PHYSICAL ASSESSMENT FOR CLINICAL NURSE SPECIALISTS NUR 860 Sections 732, 736 2 Credits Spring 2013 Catalog Course Description: Development of advanced health history and physical assessment skills for clinical nurse specialists. Additional Course Description: This course for the Clinical Nurse Specialist (CNS) is designed as an online theory based course to provide students the opportunity to integrate history taking, the nursing process and physical assessment knowledge and skills. Within a holistic framework, students learn how to systematically collect, analyze, synthesize and document their findings. The context of human development through the lifecycle, therapeutic communication, health literacy and cultural values and beliefs are integral elements of the course content. The problem oriented system for organizing and recording data is applied. Course Objectives: At the end of this course, students will: 1. Apply advanced therapeutic communication skills to data collection across the lifespan. 2. Utilize comprehensive health history and physical assessment skills for individuals across the lifespan. 3. Apply knowledge of cultural variations when collecting health assessment data. 4. Synthesize subjective and objective health assessment data into concise documentation. 5. Utilize advance assessment skills. Prerequisites: NUR 805 Co-requisites: None Professional Standards & Guidelines: The curriculum is guided by the following documents: 1. American Association of Colleges of Nursing. (1996). The essentials of master’s education for advanced practice. Washington, DC: Author. 2. American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing. Washington, DC: Author. 3. American Nursing Association. (2010). Guide to the code of ethics for nurses with interpretive statements. Silver Spring, MA: nursesbooks.org. 4. National Task Force on Quality Nurse Practitioner Education. (2008). Criteria for evaluation of nurse practitioner programs. Washington, DC: Author. http://www.nonpf.org. Faculty: Brigid Warren, MSN, RN, CS, Associate Professor Contact Information: 517-353-8686 E: mail: warrenb@msu.edu Office Hours: Arranged Note: Times can be arranged to accommodate student schedules. 1 Instruction: Required Texts: Ackley, B. J. & Ladwig, G. B. (2010). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). Mosby Elsevier: St. Louis, MO. American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, D.C.: Author. Bickley, L.S., (2013). Bates’ guide to physical exam and history taking (11th ed.). Lippincott, Williams and Wilkins: Philadelphia, PA. Recommended Texts: Bickley, L.S., (2013). Bates’ pocket guide to physical exam and history taking (7th ed.). Lippincott, Williams and Wilkins: Philadelphia, PA. Smith, R. C. (2012). Patient-centered interviewing: An evidence-based method (3rd ed.). Lippincott, Williams and Wilkins: Philadelphia, PA. b. Required Resources, References, & Supplies: ANGEL Help Line 1.800.500.1554 (24 hrs, 7 days/week) 517.355.2345 (24 hrs, 7 days/week) www.angel.msu.edu (ANGEL Help link in upper right corner) Always check with the ANGEL Help Line first! Additional materials will be available each week on the ANGEL site. Evaluation: Course Grading Scale: The course is graded as either Pass or No – Grade. In order to Pass the course, the student must achieve a grade of 80% or higher on all assignments. Failure to meet 80% will constitute a failing grade and the student will not be allowed to continue on to the next clinical practicum. The MSN student handbook discusses the procedures in the event of a failure of a course. Points 428 – 455 % 94 – 100 GRADE 4.0 396 – 427 364 – 395 87 – 93 80 – 86 3.5 3.0 (Minimum passing grade 341 – 363 75 – 79 2.5 319 – 340 296 – 318 70 – 74 65 – 69 2.0 1.5 273 – 295 < 273 60 – 64 Below 60 1.0 0.0 2 Teaching Method: On-line instruction utilizing reading and mixed media tools. Course format: The course framework is based on content specific units, each containing an outline, objectives, required reading and/or viewing, additional resources and assignments, postings or quizzes specific to the unit. History & Physical Exam Assessment: The student is responsible for identifying a mentor in a clinical setting: Advance Practice Nurse (or ideally Nurse Practitioner) is required to oversee and assess the student’s performance in these specific areas: Pulmonary Cardiovascular Neurological Musculoskeletal Head-to-Toe – the final piece to “put it all together” For each system, it is expected that you would perform the history and physical exam on a friend, family member, patient, or willing subject pertinent for that system. You will complete documentation for each system and submit your Word document into a drop box provided. A special emphasis is placed on four systems specified. Your mentor will need to provide their comments to the course faculty on the forms provided. You will be provided feedback on all documentation. Your final Head-to-Toe history and physical exam is to be completed with your mentor present and must be video-taped (exam only; thumb drive or CD-Rom sent to the instructor) or use the option to come to campus and perform the Head-to-Toe exam with the instructor present. You would provide your own simulated patient if coming to campus. This assignment is Pass/Fail. To pass a score of 90% must be achieved (106/118 points). No flash cards or notes are allowed. The video-taped exam is to be received by April 28, 2013, so plan ahead for mailing time. Class Attendance: As an online course, student attendance will be defined as frequent and active participation in course activities and assignments. In the event of illness (individual or family) or other emergent issues, it is the responsibility of the student to contact the course faculty promptly. Communication with faculty: As a web-based course, a collaborative partnership between the faculty and online peers is expected. For questions regarding the course, please review the course syllabus prior to emailing. For questions regarding specific module content, post them in the discussion forum for the benefit of all the students. If you do not wish to be identified or for other personal questions or comments, please email your questions to the course faculty. Please note that every effort will be made to respond to emails and posts within 48 hours. It is not an expectation that faculty will respond to student questions or comments during weekends or holidays. Assignments and Grading: Assignments are due on the date indicated unless students receive approval for late submission by the course instructor. If students have been granted approval to revise and resubmit an assignment, 80 percent is the highest grade that can be received. If any documentation is not satisfactory, it will be returned to be resubmitted. Quizzes in ANGEL must be taken within the allotted time frame and are only available once, unless a retake needs to be scheduled due to an emergency or technical challenge with ANGEL. The quizzes are scored electronically on ANGEL and the grade is available upon completion. A passing, cumulative, score for this course is 80%. 3 Assignments: Each student’s grade will be based on the following factors: ASSIGNMENTS 1. Introduce yourself 2. Comprehensive health history with Genogram 3. On-line discussion forums and/or case studies (5) 4. Quizzes (6) 5. Health history & physical exam documentation (9) Points 4 points 20 points 50 points 60 points 130 points (4 special areas = 20 points each; all others = 10 points each) 6. Complete history & physical exam and P/F (must achieve 90% minimum documentation score=106/118 pts) 7. Comprehensive Final Examination 73 points TOTAL POINTS POSSIBLE = 455 PASSING SCORE = 364 Percentage 1% 4% 11% 13% 29% 26% 16% 100% Comprehensive Physical Assessment Outcomes: 1. It is an expectation that a comprehensive physical examination check off and documentation of the physical exam will be performed during the final week of the course, observed by your Nurse Practitioner mentor and video taped for the course instructor. A minimum grade of 90% is required. 2. Practicing and refining these skills is self-paced. Each system has a check-off sheet, specific to the unit content, to use when practicing. As the semester progresses, students should be integrating these system-specific physical assessment skills, culminating in a head-to-toe physical assessment by the end of the semester. 3. Students are responsible for the physical examination instruments, and may choose to either purchase or borrow them. Required instruments include the following: Stethoscope Ophthalmoscope Otoscope Tuning fork Reflex hammer Tape measure/ruler Professional Development Guidelines: Preparation for the professional practice of advanced practice nursing requires more than the acquisition and application of knowledge. Therefore, in addition to the academic standards listed, the student must demonstrate the following: 1) Appropriate interpersonal relations and communication with patients, peers, faculty and other health care personnel; 2) Responsible fulfillment of class and practicum obligations, including provision of safe nursing care in the practicum setting; and honesty and integrity in all academic and professional matters. These expectations are reflected in the Graduate (MSN) Clinical Performance Criteria for each clinical nursing course. Failure to meet each Professional Development Objective will result in the student earning a grade of 0.0 for the course. 4 MSU Accommodations for Students with Disabilities: The Resource Center for persons with disabilities is available to maximize the success of students by providing disability-related information and referrals, facilitate reasonable accommodations and provide disability-related technical assistance, auxiliary aids/services, advocacy and training. Additional information can be found at http://rcpd.msu.edu/About/Mission or by phone at (517) 884-RCPD (4-7273). The student is responsible for the information found in these resources, including the honor code, student responsibilities, student conduct, HIPPA guidelines and attendance. If in doubt, please review this material. University & College Policies: The College of Nursing expects that students will demonstrate professional behavior in all situations. Specific expectations for clinical and other professional venues can be found in the appropriate handbook. You are responsible for reviewing and acting in accordance with the policies and procedures found in the following sources, including the following topics: Professionalism, Academic Integrity, Accommodations for Students with Disabilities, Disruptive Behavior, Attendance, Compliance, and Progression. • • • • • • CON MSN Student Handbook: http://nursing.msu.edu/MSN%20Programs/Handbooks/default.htm MSU Spartan Life Online: http://www.vps.msu.edu/SpLife. Information for MSU Students: http://www.msu.edu/current/index.html Academic Programs: http://www.reg.msu.edu/AcademicPrograms Code of Teaching Responsibility and Student Assessments and Final Grades: http://www.reg.msu.edu/AcademicPrograms/Print.asp?Section=514 Integrity of Scholarship and Grades: http://www.reg.msu.edu/AcademicPrograms/Print.asp?Section=534 Academic Integrity Academic integrity is a minimal expectation of this course. Academic dishonesty in any form will not be tolerated. Any student involved in academic dishonesty will be reported to the Office of Academic Affairs and the Office of Student Affairs in the College of Nursing and a grade of 0.0 may be issued for the course. Lectures, quizzes and examinations must remain the property of the College of Nursing and must not be copied from the Internet. According to university policy, consequences for academic dishonesty may include failure of the course, expulsion from the major, or expulsion from the university. Online discussions and exercises are confidential and should not be discussed with others who are not enrolled in the class. It is important for each course participant to express his/her ideas. All ideas need to be respected in discussions and exercises. Any “group projects” that are required, still require individual work as a minimal expectation. For further information you can access any of the following sites: • Academic Integrity resource at MSU http://www.msu.edu/unit/ombud/RegsOrdsPolicies.html • MSU Spartan Life Student Handbook and Resource Guide http://www.vps.msu.edu/SpLife/index.htm • Information for Current Students – including Rights, Responsibilities and Regulations for Graduate Students http://www.msu.edu/current/index.html • International Studies and Programs http://www.msu.edu/international/index.html Course calendar on next page: 5 COURSE CALENDAR Spring 2013 DATE Jan. 7 WEEK 1 Jan. 14 2 Jan. 21 3 UNIT CONTENT Bates: Chapter 1 o Overview: Physical Exam & History Taking Chapter 2 o Clinical Reasoning Chapter 3 o Interview & the Health History Bates: Chapter 4 o General Survey, Vital Signs Chapter 5 o Behavior & Mental Status Bates: Chapter 6 o Skin, Hair, & Nails ASSIGNMENTS Introduce Yourself Familiarize yourself with the course/content Begin working on Comprehensive Health History & Genogram assignment Comprehensive Health History & Genogram Skin, Hair, Nails documentation Feb. 4 4 5 Feb. 11 - 18 6&7 Feb. 25 8 Mar. 4 – 8 Mar. 11 9 Bates: Chapter 7 o Head & Neck HEENT documentation Online Discussion Forum/Case Study #2 Pulmonary documentation (to be performed with mentor) Bates: Chapter 8 o Thorax and Lungs Quiz #2 Bates: Chapter 9 o Cardiovascular System Chapter 12 o Peripheral Vascular System Bates: Chapter 10 o Breasts & Axillae Cardiovascular documentation (to be performed with mentor) - - - - - SPRING BREAK - - - - Bates: Chapter 11 o Abdominal assessment Mar. 4 – 8 Abdominal documentation Online Discussion Forum/Case Study #3 Quiz #3 Quiz #4 6 Jan. 20 at 11:55 PM to the Drop Box Jan. 27 at 11:55 PM to the Drop Box Online Discussion Forum/Case Study #1 Quiz #1 Jan. 28 Due Date Jan. 13 at 11:55 PM to the Discussion Forum Quiz opens Jan. 24 at 8:00 AM; closes Jan. 27 at 11:55 PM Feb. 3 at 11:55 PM to the Drop Box Feb. 10 at 11:55 PM to the Drop Box Quiz opens Feb. 7 at 8:00 AM; closes Feb. 10 at 11:55 PM Feb. 24 at 11:55 PM to the Drop Box Quiz opens Feb. 21 at 8:00 AM; closes Feb. 24 at 11:55 PM Mar. 17 at 11:55 PM to the Drop Box Quiz opens Mar. 14 at 8:00 AM; closes Mar. 17 at 11:55 PM Mar. 18 Mar. 25 10 12 Apr. 1 11 Apr. 8 & 15 13 & 14 Bates: Chapter 13 o Male Assessment Chapter 14 o Female Assessment Chapter 15 o Anus, Rectum & Prostate Bates: Chapter 16 o Musculoskeletal System Apr. 22 15 Bates: Chapter 17 o Nervous System Bates: Chapter 18 Chapter 19 Chapter 20 o Special Populations Putting It All Together Apr. 29 – May 3 16 Comprehensive Final Exam Online Discussion Forum/ Case Study #4 Male Assessment documentation Female Assessment documentation NOTE: History only – no physical exam performed Musculoskeletal documentation (to be performed with mentor) Quiz #5 Neurological documentation (to be performed with mentor) Online Discussion Forum/Case Study #5 Quiz #6 Head-to-Toe examination and documentation (to be performed with mentor; no notes/flash cards to be used) This time frame cannot be changed. Please make arrangements to accommodate this time. NO EXCEPTIONS! 7 Mar. 24 at 11:55 PM to the Drop Box NOTE: 2 separate documentations due Mar. 31 at 11:55 PM to the Drop Box Quiz opens Mar. 28 at 8:00 AM; closes Mar. 31 at 11:55 PM Apr. 7 at 11:55 PM to the Drop Box Quiz opens Apr. 18 at 8:00 AM; closes Apr. 21 at 11:55 PM Apr. 28 at 11:55 PM to the Drop Box MAY 2 Opens at 9 AM; closes 12 PM (2 hour exam)