Comprehensive Exam
Orientation
Spring 2014
Roxanne Garbez, RN, PhD, ACNP-BC, CNS
Mark Hawk, RN, MSN, AG ACNP-BC
Starting Spring 2015
Comprehensive exam
submissions will use the
new format.
Comprehensive exams
submitted prior to Spring
2015 will use old format.
Outline of Comp Process
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Description of the project
The Comprehensive Exam Handbook
Qualifying for the examination
Important dates
Technical requirements
Resources
Graduate Division
Language
comprehensive
examination should
demonstrate the student’s
mastery of the major field and
ability to think critically.
 “The
The Assignment
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The purpose of this paper is to
evaluate your ability to:
– Critique research as it applies to your
area of specialization
– Apply advanced clinical and theoretical
knowledge to practice
– Utilize writing skills to disseminate
nursing information using a scholarly
paper
– Demonstrate you can be a consumer of
research
Critical Points
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Twenty (20) page paper
not including title page,
references, grid and
appendices
Four exam options
– Research Proposal
– Critical Literature Review
– Problem-solving
– White Paper (still in process)
The Handbook
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You can download
a copy of the
Comprehensive
Examination
Handbook from the
UCSF School of
Nursing website
Handbook will be
available starting
September 2014.
How to Qualify for the
Examination
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You are eligible in the last quarter you
are enrolled in course and clinical
work.
If you have completed ALL course
work with the exception of the comp
exam you may submit the exam while
on filing fee status for a reduced fee.
Filing Fee Status
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Talk with your advisor
You may not take courses of any type or
utilize faculty as a resource for writing your
paper if you are on Filing Fee status
Apply and pay filing fee to OAR
Most frequently used for second time comp
exam submission
Filing fee status can be used only once. If
you pay filing fee then do not submit your
comp you must pay full tuition for the
subsequent quarter you submit your comp
Advance to
Candidacy
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Before you can be issued your individualized
Comp Number, YOU MUST ADVANCE TO
CANDIDACY.
Advance to Candidacy forms are available
from the Office of Admissions and Registrar.
Forms can also be downloaded online.
After you submit your form Graduate
Division notifies Office of Student Affairs.
OSA will then generate your Comp Number.
The Last Quarter of
Course and Clinical Work
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Advance to Candidacy the
quarter before you plan to
submit your comp
Your last chance to Advance
to Candidacy is the first week
of the quarter in which you
plan to turn in the comp
One incomplete on academic
record allowed
Payment of fees required for
number
Know the Important
Dates- Spring 2014
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Number pick up date:
– Between April 8 and April 21
Submit comp by Noon
– April 22
Notification of results
– May 22
Formatting Expectations
APA 6th Edition format
Margins 1 inch on all 4 sides of page
Can separate syllables at the end of a line
20 pages of text, not counting title page,
reference list and appendices
Title should reflect content
No abstract
Double-spaced, 12 point uncompressed font
(Acceptable font examples: Times New
Roman, Arial)
Submission Requirements
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Completed face sheet
Separate paper with student’s name,
address, home and work number, and other
pertinent information that facilitates the
student being contacted if necessary
It is the student’s responsibility to ensure
that the comprehensive exam is submitted
by 12 noon on the due date
One single-sided original of the
comprehensive examination in PDF format
Face Sheet
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In order to pick up your number you
must complete the face sheet and
return it
– List your specialty
– Topic
– Suggested readers
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ID number is given to you to be
placed on your comp
15
Reading and Scoring
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Student may select up to five preferred
readers (not required)
Student is not guaranteed a preferred
reader
Readers use a standard scoring system
Student will be given the faculty
comment sheets at the end but not the
scoring sheets
Plagiarism
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Evidence of
plagiarism results in
a failure of the
comprehensive
exam.
Plagiarism can
become grounds for
dismissal from the
School of Nursing.
A Comp Does Not Pass
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One pass and one
fail from two
readers goes to a
third reader for
decision
Exam fails if two
readers fail it
May re-submit
exam once within 5
quarters of first
submission
Vital Resources
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Vital resource—Department Administrative
Assistants
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CHS
PN
FHCN
SBS
Comprehensive Exam Coordinators
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CHS Beth Phoenix & Dana Drew-Nord
PN Roxanne Garbez
FHCN Karen Duderstadt & Mary Lynch
SBS Susan Chapman
Additional Resources
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Advisors- topic and
format
Specialty faculty
Sample comps on
reserve
Office of Student
Affairs for tutors
and editors, contact
Judy Martin-Holland
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Consider other
arrangements
– Typist
– Paid tutors and
editors
– Peers as editors and
proofreaders
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Create a timeline
– See sample
provided
Comprehensive Exam
2014-2015
SEP
OCT
NOV
DEC
JAN
Identifying the
phenomenon of interest
FEB
MAR
APR
MAY
JUN
JUL
AUG
• Advance to Candidacy: Before end of Winter
Quarter
Topic generation
Faculty input re: topic
• Pick up Comp # from Departments: From
4/08/14 to 4/21/15
Literature review
• Submit Comp to Departments: 4/22/14
Refine topic outline
Faculty input re:
topic outline
Advance to
Candidacy
Pick up
Comp #
Draft #1
Colleagues read paper
for clarity and organization
Draft #2
Edit
Submit
Comp
WORK HARD, DO WELL!
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Extensions,
examination by mail,
summer comps, oral
exam are available
only by special
arrangement. Read
the corresponding
section of the comp
handbook.
Sample Examinations
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On reserve in each of the departments
Ask your advisor and/or your
department's comprehensive
examination coordinator
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Comprehensive Exam
overview
Choosing a Theory
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Applicable to critical literature review,
research proposal and problem solving
comp
A theory should further clarify, support
and explain your topic
Nursing theory not required
Explain your theory in the text—don’t
depend on diagrams in the appendix
27
Theory or Conceptual
Framework
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Theory is the format that enables you
to explain a phenomenon. There is no
right or wrong theory--it is all in how
you want to frame the argument you
want to make.
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Concept or Phenomenon
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Possible Mechanisms Underlying the
Increased Risk of Type 2 Diabetes in
People on Atypical Psychotrophics
Potential Theoretical Frameworks
Physiological HPA axis and sympathetic nervous system hyperactivity
resulting in overproduction of cortisol.
Genetics
Diabetes only occurs in those with a genetic
predisposition.
Co-moridity
The diabetes is really due to alcoholism or binge eating.
Sociocultural
Due to socioeconomic, disability, marital status, access
to health care
Health care
Providers fail to adequately monitor overall health.
Behavioral
Inactivity, diet, smoking due to the psychiatric illness
Medication
Side effects, appetite stimulation and subsequent weight
gain
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Research Literature
Summary Critique Table
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Organize your literature into a table to
compare and contrast different
components of the critique
Briefly describe each study in the
paper
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Author(s),
Year
Purpose
Sample
Data Source,
Main Ind.
Design/Method Variable/Dep.
s
Variables
Main Findings
Smith, 2011
Identify states with
comparable
enrollment for
Medicaid-eligible
children between
immigrant and nonimmigrant families
Total 842,196
Medicaid-eligible
children (aged 017); children of
immigrants
(321,043); children
of non-immigrants
(521,153)
2009 US Census
Bureau, Crosssectional survey
Many states
had significant
enrollment
disparities
between
immigrant vs.
non-immigrant
families: CA &
HI had highest
rate of
uninsured
immigrant
families/children
DRAFT – DO NOT
USE AS FINAL
COPY
Main IVs:
immigration
status, state of
residence
Main DV:
uninsured
families
(percent)
Research Proposal
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To evaluate a student’s ability to
identify a significant research question
relevant to nursing practice, and to
design a methodology for addressing
the question.
Study does not have to be
implemented
Must have access to UCSF faculty with
research experience to mentor you
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Research Proposal
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Good choice if you plan to build on
this topic for future research or
doctoral work
Could be taken back to your workplace
for implementation if approval given
by institution
Quality of Writing
Area I
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Content & Focus
Logic & Flow
Structure & organization
Sentence structure
APA format
Correct grammar, punctuation, word
usage, and spelling
Each category 5 points = 30 points
Score of 15 points or less is a technical fail
Scoring Areas II - IV
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II: Study & its Context -70 points
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III: Conceptual Framework &
Literature Review -125 points
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IV: Methodology -105 points
The Comprehensive Exam
is Pass/Fail
points available – 330
 Points needed to pass - 231
 Total
Proposed White Paper
Area
Content Criteria
Possible Score
(330)
I: Quality of Writing
Content & focus, logic & flow, structure &
organization, sentence structure, APA,
grammar
30
Clarity of policy issue, significance of
issue/policy, importance to health
care/nursing, quality of evidence
80
II: Introduction &
Background
*must score minimum
15
III: Literature Review, Quality of theoretical discussion,. Quality of
Theoretical Framework, references, addresses elements of critique,
Summary of Research
quality of critique & interpretation
115
IV: Policy Solutions &
Recommendations
105
Implementation of solutions, feasibility &
cost analysis, evaluation framework,
summary & conclusion
DRAFT COPY
Critical Literature Review
Choosing a Topic
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Pose a question
Do initial searching
There is enough research, but no clear
synthesis of findings or clear direction
You want to argue a point that has
some evidence, but is not established
practice
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Critical Literature Review
Topic or Issue
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Clarity of topic or purpose
– State in 1 sentence!
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The purpose of this paper is to
examine the literature related to the
efficacy of using BNP to diagnose
patients with heart failure
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Topic or Issue
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Significance of topic
– 4.8 million in US have HF, 50% are
rehospitalized in 6 mos., there is no lab
test for diagnosing HF, BNP might provide
better method for effective evaluation of
SOB than symptoms
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Some evidence exists, but
practice is not well delineated
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Should diabetics use
ACE inhibitors to
prevent renal
impairment ?
This is well-established
by scientific study and
standard of practice in
most settings.
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Is it safe to give people
with stage 4 kidney
disease ACE inhibitors
to prevent
progression?
Practitioners have been
hesitant to give people
with stage 4 CKD ACE
inhibitors for fear of
increasing creatinine or
potassium to
dangerous levels.
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Literature Review
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Theoretical Discussion
Must address the foundation of your
question or problem
– Example: Sepsis and EGDT
Use Physiologic theory to explain why EGDT
is appropriate for septic patients
 Use Change Theory if you want to implement
EGDT in a new setting that manages septic
patients
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Literature Review
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Quality of References
– References significant to the problem
area – classic & current while noting gaps
in research literature if any
– Avoid multiple articles from the same
overall study (different purposes but
same sample, methodology, statistics,
etc.)
45
Literature Review
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Organization of review
Rationale for selected articles, describe how
you organized your paper
– The journal articles were chosen because they
include…….and the oldest is reviewed first….
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How many articles should you critique?
Use well written AND perhaps not so well
written research articles – the heart of the
critique process is identifying why they may
have similar study questions and yet end up
with different results
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Literature Review Critique
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Synthesis and interpretation
– YOUR ASSESSMENT OF THE STUDIES
– Too small of a sample size to have power
to find a difference between those with
and without HF
– Authors were biased b/c they knew the
BNP level and may have changed
treatment
– Only generalizable to men
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Identifies gaps in literature,
implications for practice, need for
further research
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STICK your neck out there! Make your
opinion known, however you must
base it on the critique of the literature
you presented rather than your
opinion.
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Scoring Areas I - IV
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I: Quality of Writing – 30 points
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II: Topic or Issue – 50 points
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III: Literature Review - 150 points
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IV: Discussion & Application –
100 points
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Problem-Solving Comp
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Purpose: To evaluate the student’s
ability to effectively communicate the
resolution of a problem in an area of
specialization.
Describes an identified need stemming
from a discrepancy between what is or
what could/should be.
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Choosing a
Problem-Solving Topic
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Can be a problem on
an individual or a
systems level.
Must be appropriate
to the clinical
situation
– Think of a situation
that is challenging to
you
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Must be feasible!
Must be measurable!
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Problem-Solving Cautions
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Instituting a delirium treatment program in
acute care setting
– Is delirium identified? Multiple etiologies…what will
the intervention be? How will you measure this?
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Improving parenting skills by identifying
temperament in toddlers in preschools
– What is meant by “parenting skills?” How will you
get access to preschools? Is there literature that
indicates that identifying temperament will change
parenting behavior?
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The Problem and its
Environmental Context
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Clarity of the Problem
– Who is solving the problem
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APN
– Where the problem occurs
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ICU
– What is to be accomplished
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Improve Nurses’ Knowledge
– Target population
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ICU Nurses
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The Problem and its
Environmental Context
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Significance of the Problem
– Importance of the problem to patients or
profession
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Accurate Hemodynamic Monitoring is
essential for ICU patients
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The Problem and its
Environmental Context
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Clarity of the Setting
– Home, hospital, nursing home
– Intensive Care Unit
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The Problem and its
Environmental Context
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Clarity of Roles & Inter-relationships
– Describes functions of individuals sig to
problem, their roles and influence on the
setting
– ICU nurses, Clinical Nurse Specialist,
Head Nurse
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Literature Review
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Quality of theoretical discussion
Quality of references
Addresses elements of critique
Quality of critique and interpretation
Intervention, Implementation
& Evaluation
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Expected Outcomes
Clarity & Appropriateness of
Intervention Implementation
Clarity & Appropriateness of Evaluation
Procedure
Defensibility
Realism
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Intervention, Implementation
& Evaluation
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Clarity of Expected Outcomes
– Improvement of Nurses Knowledge
evidenced by improvement on post-test
scores
59
Intervention, Implementation
& Evaluation
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Clarity & Appropriateness of
Implementation
– Outline procedures for implementing the
intervention and ensuring they are
appropriate
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Educational intervention was three-fold
– Self-study, then 4 hour mandatory class, bedside
guides developed
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Intervention, Implementation
& Evaluation
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Clarity & Appropriateness of
Evaluation
– Delineates specific measurable and
appropriate evaluation criteria
Pretest and post-test measure of ICU nurses’
knowledge is measured
 Number of incident reports are analyzed
regarding monitoring
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Intervention, Implementation
& Evaluation
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Defensibility
– Demonstrates intervention has potential
for substantial improvement in the
problem
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Realism
– Feasibility of intervention
– Will an educational intervention be
possible?
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Caveats
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Do not wait until the end to decide on
method of evaluation
When writing, do not always start with
the beginning of the paper and
progress to the end or your evaluation
will suffer.
63
Scoring Areas I - IV
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I: Quality of Writing – 30 points
II: Problem & environmental
Context – 75 points
III: Literature Review: Research,
Narrative, & Theory – 100 points
IV: Intervention, Implementation,
and Evaluation – 125 points
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Most common reasons
why comps fail
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Started too late to put in necessary time
and effort
Did not meet with your advisor to obtain
feedback and make sure you are on track
Did not follow the advice of your advisor
Changed your comp topic at the last minute
Primary editor was someone whose English
composition skills were not adequate to give
you appropriate feedback on your writing
I PASSED!
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