College of Nursing
UNIVERSITY OF CENTRAL FLORIDA
COLLEGE OF NURSING
Fall 2012
Course Number:
NGR 7065
Course Title:
Advanced Clinical Management for Advanced Practice
Nurses
Credit Hours:
3
Prerequisites or
Co-requisites:
Admission to the Doctor of Nursing Practice Program
Placement In The Curriculum:
Core Requirement: DNP
Meeting Time & Place:
WWW
Faculty:
Christopher W. Blackwell, Ph.D., ARNP, ANP-BC, CNE
Associate Professor, College of Nursing
University of Central Florida
Office: UT- 453 (hours by appt.)
Office Phone: (407) 823-2517
Personal Cellular Phone: (407) 375-4334
cwblackw@mail.ucf.edu
Catalog Description: In depth analysis of care needs of individuals with complex health
promotion, maintenance or restoration needs. Management at the individual, family and
aggregated levels will be emphasized. Cases will be in area of students’ advanced
practice specialization.
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Course Objectives: Upon completion of this course the student will:
1. Synthesis of knowledge from biopsychosocial sciences to plan care for
individuals with complex health problems in area of advanced practice nursing
specialization.
2. Demonstrate advanced levels of clinical judgment in the planning of care for
individuals, families and aggregates with complex health needs.
3. Apply evidenced based data to the design of care of individuals, groups and
aggregates.
4. Integrate evolving evidence-based practice recommendations to care of patients.
5. Systematically explore the care of individuals with health needs in a specialty
area.
6. Apply principles of ethical decision-making in the planning of care for individuals
with complex health needs.
7. Analyze health care system impact on care of individuals with complex health
problems.
Teaching/Learning Strategies:
Lecture Notes/ Power Point Presentations
Web based discussion
Reading
Written/ Group Assignments
Case Studies
Course Examinations
Review and use of library and electronic resources
Units of Instruction: (Note order of content in lecture may vary slightly. See course
schedule, below)
I. Foundations of Clinical Decision Making:
1. The NP and Relationship-Centered Care
2. The Process of Clinical Judgment
3. Assessment and Diagnosis
4. Planning and Intervention
5. Documentation
II. Writing Professional Clinical Papers:
1. Styles Used in Clinical Writing
2. Correct Use of Grammar and Punctuation
3. Review of American Psychological Association Formatting
4. The Process of Getting Published
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III. Diagnostic Testing:
1. Clinical Judgment for Special Populations
2. Special Settings
3. Clinical Judgment and Acute Care Nurse Practitioners
4. Reliability and Relevance of Clinical Data
IV. Decisional Support Systems:
1. Issues in Primary Care
2. Philosophical Considerations in Nurse Practitioner Practice
V. Non-Linear Evidence:
1. Scales of Measurement
2. Disease Classification
3. The Randomized Clinical Trial
4. Critical Reading of Medical Journals
VI. Diagnostic Errors:
1. Uncontrolled Experience
2. Diagnostic Reasoning
3. Terminological Confusion
VII. Ethical Decisions:
1. Ethics in the Healthcare Encounter
2. Medicine and the Humanities
VIII. Therapeutic Communication:
1. Establishing the client’s database therapeutically
2. Non-therapeutic communication
3. The role of Culture in therapeutic communication
4. Using therapeutic communication to diagnose and avoid error
Required Texts
Chase, S.K. (2004). Clinical judgment and communication in nurse practitioner practice.
Philadelphia, PA: FA Davis. (ISBN: 0-8036-0797-0)
Gotzsche, P. C. (2007). Rational diagnosis and treatment: Evidenced based clinical
decision making (4th ed.). Chichester, England: Wiley.
(ISBN: 978-0-470-51503-7)
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Required On-line Resources:
This course will be using the new on-line learning platform that has been officially
selected by the University of Central Florida called Canvas. Specific directions for
accessing this on-line learning platform will be sent through e-mail (Knights mail) close
to the start of the Fall 2012 semester.
Course Learning Modules/ Class Notes: Each unit within the course has a specific
learning module consisting of an outline (study packet) of the course lecture notes, pdf
version of the PowerPoint® lectures, and supplemental notes for a select few units. These
are all available for download from the Canvas Site. Students should read through each
PowerPoint® lecture and then download the study packet to aid in preparation for
midterm and final examinations. The PowerPoint® presentations are in view-only and are
viewable via the Canvas by clicking on “Modules.” The presentations are narrated and
users must have a Flash-ready device to download them.
Course Schedule
Date
August 20, 2012
Content
Orientation to course
Required Reading/ Assignments
August 27, 2012
I. Foundation of Clinical
Decision Making
 The NP and
Relationship-Centered
Care
 The Process of Clinical
Judgment
 Assessment and
Diagnosis
 Planning and
Intervention
 Documentation
II. Writing Professional
Clinical Papers:
 Styles Used in Clinical
Writing
 Correct Use of
Grammar and
Punctuation
 Review of American
Psychological
Association Formatting
 The Process of Getting
Published
Chase, S.K. (2004):
Chapters 1-5
September 3, 2012
September 10, 2012
Available through
CINAHL:
Lasater, K. & Nielsen, A.
(2009). Reflective
journaling for clinical
judgment development and
evaluation. Educational
Innovations 48 (1), 40-44.
Available through
CINAHL:
Campanelli, P.C.,
Feferman, R., Keane, C.,
Lieberman, H.J. &
Roberson, D. An advanced
practice psychiatric nurse’s
guide to professional
writing. Perspectives in
Psychiatric Care 43 (4),
163-173.
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Candib, L.M. Writing
troubles for women
clinicians: Turning
weakness into strength
through writing in-relation.
Families, Systems, &
Health 24 (3), 302-317.
Driscoll, J., & Aqultina, R.
(2011). Writing for
publication: A practical six
step approach. Journal of
Orthopaedic and Trauma
Nursing 15, 41-48.
Fowler, J. (2011). Writing
for professional publication.
Part 9: Using client case
studies. British Journal of
Nursing 20 (5), 254.
Happel,B. (2008). Writing
for publication: A practical
guide. Nursing Standard 22
(28), 35-40.
September 17, 2012
September 24, 2012
October 1, 2012
October 8, 2012
III. Diagnostic Testing:
 Clinical Judgment for
Special Populations
 Special Settings
 Clinical Judgment and
Acute Care Nurse
Practitioners
 Reliability and
Relevance of Clinical
Data
IV. Decisional Support
Systems:
 Issues in Primary Care
 Philosophical
Considerations in Nurse
Practitioner Practice
Chase, S.K. (2004):
Chapters 6-8
Gotzsche (2007):
Chapter 2
Chase, S.K. (2004):
Chapters 9-10
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October 15, 2012
October 22, 2012
October 29, 2012
November 5, 2012
November 12, 2012
November 19, 2012
November 26, 2012
December 3, 2012
Final Examination Period:
December 5-11, 2012
V. Non-Linear Evidence
 Scales of Measurement
 Disease Classification
 The Randomized
Clinical Trial
 Critical Reading of
Medical Journals
VI. Diagnostic Errors
 Uncontrolled
Experience
 Diagnostic Reasoning
 Terminological
Confusion
VII. Ethical Decisions
 Ethics in the Healthcare
Encounter
 Medicine and the
Humanities
VIII. Therapeutic
Communication
 Establishing the client’s
database therapeutically
 Non-therapeutic
communication
 The role of Culture in
therapeutic
communication
 Using therapeutic
communication to
diagnose and avoid
error
Gotzsche (2007):
Chapter 1; 3; 6; 8
Midterm Examination
(covers Units I-IV opens
Monday October 15th @
Noon and closes Sunday
October 28th at 2355).
Gotzsche (2007):
Chapter 4-5
Chase, S.K. (2004):
Chapters 11
Gotzsche (2007):
Chapter 7
Clinical Case Study Due by
2355 on 11/19/12.
See the Course Modules in
Canvas for the assigned
journal readings.
Final Examination (covers
Units V-VIII) opens @
0100 on Wednesday
December 5th, 2012 and
closes @ 2355 on Tuesday,
December 11th.
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EVALUATION METHODS (and Due Dates):
Class Attendance/ Participation
15 points
Reflective Journal
(Unit I)
8/27/12
5 points
Reflective Journal
(Unit III)
10/1/12
5 points
Reflective Journal
(Unit IV)
10/15/12
5 points
Reflective Journal
(Unit V)
10/29/12
5 points
Reflective Journal
(Unit VI)
11/12/12
5 points
Reflective Journal
(Unit VII)
11/26/12
5 points
Reflective Journal
(Unit VIII)
12/3/12
5 points
Clinical Case Study
11/19/12
50 points
Midterm Examination (Units I – IV)
10/28/12
25 points
Final Examination (Units V-VIII)
12/11/12
25 points
________________________________________________________________
Total
150 points
Percentage
96-100
92-95
87-91
83-86
79-82
75-78
70-74
69 or below
Points
143-150
137-142
130-136
124-129
118-123
112-117
104-111
< 104
Grade
A
AB+
B
C+*
C*
D*
F*
* = Unacceptable for progression in the Doctor of Nursing Practice Program.
SUMMARY OF COURSE ASSIGNMENTS AND ACADEMIC PROGRESSION:
Class Attendance/ Participation: Class participation points can be earned through
active participation in the online class discussions that demonstrate preparation (reading
assigned materials prior to class) and critical thinking.
Reflective Journals: When the clinical environment is predictable, clinical decisions
may be at the automatic level, similar to driving the same route home from work each
day. When the clinical environment has uncertainty, such as when driving home from
work in a bad rainstorm or taking an alternate route, greater attention is needed. Most
patient encounters are complex and include a degree of uncertainty. At this higher level
of clinical functioning we can decide to monitor our decision-making. This is called
metacognition and is what is the objective of your reflective journaling.
Let me know immediately if your clinical practice does not include routine interactions
with patients!
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Please begin keeping a reflective practice journal. It is required that you write in this
journal at least 1 time per unit (minus Unit II). Consider jotting down reminder
notes about patient encounters while you are at your clinical setting. Read the
specific Reflective Journal considerations for the module of that week at the
beginning of each week to help you focus on those specific aspects of your
clinical practice.
Your journal will be submitted electronically via the Discussion Journal section. So
be sure to maintain patient confidentiality--NO IDENTIFYING PATIENT OR
CLINIC INFORMATION please! Be sure to label your journal entries with
your last name and the date. Remember, none of us are perfect and we can all
learn from each other! I will be posting journals throughout the semester too and
am eager to grow my own clinical practice based on the knowledge you can
provide me as well.
Each module will ask that you look at specific aspects of your clinical practice
and reflect on this in your journal. In addition to addressing the specific criteria
for that module, your journaling should also include descriptions of patient
encounters that meet any of the following criteria:
the patient encounter was distressing to you
there were ethical dilemmas related to the patient encounter
the patient encounter was a puzzlement in regard to diagnosis, treatment or
interpersonal relations
the patient encounter was frustrating (it was a "difficult" patient?)
you felt you could have handled the patient encounter differently or better
After briefly describing the encounter, spend time reflecting and writing about why
this encounter might have had this effect on you. Are there cultural beliefs or
personal values and experiences that influenced your response to the encounter or
to your treatment decisions? How might you respond to this patient or a similar
patient encounter differently in the future? It is expected that you will use
information/resources from this course to describe these patient encounters and
subsequent clinical management strategies.
Additionally, there will be specific module journal activities that are intended to
synthesize the module information and should be included in your Reflective
Journal. You will find these specifics in the modules.
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Criteria
Points
Each patient encounters demonstrating depth of reflection,
metacognition and includes module specific foci (7 total @ 4pts
each).
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Completion and documentation of module specific activities (see
the modules and schedule)
7
Total
35
Clinical Case Study
Let me know immediately if your clinical practice does not include routine interactions
with patients! You can consider using a case study approach for a Health Care System
issue if this is more applicable to your clinical role (see the article: Case study research:
The view from complexity science) but you must discuss this with me first.
The final assignment for this class is a clinical case study paper that could be appropriate
for submission to a peer reviewed journal. Just because it is the final assignment of this
class, do NOT wait until the last week(s) to get started and always ask if you have any
questions!
Choosing a case:
Is this a unique case?
Will this case significantly advance understanding of some aspect of clinical
management?
You can use one of the patients discussed in your Reflective Journal.
Writing your case:
Case studies should be no more than 5000 words long, including references, tables,
figures, and appendices.
Each case report should follow the outline/template below-include the following sections:
THIS IS NOT A SOAP NOTE OR CHART ENTRY–DO NOT USE THAT TYPE OF
WRITING STYLE! Refer to scholarly journal examples of case studies to get a clearer
idea of case study articles.
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Title page including author details
The title should clearly and simply explain what the case report is about, for
example: “Hernia in a 6-year-old boy presenting as an incarcerated
inguinal hernia: A case report” or “Misleading pustullar plaques of the
lower limbs in Crohn’s disease: A case report”
Abstract limited to 200 words. You should not include references or acronyms.
Introduction
Explain the background of the disorder the case report focuses on, and include
a brief literature review.
Case presentation:
Include all details relevant to the case – including:
a description of the patient’s demographic information
any relevant medical history of the patient or their family
the patient’s symptoms and signs
any tests that were carried out
a description of treatments or interventions
the outcome of the case
Discussion:
This section puts the case in context and explains treatment decisions –
including:
How were theoretical foundations, research based evidence, and/or
decision support systems used in the decision making process?
Patient’s perspective (cultural beliefs, values)
Ethical considerations
What could be done to manage this case differently or better?
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Conclusion:
Explain the importance of this case, what can be learned from it, and who it
will be of interest to.
Explain how the case will advance our knowledge.
References:
Use scholarly sources with appropriate citations and references included in
APA 6th ed. Format No copies of tables, figures, or photographs should be
used without copyright permission or exemption.
Consent from patient
UCF IRB Case Study Informed Consent template to be used for this
assignment
Include a section at the end of the paper headed ‘Consent’ giving a statement
to this effect:
Written informed consent was obtained from the patient for potential
publication of this case report. All efforts were made to maintain
patient confidentiality. A copy of the written consent is available
for review upon request.
If the patient has died, consent must be sought from the next of kin. If
the patient is a minor, or otherwise unable to provide consent, then
consent must be sought from the parents or guardian. In these
cases, the consent statement in the manuscript should be amended
accordingly.
If you are unable to gain consent, the following conditions must be
met:
all reasonable attempts to gain consent have been made
there is no reason to think that the patient or their family would
object to publication
Most journals REQUIRE this consent confirmation with manuscript
submissions of case studies. While it is a given that you would not
include patient or clinic names, case studies may be specific
enough that a patient can self-identify or the patient’s friends or
family can identify them.
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
Additionally, if you intend to publish the case study you must
follow the IRB protocols of the institution that provided you with
access to this patient and patient information. You will need to
check with the individual institutions, but at the time of creation of
this document, the Florida Hospital requirements and Orlando
Health Care System requirements were as stipulated in the
Discussion Board.
You must submit your paper to Turnitin and generate an originality report that’s <
20% (not including references and quotations. Papers with originality reports >
20% should be revised and resubmitted until the report is < 20% or you course
mail the instructor explaining any mitigating circumstances that cause it to be >
20%. It typically takes anywhere from minutes to a full day (you will need to exit
and log back in periodically) for Turnitin to generate an Originality report. Thus,
it is best to plan for this delay and submit early enough make necessary revisions
and to meet the assignment due date. Turnitin can be accessed through the course
home page. Papers will not be graded if not submitted to Turnitin.
Criteria as described in syllabus above
Points
Title page
2
Abstract
2
Introduction
8
Case presentation
12
Discussion
12
7
Conclusion
Scholarly citations and references included in APA
Format
6th
ed.
5
2
Patient consent obtained and statement included
P/F*
Documentation of at least one session with UCF Writing Center
50
Total
* = Students must meet at least one time during the semester with the UCF Writing
Center (contact information is below) and submit documentation of that session for
paper to be graded.
Writing Skills Webcourse Resource:
Writing skills are an important part of your professional development. These skills will
be required throughout your education and will be a reflection of your professionalism in
clinical practice.
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Often we become complacent or forget some of the important tenets of professional
writing. This is understandable as we speed through our day and use abbreviated
terminology and incomplete sentences.
To refresh your skills, the following self-registration tutorial is being made available to
you. In this Webcourse Writing Skills Tutorial, you will find four modules: APA Writing
Style, Plagiarism, Internet site evaluations and EBP. Review the materials in the modules
that apply to your learning needs.
Feel free to attempt any of the self-assessment quizzes.They do not count towards your
grade in this course. However, your ability to write professionally is part of your course
grade. Remember, plagiarism can result in dismissal from the nursing program.
The Writing Skill Webcourse can be accessed via self-registration.
Additional writing resources:
UCF Writing Center: Orlando: 407-823-2197, Cocoa: 321-433-7873, Daytona Beach:
386-506-4025 or online at http://www.uwc.ucf.edu/
UCF Library resources http://infolit.ucf.edu/students
Students who work together or who use resources outside of the course textbooks,
medical-oriented Internet Sites, or other-instructor approved sources will have
committed academic dishonesty and will receive a failing grade in the course (see
Academic Integrity Statement, below).
Midterm and Final Examinations: To assess learning of concepts in the assigned course
readings, students must successfully pass the Midterm and Final Examination. The
average of the midterm and final exam must be >75% for any other coursework to
be added into the calculation of the student’s course grade. Each examination consists
of material from 4 Units of Instruction and consists of 25 multiple-choice questions based
on the content. See the course schedule (above) for the examination dates, times, and
periods of availability.
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American Nurses Association
The Code of Ethics for Nurses 2001
Voted on and accepted by the ANA House of Delegates on June 30, 2001
1. The nurse, in all professional relationships, practices with compassion and respect for
the inherent dignity, worth, and uniqueness of every individual, unrestricted by
considerations of social or economic status, personal attributes, or the nature of health
problems.
2. The nurse's primary commitment is to the patient, whether an individual, family,
group, or community.
3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights
of the patient.
4. The nurse is responsible and accountable for individual nursing practice and
determines the appropriate delegation of tasks consistent with the nurse's obligation to
provide optimum patient care.
5. The nurse owes the same duties to self as to others, including the responsibility to
preserve integrity and safety, to maintain competence, and to continue personal and
professional growth.
6. The nurse participates in establishing, maintaining, and improving health care
environments and conditions of employment conducive to the provision of quality health
care and consistent with the values of the profession through individual and collective
action.
7. The nurse participates in the advancement of the profession through contributions to
practice, education, administration, and knowledge development.
8. The nurse collaborates with other health professionals and the public in promoting
community, national, and international efforts to meet health needs.
9. The profession of nursing, as represented by associations and their members, is
responsible for articulating nursing values, for maintaining the integrity of the profession
and its practice, and for shaping social policy.
The Code of Ethics for Nurses is available for sale from American Nurses Publishing at
1-800-637-0323 or www.nursesbooks.org
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Office of Student Rights and Responsibilities
University of Central Florida
YOUR ENROLLMENT STATUS MAY BE AT RISK!
Academic Dishonesty in any form will not be tolerated!!!
Any student found to have plagiarized or cheated in any form on any of the
assignments in this course will receive an “F” for the course. The student cannot
progress in the course and will be immediately removed from the course.
Violations of student academic behavior standards are outlined in The Golden Rule, the
University of Central Florida's Student Handbook. See http://www.ucf.edu/goldenrule/
for further details.
1. Cheating whereby non-permissible written, visual or oral assistance including that
obtained from another student is utilized on examinations, course assignments or
projects. The unauthorized possession or use of examination or course related
material shall also constitute cheating.
2. Plagiarism whereby another's work is deliberately used or appropriated without any
indication of the source. Thereby attempting to convey the impression that such work
is the student's own. Any student failing to properly credit ideas or materials taken
from another has plagiarized.
3. A student who has assisted another in any of the aforementioned breach of standards
shall be considered equally culpable.
ACADEMIC ACTION
* Taken by Instructor, Chair, or Dean of College*
1. Counseling
2. Loss of credit for specific assignment, examination or project.
3. Removal from course with a grade of "F" and/or
CONDUCT REVIEW ACTION
*Taken by the Office of Student Conduct*
1. Warning
2. Probation
3. Suspension
4. Expulsion
5. Permanent conduct record with UCF accessible by other institutions by request.
For more information, please contact the Office of Student Conduct at 823-2851.
NUR3825summer06.doc Rev 5/2/06- CWB
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Persons With Disabilities: The University of Central Florida is committed to
providing reasonable accommodations for all persons with disabilities. Students who
need accommodations must be registered with Student Disability Services (SDS), Student
Resource Center Room 132, phone (407) 823-2371, TTY/TDD only phone (407) 8232116, before requesting accommodations from the professor. Students who are registered
with SDS and need accommodations in this course must contact the professor at the
beginning of the semester to discuss needed accommodations. No accommodations will
be provided until the student has met with the professor to request accommodations. This
syllabus is available in alternate formats upon request.
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