheal suctioning |

|f. Nutritional support |

|g. Psychosocial needs |

|Readings |

|Taylor, M. (2005). ARDS diagnosis and management. Dimensions of Critical Care Nursing, 24(5):197-207. |

| |

|Gomersall, C. et al. (2004). Introduction to respiratory failue. 6 pages. |

| |

|Haafiz, A. (2004). Acute respiratory failure. |

| |

|Flaattten, H. et al. (2003). Outcome after respiratory failure is more dependent on dysfunction in other vital organs than on severity of the |

|respiratory failure. Critical Care. 7: 72-77. |

| |

|Udobk. K, F. (2003). Acute respiratory distress syndrome. American Family Physician. |

| |

|Patient assessment: Respiratory system. Text book. |

| |

|Nursing management of the patient with acute respiratory failure. Ch. 25. |

| |

|WEEK 12: Nursing management: Cardiac electrical therapy |

|Objectives |

|1. Define cardiac electrical abnormalities that require electrical therapy |

|2. Develop understanding of basic life support principles |

|3. Identify special cases that need modifications in the resuscitation technique. |

|4. Discuss nursing management principle for patients receiving electrical therapy: defibrillation, cardioversion, pacing. |

|5. Develop understanding of advanced cardiac life support algorithms. |

|6. Discuss approaches of venous access for drug delivery during resuscitation |

|7. Design a nursing care plan for patients with pacemakers including patients education. |

|Outline |

|-Clinical parameters of fatal electrical abnormalities: Cardiac arrest, V. Fib, V Tach. Heart block |

|-Basic life support principles and techniques |

|-ACLS; defibrillation and cardioversion: |

|Mechanisms |

|Types |

|Nursing implications |

|-ACLS: Algorithms |

|Cases that induce modification in resuscitation: hypothermia, drowning, and electrocution.... |

|-Approaches of venous access: I.V. access, Peripheral veins, Central vein access |

|Complications |

|-Pacing: Modes, Complications, Nursing implications |

| |

|Readings |

| |

|2005 American heart association guidelines for cardiopulmonary resustation and emergency cardiovascular care. Overview of CPR. Circulation, |

|112(24):IV-12-IV-18. |

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|2005 American heart association guidelines for cardiopulmonary resustation and emergency cardiovascular care. Introduction. Circulation, |

|112(24):IV-1-IV-5. |

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|2005 American heart association guidelines for cardiopulmonary resustation and emergency cardiovascular care. Major changes in the 2005 AHA |

|guidelines for CPR and ECC. Circulation, 112:IV-206-IV-211. |

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|2005 American heart association guidelines for cardiopulmonary resustation and emergency cardiovascular care. part 5: Electrical therapies, |

|Automated external defibrillators, defibrillation, cardioversion, and pacing. Circulation, 112:IV-35-IV-46. |

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|2005 American heart association guidelines for cardiopulmonary resustation and emergency cardiovascular care. Part 7.4:monitoring and medications. |

|Circulation, 112:IV-78 -IV-83. |

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|Ch: 8. Care of the cardiac patient; Defibrillation and cardioversion. In Andreoli |

|comprehensive cardiac care (pp 311-331). |

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|WEEK 13: Nursing management of patients with cardiogenic shock |

|Objectives |

|1. Discuss factors that contribute to cardiogenic shock. |

|1. Describe predictors and pathophysiological mechanism of LVF and cardiogenic shock. |

|2. Describe the process of hemodynamic for patients with LVF and cardiogenic shock. |

|3. Identify subjective and objective and subjective indicators of cardiogenic shock |

|4. Identify physiological and psychological responses to cardiogeneic shock |

|5. Discuss and pharmacological and nursing interventions in the early stage of cardiogenic shock |

|4. Discuss nursing responsibilities related to IABP as non-pharmacological intervention for the management of cardiogenic shock. |

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|Outline |

|Definition of shock |

|Predictors of shock |

|Factors contribut to cardiogenic shock |

|-LVF |

|-Dysrhythmias |

|-Hypovolemia |

|Pathophysiology of shock |

|-LVF |

|-Pulmonary edema |

|-Body organs injury |

|Clinical indicators of cardiogenic shock |

|-Subjective |

|-Objective |

|Medical and nursing management |

|-General, early supportive measures |

|-Specific measures: revascularization |

|IABP: Nursing implications |

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|Readings |

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|Menon, V. & Hochman, J. S. (2006). Management of cardiogenic shock complicating AMI. Heart. 88: 531-537. |

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|Hasdai, D. et al. (2004). Cardiogenic shock complicating acute coronary syndromes. Lancet. 365(9231): 749-356. |

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|A hospital Manual (2000). Nursing protocol for the patient on the intra-aortic balloon pump in CCTC. |

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|Mower-Wade, D. & bartley, M. K. (2000). Shock do you know how to respond?. Nursing. 30(10):34-36 |

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|Bass, L. Ch: 8. Care of the cardiac patients. (pp 300-311). |

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|Sheehy, S. B. Ch.19. Shock. (pp. 265-274). |

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|Soney, E. R. Cardiogenic shock. Department of emergency medicine, Highland general hospital. |

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|Appendix 1 |

|Guidelines for Clinical Fieldwork |

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|It is the students’ responsibilities to formulate objectives for the clinical practicum by the end of second week of the course. These objectives |

|should be based on the students’ learning needs and should be consistent with the course objectives. The objectives should be stated in behavioral |

|terms. A typed copy of the objectives is to be submitted to the clinical instructors, and a copy to be retained by the students. |

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|A minimum of 7 hours each week will be spent in the clinical area, including 2-hour class sessions. Independent learning in the lab may be |

|required to demonstrate competency in physical assessment and certain nursing skills. |

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|The clinical experience may include (in clinical settings) |

|participation in direct patient care: direct patient care, patient/family teaching and counseling, patient assessment and intervention, |

|collaboration with nursing staff and other health care provides, discharge planning and other management activities |

|Other: observation of special techniques (i.e. cardiac catheterization, pulmonary studies), participation in medical and nursing rounds, in-service |

|programs, interdisciplinary conferences etc.) |

|It is the student’s responsibility: to arrange for and spend one clinical day with a unit or hospital’s manager and one with a continuing education |

|staff. |

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|Each student will maintain a written record of clinical log about his/her activities during the semester. In the log the student should record |

|clinical experiences, selection of patients, identified problems encountered in the clinical practice and with the health care system delivery. The |

|log will be reviewed by the clinical instructor during the semester, and will be submitted to the instructor at mid-term and the end of the course. |

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|The student will submit a written self-evaluation of his/her progress to the clinical instructor at the mid-term and the end of the course. |

|Self-evaluation must be based on the student’s objectives and included data to support the self-evaluation. |

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|Guidelines: How to document the clinical experience in the clinical log |

|For each clinical day, identify your specific objectives; what you want to |

|accomplish in this clinical day. |

|Document your clinical experience: Assessment data, abnormal and normal findings; related nursing diagnoses; interventions you observed or |

|participated in; any diagnostic procedure you attend-describe the nursing for the procedure; any patient teaching and/or learning activities; any |

|nursing activities you attend. |

|Identify the objectives that you could not accomplish |

|Identify barriers/difficulties to objectives’ accomplishment |

|Document factors that facilitate objectives’ accomplishment |

|Summarize your note/comment about each clinical day. |

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|EVALUATION OF CLINICAL PERFORMANCE: |

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|The evaluation of clinical performance comprises two methods: formative and summative evaluation: a 20% of the total grade will be assigned for the |

|formative evaluation, which will be evaluated based on the written daily logs. |

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|Twenty percent of the total grade will be assigned to the summative evaluation. The clinical performance of the student will be evaluated two times|

|during the course (mid-point and end-point). The focus of the assessment will be on the student achievement of the course objectives according to |

|the following criteria: |

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|Criterion |

|1 |

|Never |

|2 |

|Rarely |

|3 |

|4 |

|Often |

|5 |

|Always |

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|*Demonstrates proficiency in managing the care of the acutely ill adult clients, especially those with system specific disorders (cardiopulmonary |

|and oncology) |

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|Assessment of clients with complicated disorders comprehensively. |

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|Identification of nursing diagnoses of the client based on the data collected during the assessment phase |

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|Planning the care of the patient through setting priorities, selecting appropriate and advanced nursing interventions to help solve client problems |

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|Implementation of nursing interventions safely and effectively. |

|Evaluation of the care provided as well as the response of the client to the implemented interventions. |

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|*Integrates knowledge from the fields of nursing, pharmacology, pathophysiology and biopsychosocial sciences into specialty-based practice for |

|clients and their families adjusting to the stress of acute illness. |

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|Demonstrate knowledge and understanding of human phenomena regarding definition, mechanism of development, assessment indicators, and current and |

|advanced nursing interventions. |

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|Demonstrate knowledge of policies, standards, scope of practice, and well as legal, ethical, and professional standards of care. |

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|Incorporate family and significant others in patient's care. |

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|Demonstrate ability to incorporate current research findings in the daily practice. |

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|*Functions as an educator with acutely ill adults and their families and with other members of the health team. |

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|Develop teaching programs and teaching materials for client, families, and other health care team members utilizing principles of teaching learning |

|of adult clients |

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|Utilize current research findings in the development of the teaching programs and teaching materials. |

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|Evaluate the effectiveness of the newly developed the teaching programs and teaching materials. |

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|*Develop proficiency in identifying the continuing physical, psychosocial and environmental needs of the care of the acutely ill and those with |

|system specific disorders. |

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|Demonstrate evidence-based practice through the analysis of current literature. |

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|Upholds the ethical, professional, and legal standards of the nursing |

|profession. |

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|Recognizes the need for further learning and development of advanced skills. |

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|Demonstrates awareness of the cultural and environmental aspects in the provision of advanced nursing practice. |

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|*Analyzing current research related to the care of the acutely ill and those with system specific disorders. |

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|Keeps breast of current literature. |

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|Integrate research findings in clinical practice. |

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|Develops protocols, standardized care plans, and teaching materials based on current research findings. |

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|Provide evidence-based practice |

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|*Function as a client advocate. |

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|Demonstrates friendly approach during patient care all times. |

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|Displays respect and appropriate interaction with clients |

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|Helps clients make informed consent through educating them about disease process and available treatment options. |

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|Educate colleagues about ethical, professional, and legal standards governing nursing profession. |

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|Practice in accordance with the legislation and guidelines of the nursing profession in Jordan. |

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|*Develops increased skill in professional writing and speaking. |

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|Communicates clearly and effectively with patients, families, and other health care team members. |

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|Demonstrates acceptable level of English writing speaking through term papers, round, and feedback in assessment sessions. |

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|Develops professional English writings and speaking through involvement in language workshops, seminars, and courses designed for this purpose. |

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|*Develops collaborative intra and interdisciplinary roles designed to meet the needs of acutely ill clients. |

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|Collaborates with other health care team members in the provision of quality health care for their patients. |

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|Participates in grand rounds, meetings, board, and any other activities relevant to patient care. |

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|Educate staff nurses and other health care team members about advances in the nursing professions |

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|Appendix 2 |

|Case Study Presentation (10%) |

|Each student selects a patient with cardiopulmonary or oncology health disruptions and presents the case in the class. She/he should address the |

|patients case' key points in terms of assessment, pathophysiological alterations, human responses, or intervention strategies. The key points of the|

|case should match a topic from the theory component the student selects. The student should compare and contrast between the patient case and key |

|points extracted from the assigned readings of the selected topic. |

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|Evaluation criteria of the presentation |

|5 Outstanding |

|4 |

|3 Average |

|2 |

|1 Poor |

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|Key data of the case are comprehensive |

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|Ability to analyze and interpret patient data |

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|Infer accurate human responses using clear and logical reasoning |

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|Discuss management principles with a clear rationale |

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|Compare and contrast alternative intervention approaches using research-based evidence |

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|Integrate research into the discussion |

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|Presented clearly |

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|Presented in logical coherence manner |

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|Compare and contrast between literature and practice |

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|Illustration and use of teaching aids |

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|Appendix 3 |

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|Literature review paper: Guidelines (15%) |

|Identify a patient-related clinical issue (e.g. patients' response to illness or therapy, nursing intervention strategy). Then review the literature|

|specific to the identified issue. The review should reflect a scholarly writing in terms of knowledge, analysis, originality, synthesis, and |

|structure and organization. The content should include: significance of the issue; structured, logical, and organized discussion and understanding |

|of the current literature; research based conclusion; and recommendations for future research. |

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|The paper should be written as a manuscript for a specific nursing journal selected by the student. The student is expected to engage in the process|

|of preparing and submitting a journal manuscript. The paper should not exceed 15 double spaced pages excluding illustrations, tables, figures, and |

|references. |

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|Criteria for evaluation the literature review paper. |

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|5 Outstanding |

|4 |

|3 average |

|2 |

|1 poor |

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|Knowledge |

|1.Used accurate knowledge |

|2.Used relevant knowledge |

|3.Used updated knowledge |

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|Comprehension |

|1.Extrapolate the key points from the literature |

|2. Clear explanation and interpretation of the key points |

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|Applications |

|1.Concepts discussed are related to real life situations |

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|Analysis |

|pare and contrast a variety of views from literature and practice |

|2.Distinguish important from less important aspects of the issue |

|3.The argument is developed in a coherent, logical, well balanced and sequential manner |

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|Synthesis |

|1.Draw clear and logical conclusions |

|2.Itegrate examples from literature and practice |

|3.Evidence of creativity and independent thinking |

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|Evaluation |

|1.Identifying areas for future development in research, practice and education |

|2. Make research/practice-based generalizations |

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|Presentation |

|1.Planning and structure/organization of the content |

|2.Content is presented in an ordered logical manner |

|3.Accurately acknowledge previous authors |

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|Manuscript preparation |

|1. Appropriateness of the journal selected |

|2.Letter to the editor |

|3. Compliance with Journal guidelines: organization, citation, references |

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|Grading Criteria for Participation and Involvement |

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|Students learn through participation and positive involvement in class activities. Students are expected to participate effectively in all class |

|activities. Participation and involvement will be graded based on the following criteria: |

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|1. Meeting modules' expectations including participation in discussions, activities and answering questions as required. |

|. |

|2. Values time commitment and respect others' time commitments; meets |

|deadlines. |

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|3. Extent of effective participation in class discussions, including online discussions if applicable. |

|. |

|4. Appropriateness of the share of contribution to class discussions and activities |

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|5. Use of clear communication |

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|6. Foster a positive learning climate, and is an effective team member (Extent of respect to class manners does not cause any disruption to class |

|activities and discussions). |

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|7. Extent of preparation as demonstrated in class activities (shows evidence of reading assigned materials |

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|8. Extent of interpreting and analyzing reading materials (more than just memorizing facts). |

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|9. Enthusiasm and interest (attempts to respond and cooperate with others during class activities). |

|. |

|10. Usefulness of contributions (valuable suggestions, appropriate clarifications, constructive criticisms). |

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|11. Use of appropriate logical interpretation of issues and use critical thinking (focus on significant aspects of issue or problem and can examine |

|issues from different angles). |

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