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MICHIGAN STATE UNIVERSITY

COLLEGE OF NURSING

NUR 824

PRACTICUM FOR THE

PRIMARY CARE FAMILY

APN II

COURSE SYLLABUS

CREDITS: 7

Course Coordinator:

Katherine Dontje, R.N., M.S.N., C.S., F.N.P.

Spring, 2002

MSU is an Affirmative Action/Equal Opportunity Institution

TABLE OF CONTENTS

COURSE OVERVIEW Page

Course Description ...............................................................................................................1

Course Objectives ................................................................................................................1

Instructional Methods ..........................................................................................................2

Student Responsibilities .......................................................................................................3

SCHEDULE OF CLINICAL CONFERENCES ..............................................................................4

Long Term Patient Guidelines .............................................................................................6

Clinical Activity Log............................................................................................................8

Nursing Interventions .........................................................................................................11

Peer Review Guidelines .....................................................................................................13

Clinical Evaluations ...........................................................................................................19

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F:\Faculty Secretary\Syllabi\NUR 824\2002\NURsp02.doc 1

COURSE OVERVIEW

Course Description

This course is designed to help the APN student with integration and application of assessment

and management skills. The course will emphasize relevant conceptual and theoretical

frameworks in the primary care management of individuals. The individual is considered within

the context of family and community. The APN experience utilizes a collaborative model of

primary care practice. The student will develop skills for assessment and management of

complex and/or stable chronic health problems. The student will become increasingly

independent in the practice setting with preceptor validation.

Course Objectives

At the completion of this course the student will be able to:

(1) Demonstrate a high level of advanced nursing practice by conducting assessments, engaging

in therapeutic reasoning and arriving at diagnoses for individuals with stable chronic/or

complex health problems.

(2) Utilize advanced independent nursing interventions when managing individuals with stable

chronic health states.

(3) Communicates data on clients with chronic health problems utilizing POR format.

(4) Demonstrates increasing independence in clinical decision making.

(5) Demonstrate the components of the peer review process.

(6) Analyze practice philosophy and case log data to develop a portfolio reflective of the

students clinical experiences.


Instructional Methods

Clinical Experience All students will participate in 19 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, stable chronic illness and complex health problems, 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 development of the management plan, (3) nursing diagnosis and interventions and outcomes, 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 255

Clinical Log P/F

Preceptor Evaluation 20pts.

Long Term Patient Experience 30pts.

Peer Review 60pts. _____

365pts.


The following point scale will be used for final grade determination. Range: Low High Grade: 333 365 4.0 317 332 3.5 292 316 3.0 274 291 2.5 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 255pts. 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 allocations, the student may give rationale for his/her rating. The final decision about point allocation is determined by the faculty member.


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, nametags 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 has 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 student’s 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.


SCHEDULE OF CLINICAL CONFERENCES

DATE TOPIC

January 10 Medicare Documentation Guidelines (group meeting)

17 Case Management/Disease Management

24 Advance Directives/ End of life issues

31 Unresolved Grief vs. Depression

February 7 Insomnia and sleep disorders

14 Multiple Sclerosis and Lupus

21 Pediatric Mental Illnesses

28 Midterm Evaluations

March 7 Spring Break

14 Polypharmacy issues in the elderly

21 Incontinence and enuresis

28 Parenting issues/ working with families with chronic illness

April 4 Parkinson’s/ Alzheimer’s/ Dementia

11 Telehealth / Electronic Medical Records

18 Child/Partner and elder abuse issues

25 Final case conference – long-term patient wrap up


LONG TERM PATIENT GUIDELINES


Long Term Patient Guidelines The long term patient experience is a continuation of last semester. If possible it is recommended you use the same patient you worked with last semester. If this is not possible you will need to talk with your clinical instructor about how to adjust the assignment.

1. Class presentation – present your selected patient at least twice during the semester. The presentation needs to include the following: - Current issues and problems - Follow up on previous plan of care. Evaluate outcomes from previous visit. These

should be both individual and family outcomes. - Review theoretical framework previously used. Is this framework still appropriate

for interventions you have planned. If not what additional framework would you use. Discuss the reasons you have made your decision and support with information from your theoretical framework. Discuss how your practice philosophy guides your health care decisions.

2. Case Management activities – case management is a role you will be using as APN.

We are asking you to evaluate this component of your interventions. Especially in working with community resources. This will be a short 1-2 page paper to be handed in to your clinical instructor by March 30

th.

- Identify two case management skills you are using with your LTP (these will be

presented in class). Describe how this skill is used with this particular patient. Including specific examples. Try to include evaluation of community resources and potential use of resources by the patient.

- Identify level of patient risk for case management as discussed in class. Discuss why you have decided this.

3. Identify grief and loss issues of the patient. Utilize an intervention related to this.

Write up a one page theory paper related to the grief and loss process for your LTP. If you are having problems identifying these issues in your patient discuss with your clinical instructor. If possible try to utilize a specific nursing intervention which you may not have used before, counseling, stress management or alternative therapies. Discuss how these interventions assisted the patient with resolution of the grief and loss process and how it is supported by your theory. This paper will be due before April 20

th. Paper should be 1-2 pages.


CLINICAL ACTIVITY LOG


Clinical Activity Log

______________________________________ Student Name

Management of Chronic Illness

ACTIVITY DATE SIGNATURE COMMENTS

Uncontrolled Hypertension

COPD CHF Pediatric/Adult Asthma

Pediatric/Adult ADHD

Diabetic Management Oral medications

Insulin

Hyperlipidemia

Osteoporosis Chronic Pain

Medication Prescribing


Hormone Replacement Therapy

Depression

Anxiety

Special Exams


Geriatric functional assessment

Pediatric development assessment

High risk obstetric exam


Clinical Activity Log

______________________________________ Student Name

Activities


Write referral to at least three community agencies

Write referral to specialist

Evaluate process for referral of elder and pediatric abuse issues


Nursing Interventions

The following is a list of nursing interventions found in your Nursing Intervention Classification test 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 activities and integrate them into your practices. You need to be able to define the interventions and include them in your plans of care when applicable. Anticipatory guidance Anxiety reduction Assertiveness training Behavior management: overactivity/inattention Caregiver support Cognitive restructuring Family support Grief work facilitation Hope installation Humor Patient contracting Progressive relaxation Reminiscence therapy Simple relaxation therapy Smoking cessation assistance Values clarification


PEER REVIEW GUIDELINES


PEER REVIEW GUIDELINES Objectives: 1. Develop collaborative relationship with peers and faculty. 2. Analyze role components of the nurse in advance practice in primary care. 3. Identify common issues in advanced nursing practice and primary care. 4. Demonstrate risk taking through leading and participating in peer review process. 5. Analyze conceptual framework used for specific client situations. Expectations: 1. Presenter:

A. Choose a case for discussion that reflects current course content. B. Distribute copies of the chart/record SOAP note (and HPE if appropriate) to group members (obliterate client name and

identifying data). C. Distribute one or two pertinent current references to group members if appropriate. D. Present case and conceptual model in a manner that reflects clinical reasoning that took place in management of the case. E. Lead discussion and facilitate group completion of the peer review evaluation guide.

2. Group Member:

A. Come to session prepared to discuss references and the client situation. B. Participate in the review process, provide constructive feedback.


PEER REVIEW EVALUATION FORM


NUR 824: PEER EVALUATION FORM

Spring 2002

Student Name: __________________________________________________________ Date: _________________

Theory / Theorist: ____________________________________________________________________

CATEGORY

NOT MET PARTIALLY COMPLETELY EXCEPTIONAL

Major concepts described

Applicability of major concepts obviously threaded through the

intervention and plan of care

In your opinion, do you feel this theory/theorist is the MOST

appropriate to support the interventions and plan of care?

Did your colleague articulate what other theory/theorist they had

considered for this particular case?

Additional Comments:

PRACTICE PHILOSOPHY


CATEGORY NOT MET PARTIALLY COMPLETELY EXCEPTIONAL

Includes physical, emotional, social, cultural and spiritual data

Data is relevant to presenting problem

Appropriate past medical history (as relevant)

Presented in logical, sequential order that flows

Information complete but concise


CATEGORY


Identifies and articulates appropriate differential diagnoses

Diagnosis supported by subjective and objective data

Appropriate for presenting problem and reflects accurate clinical

decision making

Includes health maintenance and health promotion issues related

to personal and family risk factors

Includes self care strengths and areas for improvement

Utilizes appropriate language for medical and nursing diagnoses


ASSESSMENT

IMPRESSION / DIAGNOSES


CATEGORY


Includes appropriate diagnostic tests supported by guidelines,

protocols, or agency policy

Treatment appropriate for presenting problem and diagnosis

Treatment plan supported by guidelines, if alterations, rationale

for variation is articulated or explained and alteration is based on

scientific rationale

Nursing interventions (NIC) included

Education/teaching reflects knowledge of pathophysiology and

pharmacotherapeutics


CATEGORY


Goals are measurable and realistic with appropriate time frame

Based on diagnoses and plan of care

Reflect mutual goal setting

NOC format utilized


PLAN

OUTCOMES


CATEGORY


Legible

SOAP format

Complete and concise

Appropriate medical language and abbreviations utilized


CATEGORY


Materials provided were complete, appropriate and on time

Materials present recent body of literature which is evidence

based

Case presented in professional manner

Able to accept and incorporate constructive feedback

Answered peer questions in knowledgeable and professional

manner


Overall Strengths:

Recommendations for Growth:

DOCUMENTATION

PRESENTATION


CLINICAL EVALUATIONS


MICHIGAN STATE UNIVERSITY: COLLEGE OF NURSING

NUR 824 COMPREHENSIVE CLINICAL EVALUATION TOOL

Evaluation is based on the course objectives and minimum competency expectations for advanced practice nursing students. During NUR 824,

it is expected that the APN student is able to care for patients with complex health problems in an organized and competent manner. The

measurement criteria for each category will be based on a variety of information including: class participation, faculty-student interactions,

preceptor input, documentation, evidence based literature, expectations of advanced practice nursing and faculty expertise.

Each category is designated separately and the minimum expectation for meeting that category objective is listed. It is expected that category

specifications will guide student practice and be considered the minimum standard for clinical competency. Each category must be passed in order to

pass the course.

The following point scale will be utilized for objective scoring purposes:

0 = not met (student either did not complete or did not reach the minimal foundational expectation of functioning)

1 = minimal (below expected APN student level)

2 = satisfactory (performing skills at the expected student level)

3 = exceptional (performing skills at a level that exceeds expectations for an APN student)

N/A = not applicable for specific clinical site (rationale for why N/A is valid must be documented except where * appears)

Student Name: _________________________________________________________________ Date: _________________________

Faculty Evaluator Signature: ______________________________________________________________

Final Score: _______________________________

Strengths:

Recommendations:

Student Signature: _____________________________________________________________________


CATEGORY / EXPECTATION

N/A 0 1 2 3

I. DEMONSTRATES AN ADVANCED PRACTICE NURSING ROLE WITH PATIENTS WHO HAVE

COMPLEX HEALTH PROBLEMS (minimum = 60)

Obtains a comprehensive and/or problem focused health history from the client

Elicits information about cultural influences that may affect clients health status and learning experiences

Performs a comprehensive and/or problem focused physical examination

Analyzes and interprets history, presenting symptoms, physical findings and diagnostic information to

develop differential diagnosis

Identifies risk factors and develops plan to address these issues

Demonstrates critical thinking and diagnostic reasoning skills in clinical decision-making

Demonstrates knowledge of pathophysiology of chronic disease conditions commonly seen in practice

Prescribes medication based on efficacy, safety and cost as legally authorized and counsels concerning drug

regimens, drug side effects and interactions

Formulates an action plan based on scientific rationale, evidence based standards and practice guidelines

Assesses, diagnoses, monitors, coordinates and manages the health/illness status of clients over time

TOTAL POINTS

TOTAL POINTS FOR CATEGORY I = _____________ x 3 = ______________



N/A 0 1 2 3

II. UTILIZES ADVANCED INDEPENDENT NURSING INTERVENTIONS WHEN MANAGING

INDIVIDULS WITH STABLE CHRONIC HEALTH STATUS (minimum = 48)

Applies appropriate theories to guide practice

Interventions include nursing focus with NIC as guidelines and are safe, ethical and indicate awareness of

cultural differences

Implements appropriate nursing and nonpharmacological treatment modalities into management plan

Evaluates the impact of life transitions on health/illness status of clients and recognize impact of health and

illness on individuals the their families

Utilizes and evaluates the use of complimentary and alternative therapies used by clients for safety and

potential interactions

Shows respect for the inherent dignity of every human being, whatever their age, gender, religion,

socioeconomic class, ethnic or cultural group

Applies principles of self-efficacy and empowerment in promoting behavior change

Demonstrates logical, thoughtful critical thinking and decision making skills related to patient outcomes

TOTAL POINTS

TOTAL POINTS FOR CATEGORY II = _____________ x 3 = ______________



N/A 0 1 2 3

III. COMMUNICATES DATA ON CLIENTS WITH CHRONIC HEALTH PROBLEMS UTILIZING THE POR

FORMAT (minimum = 36)

Uses appropriate terminology, abbreviations, spelling and format

Diagnosis are derived from and supported by data obtained from the clients and documented on the record

Maintains confidentiality while communicating data, plans and results in a manner that preserves the dignity

and privacy of the client as well as providing a legal written record of care

Evaluates and records results of interventions using accepted outcome criteria, revises plan and consults or

refers when needed as evidences in record

Documents collaboration with other health professionals and agencies as appropriate

Demonstrates knowledge of the billing and coding regulations in regard to patient visit

TOTAL POINTS

TOTAL POINTS FOR CATEGORY III = _____________ x 3 = ______________

IV. DEMONSTRATES INCREASING INDEPENDENCE IN CLINICAL DECISION MAKING

(minimum = 40)

Demonstrates primary responsibility for making diagnosis and determining plan of care for clients seen

Creates a relationship that acknowledges the clients strengths and assists the client in addressing his or her

own needs

Initiates appropriate and timely consultation and/or referral when the problem exceeds the nurse

practitioner’s scope of practice



N/A 0 1 2 3

Uses an evidence based approach to client management that critically evaluates and applies research pertinent

to client care and outcomes

Provides care for individuals, families and communities within an integrated health care system

TOTAL POINTS

TOTAL POINTS FOR CATEGORY IV = _____________ x 4 = ______________

V. PROFESSIONAL ROLE (minimum = 20)

Creates a climate of mutual trust and establishes partnerships with clients and other health care professionals

Functions in a variety of role dimensions: health care provider, case manager, consultant, educator, coach,

advocate, researcher and leader

Interprets own professional strengths, role and ability related to peers, clients and colleagues

Engages in self-evaluation concerning practice and strives to attain the highest standards of practice

Monitors and reflects on own emotional responses to interactions with clients and uses data to further

therapeutic interactions

TOTAL POINTS

TOTAL POINTS FOR CATEGORY V = _____________ x 2 = ______________


NUR 824 CLINICAL EVALUATION SCORING FORM

Student Name: _______________________________________________________ Date: _____________________

Evaluator: ___________________________________________________________

CATEGORY TOTAL COMMENTS

I. ADVANCED PRACTICE NURSING ROLE (60)

II. INDEPENDENT NURSING INTERVENTIONS

(48)

III. COMMUNICATION OF DATA (36)

IV. INDEPENDENT CLINICAL DECISION

MAKING (40)

V. PROFESSIONAL ROLE (20)

GRAND TOTAL

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