Course Number: Nursing 753
Course Title: Advanced Practice Nursing: Acute and Critical Care Practicum
Course Description: Emphasis on care management activities of the acute/critical care advanced practice nurse: research-based care of select clients and families, consultation with others in the coordination of client care, interdisciplinary collaboration, evaluation of care based on standards of practice.
Credit/Hours:
Time:
3 units, 9 clinical hrs/week x 15 weeks for total of 135 hours.
As arranged with preceptor. Weekly communication with faculty will document number of clinical hours.
Location:
Prerequisites:
Facility that employs advanced practice nurse preceptor
Concurrent registration in Nursing 751
Faculty: Beverly Carlson, PhD, RN, CNS, CCRN
SDSU School of Nursing, Hardy Tower, 61 bcarlson@mail.sdsu.edu
(619) 203-3483
Della Burns, MN, APRN, FNP, BC
SDSU School of Nursing, Hardy Tower, 51 dburns@mail.sdsu.edu
cell (858) 414-6743
Melissa Rouse PhD,RN,CNS,CEN melissarousern@aol.com
(951) 239-6885
Concentration: Advanced Practice Nursing of Adults/Elderly
Specialization in Acute and Critical Care
Text/Readings: Foster, J.G.W. & Prevost, S.S. (2012) Advanced Practice
Nursing of Adults in Acute Care. Philadelphia: F.A. Davis Co.
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Course Outcomes: At the end of this semester the student will be able to:
1.
Acquire/refine advanced clinical assessment techniques to differentiate human responses to acute or critical illness.
2.
Synthesize knowledge of advanced pathophysiology with clinical and laboratory data to systematically assess acutely/critically ill clients.
3.
Synthesize knowledge of biopsychosocial stressors with clinical and laboratory data to plan and prioritize the nursing care of acutely/critically ill clients.
4.
Implement select preventive and restorative nursing interventions with acutely/critically ill clients.
5.
Enhance knowledge of advanced technology and instrumentation appropriate for the assessment and care of acutely/critically ill clients.
6.
Use standards of care and appropriate research findings to evaluate delivered care.
7.
Analyze the utilization of specific coping strategies by families of acutely/critically ill clients.
8.
Implement select crisis reduction strategies with families of acutely/critically ill clients.
9.
Use change theory in the implementation of the practice component of the advanced practice nurse role.
10.
Operationalize the role of the acute/critical care advanced practice nurse: advanced practitioner, researcher, educator, consultant, care manager.
Methodology:
This course is a clinical practicum. Students will develop individual objectives in collaboration with the faculty and work closely with a clinical preceptor in either acute care or critical care setting. The purpose of the course is to learn and enact the role components of the clinical nurse specialist in the clinical setting.
DISABLED STUDENT SERVICES
If you are challenged by physical, perceptual, cognitive, or other disabilities certified by SDSU
Disabled Student Services, please consult with the instructor on a confidential basis at your earliest convenience.
Students who need disability accommodation should provide documentation of their disability to
Student Disability Services at 619-594-6473 (Calpulli Center, Suite 3101), and receive authorization for academic or clinical accommodations. After accommodations have been authorized by SDS, students are responsible for notifying faculty in advance of the need for accommodation . This can best be accomplished by making an appointment to meet privately with the faculty member early in the semester, or as soon as possible in the event that a disability is diagnosed during the course of the semester.
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COURSE REQUIREMENTS AND GRADE DETERMINATION
Students must achieve 100% satisfactory on clinical outcomes to pass this course as evaluated by clinical faculty. The student, preceptor and faculty will contribute to the evaluation. Required assignments include clinical objectives, clinical logs, self-evaluations, preceptor evaluations, the journal club or organized teaching project, and the Evidence based practice change project/paper.
Points will be lost for assignments turned in after the due date.
The following plus/minus scale will be used:
93-100%
90-92%
87-89%
83-86%
80-82%
A
A-
B+
B
B-
77-79
73-76
70-72
C+
C
C-
67-69 D
Less than 67% F
REQUIREMENTS
Clinical Objectives/Clinical Logs
Percent of Grade
30%
Due Date
Objectives: 2/11/14
Weekly log: Due every Sunday
by midnight
Journal Club OR Teaching Experience 30% by 4/22/14
Evidence-based Practice Project/Paper 40% by 4/29/14 by 1pm
_______________________________________________________________________
Total 100%
Midterm Evaluation by 3/12/14
Final Evaluatio n by 4/29/14
Clinical Hours: 60 hours to be completed by 3/11/14. Total 135 hours must be completed by
5/6/124
***20 hours of the 135 assigned hours may be used for ‘off site’ research…Please note these hours in your log. All other hours should be spent ‘on site”.
Assignment Description:
1.
Individual Clinical Objectives : Objectives should be discussed during the first shift with your preceptor and should be turned in to the clinical instructor.
Each student will develop 3-5 individual objectives for the clinical experience as agreed
upon by the preceptor and the faculty instructor and written in measurable terms.
Objectives must be based on the course objectives and address specific goals related to the
target population/clinical area and desired accomplishments. Each student is expected to
have weekly involvement in clinical activities with staff and patients. Incorporate the
advanced nursing component areas (expert clinical practice, education, research,
consultation, and clinical leadership) and the CNS spheres of influence (patient/client,
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nursing personnel, and organizations/networks) into your objectives. Objectives may
be revised throughout the semester with faculty approval.
2.
Clinical Log: Each student will maintain a clinical log of his or her experience. Each student will transmit the log to the faculty on a weekly basis via email. Email logs are due to clinical instructor each Sunday by midnight . Points will be deducted for logs turned in after the due date. (One point per day)
Use the form attached as Attachment 2 to complete the logs.
3.
Midterm and Final Evaluations – (forms found in syllabus) must include selfevaluation and validation/comments by preceptor. Submit on time and include discussion of objectives met and your plan to complete them by the end of the clinical rotation.
4.
Journal Club OR Organized Teaching: Each student will lead EITHER a journal club or an organized teaching activity. The class format will be discussed with the preceptor to determine what will best the meet the needs of the unit at this time. The topic will be agreed upon by the preceptor and the faculty. Student will complete a self-evaluation due one week after activity.
5.
Evidence-based Clinical Practice Project and Paper : Each student will complete one project in the clinical area. The project will be chosen by the student in collaboration with the clinical preceptor and faculty, and should be something that the PRECEPTOR indentifies as valuable to the agency. Please consult with the faculty and preceptor before starting your project. The final paper will be a manuscript written in APA format, about this project.
Guidelines for Individual Clinical Objectives:
To help guide the experience, you are asked to develop 3-5 personal learning objectives for this experience. Think about the CNS spheres of influence and the subroles. Learning goals should be realistic and measurable. You will be asked to update progress towards these goals in your midterm evaluation and at the end of the semester.
Use the following suggestions for writing learning objectives:
1.
Consider what you want to learn from your preceptor during the clinical experience.
2.
Do you want to participate in any particular clinical opportunities?
3.
Would you be interested in attending a professional role related meeting or faculty development/education conference or workshop?
4.
What do you MOST want to learn from this experience?
5.
Ask your preceptor for feedback to determine the feasibility of implementing your objectives during the semester.
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Guidelines for Clinical Logs :
The purpose of the clinical log is to give the student an opportunity to reflect on learning experiences and track progress through the semester. The Clinical log should contain the following parts: Date; record of clinical hours; list of activities; and response to the following
1.
What was the most important thing you learned through your activities?
2.
What did you discover about yourself through your activities?
3.
Identify the CNS role fulfilled and the sphere of influence involved.
Use the form attached as Attachment 2 to complete the logs.
Guidelines for Journal Club : (Choose to do Journal club OR Teaching activity)
For this requirement, you will lead a journal club. This will involve a research critique of a current nursing research article relevant to the clinical setting and evaluation of the activity. The discussion will include review of the research process, applicability for the clinical setting and key “take home” messages for bedside nurses. The article will be agreed upon by the preceptor and the faculty and the journal club meeting will be scheduled so the clinical instructor can attend.
Use the form (attachment 3) to complete a self evaluation of the journal club. Submit to clinical instructor within one week of your journal club meeting.
Guidelines for Organized Teaching Activity : (Choose to do Journal club OR Teaching activity)
For this requirement, you will prepare an organized teaching activity. Preparation will include learning objectives, review of evidence, and integration of clinical expertise, patient preferences, selection of teaching methodologies, evaluation of learning outcomes and creation of learner materials. The class format will be discussed with the preceptor to determine what will best the meet the needs of the unit at this time. The topic will be agreed upon by the preceptor and the faculty and will be scheduled so the clinical instructor can attend.
Use the form (attachment 4) to complete a self evaluation of the activity. Submit to your clinical instructor within one week after your teaching activity. Include student evaluations
(using your own form, or one used by your facility.
Guidelines for Evidence-Based Clinical Practice Project and Paper
See Attachment 5 for Grading Guidelines and Criteria for Evaluation.
***5 points per day will be deducted for late papers.
Learning how to manage change is one of the major components necessary to developing future nurse leaders. The evidence-based planned change project will provide the student the experience of initiating and coordinating a planned change in a health care organization. The purpose of this assignment is to engage the student in an analysis of evidence-based practice within the clinical experience.
Example projects include: incorporation of new evidence based practice guidelines for care of bariatric patients, evaluation of outcomes related to early extubation post cardiac surgery, implementation of insulin protocol with treatment beginning for blood sugars over 120, and revision of orthopedic care maps based on current patient outcomes.
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Paper will be written in APA format (6 th
edition) with careful attention to spelling and grammar. This is a scholarly manuscript about the evidence based clinical practice project.
Part 1: Problem Identification and Evidence-Base
1.
Practice Problem Identification : A clinical problem will be uncovered during clinical experiences in collaboration with the unit leaders, your preceptor and clinical instructor.
Digging up clinical problems can start with observation of practice on your assigned unit, asking staff about the problems they face delivering care, looking through policies and procedures and guidelines of care, and talking with patients about their perceptions of the care they are receiving. A clinical question should be developed using the PICOT process.
2.
Evidence Base - Review of literature : The review of literature should begin with a description of the search process used to identify articles. The majority of the literature reviewed should utilize systematic reviews, meta-analysis, or clinical guidelines.
Individual studies, review articles and clinical articles can be used as supportive literature for clinical issues with limited research. Approximately 10-15 sources should be adequate, see your clinical instructor if you have a problem with a particular content area.
Students are encouraged to use evidence-based sources from the Internet, as they are appropriate. Use of a clinical/medical librarian is encouraged. The individual sources should be critiqued and a summary evidence grid should be completed. (Evidence summary grid is attachment 6)
3.
Critical Analysis : The critical analysis section should include a discussion of the synthesis of the evidence. What are the implications for nursing practice? Summarize what the evidence supports are the best practices related to the problem you selected.
Compare and contrast the evidence gained from your critique to the existing clinical practice. Summarize in a conclusion whether or not the clinical practice is consistent with the best practice identified in the evidence. Were you able to make the practice change?
Take Home Message : This section should conclude with “take home” messages relevant to clinical practice. Citations for each point are critical.
Part 2: Implementation Strategies : This section should describe the innovation or new practice based on the best evidence and explore strategies to implement the practice change.
Baseline assessment - What is the current practice and what is the history? Change theory should underpin the implementation strategies selected. Key stakeholders should be identified.
Challenges to implementing evidence-based care in the clinical setting should be identified with potential solutions for each challenge explored. Is there a cost benefit to making the change?
A proposed implementation timeline should be included. If you cannot complete the change during the semester, explain what will continue after you are done. What do you propose should happen? Outcome measures should be identified and an evaluation should be included as a proposal if there is not time to actually carry it out.
1.
Clinical practice : What is the current clinical practice that you are proposing to change?
Why do they do it that way? What is the history? The description of clinical practice can be a client care scenario in which the student was involved or be clinical practices
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observed while in a given clinical area. The rationale nursing staff offers for engaging in the particular clinical practice should also be explored.
2.
Innovation/New practice : The proposed change in practice should be outlined. Be sure to justify with the evidence.
3.
Implementation Strategies : An implementation strategy should be outlined with clear evidence of integration of the change theory chosen to guide the project.
4.
Evaluation of Outcomes : Discuss the outcomes of your project. How did your project change clinical practice? Patient care? Patient outcomes? Staff knowledge? Discuss the evaluation methods you used and whether the evaluation supported the effectiveness of your project. If appropriate, discuss both cost and quality outcomes. The “what happened as a result of my actions” section.
5.
Summary : This section should incorporate your reflection on the process of implementing a clinical change. What did you learn during the process? What would you do differently the “next” time based on what you learned “this” time? Was the change a success?
6.
Support Materials: Any materials developed in conjunction with this project should be added as attachments to the final paper.
Clinical Practicum:
Students may not start clinical until all requirements for the assigned institution are complete.
Use the consortium website for all paperwork requirements: http://www.sdnsec.org/
Look for your assigned hospital setting and complete all requirements listed.
Students must communicate completion of all requirements to the clinical instructor before they can start clinical.
Clinical hours may be arranged by the student with his/her preceptor, however students are generally assigned specific hours due to preceptor availability which may include evening or weekend hours. Graduate students are responsible for submitting a clinical schedule to the faculty and preceptor at the beginning of the semester. Any change in the clinical schedule must be submitted to faculty.
Attendance at all scheduled clinical assignments is MANDATORY. These assignments involve contractual relationships with professionals who have committed their time to preceptorships. A student who must miss a scheduled laboratory due to illness or emergency must notify the clinical agency or preceptor and the course faculty member
BEFORE the scheduled clinical assignment. Students who miss clinical experiences will be required to make up time lost prior to course completion. It may be necessary to take an incomplete in the course.
Students are expected to dress in appropriate professional attire at all times .
Professional attire for the CNS role is business dress (or scrubs if your preceptor requests) with a clean, white lab coat, no visible tattoos or piercings other than a single earring in each ear. Exceptional personal hygiene is expected. It is the responsibility of the graduate to verify and comply with the dress code for the institution where clinical hours will be conducted. Graduate students should obtain and wear a name tag indicating their affiliation with SDSU. Some clinical agencies require special identification.
Students are responsible for complying with all agency regulations.
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Each student is required to comply with the School of Nursing Compliance Policy.
Clinical Placements:
Students are assigned to preceptors who provide health care in acute and critical settings.
Students are expected to assume responsibility for the accomplishment of all course objectives.
Students are responsible for reviewing the literature, studying, and increasing their knowledge base in their areas of clinical assignment. In addition, professional development in the advanced practice role is expected .
Clinical assignments will be distributed as soon as they are available. Due to unanticipated circumstances, clinical days may change during the semester. Therefore, students MUST BE AVAILABLE anytime during the semester to complete their clinical hours. Clinical sites will not be available next semester to complete clinical hours. Work schedules are not valid excuses for not completing clinical hours.
HARM RELEASE STATEMENT
This course requires students to participate in fieldtrips, research or studies that include course work that will be performed off-campus. Participation in such activities may result in accidents or personal injury. Students participating in the event are aware of these risks, and agree to hold harmless San Diego State University, the State of California, the
Trustees of the California State University and Colleges and its officers, employees and agents against all claims, demands, suits, judgments, expenses and costs of any kind on account of their participation in the activities.
Students using their own vehicles to transport other students to such activities should have current automobile insurance.
Confidential Information:
In the course of your graduate education you encounter personal and sensitive information about patients and staff. It is your legal and ethical responsibility to maintain the confidentiality of this information and to protect the anonymity of those involved. This includes, but is not limited to, avoiding discussions that would allow others to identify the subject of the information and removing all identifying information from written notes, etc.
1. As such, you should NEVER leave the clinical setting with any source of information that could be linked to a patient (e.g., patient name, social security number, or other identifying data). It is not sufficient to white-out or ink over identifying information.
2. You should not store patient and staff information in electronic format (e.g., PDAs, computers, etc.)
Failure to comply with the standard as noted above, holds serious consequences for the
Hospital, Clinic, University, School of Nursing and the Patient. As such, any violation
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may have serious repercussions. At the very minimum, clinical credit hours will not be given for the clinical day if patient information is found in one’s possession outside of the clinical setting.
Nursing Student Compliance Policy and Procedures
Policy: In order to attend clinical practicum, each nursing student must present a Compliance
Permission Slip to the clinical instructor at the start of each semester. Faculty will not allow any student who does not present a permission slip to attend clinical. Faculty may allow students to attend orientation sessions so long as there is no contact with patients.
Procedure:
1.
Before going to the first clinical lab, each student will obtain a Compliance Permission
Slip from the Admissions Coordinator.
2.
The Admissions Coordinator will be available to issue Permission Slips during administrative days and the first week of each semester. o o
Students may obtain Permission Slips only during posted hours.
The hours during which the Admissions Coordinator is available will be posted on the SON web site.
3.
For graduate students and undergraduate students in semesters 3-6, permissions slips will be given only if the student meets the following criteria: o o o o o all immunizations are complete and up to date or:

 a waiver is in effect titers indicate immunizations are not needed
TB testing will not expire before the last day of classes of the semester as per the academic calendar.
CPR certification will not expire before the last day of classes as per the academic calendar.
Malpractice insurance will not expire before the last day of classes as per the academic calendar.
Background Check and Drug Test
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San Diego State University
School of Nursing
N753: Preceptor Evaluation Form
Midterm Evaluation
Student:
Semester:
Faculty:
Preceptor:
Institution:
Clinical Area:
Student Self-Evaluation (List progress for each objective and include strengths and areas for improvement):
Preceptor Comments:
This evaluation has been reviewed and discussed by both the student and preceptor.
__________________________________________Date_______________
__________________________________________Date_______________
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San Diego State University
School of Nursing
N753: Preceptor Evaluation Form
Final Evaluation
Student:
Semester:
Faculty:
Preceptor:
Institution:
Clinical Area:
Student Self-Evaluation (List progress for each objective and include strengths and areas for improvement):
Preceptor Comments:
This evaluation has been reviewed and discussed by both the student and preceptor.
__________________________________________Date_______________
__________________________________________Date_______________
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Attachment 1:
Exploration of CNS Position
Important Agency Documents
Philosophy of the Department of Nursing
Hospital Organizational Chart
Nursing Department Organizational Chart
CNS Job Description
Nurse Manager Job Description
Professional Organization Role Descriptions
ANA and AACN descriptions of the CNS Role and Role Behaviors
CA BRN Description of CNS Role Components
Agency Variables
What type of hospital is it, occupancy rate, and specialty areas?
What is the current TJC status of the hospital?
What are the future plans for the hospital?
What nursing care delivery model is currently used?
How are ancillary personnel (non-licensed personnel) used in the unit/hospital?
Are there collaborative arrangements with Schools of Nursing, Medicine etc?
What is the nursing staff turnover on your unit or service, hospital?
Is there a clinical career ladder?
What is the educational preparation of most staff nurses, unit managers?
Is there a shared governance model and how are nurses represented?
Are nurses unionized?
Is flexible scheduling possible?
CNS Role in the Organization
What organizational responsibilities are associated with the CNS position?
What percent of CNS time is usually spent on these responsibilities?
What hospital wide committees does the CNS sit on?
How do CNSs contribute to changes in nursing practice?
Are there shared organizational responsibilities between the unit manager and the CNS? (hiring, interviewing, evaluation, policies, committees)
Is there an expectation that one CNS role is needed or valued more highly?
Are there other CNSs in the hospital?
If so, how many and where do they practice and for how long?
Who does the CNS report to?
Who evaluates CNS performance, who contributes?
Whose budget supports the CNS position?
What are the CNS role expectations for the administration, staff?
What are the perceived benefits of having a CNS in the hospital, service, unit?
What problems do CNSs face in this organization?
What are indicators of a successful CNS in this organization?
Support Services Available
Office and furniture, secretarial support, duplicating, audiovisual materials, library resources including selection of journals and books, librarian with an inter-library loan service, computers, statistician, media department, printers, parking, beeper, etc.
Benefits
Salary, schedules, vacation policy, basis of salary increments, incentives, educational benefits, conference time (attendance vs. presentation), out of hospital library time, terms of leave etc.
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Attachment 2:
Nursing 753 Clinical Log
Name :
Date Hrs/Cum
Hrs
Clinical Site
Preceptor:
:
__________________
Activities &
Clinical Objectives
Addressed
Reflection on Activities
1.
What was the most important thing you learned through your activities?
2.
What did you discover about yourself?
3.
Identify the CNS role fulfilled and the sphere of influence involved.
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Attachment 3
Journal Club Summary Form
Student:
Date:
Clinical Setting:
Learning objective for the activity: (there should be 1-3 depending on the nature of the activity).
Justify the need for the article selected for the journal club:
Evidence Citation (s):
What is the level of the selected evidence?
Evidence Critique Summary:
Take Home Messages from the evidence for audience: (bullet point most salient messages)
Learner Evaluation:
Number of attendees:
How did you evaluate your audience’s response to your journal club?
Self-Evaluation:
What are your reflections about your role as a leader for the journal club? What would you do the same or change?
Attach any learner materials distributed.
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Attachment 4
Organized Teaching Activity Summary Form
Student:
Date:
Clinical Setting:
Learning objective for the activity: (there should be 1-3 depending on the nature of the activity).
Justify the need for the teaching activity:
Evidence Citations for content: (3-5 research-based articles)
Evidence Citations for teaching methods selected: (3-5 theoretical or research articles)
Teaching Methodologies Used:
Learner Evaluation:
Number of attendees:
How did you evaluate your audience’s response to your teaching activity?
Attach attendee EVALUATIONS (Use your own brief form or the one used by the facility)
Self-Evaluation:
What are your reflections about your role as a leader for the teaching activity? What would you do the same or change?
Attach any Learner Materials Distributed
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Attachment 5
STUDENT___________________________SEMESTER__________
Evidence-Based Practice Project - Paper
Grading Guidelines and Criteria for Evaluation
Points
Possible
Points
Earned
Problem Identification and Evidence Base
1.
Practice Problem Identification
 Description of clinical practice to be addressed.
 Significance of project, be able to answer the question: so why is this problem significant?
 Problem statement in PICO format
2. Evidence-Base
 Document search process for identifying articles. (consulted a librarian?)
 Identify key search terms.
 Body of Evidence presented was necessary and sufficient (10-15 sources minimum).)
 Fill in The Summary of Evidence Grid (attachment 6)
10
30
3. Critical Analysis

Synthesize the evidence in a 3-5 page summary

Summarize the implications for Nursing practice

Summarize what the evidence supports as the best practice related to the problem you selected

Contrast and compare to the evidence gained from your critique to the existing clinical practice.

Summarize with a conclusion about whether or not the clinical practice is consistent
20 with the best practice identified in the evidence.
Implementation Strategy
4. Implementation and Evaluation Plan
 Baseline assessment (describes what the current practice is and it’s history) o Query staff about the rationale hospital staff for the clinical practice – summarize the range of responses.
 Protocol or methods used outlining the steps involved in the change in practice
 Clear identification of a change theory and its application in designing the project.
 Cost Benefit assessment as appropriate
 Outcomes measure assessed or proposed

4.
Summary
 Address lessons learned from the process- your reflections on changing practice
6. Support Materials, APA format, Spelling and Grammar
Total Points (5 points a day deducted for late papers)
COMMENTS:
20
10
10
100
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Faculty signature:______________________
Attachment 6:
PICO format for EBP Question:
______________________________________________________________
Author – year – contact information
(include the full citation in your reference
Databases searched: SumSearch_____; Trip______; NCG_______;
AHRQ_______; RNAO_______; JBI_______;
CINAHL________; Pub Med________; PsychInfo________;
Other__________; Other___________
Purpose Design
Sample:
Size & characteris tics
Data
Sources
(surveys, interviews, tools)
Intervention list)
Findings/
Strengths/
Weaknesses
&
Take Home
Message
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