Merced College Registered Nursing 34: Advanced Medical/Surgical Nursing and Pediatric Nursing

Merced College Registered Nursing 34: Advanced Medical/Surgical Nursing and Pediatric Nursing Course Description, Student Learning Outcomes and Competencies, Clinical Evaluation Tool, and Clinical Activities Portfolio Prepared by Linda Caputi, MSN, EdD, RN, ANEF, CNE June, 2012 T:\RN LVN Nursing\MyFiles\Nursing\RN\Forms\Clinical Eval\REGN 34_Clinical_Portfolio.doc 1

Course Student Learning Outcomes and Competencies The following course student learning outcomes and competencies represent the overall behaviors the student is to accomplish by the end of the course. They will build throughout the program to culminate in the program student learning outcomes and competencies. The individual weeky units taught in the classroom specify the specific content to be taught. As that content is taught it should be connected to the course student learning outcomes and competencies; this puts the weekly lesson content into the bigger perspective of your curriculum strucuture. The same is true for the clinical experience. Therefore, the clinical evaluation tool (CET) is developed based on these course student learning outcomes and competencies. Included with the CET are clinical activities for each competency that provide students an opportunity to demonstrate their ability to achieve that particular competency. This provides validity to the CET. Grading rubrics are used for each activity so all faculty are grading students using the same criteria and all students are aware of the criteria used to grade them. This provides reliability to the CET. Grading rubrics are included, but faculty should review these and revise if they believe the expected level of behaviors should be higher or lower than indicated. Students keep all the activities for the course in a 3 ring binder known as a clinical activity portfolio. Each of the 6 course outcomes can be divided into sections with a page divider then all the activities for the competencies for each of the outcomes are contained in the section for each that outcome. Some of the activities may be completed as students provide traditional patient care. However, some of them may be carried out as the only assignment for the day. Often two students work together on an activity then discuss their findings in postconference. It is most helpful to complete these clinical activities during clinical time with feedback from the faculty during clinical time. This promotes active learning in the context of the environment and the patient. Students can be asked to correct any errors T:\RN LVN Nursing\MyFiles\Nursing\RN\Forms\Clinical Eval\REGN 34_Clinical_Portfolio.doc 2

while still in the environment where the information resides and with the faculty available for feedback and discussion. Please feel free to add, delete, or revise any of the clinical portfolio activities. Nursing 34: Advanced Medical/Surgical Nursing and Pediatric Nursing Registered Nursing 34 builds on REGN 24, focusing on complex medical/surgical conditions of the adult patient and common pediatric conditions. Builds on nursing theory, communication, collaboration, and critical thinking skills necessary for safe, patient centered nursing care to developmentally and culturally diverse adult and pediatric patient populations. Incorporates best practices, professional standards, and legal and ethical responsibilities of the professional nurse as applied in the acute care and pediatric settings. Includes acquisition of nursing skills required in the acute care and pediatric settings. Application of knowledge and skills occurs in the nursing skills laboratory and clinical settings. Registered Nursing 34 Course Outcomes 1. Apply medical/surgical nursing concepts to plan patient centered, evidence based care to pediatric patients and patients with complex medical/surgical conditions taking into consideration individual differences, developmental level, and culture. 2. Engage in collaboration with members of the interdisciplinary team when caring for pediatric patients and patients with complex medical/surgical conditions. 3. Demonstrate critical thinking and clinical reasoning when addressing patient care issues for pediatric patients and patients with complex medical/surgical conditions. 4. Differentiate various roles of leadership and how they impact patient care and quality improvement for pediatric patients and patients with complex medical/surgical conditions. 5. Demonstrate ways information technology can be used to increase safety and quality when caring for pediatric patients and patients with complex medical/surgical conditions. 6. Interpret ways in which professional standards of legal and ethical conduct are required for safe, quality care of pediatric patients and patients with complex medical/surgical conditions. Course Outcomes and Competencies 1. Apply medical/surgical and pediatric nursing concepts to plan patient centered, evidence based care to pediatric patients and patients with complex medical/surgical conditions taking into consideration individual differences, developmental level, and culture. Relate physiological processes that require medical/surgical interventions to nursing care for adult and pediatric patients. T:\RN LVN Nursing\MyFiles\Nursing\RN\Forms\Clinical Eval\REGN 34_Clinical_Portfolio.doc 3

Apply medical/surgical nursing concepts to plan compassionate, patient centered, evidence based care taking individual differences including growth and developmental stages into consideration. Conduct a comprehensive and focused physical, behavioral, psychological, spiritual assessment of pediatric patients and patients with complex medical/surgical conditions, eliciting patient values, experiences, and expressed needs. Plan holistic, patient centered care that reflects psychosocial integrity, physiological integrity, and health promotion and maintenance for pediatric patients and patients with complex medical/surgical conditions within a variety of healthcare systems. Perform psychomotor skills for the efficient, safe, and compassionate delivery of nursing care to pediatric patients and patients with complex medical/surgical conditions. Deliver care within expected timeframe. Monitor patient outcomes, including interpretation of assessment data and appropriate follow up, to evaluate the effectiveness of nursing interventions for pediatric patients and patients with complex medical/surgical conditions. Analyze the clinical microsystem of the medical surgical and pediatric units. Apply quality measures when evaluating effects of medical surgical and pediatric nursing interventions appropriate to the care environment. Create a culture of caring for the patient and the patient s support network. Communicate effectively with the patient and the patient s support network. Communicate effectively when reporting care provided and evaluation data including appropriate handoff reports. Evaluate own level of communication skills in encounters with patients, families, children, and other healthcare providers. Employ patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and level of health literacy for pediatric patients and patients with complex medical/surgical conditions. Evaluate effectiveness of patient teaching to pediatric and adult patients and families experiencing high acuity medical/surgical interventions. Plan, implement, and evaluate evidence based care based on the components of research evidence, clinical expertise, and patient/family values. 2. Engage in collaboration with members of the interdisciplinary team when caring for pediatric patients and patients with complex medical/surgical conditions. Use effective communication techniques that produce positive professional working relations in the medical surgical and pediatric environments when caring for pediatric patients and patients with complex medical/surgical conditions. Interact with members of the healthcare team to plan patient care based on patient values, preferences, and expressed needs for pediatric patients and patients with complex medical/surgical conditions. Collaborate with the patient, the patient s support network, and other members of the healthcare team to evaluate progress toward achievement of outcomes. T:\RN LVN Nursing\MyFiles\Nursing\RN\Forms\Clinical Eval\REGN 34_Clinical_Portfolio.doc 4

Analyze the nurse s role in decision making related to pediatric patients and patients with complex medical/surgical conditions. Examine examples of conflict on the medical/surgical and pediatric units and describe possible resolutions. Incorporate own role as a member of the interdisciplinary healthcare team when working with pediatric patients and patients with complex medical/surgical conditions. Relate ways the interdisciplinary team functioning impacts safety and quality improvement for pediatric patients and patients with complex medical/surgical conditions. 3. Demonstrate critical thinking and clinical reasoning when addressing patient care issues for pediatric patients and patients with complex medical/surgical conditions. Apply critical thinking/clinical reasoning skills when planning patient care and working with pediatric patients and patients with complex medical/surgical conditions. Demonstrate ambiguity and unpredictability when caring for pediatric patients and patients with complex medical/surgical conditions. Interpret and correctly implement physician and inter professional orders for pediatric patients and patients with complex medical/surgical conditions. Anticipate risks and predict and manage potential complications that may occur when caring for pediatric patients and patients with complex medical/surgical conditions. Prioritize patient care activities. Identify gaps between local and best practice. Identify errors and ways to improve the healthcare system. 4. Differentiate various roles of leadership and how they impact patient care and quality improvement for pediatric patients and patients with complex medical/surgical conditions. Apply the delegation process in the care of pediatric patients and patients with complex medical/surgical conditions. Compare and contrast the differences in the provision of patient care among various pediatric patients and patients with complex medical/surgical conditions. Compare and contrast the nursing leadership and its effect on a medical surgical and pediatric unit. Adapt the provision of patient care to changing healthcare setting and management system required for the safe care of pediatric patients and patients with complex medical/surgical conditions. Describe the quality improvement processes on a pediatric and medical surgical unit used to effectively implement patient safety initiatives and monitor performance measures. Apply the National Patient Safety Goals to patients on a pediatric and medicalsurgical unit and identify any areas in need of improvement. T:\RN LVN Nursing\MyFiles\Nursing\RN\Forms\Clinical Eval\REGN 34_Clinical_Portfolio.doc 5

5. Demonstrate ways information technology can be used to increase safety and quality when caring for pediatric patients and patients with complex medical/surgical conditions. Maintain organizational and patient confidentiality. Use the clinical information system on the pediatric and medical surgical unit for safe nursing practice. Analyze the role of information technology in improving patient care outcomes and creating a safe care environment on the pediatric medical surgical unit. Use high quality electronic sources of healthcare information. 6. Interpret ways in which professional standards of legal and ethical conduct are required for safe, quality care of pediatric patients and patients with complex medical/surgical conditions. Apply rules and regulations that authorize and define professional nursing practice related to the care of pediatric patients and patients with complex medical/surgical conditions and their families. Demonstrate professional standards of moral, ethical, and legal conduct when providing care for pediatric patients and patients with complex medical/surgical conditions and their families. Assume accountability for own behaviors, including a recognition for when to ask for assistance. Practice within the parameters of individual knowledge and experience. T:\RN LVN Nursing\MyFiles\Nursing\RN\Forms\Clinical Eval\REGN 34_Clinical_Portfolio.doc 6

Registered Nursing 34: Advanced Medical/Surgical Nursing and Pediatric Nursing: Mid term and Final Clinical Evaluation Tool Scoring Sheet Student: Clinical Faculty: S = Satisfactory NI = Needs Improvement U = Unsatisfactory (Must be Satisfactory by final evaluation) Course Outcome 1. Apply medical/surgical and pediatric nursing concepts to plan patientcentered, evidence based care to pediatric patients and patients with complex medical/surgical conditions taking into consideration individual differences, developmental level, and culture. a. Relate physiological processes that require medical/surgical interventions to nursing care for adult and pediatric patients. b. Apply medical/surgical nursing concepts to plan compassionate, patientcentered, evidence based care taking individual differences including growth and developmental stages into consideration. c. Conduct a comprehensive and focused physical, behavioral, psychological, spiritual assessment of pediatric patients and patients with complex medical/surgical conditions, eliciting patient values, experiences, and expressed needs. d. Plan holistic, patient centered care that reflects psychosocial integrity, physiological integrity, and health promotion and maintenance for pediatric patients and patients with complex medical/surgical conditions within a variety of healthcare systems. e. Perform psychomotor skills for the efficient, safe, and compassionate delivery of nursing care to pediatric patients and patients with complex medical/surgical conditions. f. Deliver care within expected timeframe. g. Apply quality measures when evaluating effects of medical surgical and pediatric nursing interventions appropriate to the care environment. h. Create a culture of caring for the patient and the patient s support network. Midterm Grade Final Grade S NI U S U Evaluation Tool a. Pathophysiology of a Disease Process and Planning Table b, c. Collecting data for Patient Centered Care d. No tool for this competency; completed with 1a e. Psychomotor Skills Reflection Sheet f. No tool for this competency; faculty observation. g. Evidence based Care with the RN h. Create a Caring Outcome Grid Course Outcome Midterm Grade Final Grade Evaluation Tool 7

i. Communicate effectively when reporting care provided and evaluation data including appropriate handoff reports. j. Evaluate own level of communication skills in encounters with patients, families, children, and other healthcare providers. Employ patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and level of health literacy for pediatric patients and patients with complex medical/surgical conditions. k. Communicate effectively with the patient and the patient s support network. Evaluate effectiveness of patient teaching to pediatric and adult patients and families experiencing high acuity medical/surgical interventions. l. Plan, implement, and evaluate evidence based care based on the components of research evidence, clinical expertise, and patient/family values. 2. Engage in collaboration with members of the interdisciplinary team when caring for pediatric patients and patients with complex medical/surgical conditions. a. Use effective communication techniques that produce positive professional working relations in the medical surgical and pediatric environments when caring for pediatric patients and patients with complex medical/surgical conditions. b. Interact with members of the healthcare team to plan patient care based on patient values, preferences, and expressed needs for pediatric patients and patients with complex medical/surgical conditions. c. Examine examples of conflict on the medical/surgical and pediatric units and describe possible resolutions. d. Relate ways the interdisciplinary team functioning impacts safety and quality improvement for pediatric patients and patients with complex medical/surgical conditions. S NI U S U i. SBAR Patient Report j, k. Patient Teaching Tool l. Using Evidence Based Guidelines Evaluation of Skills Performance Tool a. Communication as Perceived by the Patient b. Teamwork for Planning Care c. Conflict Resolution d. Informed Consent 8

Course Outcome 3. Demonstrate critical thinking and clinical reasoning when addressing patient care issues for pediatric patients and patients with complex medical/surgical conditions. a. Apply critical thinking/clinical reasoning skills when planning patient care and working with pediatric patients and patients with complex medical/surgical conditions. b. Demonstrate ambiguity and unpredictability when caring for pediatric patients and patients with complex medical/surgical conditions. c. Interpret and correctly implement physician and inter professional orders for pediatric patients and patients with complex medical/surgical conditions. d. Anticipate risks and predict and manage potential complications that may occur when caring for pediatric patients and patients with complex medical/surgical conditions. e. Prioritize patient care activities. f. Identify gaps between local and best practice. g. Identify errors and ways to improve the healthcare system. 4. Differentiate various roles of leadership and how they impact patient care and quality improvement for pediatric patients and patients with complex medical/surgical conditions. a. Apply the delegation process in the care of pediatric patients and patients with complex medical/surgical conditions. b. Compare and contrast the nursing leadership and its effect on a medicalsurgical and pediatric unit. c. Adapt the provision of patient care to changing healthcare setting and management system required for the safe care of pediatric patients and patients with complex medical/surgical conditions. d. Describe the quality improvement processes on a pediatric and medicalsurgical unit used to effectively implement patient safety initiatives and monitor performance measures. e. Apply the National Patient Safety Goals to patients on a pediatric and medical surgical unit and identify any areas in need of improvement. Midterm Grade Final Grade S NI U S U Evaluation Tool a, b, c. Applying Critical Thinking d, e. Predict and Manage Potential Complications f, g. The Joint Commission's Roadmap for Hospitals a. Delegation Tool b. Nursing Leadership and Safe, Quality Patient Care c. Adapting Care d. Nursing Sensitive Quality Indicators e. National Patient Safety Goal Activity Course Outcome Midterm Grade Final Grade S NI U S U Evaluation Tool 9

5. Demonstrate ways information technology can be used to increase safety and quality when caring for pediatric patients and patients with complex medical/surgical conditions. a. Use the clinical information system on the pediatric and medical surgical unit for safe nursing practice. b. Analyze the role of information technology in improving patient care outcomes and creating a safe care environment on the pediatric medicalsurgical unit. c. Use high quality electronic sources of healthcare information. 6. Interpret ways in which professional standards of legal and ethical conduct are required for safe, quality care of pediatric patients and patients with complex medical/surgical conditions. a. Apply rules and regulations that authorize and define professional nursing practice related to the care of pediatric patients and patients with complex medical/surgical conditions and their families. b. Demonstrate professional standards of moral, ethical, and legal conduct when providing care for pediatric patients and patients with complex medical/surgical conditions and their families. c. Assume accountability for own behaviors, including a recognition for when to ask for assistance. d. Practice within the parameters of individual knowledge and experience. a, b. Using the Clinical Information System c. Electronic Sources of Healthcare Information a, b. Moral, Ethical, Legal, and Professional Standards Observation Rubric c, d. Accountability Observation Rubric Additional Comments: 10

REGN 34 Grade C.T. Tool Completion Expired Immunization Skills Check Off Clinical Performance: REGN 34 Grade C.T. Tool Completion Expired Immunization Skills Check Off Clinical Performance: Signatures: Midterm Evaluation Date: Signatures: Final Evaluation Date: Student Student Faculty Faculty 11

The following pages contain the Clinical Activity Portfolio Tools for Advanced Medical/Surgical Nursing and Pediatric Nursing Course Student Learning Outcome #1. Course Student Learning Outcome #1: Apply medical/surgical and pediatric nursing concepts to plan patient centered, evidencebased care to pediatric patients and patients with complex medical/surgical conditions taking into consideration individual differences, developmental level, and culture. 12

Course Student Learning Outcome #1, Competency: a. Relate physiological processes that require medical/surgical interventions to nursing care for adult and pediatric patients. Tools: Pathophysiology of a Disease Process and Planning Table 13

Medical Surgical Patient Pathophysiology of a Disease Process and Planning Table Pathophysiology Medications & Treatments Disease *** START HERE *** Risk Factors Signs & Symptoms/ Risk Factors Nursing Diagnoses Diagnostic Tests 14

Using the information in the previous tools, answer the following questions: What care will you plan related to the patient s level of growth and development? What care will you provide related to the pathophysiology? What care will you provide related to pharmacology? What care will you provide related to the medical management of this patient? What evidence based nursing interventions will you plan into the patient's care? Then, complete this Planning Table: Nursing interventions Related to the above Questions Expected outcomes from the nursing interventions for THIS patient 15

Grading Rubric for Planning Table Performance Level S NI U Plans nursing interventions based on completed tools. Analyzes data and derives expected outcomes based on individual patient data. Identifies > 5 nursing interventions based on completed tools. Develops > 3 expected outcomes based on individual patient data. Identifies 3 4 nursing interventions based on completed tools. Develops 1 or 2 expected outcomes based on individual patient data. Identify less than 2 nursing interventions based on completed tools. Unable to develop expected outcomes based on individual patient data. 16

Course Student Learning Outcome #1, Competencies: b. Apply medical/surgical nursing concepts to plan compassionate, patient centered, evidence based care taking individual differences including growth and developmental stages into consideration. c. Monitor patient outcomes, including interpretation of assessment data and appropriate follow up, to evaluate the effectiveness of nursing interventions for pediatric patients and patients with complex medical/surgical conditions. Tool: Collecting data for patient centered care Assignment: Students in all areas of care should review the patient s chart. Review the patient s history and related conditions. Address the following with patient data: Medical/Surgical Pediatrics Age of the patient Cultural background, beliefs, Socioeconomic status Approach to nursing care based on: Behaviors that are age and developmental level appropriate, those that are not Acute & Chronic conditions Extent of family involvement: who is present? How much involvement does that person have with the patient? Is that person close, distant, wanting to learn? 17

Approach to teaching based on patient/family characteristics How will you individualize the care for your patient based on this data? Compare and contrast the care of similar cases. What was done the same? What was done differently and why? Type of medical insurance, any limitations related to medical insurance 18

Rubric for Collecting Data for Patient Centered Care Performance Level S NI U Compare and contrast care of Able to compare and contrast similar cases care of similar cases Able to correctly compare and contrast care of similar cases with some of the information, but not all information. Unable to compare and contrast care of similar cases 19

Course Student Learning Outcome #1, Competency: e. Perform psychomotor skills for the efficient, safe, and compassionate delivery of nursing care to pediatric patients and patients with complex medical/surgical conditions. Tool: Psychomotor Skills Reflection Sheet Date Skill Oral Medications How the performance of this skill varied from the textbook explanation and why the adaptation was needed. How performance of this skill varied for the pediatric patient. How I believe I performed. Ways I can improve. LPAT I.V. Medications 20

Rubric for the Psychomotor Skills Reflection Sheet Performance Criteria S NI U Demonstrates competent and safe nursing care. Clearly describes how the psychomotor skill was performed, evaluates self performance, and offers 2 ways for improvement. Able to describe how the psychomotor skills was performed but with limited insight to problems on self performance. Offers one way to improve performance. Descriptions of performance of psychomotor skills are scant and unorganized. Does not offer ways to improve future performance. 21

Course Student Learning Outcome #1 Competency: g. Apply quality measures when evaluating effects of medical surgical and pediatric nursing interventions appropriate to the care environment. Tool: Evidence based care with the RN Activity: 1. Work with your staff RN leader. 2. The student will observe the RN performing one nursing intervention (e.g. changing a dressing, educating a patient on a specific topic, assessing one or more vital signs). Students are encouraged to NOT make medication administration a focus of this activity. 3. As soon as possible after the observation, ask the RN the questions listed in the box below. Be sure to be non judgmental and thank the RN for assisting you with this activity. You might also offer to share the conclusions from the class discussion on this topic after it occurs. 4. Locate and review the policies, procedures or standards available in that clinical setting related to the intervention you observed and answer the second set of questions listed below. Are there policies/protocols/procedures that define practice standards for this intervention? Are there references to research or evidence used to determine the standards? Did the RN you observed perform the intervention according to those standards? 5. Using the information search strategies you have learned previously, locate the best published evidence regarding recommendations related to the intervention you observed and complete the third set of questions below. How difficult was it for you to locate quality, relevant, timely evidence? How do the policies/protocols/procedures compare with the best evidence you located? How does the observed RN s performance compare with the best evidence you located? 6. Reflect on your activity by answering: What did you learn? How will you use the lessons learned? What more do you need to learn about evidence based nursing practice? How does this evidence based practice experience relate to quality improvement? What quality improvement processes are used on the pediatric unit? How do they relate to patient safety? 22

Rubric for Evidence based care with the RN in Pediatric Rotation Performance Level S NI U Tool completion. All areas of the tool are Able to, but not all, areas of Unable to complete the tool. completed. the tool are completed. Relates the evidence based practice interventions to quality improvement. Able to relates the evidencebased practice interventions to quality improvement. Makes some relationship but not complete. Unable to relates the evidencebased practice interventions to quality improvement. Rubric for Evidence based care with the RN in Medical/Surgical Rotation Performance Level S NI U Tool completion. All areas of the tool are Able to, but not all, areas of Unable to complete the tool. completed. the tool are completed. Relates the evidence based practice interventions to quality improvement. Able to relates the evidencebased practice interventions to quality improvement. Makes some relationship but not complete. Unable to relates the evidencebased practice interventions to quality improvement. 23

Course Student Learning Outcome #1 Competency: h. Create a culture of caring for the patient and the patient s support network. Tool: Create a Caring Outcome Grid Observe the workings of the unit and the interactions of the RN and staff with the patient and the patient s response. Indicator of Caring Behaviors Example of the caring behavior by the nurse/staff Examples of violations of the caring behavior by the nurse/staff Compare and contrast the caring environment of the Medical/Surgical unit with the Pediatric unit Med/Surg. Pediatrics 24

Rubric for Create a Caring Outcome Grid Pediatrics Performance Level S NI U Answers all questions on the Accurately answers all Able to answer some, but not Unable to accurately answers tool. questions on the tool. all, of the questions on the all questions on the tool. Compares the medical/surgical unit with the pediatric unit. Completely and accurately compares the medical/surgical unit with the pediatric unit. tool. Makes some comparisons but misses some important aspects. Unable to compare the medical/surgical unit with the pediatric unit. Rubric for Create a Caring Outcome Grid Medical/Surgical Performance Level S NI U Answers all questions on the Accurately answers all Able to answer some, but not Unable to accurately answers tool. questions on the tool. all, of the questions on the all questions on the tool. Compares the medical/surgical unit with the pediatric unit. Completely and accurately compares the medical/surgical unit with the pediatric unit. tool. Makes some comparisons but misses some important aspects. Unable to compare the medical/surgical unit with the pediatric unit. 25

Course Student Learning Outcome #1 Competency: i. Communicate effectively when reporting care provided and evaluation data including appropriate handoff reports. Tool: SBAR Patient Report Situation Include basic demographics about your patient; name, ethnicity. age, gender, and pertinent information about the patient s condition/situation. Include patient preferences. Background patient s admitting diagnosis, hospital day, medical history that might complicate her current admission, any data about what has led up to any problems the patient is currently experiencing. Assessment Signs and symptoms that are related to patient s diagnosis, including vital signs, O2 Sats, and any other pertinent assessment data. Patient Name: Code Status: VS: Outputs: IVs/fluids: Abnormal/concerns: Pertinent background information affecting the patient s current condition. Other history that is also present and may or may not affect current condition but needs to be considered. Mental Status: Alert and oriented Confused Cooperative or non cooperative Agitated or combative Lethargic but conversant and able to swallow Stuporous and not talking clearly and possibly not able to swallow Comatose. Eyes closed. Not responding to stimuli Skin: 26

Should correlate with the information on the signs and symptoms tools. Recommendations Include what you have done and the patient s response. Warm and dry Pale Mottled Diaphoretic Extremities are cold Extremities are warm Patient is or is not on oxygen: L/min or oxygen for min(hrs) Pulse ox reading What you think the problem is: The pt is Stable, unstable, getting worse I suggest that you: Any diagnostic labs/test needed/pending: Need to notify the physician or primary healthcare provider: 27

Grading Rubric for the SBAR Patient Report Performance Criteria S NI U Informs responsible staff member of patient status. Clearly completes the SBAR report for a patient. All criteria are documented on and are easy to understand and follow. Clearly completes portions of the SBAR report for a patient. Some criteria do not have documentation and/or and are not easy to read. The SBAR report is scant and/or unorganized. It is difficult to understand. 28

Course Student Learning Outcome #1 Competencies: j. Employ patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and level of health literacy for pediatric patients and patients with complex medical/surgical conditions. k. Evaluate effectiveness of patient teaching to pediatric and adult patients and families experiencing high acuity medical/surgical interventions. Tool: Patient Teaching Tool Refer to your pathophysiology tool. Plan teaching related to the needs identified on your concept map?. What modifications will you need to make related to your teaching methods based on the patient s developmental stage, age, culture, preferences, and level of health literacy? Teach your patient. Was your teaching effective? If so, how do you know? If no, how do you know and what will you do? 29

Grading Rubric for the Patient Teaching Tool Performance Level S NI U Identifies teaching In depth explanation of needs. patient's learning needs. Explanation includes some but not all of patient's learning needs. Brief explanation of patient's learning needs. Explains modifications to teaching based on patient's developmental stage, age, culture, spirituality, patient preferences, and level of health literacy. In depth explanation of necessary modifications to teaching based on patient's developmental stage, age, culture, spirituality, patient preferences, and level of health literacy. Explanation includes some but not all necessary modifications to teaching based on patient's developmental stage, age, culture, spirituality, patient preferences, and level of health literacy. Brief explanation of necessary modifications to teaching based on patient's developmental stage, age, culture, spirituality, patient preferences, and level of health literacy. Evaluates effectiveness of teaching. In depth explanation of effectiveness of teaching. Explanation includes some but not all issues related to the effectiveness of teaching. Brief explanation of the issues related to the effectiveness of teaching. 30

Course Student Learning Outcome #1 Competency: l. Plan, implement, and evaluate evidence based care based on the components of research evidence, clinical expertise, and patient/family values. Tools: Using Evidence Based Guidelines: Core Measure Sets The Joint Commission: i.e., VTE, PNE, HF, MI Individualize care based on best current evidence in practice and patients /families preferences and values. Describe reliable sources for locating evidence reports and clinical practice guidelines. Activity: Access an Internet source used by the agency to locate a national agency with guidelines related to your patient (ie, American Heart Association Guidelines, American Diabetes Association, etc.) Access the agency s Intranet source they have for clinical guidelines. Select the pertinent guidelines. Review your textbook related to care for this patient Review the appropriate guidelines with the patient s chart to see how closely the guidelines are followed. Note if there are variances and find our why there are variances. Key recommendations of guidelines Adherence to guidelines or variation Reasons for variance (Pt preference, physical or other conditions) RN responsibility to patient and his or her prescribed plan of care 31

Grading Rubric for Using Evidence Based Guidelines Performance Criteria S NI U Completed table with information from evidence based guidelines Completed all aspects of table noting evidencebased guidelines. Completed some, but not all, aspects of table. Able to note evidence based guidelines. Unable to complete the table and unable to located evidence based guidelines. 32

The following pages contain the Clinical Activity Portfolio Tools for Advanced Medical/Surgical Nursing and Pediatric Nursing Course Student Learning Outcome #2. Course Student Learning Outcome #2: Engage in collaboration with members of the interdisciplinary team when caring for pediatric patients and patients with complex medical/surgical conditions. 33

Course Outcome #2 Competency: a. Use effective communication techniques that produce positive professional working relations in the medical surgical and pediatric environments when caring for pediatric patients and patients with complex medical/surgical conditions. Tool: Communication as Perceived by the Patient This tool reflects information from HCAHPS, which stands for Hospital Consumer Assessment of Health Providers and Systems which is a government survey for measuring patient satisfaction at hospitals across the country. The HCAHPS survey provides information from the patient s perspective regarding hospital care, including communication among the healthcare team. This tool builds on the work of HCAHPS and focuses on communication: Interview direct care RN or Unit Manager regarding continuous efforts to improve patient satisfaction. o How can nurses improve communication with the patient and with other healthcare providers. o What are the barriers to communication and how can they be managed? o How can patients be reassured of staff responsiveness? o How can student nurses assist with patient satisfaction related to communication? o What role does the "Patient Board" play in clear communication that results in positive professional working relations? o What lessons can you derive from the above answers that you can use to improve your practice as a nurse? 34

Grading Rubric for the Communication as Perceived by the Patient Performance Criteria S NI U Questions answered Answered all questions clearly and completed. Answered most questions clearly and completed. Unable to answer all questions. Lessons learned Lessons learned are clear, practical, and easy to implement. Lessons learned are superficial and/or not necessarily helpful. Unable to draw conclusions related to lessons learned. 35

Course Outcome #2 Competency: b. Interact with members of the healthcare team to plan patient care based on patient values, preferences, and expressed needs for pediatric patients and patients with complex medical/surgical conditions. Tool: Teamwork Collaboration for Planning Interdisciplinary Care Answer the following questions considering how they relate to the healthcare team working to plan patient care based on the individual patient. 1. Who are the members in the interdisciplinary care team? 2. How can the team improve the patient s hospital stay (i.e., safety, quality, satisfaction) based on information gathered in number one? 3. What safety considerations come to mind given this patient s age, developmental level, current diagnosis, medical history, and problems? 4. How can other members of the healthcare team contribute toward enhancing the patient s hospital experience? 5. What lessons can be derived from the above relating to planning care that focuses on the individual patient's needs? 36

Grading Rubric for the Teamwork for Planning Care Performance Criteria S NI U Questions answered Answered all questions clearly and completed. Answered most questions clearly and completed. Unable to answer all questions. Lessons learned Lessons learned are clear, practical, and easy to implement. Lessons learned are superficial and not necessarily helpful. Unable to draw conclusions related to lessons learned. 37

Course Outcome #2 Competencies: c. Examine examples of conflict on the medical/surgical and pediatric units and describe possible resolutions. Tool: Conflict Resolution Interview a Nurse and One Other Healthcare Provider to Identify An Area of Conflict on the Unit Ask the Nurse and Healthcare Professional How the Conflict was Resolved Observe the Interactions of the Healthcare Professionals on the Unit What Conflicts did you Observe and How were they Handled or Not Handled Compare and Contrast Your Findings on the Two Units: Pediatric and Medical/Surgical Units Med/Surg. Pediatrics 38

Grading Rubric for the Conflict Resolution Medical Surgical Performance Criteria S NI U Conflict identified on the unit. Clearly describes a conflict on Description of a Unable to describe any the unit. conflict on the unit are conflicts on the unit. Suggestions for how to resolve the conflict. Compares the medical/surgical unit with the pediatric unit. Clearly and accurately describes solutions for resolving the identified conflict. Completely and accurately compares the medical/surgical unit with the pediatric unit. is vague and unclear. Identifies some but not all possible solutions for resolving the identified conflict. Makes some comparisons but misses some important aspects. Grading Rubric for the Conflict Resolution Pediatric Unable to describe solutions for resolving the identified conflict. Unable to compare the medical/surgical unit with the pediatric unit. Performance Criteria S NI U Conflict identified on the unit. Clearly describes a conflict on Description of a Unable to describe any the unit. conflict on the unit are conflicts on the unit. Suggestions for how to resolve the conflict. Compares the medical/surgical unit with the pediatric unit. Clearly and accurately describes solutions for resolving the identified conflict. Completely and accurately compares the medical/surgical unit with the pediatric unit. is vague and unclear. Identifies some but not all possible solutions for resolving the identified conflict. Makes some comparisons but misses some important aspects. Unable to describe solutions for resolving the identified conflict. Unable to compare the medical/surgical unit with the pediatric unit. 39

Course Outcome #2 Competency: d. Relate ways the interdisciplinary team functioning impacts safety and quality improvement for pediatric patients and patients with complex medical/surgical conditions. Tool: Informed Consent Assure the patient has given informed consent for treatment. (Informed consent requires team of the nurse and other professionals working together to ensure safe performance of a procedure that requires consent from the patient or the patient s guardian.) Answer the following Questions: 1. Who is legally responsible to educate and discuss the risks and benefits to the patient? 2. Who is legally eligible to sign consent? 3. What considerations come into play for a minor, under age 18, signing consent? 4. When a patient is admitted to a hospital what consent forms are obtained? 5. When a nurse witnesses consent what does it indicate? 40

Grading Rubric for Informed Consent Performance Criteria S NI U Identifies the nurse's role on the interdisciplinary team related to informed consent. Describes how team functioning impacts patient outcomes related to safety and quality improvement measures. Clearly and accurately describes the nurse's role on the interdisciplinary team related to informed consent. Clearly and accurately describes how team functioning impacts patient outcomes related to safety and quality improvement measures. Identifies some but not all roles of the nurse on the interdisciplinary team related to informed consent. Identifies some but not all ways team functioning impacts patient outcomes related to safety and quality improvement measures. Unable to describe the nurse's role on the interdisciplinary team related to informed consent. Unable to describe how team functioning impacts patient outcomes related to safety and quality improvement measures. 41

The following pages contain the Clinical Activity Portfolio Tools for Advanced Medical/Surgical Nursing and Pediatric Nursing Course Student Learning Outcome #3. Course Student Learning Outcome #3: Demonstrate critical thinking and clinical reasoning when addressing patient care issues for pediatric patients and patients with complex medical/surgical conditions. 42

Course Outcome #3 Competencies: a. Apply critical thinking/clinical reasoning skills when planning patient care and working with pediatric patients and patients with complex medical/surgical conditions. b. Demonstrate ability to deal with ambiguity and unpredictability when caring for pediatric patients and patients with complex medical/surgical conditions. c. Interpret and correctly implement physician and inter professional orders for pediatric patients and patients with complex medical/surgical conditions. Tool: Applying Critical Thinking On another sheet of paper address the following: Introduction: Describe a nursing situation you encountered this week. Background: Describe your relationship to the patient at the time you noticed the situation (e.g., previous contact with patient and /or family, the quality of your relationship). Consider experiences you have had that helped you provide nursing care in this situation. Describe your formal knowledge (e.g., physiology, psychology, communication skills), previous nursing experience with a similar problem, and/or personal experiences that helped guide you as you worked with the patient. Describe your role as the nurse working in this situation. Describe any emotions you had about the situation. What physician/inter professional orders were written focused on this condition and how will you implement nursing actions related to these order? 43

Noticing: What did you notice about the situation initially? Describe what you noticed as you spent more time with the patient and /or family. Interpreting: Describe what you thought about the situation (e.g., its cause, potential resolutions, patterns you noticed). Describe any similar situations you have encountered in practice before. Describe any similarities and differences you observed when compared with the current situation. What other information (e.g., assessment data, evidence) did you decide you needed as you considered the situation? How did you obtain this information? What help with problem solving did you get from your professional partner? Your conclusion: What did your observations and data interpretation lead you to believe? How did they support your response to the situation? Include pertinent pathophysiology and/or psychopathology. Responding: After considering the situation, what was your goal for the patient, family, and /or staff? What was your nursing response, or what interventions did you do? List all actions that you took. Describe stresses you experienced as you responded to the patient or others involved in the situation. Reflection in Action What happened? How did the patient, family and/or staff respond? What did you do next? Reflection on Action and Clinical Learning Describe three ways your nursing care skills expanded during this experience. Name three things you might do differently if you encountered this kind of situation again. What additional knowledge, information and skills do you need when encountering this kind of situation or a similar situation in the future? Describe any changes in your values or feelings as a result of this experience. This reflection tool is adapted from Tanner s Clinical Judgment Model: Tanner, C.A. (2006) Thinking Like a Nurse: A research based model of clinical judgment in nursing. Journal of Nursing Education, 45, 204 211. 44

Rubric for Applying Critical Thinking Pediatrics Performance Criteria S NI U Clear and accurate answers to all questions on tool. Clearly and accurately answers all questions on tool. Clearly and accurately answers some but not all questions on tool. Unable to clearly and accurately answers all questions on tool. Rubric for Applying Critical Thinking Medical/Surgical Performance Criteria S NI U Clear and accurate answers to all questions on tool. Clearly and accurately answers all questions on tool. Clearly and accurately answers some but not all questions on tool. Unable to clearly and accurately answers all questions on tool. 45

Course Outcome #3 Competencies: d. Anticipate risks and predict and manage potential complications that may occur when caring for pediatric patients and patients with complex medical/surgical conditions. e. Prioritize patient care activities. Tool: Predict and Manage Potential Complications For each patient answer these questions: 1. What are you on alert for today with this patient? 2. What are the important assessments to make? 3. What complications may occur? What could go wrong? 4. What interventions will prevent complications? 5. How will you prioritize implementation of nursing interventions? Explain. 46

Rubric for Predict and Manage Potential Complications Pediatrics Performance Criteria S NI U Able to identify the potential Clearly identifies potential Description of potential Unable to identify potential complications. complications. complications for this patient is complications. Able to identify the important assessment data to monitor for this patient. Clearly identifies the important assessment data to monitor for this patient. scant. Description of the important assessment data to monitor for this patient is scant. Unable to identify the important assessment data to monitor for this patient. Able to identify all factors influencing the most important data to monitor. Able to prioritize planned interventions. Clearly identifies all factors influencing the most important data to monitor. Clearly identifies ways to prioritize planned interventions. Description of all factors influencing the most important data to monitor is scant. Superficially discusses ways to prioritize planned interventions. Unable to identify the most important data to monitor. Unable to prioritize planned interventions Rubric for Predict and Manage Potential Complications Medical/Surgical Performance Criteria S NI U Able to identify the potential Clearly identifies potential Description of potential Unable to identify potential complications. complications. complications for this patient is complications. Able to identify the important assessment data to monitor for this patient. Clearly identifies the important assessment data to monitor for this patient. scant. Description of the important assessment data to monitor for this patient is scant. Unable to identify the important assessment data to monitor for this patient. Able to identify all factors influencing the most important data to monitor. Able to prioritize planned interventions. Clearly identifies all factors influencing the most important data to monitor. Clearly identifies ways to prioritize planned interventions. Description of all factors influencing the most important data to monitor is scant. Superficially discusses ways to prioritize planned interventions. Unable to identify the most important data to monitor. Unable to prioritize planned interventions 47