1
CLEVELAND STATE UNIVERSITY
BACCALAUREATE NURSING PROGRAM
NUR 326
SECONDARY PREVENTATIVE STRATEGIES
FOR CHILDREN EXPERIENCING STRESS
CLINICAL LABORATORY
Fall, 2004
COURSE NUMBER:
NUR 326
COURSE TITLE:
Secondary Preventative Strategies for Children
Experiencing Stress - Laboratory
FACULTY:
Coordinator:
Marilyn Weitzel Ph.D., R.N.
Clinical Faculty:
COURSE CREDITS:
3 Credits
COURSE HOURS:
10 Hours per week in a Clinical Laboratory
2 Hours in lab/recitation session
COURSE PLACEMENT: Spring Semester, Junior year
PREREQUISITES:
the instructor.
Junior level standing in the Nursing Major or permission of
COURSE DESCRIPTION:
Focuses on the use of the nursing process in a
structured setting to plan care for children who have diseases of adaptation.
Emphasis is the student's ability to provide secondary preventative care to
children and their families. Psychomotor skills unique to providing care for
children will be practiced in a skills laboratory prior to performance in the
clinical laboratory.
COURSE OBJECTIVES:
By the end of the course the student will:
1.
Apply the stress framework to the management of pediatric clients
experiencing diseases of adaptation.
2.
Demonstrate the use of the nursing process while providing nursing care to
pediatric clients experiencing selected diseases of adaptation.
3.
Use scientific rationale to support nursing intervention in providing
nursing care for pediatric clients.
4.
Develop facilitative relationships with the child, family, peers,
colleagues, and members of the interdisciplinary health team.
5.
Assume responsibility for nursing actions while caring for children with
diseases of adaptation.
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6.
Demonstrate the relationship between planned learning opportunities and
professional growth.
REQUIRED TEXTS:
London, M.L., Ladewig, P.W., Ball, J.W., & Bindler, R.C., (2003). MaternalNewborn & Child Nursing: Family Centered Care, Upper Saddle River, New
Jersey, Prentice-Hall.
Student Study Guide
Teaching/Learning Strategies:
Clinical experience in an acute care pediatric facility and in a primary
or tertiary community setting.
Evaluation:
Clinical evaluation
Written evaluation
= 75%
= 25%
Written Assignments:
Paper work
= 25% of course grade
Secondary Preventive Care (in acute care hospital sites)
Weekly skeletal care plans
120 points
(20 each week)
Clinical seminar
Week 3, 4, 5, 6, 7
50 points
Nursing Care Plan
100 points
Due as assigned week 5, 6, or 7
Primary Preventive Care (in community sites)
Family Assessment
100 points
WebCT assignment due Week 5
Process Recording
75 points
Due Thursday of the week for Glenville High School
experience
Teaching Plan
40 points
Due Thursday of the week of the Day Care experience
DDST II
15 points
Due Thursday of the week of the Day Care experience
TOTAL POINTS
500 points
Computing grades
Clinical percentage grade multiplied by 0.75 = ------Plus Written percentage grade multiplied by 0.25 = -------Equals-----------------------------------Course Grade = ----------
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Sample of distribution of written assignments
Week 1
First Day
Orient
Second Day
Orient
Week 2
wscp
Week 3
seminar; wscp
Week 4
seminar; wscp
Week 5
seminar; wscp; Family assessment
Week 6
DDST II; Teaching Plan
Week 7
Process Recording
Clinical experience:
MetroHealth:
Assignments for direct care
Recitation at hospital after clinical
Submission of papers.
OR
Health Hill Hospital:
Assignment for direct care
Recitations at hospital after clinical
Submission of papers.
OR
Community sites such as Glenville High school, day care centers, Berean
Home for Profoundly MR/DD
Alternative Clinical Experiences as available in clinical site -- including -Outpatient Care, Pediatric Intensive Care, Juvenile Court Visitation, Child Life
Observation, Day Care, Pediatric UrgiCare and others that your particular site
may have available.
RECITATION SESSION:
Purpose:
to provide an opportunity for students to integrate knowledge
from didactic and clinical component on NUR 325/326 through:
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1.
Group discussion seminars that focus on patient care issues.
2.
Discussion or role play of care situation for the purpose of
generating alternative approaches to nursing care problems.
3.
Demonstration of pediatric skills in performing nursing care
tasks.
4.
Participation in peer review conference.
4
EVALUATION METHODS:
1.
Evaluation of skills in performing specific patient care tasks.
2.
Attendance, punctuality and thoroughness of clinical assignments;
patient care and written work.
3.
Participation in clinical seminars.
4.
Participation in peer review conferences.
5.
Presentation of one Clinical seminar.
6.
Nursing care plans, clinical log.
7.
Teaching plan.
8.
Family Assessment
9.
Other written work.
10.
All students are required to take the ATI Peds/OB assessment exam at
the end of the semester.
GRADING:
Satisfactory Completion of:
1.
Nursing care plan and clinical logs
2.
Clinical seminar - See Evaluation form in Appendix
3.
DDST
4.
Process Recording - See Evaluation form in Appendix
5.
Teaching Plan
6.
Other Papers:
(Denver Developmental Screening Test)
** ALL PAPERS MUST BE TYPEWRITTEN or word processed**
Self Evaluation:
Midterm Self Evaluation -- Schedule with individual faculty member.
End of Course Self Evaluation -- Bring to scheduled End of Course
Evaluation meeting with faculty member.
** NO COURSE EVALUATION WITHOUT SELF EVALUATION **
** NO GRADE WILL BE SUBMITTED WITHOUT AN EVALUATION CONFERENCE**
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GRADING:
1.
2.
Clinical Care
Paper Work
Clinical log
Clinical seminar
DDST
Family assessment
Nursing Care Plan
Process recording
Teaching Plan
75 %
25 %
120 points (20 points/week)
50 points
15 points
100 points
100 points
75 points
40 points
500 points possible
95%-100%
92%-94%
89%-91%
86%-88%
83%-85%
80%-82%
75%-79%
65%-74%
0%-64%
475-500
465-474
450-464
435-449
420-439
405-419
375-404
325-374
000-324
=
=
=
=
=
=
=
=
=
A
A B+
B
BC+
C
D
F
Students are expected to attend each clinical day. Any clinical absence
jeopardizes successful completion of the course. Should one absence be
necessary, please follow policy and procedure outlined in the Student Handbook.
Tardiness is not acceptable in professional careers. Three times tardy
will count as one absence. Any student tardy over 30 minutes will not be
allowed on the clinical unit. Any absence for more than one day for illness
requires written permission from the physician to return to the clinical area.
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NUR 326
Week #1:
Seminar
GROWTH AND DEVELOPMENT
PHYSICAL ASSESSMENT
CLINICAL DAY #1
ORIENTATION TO COURSE
OBJECTIVES: GROWTH & DEVELOPMENT
1.
State four ways in which knowledge about childhood development contributes
to the practice of pediatric nursing.
2.
State seven principles of child development and give at least one
example showing how each principle relates to nursing care.
3.
Describe how a nurse can use developmental norms and still design nursing
care compatible with the uniqueness of each child and each family.
4.
Define developmental task and give one example for each childhood age
group (newborn, infant, toddler, etc.).
5.
Name and describe the specific developmental issue or problem Erickson
identified for each of his stages.
6.
Name the four developmental stages identified by Piaget and describe the
major characteristics of each stage.
7.
Record a particular child's weight, height, and head circumference on a
growth chart.
8.
Compare a child of any age with the developmental norms for that age group
and identify ways in which the child does and does not conform to the
norms.
AUDIO-VISUALS: TBA
PHYSICAL ASSESSMENT
OBJECTIVES:
1.
Discuss the developmental approach for performing physical
assessments in the pediatric population.
2.
Discuss the importance of length measurements in relation to weight and
head circumference measurements.
3.
List the historical questions that pertain to each body system.
4.
Describe and list the normal findings.
5.
Demonstrate the use of distraction in performing physical assessment of
children at different ages.
Audiovisuals: View:
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Nsg 8025
DDST
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Week #2:
THE HOSPITALIZED CHILD PEDIATRIC NURSING PROCEDURES
OBJECTIVES:
1.
Discuss the process involved in admitting a child to a pediatric unit.
2.
Describe the effects of pain, sensory deprivation, and sensory over
stimulation in the course of an infant's hospitalization.
3.
Identify and elaborate on five factors which influence a toddler's
response to hospitalization.
4.
List four types of play activities which can be used in working with
hospitalized preschoolers.
5.
Identify four variables which affect the hospitalization of adolescents.
6.
List and discuss all the components, of discharge planning.
Supplementary Materials: The following videos are available to enhance your
learning. They can be found in RT 31, the ground floor of Rhodes Tower
Seminar SCHEDULE:
******Seminar topics will be assigned during Orientation. Outline with
Objectives for Individual Seminars will be due in the second week of clinical
for all seminars. A reference list will be submitted the day of the seminar.
WEEK 1:
ORIENTATION
by faculty
WEEK 2:
MED CALCULATION AND SKILLS REVIEW
by faculty
WEEK 3:
SEMINAR:
by students
WEEK 4:
SEMINAR: CHILD ABUSE, NEGLECT,
and DEPENDENCY
by students
WEEK 5:
SEMINAR:
EMOTIONAL DISORDERS
by students
WEEK 6:
SEMINAR:
CHRONIC ILLNESS
by students
WEEK 7:
SEMINAR:
MENTAL RETARDATION
by students
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CHILDREN'S NUTRITION
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APPENDICES
TABLE OF CONTENTS
A.
Forms
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Guidelines for daily skeletal care plans
Skeletal care plan form
Medication form
Developmental assessment form
Nursing Care plan form
Clinical log form
Family assessment form
Clinical Seminar Guidelines
Guidesheet: Exploring child day care centers
The Teaching Plan
B.
Evaluations
1.
2.
3.
4.
Family assessment
Clinical seminar evaluation tool
Process recording evaluation tool
Clinical evaluation tool
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Appendix A -1
Guidelines
Daily Skeletal Care Plans
1.
Day one in the clinical agency will be an orientation to the nursing
unit assigned.
2.
Day two in the clinical agency, each student will be assigned to a
staff nurse. The student will be able to collect data from the
chart, kardex, staff, etc. On this day, students should become
familiar with the unit, the types of patients, and the standard
procedures used when providing care.
3.
Day three in the clinical area and each day thereafter, the student
is expected to have developed a beginning care plan using CSU format
which will include the following:
a.
b.
c.
d.
e.
f.
g.
h.
i.
4.
Each succeeding day that the student is assigned to the client, the
information in #3 will be expanded to include:
a.
b.
c.
5.
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Client profile
Normal growth and development for the client (use
Development Assessment Form)
Brief summary (in student's own words) of the client's
pathophysiologic condition
Medication cards or written explanation including
calculation of safe dosage, use in this patient, action,
side effects and nursing measures
Treatments
Lab data
Diet (discuss if special)
Basic list of objective/subjective data to be collected.
At least 1 nursing diagnosis
Additional appropriate nursing diagnosis
Nursing orders and scientific rationale relevant to the
nursing diagnosis
Evaluation of the effectiveness of the care plan
A clinical log will be expected for each clinical day
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Form A-2
Skeletal Care Plan
Student:____________________________
Date of Assignment: __________
Guide for Clinical Preparation:
Patient Name: ____________________________ Age:___________________
Ht. _______________
Wt. _________________
H.C. ___________________
Interpretation the measurement
taken____________________________________________________
Date of Admission _____________________
CC: ______________________
Medical Diagnosis ________________________________________________
Nursing Diagnoses
______________________________________________
Pathophysiology:
Diet: ___________________________________________________________
________________________________________________________________
Interpretation of Diet: ______________________________________________
Activity: _________________________________________________________
Vital Signs over last 24 hours:
_________________________________________________________________
Interpretation and Comparison with Normal for Age:
_________________________________________________________________
Medications: (Follow up medications with check for safe dosage. Include patient
initials, name of medication, action, side effects, and nursing measures (See
medication form:(Form A-3)
IV Therapy
Special Procedures:
Family:
Pertinent Lab Data:
Name:
Values:
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Norm:
Interpretation
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Form A - 3
Medication Form
Student:________________________________
Date:___________________
This form may be used or another as assigned by clinical instructor. (3x5 card
is appropriate)
Medications
Medication Name, Dosage, Time of Administration:
Safe Dosage or Usual Dosage (source)
Calculation of Safe Dosage:
Administration: Guidelines -- if an IV medication -- Discuss dilution, diluent,
and time over which medication must be administered.
Use in this patient:
Action :
Side Effects:
Nursing Measures:
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Form A - 4
Developmental Assessment Form
Student:________________________________
Date:___________________
Child's Initials ________ Age ________ Sex ________
Height ______________ Weight __________
Head Circ. __________
Interpretation__________________________________________________________________
_
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Motor Skills:
Gross:
Fine:
Psychological:
Erickson Expected Stage:
Child's Stage:
Language:
Play: Expected:
Actual:
Effects of Illness/Hospitalization: Expected:
Actual:
_______________________________________________________________________
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Form A - 5
Nursing Care Plan
(Incorporates all of skeletal plan plus following)
Name: _____________________________________ Date:
______________
Diagnosis: _______________________________________________________
_________________________________________________________________
Goal:
___________________________________________________________
Outcome Criteria: __________________________________________________
_________________________________________________________________
Interventions:
Evaluation:
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Form A - 6
Clinical Thought Journal
Name: _______________________________
Week Number: ________________________
Dates: _______________________________
Incorporate throughout areas of satisfaction or concern. For the first three
weeks, incorporate responses to those objectives set forth earlier in the
syllabus. In addition, reflect upon and respond to each item below.
1.
Utilization of interpersonal skills (with patient and family, instructor,
peers, staff on unit).
2.
Ability to identify priorities of care and organizational abilities.
3.
Performance of physical care and procedures.
4.
Ability to perform accurate physical, developmental, and family
assessments.
5.
Demonstration of accountability (clinical preparation, reporting to
pertinent persons, participation in conference, handing in assignments on
time).
6.
Identify methods through which your instructor can facilitate your
learning (be specific).
7.
Learning objectives for next week.
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Form A - 7
Family Assessment
Family assessment should be approached using the CSU conceptual framework
1.
2.
Assess all GRRs
Use book's description of family assessment.
Include each of the following topics:
Duvall's Development Stage of the Family
Family Structure (Family composition)
Use the Double ABCX model to assess the family’s GRD’s and GRR’s
Home and community environment
Occupation and education of family members
Cultural and religious traditions
Family Function (Family interactions and roles)
Power, decision making, and problem solving
Communication
Expression of feelings and individuality
Some consideration of parenting
Pedigree chart
Ecomap
3.
Conclusions must be drawn from the data and possible nursing diagnosis
stated.
Example: Family coping: potential for growth related to appropriate
social support and resources available as evidence by the child's mother asking
the nurse how to improve the child's nutrition and her asking the Child Life
Specialist what would be the best activities for the child.
______________________________________________________________________
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Form A-8
Clinical Seminar
Each student will present one clinical seminar or case study during the
semester. A list of possible topics and dates will be discussed during the
first clinical session. The student will select a topic of interest at that
time, and will have the opportunity to be leader or co-leader for that topic.
The following guidelines will be utilized for the clinical seminar
presentations. The student will:
1.
2.
3.
4.
5.
6.
7.
8.
9.
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Develop behavioral objectives for the presentation.
Identify content for topic.
a. appropriate content for topic.
b. at least two additional references along with text.
Present outlines (with objectives) to clinical instructor during
the second week of the course.
Meet with clinical instructor at ten days prior to date of
presentation.
Select teaching/learning strategies appropriate to the topic.
Be familiar with roles of group members as outlined in
discussion guide.
Dress appropriately for professional presentation.
Provide copies of revised objectives and required/suggested
readings to class members and the instructors at least one
week prior to the presentation.
The clinical seminar will be evaluated using the
Leader/Seminar evaluation form found in the Appendix.
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Form A-9
Guidesheet: Exploring Child Day Care Centers
PURPOSE: This experience will introduce the student to the role of assessing
child care centers. Children attend day care more today than at any tine in our
history. These patterns are not likely to change in the near future. families
have increased demands placed on them and the need for single parents to work
and/or both parents to work is increasing. Parents sometimes become concerned
about their children's care and ask questions of community based nurses about
what to expect from child care centers and what criteria to use in choosing one.
Nurses need to be aware of state regulations, types of child care centers and
criteria for determining quality. This experience provides an opportunity for
the student to observe several day care environments and discuss the role of the
community based nurse in these environments.
DESCRIPTION OF ACTIVITY: During the assigned time at a day care center, each
student will observe the normal routines and schedules of the children. The
project will focus on observing child care centers and staff and their
relationships with the children.
STUDENT OUTCOMES:
Performance: The final due date of the written report and evaluation of this
project will be due as determined by the faculty. (No later than the last
clinical day of the course.) Professional attire is dependent upon clinical
site and is determined in collaboration with the clinical faculty.
Product: A written evaluation of the project must be submitted to the clinical
faculty one week after completion of the project. List all references and
resources used. The written report should be in sentence form and will. be
evaluated for content as well as sentence structure, grammar, and spelling You
will not be penalized for negative comments or if you include suggestions for
change. All objectives included below should be addressed.
OBJECTIVES: During the observation and completion of the written evaluation of
the project, the following should be considered:
1.
Describe the appropriateness of the child care center for the children
enrolled.
2.
Identify the state regulatory agencies that license child care centers.
3.
List the amount of time children spend in the center weekly.
4.
List 5-7 state regulations the child care centers need to implement.
5.
List 3-5 ways a community based nurse could meet needs of families through
child care centers.
6.
Summarize the overall effectiveness of the project.
7
How does this assignment relate to role of the pediatric nurse that you have
seen this quarter in the hospital and the community?
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Form A-10
THE TEACHING PLAN
Goal:
Formulation and implementation of a teaching plan for an assigned client.
Directions: Each student will be responsible for the development and
implementation of a teaching plan for a client assigned during which a need is
identified for teaching. Topics for this project will vary widely but must
result from the student's assessment of the client's needs.
When possible, the written plan for the material to be taught should be reviewed
with the clinical faculty prior to implementation. This allows feedback from
the faculty prior to the actual teaching experience. The final plan, and the
actual outcomes of the teaching experience should be submitted to the faculty
person following the experience, and prior to the next clinical day.
The teaching plan should include:
Identification of learner needs.
A clearly worded problem statement (Nursing - Diagnoses in the
PES format)
Learner objectives
Content outline of material to be discussed/presented.
Teaching strategy(ies) specific for plan proposed.
Expected outcomes.
Evaluation methods.
If you plan to include a pre and post test, please include with the materials
given to the faculty as well as a report of learner performance. An example of
a teaching plan can be found in your Med/Surg Text and syllabus.
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APPENDIX B-1
EVALUATION FORMS
Family Assessment Tool
1.
2.
3.
All GRRs assessed
Artifactual GRR
Cognitive/Emotional GRR
Interpersonal GRR
Valuative/Attitudinal GRR
Macrosociocultural GRR
Physical-Biochemical GRR
Includes:
Duvall's Developmental Stages
of the Family
Stage of Growth and
Development of Family Members
(especially parents)
Family Structure
(Family Composition)
Pedigree Chart
Ecomap
Home and Community
Environment
Occupation and Education
of Family Members
Cultural and Religious
Traditions
Family Function (Interactions
and Roles)
Power, Decision Making, and
Problem Solving
Communication
Expression of Feelings and
Individuality
Some Consideration of
Parenting
Conclusions
Family Nursing Diagnosis
Discusses Strengths and
Weaknesses
Discusses Parenting
Each item in order
Each item labeled
Total Possible Points = 100
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0
0
0
0
0
0
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
4
4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 2 4 6 8
0
0
0
0
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
20
Evaluation
Form B2
Tool for Clinical Seminars
Name _______________________________ Date _______________________
Seminar ____________________________
The following scale will be used to evaluate each item below.
on a scale of 0 - 4.
A
B
C
D
E
=
=
=
=
=
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Needs improvement (1)
Somewhat weak
(2)
Adequate or O.K. (3)
Strong or effective
Exceptionally strong
or very effective (5)
Items are ranked
(4)
Preparation.
Outline to Instructor, Students
Behavioral Objectives
Overall organization of presentation
Leader's knowledge of the content and material
presentation
Leader's effectiveness in responding to
questions from participants
Leader's poise
Intellectual challenge provided by the
presentation
Leader's ability to stimulate discussion
Leader's use of summarization
Clarity with which important ideas, concepts
and information were communicated
A B C D E
A B C D E
A B C D E
A B C D E
A B C D E
A B C D E
A B C D E
A B C D E
A B C D E
A B C D E
Total Possible Points = 50
________________________________________________________________________
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Form B - 3
PROCESS RECORDING EVALUATION
Student _______________________ Client ____________________________
Date __________________________
Reason for Contact
1.
States purpose for interaction
2.
Describes defining characteristics, including
physical appearance of person with whom
interacting.
3.
Describes situation and setting of the
interaction.
4.
Describes any necessary nursing diagnosis
central to understanding interaction.
Planning
5.
States goal(s) of interaction for client.
6.
Write goal in behavioral terms.
Interaction-Intervention
7.
Records nurse and client verbal communication.
8.
Records facial expressions of nurse and client.
9.
Notes body movements of nurse and client.
10.
Records spatial aspects of the physical setting
in which the interaction takes place.
11.
Notes thoughts and feelings about self and
toward client.
12.
Identifies thoughts and feelings about content
of the interaction.
13.
Correctly identifies the communication
techniques used by the nurse.
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
Other Pertinent Behaviors
*14. Summarizes major points of present interaction
with client.
1 2 3 4 5
15.
Evaluates if identified goal(s) for interaction
were met.
1 2 3 4 5
TOTAL _______
7/7/04/mw
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