Collaborative Bachelor of Science in Nursing Program (University of Windsor, Lambton College, St. Clair College) Clinical Nursing Experience 63-378 August 2007/May 2008 Professors: Susan Fox (Lead teacher) Room 322, Health Education Centre 519-253-3000 ext. 2284 sfox@uwindsor.ca Pat McKay Room 317, Health Education Centre pmckay@uwindsor.ca Clinical Instructor: __________________________________________ Telephone #: ________________________________________________ Email: _____________________________________________________ © FACULTY OF NURSING: COLLABORATIVE NURSING PROGRAM 2004 ALL RIGHTS RESERVED K:CourseOutlines/378April/May2007 1 63-378 - Clinical Nursing Experience I. COURSE DESCRIPTION This course is a clinical practice course. The focus is on assessment, goal orientated interventions and outcomes associated with clients with complex or multi system health disruption within the context of family and community, within medical, surgical, acute care, oncology maternal/child, and pediatric settings. Prerequisites: 63-374, 63-375, 63-377. Offered on a Pass/Non Pass basis. II. COURSE INTENT The purpose of this course is to provide students with the opportunity to learn the knowledge and skills that are necessary to provide nursing care to clients experiencing complex or multi system health disruption within the context of family and community. III. PROGRAM COMPETENCY OUTCOMES By the completion of the program, graduating students will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Implement behaviours to promote personal and professional self-development. Integrate the ethical, legal, professional and regulatory parameters into nursing practice. Formulate clinical judgements that are based on critical inquiry and analytical reasoning. Integrate nursing and multidisciplinary knowledge into nursing practice. Integrate research findings into clinical practice, education and management. Implement the nursing process to promote, maintain, and restore the health of individuals, families, groups and communities. Use of teaching/learning process to promote health of individuals, families, groups and communities. Collaborate with clients, their families, communities, and members of the health team and other organizations for the promotion, achievement and restoration of optimal health. Integrate leadership and management roles into the delivery of health care. Engage in activities to promote the development of the profession of nursing. K:CourseOutlines/378April/May2007 2 IV. COURSE COMPETENCY OUTCOMES 63-378 By the end of this course the student will be able to: 1. Build positive personal, interpersonal, group, community and professional relationships to foster the health of families experiencing crisis due to complex health problems Critical Elements 2. Demonstrate personal strategies using reflective journaling, that will support professional practice Integrate feedback from the health care team to set goals to improve one’s own practice Develop a personal learning plan to support the continued development of professional practice Integrate leadership skills and the principles of group process in professional practice Integrate standards of professional practice as they apply to issues of care for complex health problems Critical Elements Implement strategies that advocate for the rights of clients in the provision of care to clients with complex health problems Use the College of Nurses of Ontario Standards of Practice in the care of client/families with complex health problems Adhere to the policies of the Collaborative Nursing Program and participating agencies, when caring for clients with complex health problems Anticipate ethical dilemmas encountered in the care of clients with complex health problems Demonstrate responsibility for continued professional competency Document client care according to CNO standards 3. Formulate clinical judgments based on the complex health needs of clients Critical Elements Demonstrate diagnostic reasoning skills Generate strategies, in collaboration with the client to promote health Demonstrate evidence-based clinical judgments Critically evaluate community resources appropriate to the needs of an identified client K:CourseOutlines/378April/May2007 3 4. Integrate selected theoretical frameworks to promote health for clients who are experiencing complex health problems and for their families Critical Elements Integrate selected theoretical models/ frameworks (health belief model, change theory, crisis, loss) to promote health in families experiencing complex health problems Compare / contrast the health status of clients in W/EC with provincial and national data Integrate systems theory to the provision of complex care Analyze the relationship between the health, maturation, and adaptation that a client and his/her family experiences and the experience of a complex health problem/ high stress. 5. Use evidence based nursing and research strategies to promote the optimal well-being of clients and/or families experiencing complex health problems Critical Elements Demonstrate evidence based practice with clients and families with common complex problems Formulate researchable questions to promote the health of clients and families experiencing complex health problems Provide rationale for evidence based nursing care for clients and families experiencing complex health problems 6. Apply the nursing process to promote health and well-being and prevent illness/injury for clients and families with complex health concerns Critical Elements Take appropriate health histories Perform focused physical assessments Collaborate with clients and families to formulate outcome criteria Integrate selected Evidence-Based Practice Guidelines related to clients with complex health problems Implement counseling interventions which meet client and family needs when there is a complex health problem Apply selected criteria/formats to develop and implement comprehensive care plans for individuals, families/groups and communities Use various health decision-making strategies related to the provision of complex care Evaluate client and family outcomes and modify the plan of care as required K:CourseOutlines/378April/May2007 4 7. Implement teaching/learning plans to assist clients with complex health problems Critical Elements Perform client assessments to determine teaching/learning needs Collaborate with a client with complex health problems to identify learning needs Mutually develop outcome criteria with a client with a complex health problem Implement effective learning plans to promote client centered health during a complex health problem Evaluate effectiveness of teaching strategies with clients with complex health problems Modify teaching/learning plan as required for clients and families experiencing a complex health problem 8. Collaborate with clients experiencing complex health problems, their families, and the health care team, in developing empowerment strategies to achieve optimal health Critical Elements Analyze the effective use of therapeutic and professional communication techniques in selected situations Respect clients/families and apply the principles of a helping relationship Use strategies that protect the rights of the client and family during a complex health problem Integrate strategies that promote client and family autonomy Collaborate with members of the health team and related agencies to promote optimal health Use therapeutic and professional counselling and communication techniques with clients and families experiencing complex health problem Advocate for a family’s plan of care during crisis 9. Integrate leadership and management skills in the care of clients with complex health needs Critical Elements Use leadership strategies, that optimize client health Use social action skills to advocate for the rights of clients Develop client/family/group partnerships that support health care networks and coalitions Demonstrate time and resource management in the care of clients with complex health problems and for their families Lead discussions on a health care issue relevant to a family experiencing a complex health problem Analyze the leadership and management roles of nurses who work with clients with complex health problems and with their families K:CourseOutlines/378April/May2007 5 10. Influence Nursing’s role in the promotion of health for clients with complex health problems Critical Elements Demonstrate professionalism, ethical care and competence in complex care situations Participate in clinical group conferences on health promotion and illness/injury prevention on clients and/or families with complex health needs Demonstrate effective communication skills with other members of the health care team Articulate the role of nursing in advocating for the client by increasing available choices Course Competencies: Ten Core Practice Competencies and Universals will be applied to selected human health care needs. Nursing interventions and application of critical thinking to the Nursing Process will be performed. Clinical experiences may include simulated, virtual (computerized) and real individuals in the “client” role. A Universal Competency (UC) is an outcome that nurses must continue to demonstrate in any nursing activity or action. Critical elements are defined as single, discrete, observable behaviours that are mandatory for designated target elements. As such, all critical elements must be demonstrated safely, professionally and knowledgeably for the designation of practice “competence”. All course competencies must be demonstrated in this course for a “pass” indicating the first/beginning/novice practitioner level of achievement in this course. Technical elements/skills are psychomotor activities that integrate universal competencies into care/interventions. 63-378 Course Competency Outcomes are derived from the program competency outcomes. Critical Elements are developed to guide experiences and learning activities throughout the semester to provide learning opportunities as students strive to master Universal Competencies and CPEs, and to apply knowledge through CPE activities. Students must integrate theoretical components and rationale, safety, critical thinking, and current CNO Standards and therapeutic interactions as well as the level of expectation of 10 core competencies by the end of the first semester. V. COURSE REQUIREMENTS, EVALUATION METHODS, GRADING SYSTEM 63-378 will be offered on a Pass/Non Pass basis All critical elements must be met. All universal competencies must be consistently demonstrated. At midterm the student will receive a formative evaluation. If there is no opportunity to assess a specific competency, it is to be left blank at midterm. All competencies must be evaluated on the final evaluation. K:CourseOutlines/378April/May2007 6 CPEs: Methods of Student Evaluation 1) Learning Plan Due Date During the first scheduled week of the clinical experience During the first scheduled week of the clinical experience. 2) Medication Quiz – All students must achieve 100% on this quiz before permission will be given by the clinical instructor to dispense medications 3) Reflective Practice Activity – As designated by the assigned clinical instructor, all students will be expected to maintain ongoing (daily) documentation of self-reflection regarding their perceptions of progress during the clinical experience 4) Mid-term written student selfevaluation and instructor evaluation of student using CPE tool and summary form. 5) End-of-term written student selfevaluation and instructor evaluation of student using CPE tool and summary form. 6) All students are expected to be prepared for patient assignments. The clinical instructor may ask a student to submit verbal patient care plans in written form and/or related nursing documentation as required Students are expected to bring their reflective tool to the clinical setting for each scheduled day and be prepared to share the entries completed to date with their clinical instructor upon request. As established by the assigned clinical instructor at a mid-point in the scheduled clinical experience. As established by the assigned clinical instructor at the conclusion of the clinical experience. Ongoing Failure to meet the expected assignments as designated by the clinical instructor as requested may lead to a student’s removal from the clinical area, as the instructor’s ability to evaluate the therapeutic relationship between student & client may be limited. All written assignments will be considered as evidence of professional documentation. Policy regarding Medication Administration tests Regular medication administration tests will be administered throughout the program. a. Pass mark for the test will be 100% b. Students will have a maximum of 3 opportunities to pass the test c. Use of calculators will not be permitted. Students should show their calculations on the test sheet (e.g. long division) d. A student will not be permitted to administer medications in the clinical area until 100% has been achieved on the test e. Students who do not achieve 100% by the third test will be deemed to have not met the Universal Competency of patient safety and are unsuccessful in the clinical course. K:CourseOutlines/378April/May2007 7 VI. FACULTY OF NURSING POLICIES No supplemental examinations or assignments will be offered in this course. Clinical Students must attend all clinical nursing experiences and laboratories unless they have prior permission from the professor and/or a medical certificate to account for their absence. Student nurses in the clinical setting are to be punctual (if going to be late notify agency/instructor as directed in Course Outline). In the event of absence, students must notify the clinical setting prior to the scheduled start time. It is assumed that students will return for the next day of experience unless the instructor/agency has been otherwise notified. In the case of prolonged absence due to illness, students may be required to provide medical clearance before returning to the clinical setting. This clearance should be obtained from your own physician or nurse practitioner or through the University of Windsor, St. Clair College or Lambton College Health Centre. Students with casts or wounds are not permitted on some hospital units. Check agency policies for each setting. Professional Conduct and Appearance Nursing students are offered experiences in a variety of settings. As members of the nursing profession, conduct and personal appearance should be congruent with professional expectations of the College of Nurses of Ontario. Nursing students are required to demonstrate behaviours consistent with the following College of Nurses of Ontario documents: - Professional Standards for Registered Nurses and Registered Practical Nurses The Standard for the Therapeutic Nurse - Client Relationship The Ethical Framework for Nurses in Ontario and Explanation of Professional Misconduct The failure of any nursing student to conform to the principles of these documents and the policies of the Faculty of Nursing, University of Windsor, may result in dismissal from the nursing programme. Anyone demonstrating dishonesty, plagiarism, cheating or unethical behaviour in relation to any aspect of this course will receive an F grade and will be dealt with in the severest manner allowed by University policy. K:CourseOutlines/378April/May2007 8 Dress Code Policy A dress code policy is necessary for the purpose of infection control and the conveyance of a professional, well-groomed appearance. Hair must be neat, clean and worn above the collar; moustache and beards must be neatly groomed. Hands: Nails must be short, clean and well manicured. Clear or pastel polish may be worn but must not be chipped. Make-up may be used conservatively, but must be scent-free. Proper hygienic practices are expected. Jewellery is restricted to a plain wedding band, watch and only a small earring worn in one or both ears. Tattoos must be concealed wherever possible. Equipment: Students must follow medical asepsis practices to care for their equipment; i.e., bandage scissors and stethoscope. Uniforms Students provide their own uniform, white lab coat, white duty shoes, white stockings or socks, watch with a second hand, bandage scissors, penlight, stethoscope and photoidentification name tag. Uniforms are to be clean and sized appropriately. They may be either white or a solid colour. Students must follow the uniform policies for specialty areas (Labour and Delivery, Renal Dialysis, NICU, Psychiatry and the Operating Room). Students’ nametags should be clearly visible. Solid white, closed, athletic shoes are acceptable in lieu of duty shoes. Students are to be dressed in casual-business attire (no jeans) when uniforms are not required, i.e. Psychiatry, community agencies, seminars or field trips. Refer to agency’s policy and professional guidelines. Lockers are generally not available. Areas for coat and boots will be identified. Keep valuables on your person or in designated areas. Uniforms should be worn only while on duty. Changing after duty, though recommended, may not be feasible; therefore, cover your uniform when it is necessary to wear it home to maintain infection control. When doing clinical research, students must wear appropriate professional attire, for example, a lab coat over street clothes and photo-identification badge. VII REQUIRED TEXT(S) C.N.O. Standards of Practice: Therapeutic Communications, Ethical Guidelines, Medication Guidelines, Consent, Behavioural Interventions, Role Models and Preceptorship, Advocacy. Publication manual for the American Psychological Association 5th Edition. (2001). Same. K:CourseOutlines/378April/May2007 9 Craig, Gloria (2001). Clinical Calculations Made Easy: Solving Problems Using Multi- dimensional Analysis (2nd ed.), Philadelphia: Lippincott Lewis, S., Heitkemper, M., & Dirksen, S. (2006). Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems (1st ed.). Toronto: Mosby Various Health Reports, Website content, Videos, Other pamphlets and materials as provided or posted on the web and Articles as indicated each week. R.N.A.O. Best Practice Guidelines (as directed). Jarvis, C (2000). Physical examination and health assessment (3rd ed.). Philadelphia: W.B. Saunders. Karch, A. (ed.) (2003). 2003 Lippincott’s Nursing Drug Guide. Philadelphia: Lippincott (or similar drug book) or other current medication reference book Perry, A. & Potter, P. (2002). Clinical Nursing Skills and Techniques (5th ed.). St. Louis: Mosby. Ross-Kerr, J. & Wood, M. J. (ed.) (2001). Potter & Perry Canadian Fundamentals of Nursing (2nd ed.). Toronto: Mosby VIII PREPARATION Each student is expected to be well-prepared for each clinical experience. He/she must be prepared to discuss the diagnoses, medications, procedures, treatments and related care plan activities associated with the care of his/her assigned clients. IX LEARNING PROCESS Tutorial sessions may include: 1. Discussion/clarification of unit material 2. Case discussions 3. Demonstration / return demonstration Clinical experiences will include: 1. Practice in obtaining health histories 2. Practice in performing physical examinations 3. Practice in integrating significant health history and physical examination data into diagnostic statements and initial diagnostic &/or therapeutic &/or education plans. 4. Observation and practice of clinical skills K:CourseOutlines/378April/May2007 10 Teaching/learning strategies may include: 1. Reading/group discussion of unit material 2. Demonstration 3. Return demonstration 4. A-V material/models 5. Hands on experience Teaching/learning modalities may include: 1. Home study 2. Tutorials 3. Group learning 4. E-mail 5. Clinical Placements Clinical Experience The purpose of the clinical experience is to give you the opportunity to demonstrate all critical elements associated with each of the 10 Core Practice Competencies. K:CourseOutlines/378April/May2007 11