MICHIGAN STATE UNIVERSITY COLLEGE OF NURSING

MICHIGAN STATE UNIVERSITY COLLEGE OF NURSING NUR 822 PRACTICUM FOR THE PRIMARY CARE FAMILY APN I COURSE SYLLABUS CREDITS: 6 Course Chair: Katherine Dontje, R.N., M.S.N., C.S., F.N.P. Fall, 2001 MSU is an Affirmative Action/Equal Opportunity Institution KD/ds NUR822 Fall 2001.Syllabus

TABLE OF CONTENTS COURSE OVERVIEW Page Course Description...1 Course Objectives...1 Instructional Methods...2 Course Evaluation...2 Nursing Interventions...3 Required Text...3 Recommended Text...3 LONG TERM PATIENT EXPERIENCE...4 STUDENT RESPONSIBILITIES...5 SCHEDULE OF CLINICAL CONFERENCES...6 APPENDIX A: CHARTING REQUIREMENTS...7 HANDOUT #4: THE PROBLEM ORIENTED RECORD (POR)...8 APPENDIX B: CLINICAL EVALUATION CRITERIA...9 CLINICAL EVALUATION...10 GRADUATE STUDENT PRECEPTOR EVALUATION...11 CLINICAL EVALUATION SHEETS... 12-13 CLINICAL ACTIVITY LOGS... 14-15 CLINICAL HOURS LOG...16 PATIENT ENCOUNTER LOG...17 KD/ds NUR822 Fall 2001.Syllabus

Course Description COURSE OVERVIEW This course is designed to provide opportunity to integrate assessment skills and apply theory to primary care management of clients across the life span. This will be done within a collaborative model of primary care practice. The emphasis is on developing skills in health promotion, health maintenance, risk reduction strategies and management of common single acute conditions. This will be done for individuals within the context of the family. Documentation will be done in the problem oriented format to facilitate organization of client data. Course Objectives At the completion of this course the student will be able to: (1) Conduct assessments, apply therapeutic reasoning and determine diagnoses when providing primary care to individuals in the context of families related to health promotion, disease prevention and/or single acute primary health conditions. (2) Apply appropriate diagnostic and therapeutic intervention regimens which reflect issues related to safety, cost, simplicity, acceptability and efficacy. (3) Utilize advanced independent nursing interventions when managing clients health/illness states. (4) Initiate strategies to facilitate interdisciplinary team functioning. (5) Integrate applicable conceptual and theoretical frameworks in the development of a comprehensive management plan. (6) Evaluates client outcomes and effectiveness of care of the APN including utilization of nursing languages. (7) Assume leadership in implementing educational strategies appropriate to the individual and/or family outcomes. (8) Utilize the clinical therapeutic reasoning process in the management of individuals including documentation of individual and family assessment data, the medical and nursing diagnoses, the management plan and the individual and/or family outcomes. (9) Provide health promotion and disease prevention services based on age, gender, health risk, ethnicity and cultural background. (10) Analyze client case log data to determine patterns of practice in primary care. (11) Communicate information in an appropriate problem oriented format. (12) Demonstrate progression in level of decision making from preceptor made decision making to student made with preceptor validation. KD.VD/dw/NUR822.Fall2001.Syll.web 1

Instructional Methods Clinical Experience All students will participate in 16 hours of Clinical per week for 14 weeks at their selected agencies guided by a clinical faculty from that agency. The clinical faculty from the College of Nursing will be available for consultation, assistance, and evaluation. The student will provide direct services to patients/families concerning well care, health maintenance and promotion, and management of single acute illness, while utilizing her/his knowledge from independent study, seminar/discussion and focal problems. The clinical experience should provide opportunity to see patients from birth to elderly, including pregnant patients. In providing the above direct services, students will be responsible for: (1) the client history and physical examination, (2) collaboration with clinical faculty and supervising faculty (plus other team members) on the findings and management plan, (3) nursing diagnosis and interventions, and (4) recording on the client record using the S.O.A.P. - P.O.R. method. Recording. Recording will include the subjective and objective findings from the patient, the assessment including the medical and nursing diagnoses, and the management plan, which includes: (1) diagnostic studies, i.e., lab, developmental assessment, etc.; (2) therapeutic measures including medication, counseling, etc.; (3) patient education; (4) outcomes. The student will begin to generate outcome criteria for each management plan and form a master problem list. Students will turn in written documentation on selected patients, as documented in patient record. Documentation will include NIC & NOC as appropriate. Caseload Data. Students are required to collect and record data on all patients they see. The procedure and process for managing caseload data will be presented at the beginning of the semester. The data will be reviewed at midterm and finals weeks. In this manner, numbers and types of patients, and services provided can be tabulated for the educational experience. Course Evaluation STUDENT MUST PASS COMPONENTS AT 80% FOR PASSING GRADE IN COURSE Clinical Evaluation Participation in Clinical Conf. Long Term Patient Experience Clinical Log Preceptor Evaluation 135 pts 60 pts 25 pts P/F 30 pts 250 pts KD.VD/dw/NUR822.Fall2001.Syll.web 2

NURSING INTERVENTIONS: The following is a list of nursing interventions, found in your Nursing Intervention Classification text by McCloskey and Bulechek. These are only a few of many interventions that you will be utilizing in practice, thus you need to become familiar with the interventions and integrate them into your practices. You need to be able to define the interventions and include them in your case discussions and later in your plan of care in the clinical courses (NUR822/824). Anticipatory guidance Anxiety reduction Assertiveness training Behavior management: overactivity/inattention Behavior modification Caregiver support Cognitive restructuring Counseling Family support Grief work facilitation Hope installation Humor Patient contracting Progressive relaxation Reminiscence therapy Simple relaxation therapy Smoking cessation assistance Values clarification REQUIRED TEXT: Johnson, M., Maas, M. & Moorehead, S. (2001). Nursing outcomes classification (NOC). St. Louis, MO: Mosby (2 nd Ed.) McCloskey, J. C. & Bulechek, G. M. (2001). Nursing interventions classification (NIC). St. Louis, MO: Mosby (3 rd Ed.) Uphold, C. R. Graham, M. V. (1998). Clinical guidelines in family practice. Gainesville, Florida: Barmarrae Books. (3 rd Ed.) RECOMMENDED TEXT: Carlson, Eisenstar, Frigoletto & Schiff (1995). Primary care of women. Mosby. Green-Hernandez, Singleten & Aronzon (2001). Primary care pediatrics. Lippencott. Fitzpatrick, T. B., Johnson, R. A., Wolff, K. & Suurmond, D. (2001). Color atlas and synopsis of clinical dermatology. McGraw Hill. KD.VD/dw/NUR822.Fall2001.Syll.web 3

Long Term Patient Experience Each student is responsible for selecting a patient to follow long term. This should be a patient who has health care issues which requires and has agreed to a commitment to work on this behavior modification (smoker, over-weight or need to start exercise program). The student will discuss issues with patient and get agreement to work with an individual over time. This experience will continue over both semesters. The patient needs to be identified by mid-term at the latest. The experience will be evaluated by: 1. Presentation of case in class including NANDA, NIC, NOC and theory basis for interventions. 2. Identify family diagnosis and developing management plan with outcomes. 3. Evaluate progress in interventions over time using NOC. The long term patient needs to be presented two times in class with reference to the information indicated above. Patient documentation should be turned into clinical instructor each time you have interaction with the long term patient. Guidelines Assignment Guidelines are an important part of evidence based practice. You will be asked to review a common guideline and be prepared to present in class. More information will be provided concerning this in class. KD.VD/dw/NUR822.Fall2001.Syll.web 4

Student Responsibilities 1. Transportation to and from clinical agencies is the responsibility of the student. 2. Clothing: Students are to wear white lab coats or jackets while working at all clinical agencies. 3. ID tags, name tags should be worn on your lab coat or jacket. The format should be the following: Jane Doe, R.N. Family Clinical Nurse Specialist MSU Graduate Student 4. Personal equipment needed at your clinical site: a. stethoscope b. pen light c. tape measure 5. Absences: If the student becomes ill during the term, it is her/his responsibility to notify her/his clinical faculty, the clinical agency and the supervising faculty. All missed clinical days must be made up prior to the final exam. Arrangements for make-up days are to be made with the supervising faculty. Attendance at weekly clinical conferences is required. 6. Clinical agency: Each student selects a primary care clinical site for two semesters (NUR 822, 824), thus providing continuity of care to the patients. Additionally, by remaining at the same agency for two semesters, the student and agency staff have time to develop their relationships while the student develops her/his APN role. 7. If there are problem(s) with site arrangement, it is the students responsibility to first discuss the problems with her/his supervising faculty. If the student feels that the problem is not resolved, students should discuss this with the course coordinator. KD.VD/dw/NUR822.Fall2001.Syll.web 5

SCHEDULE OF CLINICAL CONFERENCES DATE August 30 September 6 September 13 September 20 September 27 October 4 October 11 October 18 October 25 November 1 November 8 November 15 November 22 November 29 December 6 TOPIC Orientation introduction to ethics discussions Evaluation and Management of Acute Infection (CBC, Antibiotic) Abnormal Pap Weight Management Anemia Complementary therapies Midterm Conferences/Eval Stress Reduction Breast Disease/Mammography Adolescent Issues Behavioral Peds Guidelines Discussion - OM Thanksgiving Dizziness Final Conferences/Eval Each student will be required to present cases at Clinical Conferences and be prepared to discuss relevant issues. Any missed clinical conferences will need to be made up with the clinical instructor. KD.VD/dw/NUR822.Fall2001.Syll.web 6

APPENDIX A CHARTING REQUIREMENTS KD.VD/dw/NUR822.Fall2001.Syll.web 7

KD.VD/dw/NUR822.Fall2001.Syll.web 8 HANDOUT #4 The Problem Oriented Record (POR) SOAP Charting CC: (chief complaint) Reason for visit, in the patient's own words. S: (subjective data) - Gathered from the patient. 1. Opening statement about the patient-age, reason for visit, when was last visit. 2. HPI (history of present illness) includes - usual state of health, chronology of symptoms - when did they start, how long have they lasted, any pattern, any change location, quality, quantity, setting, aggravating/alleviating factors associated manifestations - review of systems that are pertinent, also pertinent negatives. 3. Relevant past history, family history and personal social history. 4. Major medical problems or surgeries. 5. Current medications or any medication allergies. 6. Assessment of disability-has this affected ability to function on a daily basis. O: Objective Data - Gathered from observation and physical exam 1. Includes pertinent general survey. 2. Physical exam appropriate to chief complaint. 3. Any lab results. A: Assessment/Diagnosis - Must match data you have. Both nursing and medical diagnosis are expected. 1. Rationale must be present. 2. If multiple problems can say, "This person presents with multiple problems/concerns based on..." the priority for this visit will be." 3. If don't know the cause for sure can state "R/O..." with plan addressing R/O. P: Plan - Has four components. Interventions should incorporate NIC when appropriate 1. Dx: anything that will give data, i.e. lab tests awaiting results, diet diary, home visit, group meeting. 2. Tx: i.e. medications written as if a prescription, special diets (1500 cal ADA), increase fluids to 64 oz per day, etc 3. Ed: use words "counseling/education", i.e. counseled on the risks of smoking and the use of oral contraceptives. 4. Expected outcomes these should be measurable and utilize NOC when appropriate

APPENDIX B CLINICAL EVALUATION CRITERIA KD.VD/dw/NUR822.Fall2001.Syll.web 9

NUR 822 Clinical Evaluation The clinical evaluation includes 7 categories of performance developed from the course objectives. These categories include: Assessment, Decision-Making, Management Plan, Communication Skills, Relationships with Others, Documentation and Evaluation. 4.0 = outstanding performance/exceeds expectations at high level 3.5 = very consistently meets objective/exceeds expectations 3.0 = meets objective at least 80% of the time 2.5 = meets objective majority of the time 2.0 = inconsistently meets objective (<50%) 1.5 = rarely meets objective 1.0 = objective never met The following point scale will be used for final grade determination. Range: Low High Grade: 233 250 4.0 218 232 3.5 200 217 3.0 188 199 2.5 125 187 2.0 163 174 1.5 150 162 1.0 <149 0 An evaluation form will be completed by the student and also by the clinical instructor both at midterm and at the conclusion of the 14 weeks of clinical. The rating at midterm is EXPECTED TO BE at a low level since it is highly unlikely that a student will be meeting an end of course objective at this time. The midterm point totals are used to help identify areas that need work. The midterm evaluation is NOT used to calculate the final grade. Only the rating on the final evaluation will be used to determine the clinical grade. The final evaluation will count 135 pts. of the final grade in the course. The student is expected to provide rationale (examples) for his/her self-rating. The instructor's evaluation will be used to calculate the grade. If there is a discrepancy between the student and faculty member's point allocation, the student may give rationale for his/her rating. The final decision about point allocation is determined by the faculty member. KD.VD/dw/NUR822.Fall2001.Syll.web 10

NUR 822 Clinical Evaluation Student Name Category Criteria Comments 1 ASSESSMENT = 25 pts. History and Physical assessment in organized manner. HPI complete and appropriate to chief complaint(s). PE complete and appropriate to chief complaint(s). No extraneous data. Identifies risk factors for disease and considers age, gender, ethnic/socio/cultural factors. Family assessment included as appropriate. 2 DECISION MAKING = 25 pts. Recognizes how own values/beliefs impact decision making. Develops list of differential diagnosis appropriate to central features. Medical diagnoses appropriate to data. Nursing diagnosis appropriate to data. Relevant family diagnoses included. Able to discuss risk/benefit rationale for intended interventions. Considers sensitivity and specificity of diagnostic studies ordered. 3 MANAGEMENT PLAN = 25 pts. Includes relevant health promotion, health maintenance, and illness prevention interventions. Able to articulate pathophysiology and pharmacology basis for choices in plan. Interventions are evidence based. Nursing and medical interventions appropriate to desired outcome. Includes interventions directed towards family. Plans mutually developed by student and patient/family. KD.VD/dw/NUR822.Fall2001.Syll.web 11

4 COMMUNICATION SKILLS (verbal) = 10 pts. Articulates patient information in organized, concise manner. Communicates effectively with patients/families. 5 RELATIONSHIPS WITH OTHERS = 10 pts. Develops good working relationship with preceptor/staff/faculty. Develops therapeutic relationship with patients/families. Able to accept constructive comments from faculty/preceptor/peers. Appropriately seeks consultation and collaboration. 6 DOCUMENTATION = 20 pts. Uses appropriate terminology/abbreviations/spelling. Uses appropriate SOAP format. HPI organized and complete. PE organized and complete. 7 EVALUATION = 20 pts. Coding of visit and charting content are consistent. Records collaborative and consultative activities. Includes measurable outcome for every client. Family outcomes included as appropriate. Appropriately uses NOC for selected patients/families. Records evaluation of care on return visits. Evaluates own progress in developing advanced practice role. Total Points: Summary statement: Recommendations: KD.VD/dw/NUR822.Fall2001.Syll.web 12

MICHIGAN STATE UNIVERSITY COLLEGE OF NURSING FALL 2001 Graduate Student Preceptor Evaluation Dear Preceptor, please candidly evaluate your NP student using the 1-3 scale below. Comments pertaining to the you may have should be included in the section at the bottom of the page. Thank you for participating in the evalu Rating scale: 0 1 2 3 (Rarely) (Satisfactory performs (meets all objectives) (Exceptional @ minimal level) Performance) STUDENT NAME: Rating: Behaviors --Communicates patient information to you clearly and succinctly (2-3 minutes) -- H & P pertinent to patient complaint --Collaborates/consults appropriately with you --Assumes major responsibility for developing diagnosis & differential --Able to articulate rational for diagnosis --Assumes major responsibility for developing management plan --Develops positive working relationship with patients/providers --Able to accept constructive comments and change behavior appropriately --Timelines --Professional conduct, motivation, attitude, resourcefulness, strengths Additional comments: Areas of development Preceptor Signature: Preceptor Printed Name: # of hours percepted this semester Date: KD.VD/dw/NUR822.Fall2001.Syll.web 13

CLININCAL ACTIVITY LOG Health Maintenance Exam ACTIVITY DATE SIGNATURE Infant - 0 to 6 mo. Toddler - 9 to 18 mo. Child - 2 to 5 yrs. School Age - 6 to 12 yrs. Young Adolescent - 12 to 16 yrs. Young Adult - 25 to 35 yrs. Adult - 36 to 54 yrs. Older Adult - 55 to 65 yrs. Elderly - 65 and older Student Name _ Prenatal Exam ACTIVITY DATE SIGNATURE First Visit 1 st Trimester 2 nd Trimester 3 rd Trimester Post Partum Single Acute Problem ACTIVITY DATE SIGNATURE UTI URI Pharyngitis Otitis Media KD.VD/dw/NUR822.Fall2001.Syll.web 14

Student Name _ CLININCAL ACTIVITY LOG Musulo Skeletal Exam ACTIVITY DATE SIGNATURE C Back Knee Ankle Shoulder Prescribe Medication ACTIVITY DATE SIGNATURE C Antibiotic Oral Contraceptives Hormone Replacement Lipid Lowering Medications Anti Depressants Special Exams ACTIVITY DATE SIGNATURE C Pap & Pelvic Female Genitalia (2) Adult Male Genitalia (2) Rectal Exam - Male Rectal Exam - Female Prostate Exam Breast Exam Wet Prep (min 4) KD.VD/dw/NUR822.Fall2001.Syll.web 15

Clinical Calendar Student Name: Preceptor (Please Print): Preceptor s Signature: Agency: Total # Hours Completed: Clinical Calendar MONTH/YR: Monday Tuesday Wednesday Thursday Friday Saturday Sunday MONTH/YR: Monday Tuesday Wednesday Thursday Friday Saturday Sunday MONTH/YR: Monday Tuesday Wednesday Thursday Friday Saturday Sunday KD.VD/dw/NUR822.Fall2001.Syll.web 16

STUDENT WEEK # NUR 822/824 PATIENT ENCOUNTER LOG DATE AGE/SEX ID# DIAGNOSES/INTERVENTIONS KD.VD/dw/NUR822.Fall2001.Syll.web 17

Clinical Conference Participation NUR 822 APN Practicum Fall 2001 Printed Name: 20% of the total grade for this course will be for ACTIVE CLASS PARTICIPATION. The following criteria will be utilized by faculty to determine the extent and quality of your involvement and contribution to the class. CRITERIA Offered pertinent, quality information on specific topics covered by course that helped to enrich the learning environment. -Shared personal clinical experience or case studies -Shared web sites, articles, books, etc Collaborated with peers during group activities with added value contributions. Actively contributed to the learning environment by POSSIBLE POINTS 2 asking relevant questions. Demonstrated respect for peers and faculty. 1 POSSIBLE POINTS 5 TOTAL POINTS 1 1 YOUR POINTS Comments: KD.VD/dw/NUR822.Fall2001.Syll.web 18