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)