Master’s Degree Program Syllabus NURS 6140 ST. CATHERINE UNIVERSITY DEPARTMENT OF NURSING MASTER’S DEGREE PROGRAM NURS 6140: ADVANCED HEALTH ASSESSMENT ACROSS THE LIFESPAN Fall 2012 COURSE NUMBER NURS 6140 COURSE TITLE Advanced Health Assessment Across the Lifespan CREDIT HOURS 2 credits (Classroom credits:1.5; Clinical credits; 0.5) CONTACT HOURS Classroom: 22.5 hours; Practice 30 hours COURSE PLACEMENT Level I Fall 2012 COURSE DAYS/TIME Thursdays (9/6, 9/13, 9/20, 9/27, 10/4, 10/11, 10/18 & 10/25) COURSE LOCATION Whitby Hall Jeanne D’Arc Auditorium COURSE FACULTY Vicki Ericson, DNP, RN, ANP, FNP Office: Whitby Hall 112 Office hours: by appointment Phone: 651-690-6057 Cell: 612-229-5452 Email: vlericson@stkate.edu Mary Lagaard, DNP, RN,CNP Office: Whitby 435 Phone: 651-690-6126 Email: mwlagaard@stkate.edu Angie Grabau, DNP, RN, PNP Office: Whitby 431 Phone: 651-690-6596 Email: amgrabau@stkate.edu Steven Roback, MA, RN, PNP Office: Whitby 112 Phone: 651-690-6057 Email: sproback@stkate.edu Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Gretchen Moen, MS, RN, CNP Office: Whitby 434 Phone: 651-690-6129 Email: gmmoen@stkate.edu COURSE DESCRIPTION This course introduces advanced practice physical assessment of patients across the lifespan with particular focus on the use of the problem oriented health record format, health history and physical examination techniques. Content focuses on screening, assessment skills and on population specific assessment techniques. Prerequisites: Admission to the Neonatal, Pediatric or Adult/Gerentologic NP program. Or Nurse Educator Program COURSE LEARNING OBJECTIVES/OUTCOMES Upon completion of this course, the student will be able to: 1. Use a systematic framework to collect a complete health history in the context of various delivery systems, reimbursement policies, nurse practitioner practice, and the economics of public and private financing (Context and Environment; “Leadership and Collaboration:, NONPF CC 1, 5, 6; Essentials 1, 10) 2. Integrate best practices with relevant inter-professional and developmental theories to guide diagnostic reasoning and systematic data collection. (Knowledge and Science; “Critical and Creative Thinking”, “Discipline-Based Competence;” NONPF CC 1, 4, 8; Essentials I, IV) 3. Evaluate theories of aging, development, social, family and race related to patient assessment in advanced practice role. (Personal and Professional Development; “Leadership and Collaboration”, and “Purposeful Lifelong Learning;” NONPF CC 2, 9; Essentials IX) 4. Organize data using appropriate electronic data systems to formulate a problem list based on cumulative data integrating nursing and medical terminology and diagnostic taxonomies. (Quality and Safety; “Effective Communication in a Variety of Modes;” NONPF CC 3, 7, 8; Essentials, II, III) 5. Perform a complete health assessment appropriate for specialty population incorporating safety measures, health history and exam technique and document findings in a clear succinct manner using appropriate terminology. (Relationship-Centered Care; “Discipline Based Competence;” NONPF CC 9; Essential IX) 6. Develop interviewing and communication skills that promote effective professional relationships. (Teamwork; “Leadership and Collaboration,” “Effective Communication in a Variety of Modes;” NONPF CC 2, 5, 7; Essentials II, VII) Please note. Department of Nursing “curricular threads” are identified in italics; University “Goals of a Liberal Arts Education” are identified in quotes, NONPF competencies in regular font. Please note. Course learning objectives/outcomes are related to academic and professional standards in nursing. Please refer to Appendix A for these relationships. Assignments in this course are designed to promote your achievement of the course learning objectives/outcomes (please refer to “Course Assignments and Grading”). Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 TEACHING-LEARNING ACTIVITIES Teaching-learning activities in NURS 6140 include (a) lectures, (b) audiovisual and PowerPoint presentations, (c) demonstrations, (d) discussion, and (e) written assignments. FACULTY EXPECTATIONS As faculty members, our responsibility is to ensure that you receive the best possible education and learning experiences. Therefore, students can expect from faculty members that we… Appreciate the diversity of our campus and respect the rights of each member. Show human concern for each of those with whom we work and study while presenting a positive attitude and professional demeanor. Be on time for class and return from scheduled breaks. Respond to e-mail messages and voice mail messages within 24-48 hours, except on weekends and holidays. Treat the students with courtesy. Refrain from any behaviors that may distract others. Minimize distraction and interruptions. This includes limiting private conversations, and keeping phones and pagers in a vibrate mode. Understand that this class is a dynamic one, where disagreements may occur. Respect diverse opinions and listen politely when others are speaking. Give everyone a chance to contribute and value hearing all voices. Come prepared for the class and having thought about how the day's teaching-learning will unfold. STUDENT EXPECTATIONS To create an optimal respectful learning environment for everyone, your faculty members expect you to… Appreciate the diversity of our campus and respect the rights of each member. Show human concern for each of those with whom you work and study while presenting a positive attitude and professional demeanor. Be on time for class and return from scheduled breaks. Treat the faculty members and fellow students with courtesy. Refrain from any behaviors that may distract others. Minimize distraction and interruptions. This includes limiting private conversations, and keeping phones and pagers in a vibrate mode. Understand that this class is a dynamic one, where disagreements may occur. Respect diverse opinions and listen politely when others are speaking. Give everyone a chance to contribute and value hearing all voices. Accept the challenge of doctorate level studying, thinking, and learning. Anticipate that the level and quantity of work in this course may exceed your prior experiences. Come to class prepared, having read the assignment beforehand and having thought about how you can participate in that day's discussion. COURSE SCHEDULE AND TOPICAL OUTLINE Our course outline may be revised to address particular needs that present during the teaching of the course itself. Potential revisions will be discussed in class prior to making any changes. Class content may also be modified during class sessions based upon learning needs and interests of course participants. The topical outline for this course will address the following content areas: Date Topic Readings & Assignments 9/6/2012 Introduction, Course Overview Readings: Seidel, et al: Chapters 1, 2, 3, 4, 5, 6 , 7 & 26 View video content on assigned chapters (follow the Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Date Topic Components of the Health History/ interviewing in the context of age, developmental, cultural/ethnic and socioeconimic status. Genogram *Class attendance required 9/13/2012 Assessment of Female Genitalia Readings & Assignments instructions in your textbook for access to the online content) Complete the anatomy Review prior to class and **PRINT AND BRING YOUR COMPLETED REVIEW TO THE FIRST CLASS In class activities: Complete History (including genogram), on a classmate. Submit written history to the dropbox by 9/9/2012 Sometime during the first week of class you should view the “Putting it all together-complete physical exam’ video clip available online with the 7th edition of Seidel. Readings: Seidel, et al Chapters 16 & 18. View video content on Pelvic exam/female genitalia exam. Breast Exam In class activities: 9/20/2012 *Class attendance required Lab practice Skin Seidel: Chapters 8, 9, 10, 11, 12 HEENT/ & Lymphatics View video content on Skin and HEENT In patients cross the lifespan. Lab Practice *SOAP note #1 due 9/24/2012 9/27/2012 10/4/2012 Cardiac, Peripheral vascular, Heart sounds Thorax and Lungs Readings: Seidel, chapters: 13-15 and 17, 19 & 20 . View video content on cardiac, respiratory, abdomen and male G/U Abdomen and Rectum And Male genitalia Lab practice 10:00am -1:00pm & 3:30-5:00pm *SOAP note #2 Due 10/1/2012 In patients across the lifespan. Assessment of Seidel Chapters 21 & 22. Neuromuscular system View video content on neuromuscular exam. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Date Topic Readings & Assignments Class will be divided into 2 groups #1@ 10:00am 1:00pm & #2 @3:30-5:00pm (groups will be assigned on 9/27) 10/11/2012 Putting it all together Complete PE practice/ Documentation Lab Presenting a pt. *Class attendance required Read Seidel, chapters 24 &25. In Class Activities: Class will be divided into 2 groups #1@ 10:00am 1:00pm & #2 @3:30-5:00pm (groups will be assigned on 9/27) *Complete History Write up on NH patient (or family/friend) due10/15/2012. Vide- taped Interview and Exam along with Self Critique due on 10/21/2012 Evaluation of Peer video-taped interview and exam due on 10/25. 10/18/2012 Final Clinical Exam* To be scheduled individually (# 25 students) 10/25/2012 Final Clinical Exam* To be scheduled individually (# 25 students) *See Appendix F for grading rubric final clinical exam COURSE ASSIGNMENTS AND GRADING Assignments, assigned points, and due dates will be reviewed, revised, and/or developed by students and faculty during our first class session. Name of Assignment Health history write up on classmate Assignment #1 HEENT SOAP note (on a patient with a diagnosis of allergic rhinitis and acute otitis media) Assignment #2 Heart/Respiratory SOAP note (on a patient with a diagnosis of acute asthma exacerbation and mitral valve prolapse) Assignment #3 Health history write up on NH patient Assignment #5 Self-Critique of video interview Assignment #6 Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Objectives 1-6 Points % S/U Due Date 9/9/2012 1,2,3,4 10 8.5% 1,2,3,4 10 8.5% 1-6 10 8.5% 10/15/2012 1,2,3,4,5,6 10 8.5% 10/21/2012 9/24/2012 10/1/2012 Master’s Degree Program Syllabus NURS 6140 Name of Assignment Objectives Points Peer Interview Evaluations 2,3 20 (20 points) Assignment #7 Final Clinical exam* 1-6 60 Total 120 Please note. Assignments are designed to address specific course objectives. % 16% Due Date 10/ 25/2012 50% 100% See Appendix A for Relationship of Course Objectives to Academic and Professional Standards See Appendix B for St. Catherine University: Liberal Arts Themes, Goals, and Outcomes, and NONPF Competencies See Appendix C for Clinical Guidelines for Health Assessment Class See Appendix D for Interview Evaluation guidelines (use for self critique) See Appendix E for History and Physical guidelines See Appendix F for SOAP note grading rubric See Appendix G for H & P write up grading rubric See Appendix H for grading rubric final clinical exam See Appendix I Clinical Competencies Evaluation Form See Appendix J Clinical Log Assignments: Students are responsible for completing all course assignments and learning activities. Course assignments are due on the scheduled due date. Late assignments will not be accepted unless you notify Vicki Ericson by e-mail (vlericson@stkate.edu) or voice mail (612-229-5452) prior to when the assignment is due. Final Clinical Exam—You will be observed performing a complete physical exam (no breast or G/U exam) on either a classmate or someone you choose. You will be graded on your patient interactions and appropriate exam techniques. Grading Policy: NURS 6140 must be taken for a grade and must be satisfactorily completed with a minimum grade of B (87% of the total possible points). Each course assignment must be completed with a minimum grade of C (78% of total possible points). Assignments may be resubmitted once if not completed satisfactorily the first time (if evaluation of assignment is <78% possible points). Resbmitted assignments receive a maximum of 78% of total possible points for that assignment. If you have questions about how to complete a particular assignment, please contact Vicki Ericson. Grading Scale: The grading scale for NURS 6140 is determined as follows: A 96% and over B+ 90-92% C+ 81-83% A- 93-95% B 87-89% Passing C 78-80% B- 84-86% C- 75-77% Incomplete Grades: A grade of incomplete is given only when unusual circumstances deem it appropriate. Ordinarily, such circumstances would involve matters that are not wholly within your control, such as illness. If you wish to receive an incomplete grade you must complete a Petition for Incomplete Grade form (available online) no later than the last day of the term in which course requirements are due. You must be making satisfactory progress in the course and you must have completed 75% of the course at the time the petition is filed. Incompletes are awarded at the faculty’s discretion. If granted, the normal deadline for completion of the Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 work is no more than 8 weeks after the last day of classes in the term in which the course is offered. The course faculty may establish a due date after the normal deadline if you request it and special circumstances warrant it. The faculty will submit an alternate grade that will automatically be recorded if you do not complete the requirements for the course by the deadline. If you complete the course requirements in the time allotted, the faculty must submit the final grade by the deadline. Extensions to the due date originally agreed to by you and your course faculty must be approved by the academic dean. COURSE POLICIES Additional policies related to this course may be found in the Master’s Degree Program Student Policies located in the online Nursing Student Handbook. Academic Integrity: Please refer to the “Academic Integrity Policy” in the Graduate Academic Catalog. Accommodations: St. Catherine University is committed to equal access for all and recognizes that disability is an aspect of diversity. The University’s goal is to create learning environments that are usable, equitable, inclusive, and welcoming. If there are aspects of the instruction or design of this course that result in barriers to the learning environment, accurate assessment, or your achievement, please contact me and the Resources for Disabilities office as soon as possible. Access Consultants can be reached in the O’Neill Center at 651.690.6563 to discuss academic adjustments or accommodations. Attendance: The most significant learning activity is attendance and active participation in all class sessions. Taking initiative in learning is a hallmark of advanced nursing practice. This requires preparation for all class sessions, the belief that you have a unique and valuable perspective to offer to class discussions, and the willingness to enter into to our class discussions. Therefore, attendance will be taken and active participation and engagement in class discussions and learning activities will be noted. Regular class attendance is expected and is defined by the format of the course. For online courses, attendance means following the communication requirements and due dates on the syllabus. For in-class learning, attendance means that (a) you arrive at class on time and stay for the duration of the class; and (b) whether present or not, you are responsible for in-class content. For hybrid courses, you must follow both the online and in-class attendance requirements. Failure to attend, for any reason, may be taken into account in the evaluation of your work. First day attendance (for in-class) or first week online communication (for online learning) is required. If you will be late or absent for a class session, please e-mail or call Vicki Ericson prior to class (vlericson@stkate.edu or 651.690.6057). Failure to regularly attend class sessions will result in implementation of the Performance Issue Algorithm/Guided Improvement Plan described in the Master’s Degree Program Student Policies. St. Catherine University is committed to the healthy well-being of our community; therefore, we support The Centers for Disease Control and Prevention’s recommendations related to communicable diseases that could be transferred during class activities. In the event that students are unable to attend classes due to selfisolation recommendations, they should notify their professors of their absence and arrange alternative activities. Course Communication: Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Please check your St. Kate’s e-mail and D2L regularly for messages and updates related to the course--at least every 2-3 days. E-mail messages and voice mail messages will be responded to within 24 hours, except on weekends and holidays. You are encouraged to discuss optimal means of communication with course faculty. In the event of severe weather on a planned class day or learning event, please monitor e-mail and D2L closely for alternative assignments or plans. Grades will be posted in the online gradebook on our D2L course site. Evaluation: Evaluation is an essential component of this course. Informal and formal evaluations will be conducted during the course and evaluative data will be used by faculty to improve the course and ensure that learning is being facilitated through teaching-learning activities and course assignments. Online course and faculty evaluations are completed at the end of this course. Information about how to complete these online evaluations will be sent by a staff member in the Department of Nursing, usually before the final class session. Final course evaluations are confidential; only aggregated data are reported to faculty. Inclusivity:1 Nurses are called to promote human dignity. In order to be aware of the ever changing environment in nursing and health care, an open dialogue must be able to occur in a non-threatening environment in which students and faculty can engage in discussions that are taking place, challenge comments that are made, and evaluate aspects of the structural environment that support injustice. Bringing attention to expressions of cultural bias is a way to model against stereotyping. At any time, a moment of consideration can be called. This can and should be called by anyone, student or faculty, in order to facilitate needed conversation around sensitive issues. These moments are times for all of us to learn how to become more sensitive in our language and actions. Such dialogues may pertain to stereotypes related to “race,” sex, religion, gender identity, sexual preference, weight, economic status, and anything that can impact the dignity of persons, including equitable treatment of patients and students. These moments of consideration should be freely addressed in the classroom and are an essential aspect of learning in this course. PROFESSIONAL STANDARDS, WRITING AND TECHNOLOGY REQUIREMENTS Faculty in the Department of Nursing use professional nursing standards in the development, implementation, and evaluation of curricula as well as to promote and evaluate student learning. In the Nurse Practitioner Concentration of the Master’s Degree Program, professional standards include: Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) Code of Ethics for Registered Nurses (Canadian Nurses Association, 2008 [Canadian]) International Council of Nurses Code of Ethics for Nurses (ICN, 2006 [All]) Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative Expert Panel, 2011) The Essentials of Master’s Education in Nursing (AACN, 2011) NLNAC Accreditation Standards and Criteria: Master’s Degree Programs (NLNAC, 2012) National Task Force Criteria for Nurse Practitioner Programs (NTF, 2012) Nurse Practitioner Core Competencies (NONPF, 2012) Nursing: Scope and Standards of Practice, 2nd Edition (ANA, 2010) Nursing’s Social Policy Statement: The Essence of the Profession (ANA, 2010) Quality and Safety Education for Nurses: Graduate Competencies (QSEN, 2011) Writing and Technology Requirements: 1 This statement is based on a statement written by NURS 6790 student, Maria Kludt (Spring 2009). Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 The ability to write, use technology, and communicate effectively is essential in advanced nursing roles. Professional nursing standards and competencies for advanced nursing practice specifically address these skills. Courses in the Master’s Degree Program in Nursing are designed to provide opportunities for you to learn and develop writing abilities and skills in using technology. In NURS 6140, written assignments will be evaluated by faculty for (a) the logical flow of ideas and organization of content; (b) spelling, grammar, and punctuation; and (c) the use of American Psychological Association style (APA, 2010). If specific concerns are identified, you will be encouraged to seek assistance with your professional writing skills, including the use of APA style. CONGRUENCE WITH THE ST. CATHERINE UNIVERSITY MISSION NURS 6140, advances the “Goals of a Liberal Arts Education” at St. Catherine University by challenging you to commit yourself to learning a new skill set, drawing on your current level of knowledge. Each of the “Goals of a Liberal Arts Education” is related to one or more of the course objectives and consistent with the teaching and learning activities used in this course. TEXTBOOKS AND COURSE MATERIALS Required Texts for this course include: Seidel, Ball, Dains, Benedict (2010). Mosby’s guide to physical examination (7thed.) St. Louis, MO: Mosby/Elsevier. LEARNING RESOURCES E-mail and D2L will be used for communication among faculty and class participants and for distribution of class materials. Please go to our D2L course site for course announcements and course learning resources, including course documents, websites related to course content, and other helpful information. The following equipment will be needed during the course: Stethoscope Peds option only: Otoscope Please let Vicki Ericson know if you have any questions about our course syllabus. Thank you Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix A Relationship of Course Objectives to Academic and Professional Standards Integrating Concepts Context and Environment (CE) Related Course Objectives 1. Knowledge and 2. Science (KS) Personal and Professional Development (PD) 3. Quality and Safety (QS) 4. Use a systematic framework to collect a complete health history in the context of various delivery systems, reimbursement policies, nurse practitioner practice, and the economics of public and private financing. Integrate best practices with relevant interprofessional and developmental theories to guide diagnostic reasoning and systematic data collection. Evaluate theories of aging, development, social, family and race related to patient assessment in advanced practice role. Organize data using appropriate electronic data collection systems to formulate a Liberal Arts Goals Master’s Essentials Ethics and Social Justice Essential I: Background for Practice from Sciences and Humanities Diversity and Global Perspectives Essential V: Informatics and Healthcare Technologies Effective Communication in a Essential VI: Health Policy and Variety of Modes Advocacy QSEN (IOMa) Interprofessional Competencies Informatics Values/Ethics (Informatics) Interprofessional Communication Technology and Information Literacy Competencies Essential VIII: Clinical Prevention and Population Health for Improving Health Policy Competencies Critical and Creative Thinking Essential I: Background for Practice from Sciences and Humanities Evidence-Based Practice Discipline-Based Competence Essential IV: Translating and Integrating Scholarship into Practice (Evidence-Based Practice) Leadership and Collaboration Essential IX: Master’s-Level Nursing Practice ALL Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Scientific Foundation Competencies Practice Inquiry Competencies Roles/ Responsibilities Purposeful Lifelong Learning Effective Communication in a Variety of Modes Nurse Practitioner Competencies Scientific Foundation Competencies Ethics Competencies Leadership Competencies Independent Practice Competencies Essential II: Organizational and Systems Leadership Essential III: Quality Improvement and Safety Quality Improvement Safety (Quality Roles/ Responsibilities Quality Competencies Health Delivery System Master’s Degree Program Syllabus NURS 6140 Integrating Concepts RelationshipCentered Care (RC) Teamwork (TW) Related Course Objectives 5. 6. problem list based on cumulative data integrating nursing and medical terminology and diagnostic taxonomies. Perform a health assessment appropriate for specialty population incorporating safety measures, health history and exam technique and document findings in a clear succinct manner using appropriate terminology. Develop interviewing and communication skills that promote effective professional relationships. Liberal Arts Goals Master’s Essentials QSEN (IOMa) Interprofessional Competencies Improvement) Nurse Practitioner Competencies Competencies Ethics Competencies Discipline-Based Competence Essential IX: Master’s-Level Nursing Practice Patient-Centered ALL Care Independent Practice Competencies (PatientCentered Care) Leadership and Collaboration Essential II: Organizational and Systems Leadership Teamwork and Collaboration Interprofessional Communication Leadership Competencies Effective Communication in a Variety of Modes Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes (Interdisciplinary Teams) Teams/Teamwork Technology and Information Literacy Competencies Health Delivery System Competencies Please note. aLiberal Arts Goals are defined in the table on the following page. bQSEN competencies are related to the IOM competencies described in Health Professions Education: A Bridge to Quality (2003) and identified in parentheses. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix B St. Catherine University: Liberal Arts Themes, Goals, and Outcomes Leadership and Collaboration: The ability to lead and influence for ethical and responsible action and for systemic change; the ability to work well with others, especially in joint intellectual effort. Ethics and Social Justice: The ability to apply ethical standards to judge individual and collective actions; the development of attitudes and behaviors that reflect integrity, honesty, compassion, and justice in one’s personal and professional life. Diversity and Global Perspectives: The ability to understand and analyze the impact of diversity and systems of power and privilege on the individual and society; the ability to decipher and honor multiple and global perspectives in creating mutual understanding; the ability to imagine and take action towards justice. Liberal Arts Themes, Goals, and Outcomes Students will demonstrate leadership and collaboration by their ability to: a) act from a strong self-concept; b) transform information into knowledge and knowledge into judgment and action; c) make timely and relevant decisions based on sound reasoning; d) discern consequences, including ethical consequences, of decisions and actions; e) articulate a positive sense of direction and evoke hope; f) work well in teams and work groups of diverse composition, building consensus and integrating conflict resolution strategies. Students will demonstrate a commitment to ethics and social justice by: a) understanding principles of ethics and social justice from multiple perspectives; b) understanding Catholic Social Teaching and the Catholic commitment to social justice; c) applying ethical and justice frameworks to contemporary issues; d) exhibiting personal and academic integrity; e) practicing social responsibility through community engagement, citizenship and advocacy. Students will demonstrate a commitment to diversity and global perspectives by their ability to: a) understand the experiences and contributions of women across history and cultures; b) recognize the historic and current relationships within and among cultural communities, locally, nationally, and globally; c) identify and critically analyze the intersections and impact of race/ethnicity, gender, social class, religion, sexual orientation, age, ability and other differences on identity, experience, and systems of power and privilege; d) understand how economic, social, religious and political systems interact and how those systems vary across societies; e) understand the interrelationships between nature and humans and develop eco-centric perspectives; f) increase critical cultural competencies and cultural responsiveness through engaging with multiple communities; g) take action to dismantle systems of oppression and build a more just world. Students will demonstrate critical and creative inquiry by their ability to: Critical and Creative a) locate appropriate information from a variety of sources and evaluate its relevance and reliability; Inquiry: The ability to gather, analyze b) organize, describe, interpret, and integrate both qualitative and quantitative information; and critically evaluate c) shape ideas and discern meaning from experience, observation, imagination, and passion; information to develop d) analyze complex issues and arguments in various intellectual contexts (scientific, aesthetic, reasonable arguments, sound philosophical, etc.) and evaluate the validity and soundness of such arguments; judgments, and effective e) develop and evaluate action plans for solving significant social and intellectual problems; solutions. This ability is f) demonstrate breadth of knowledge of the major accomplishments of human endeavors and of the founded on a broad knowledge distinct methods of exploring truths (in the natural sciences, social sciences, and the arts and of the achievements of human humanities); * creativity and of the variety of g) identify and interpret similarities and differences among various disciplinary approaches and examine disciplinary approaches for the relationships among them. exploring truths. * Breadth of knowledge applies to all degrees except the graduate degrees, where the focus is on in-depth development of disciplinary skills. Students will demonstrate discipline-based competence by their ability to: Discipline-Based Competence**: The ability to a) use in-depth knowledge and engage key ideas in at least one field of study; demonstrate in-depth b) exercise disciplinary methods and skills, and carry out research or learn independently in that field; knowledge, values and skills c) develop disciplinary perspective and identity, including an understanding of the route to acquiring in at least one major field of knowledge in that discipline; study and to relate disciplinary d) identify and analyze similarities and differences between the student’s major field and other approaches to those of other disciplinary approaches. fields. **Discipline-Based Competence applies to all degree programs except the Associate of Arts Degree Program. Effective Communication in Students will demonstrate effective communication by the ability to: a Variety of Modes: The a) read, view, and listen with understanding and critical discernment; ability to read, write, speak b) organize, evaluate, and communicate ideas effectively through writing and public speaking to various Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 and listen effectively; the ability to present information in a clear and engaging manner. Purposeful Life-long Learning: The ability to continue personal and professional development based on ongoing selfassessment, feedback from others, and new learning. Liberal Arts Themes, Goals, and Outcomes audiences; c) prepare and present information visually and through the use of technology; d) find expression in fine, literary, and performing arts; e) develop and put into practice interpersonal, group, and cross-cultural communication skills and listening skills; f) show competency in a second language (applies only to bachelor’s degree). Students will demonstrate a commitment to purposeful life-long learning by: a) assuming responsibility for their own learning; b) engaging in and reflecting on opportunities that prepare for life after college; c) practicing a variety of methods of learning, including reading and research, observing and listening, self assessment and feedback, work and life experience; d) developing knowledge and strategies for maintaining a balance of body, mind and spirit; e) reflecting on and developing a meaningful, purposeful, and spiritual life. Nurse Practitioner Core Competencies Scientific Foundation Competencies 1. Critically analyzes data and evidence for improving advanced nursing practice. 2. Integrates knowledge from the humanities and sciences within the context of nursing science. 3. Translates research and other forms of knowledge to improve practice processes and outcomes. 4. Develops new practice approaches based on the integration of research, theory, and practice knowledge Leadership Competencies 1. Assumes complex and advanced leadership roles to initiate and guide change. 2. Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care. 3. Demonstrates leadership that uses critical and reflective thinking. 4. Advocates for improved access, quality and cost effective health care. 5. Advances practice through the development and implementation of innovations incorporating principles of change. 6. Communicates practice knowledge effectively both orally and in writing. 7. Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus. Quality Competencies 1. Uses best available evidence to continuously improve quality of clinical practice. 2. Evaluates the relationships among access, cost, quality, and safety and their influence on health care. 3. Evaluates how organizational structure, care processes, financing, marketing and policy decisions impact the quality of health care. 4. Applies skills in peer review to promote a culture of excellence. 5. Anticipates variations in practice and is proactive in implementing interventions to ensure quality. Practice Inquiry Competencies 1. Provides leadership in the translation of new knowledge into practice. 2. Generates knowledge from clinical practice to improve practice and patient outcomes. 3. Applies clinical investigative skills to improve health outcomes. 4. Leads practice inquiry, individually or in partnership with others. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 5. Disseminates evidence from inquiry to diverse audiences using multiple modalities. 6. Analyzes clinical guidelines for individualized application into practice. Technology and Information Literacy Competencies 1. Integrates appropriate technologies for knowledge management to improve health care. 2. Translates technical and scientific health information appropriate for various users’ needs. 2a). Assesses the patient’s and caregiver’s educational needs to provide effective, personalized health care. 2b). Coaches the patient and caregiver for positive behavioral change. 3. Demonstrates information literacy skills in complex decision making. 4. Contributes to the design of clinical information systems that promote safe, quality and cost effective care. 5. Uses technology systems that capture data on variables for the evaluation of nursing care. Policy Competencies 1. Demonstrates an understanding of the interdependence of policy and practice. 2. Advocates for ethical policies that promote access, equity, quality, and cost. 3. Analyzes ethical, legal, and social factors influencing policy development. 4. Contributes in the development of health policy. 5. Analyzes the implications of health policy across disciplines. 6. Evaluates the impact of globalization on health care policy development. Health Delivery System Competencies 1. Applies knowledge of organizational practices and complex systems to improve health care delivery. 2. Effects health care change using broad based skills including negotiating, consensusbuilding, and partnering. 3. Minimizes risk to patients and providers at the individual and systems level. 4. Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders. 5. Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the environment. 6. Analyzes organizational structure, functions and resources to improve the delivery of care. 7. Collaborates in planning for transitions across the continuum of care. Ethics Competencies 1. Integrates ethical principles in decision making. 2. Evaluates the ethical consequences of decisions. 3. Applies ethically sound solutions to complex issues related to individuals, populations and systems of care. Independent Practice Competencies 1. Functions as a licensed independent practitioner. 2. Demonstrates the highest level of accountability for professional practice. 3. Practices independently managing previously diagnosed and undiagnosed patients. 3a). Provides the full spectrum of health care services to include health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end of life care. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 3b). Uses advanced health assessment skills to differentiate between normal, variations of normal and abnormal findings. 3c). Employs screening and diagnostic strategies in the development of diagnoses 3d). Prescribes medications within scope of practice 3e). Manages the health/illness status of patients and families over time. 4. Provides patient-centered care recognizing cultural diversity and the patient or designee as a full partner in decision-making. 4a). Works to establish a relationship with the patient characterized by mutual respect, empathy, and collaboration. 4b). Creates a climate of patient-centered care to include confidentiality, privacy, comfort, emotional support, mutual trust, and respect. 4c). Incorporates the patient’s cultural and spiritual preferences, values, and beliefs into health care. 4d). Preserves the patient’s control over decision making by negotiating a mutually acceptable plan of care. Reference National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core competencies. Retrieved from http://www.nonpf.com/associations/10789/files/NPCoreCompetenciesFinal2012.pdf Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix C Clinical Guidelines for Health Assessment Class Each student will participate in 30 hours of clinical experiences. Students will work with clinical faculty and community providers to observe and practice, history taking and aspects of the physical exam. All patient encounters should be documented in the clinical log. Patient Interview Evaluation Patient/provider communication and good patient provider relationships have a significant impact on patient satisfaction and patient health outcomes. Difficulties in the effective delivery of health care can arise from problems in communication between patient and provider rather than from any failing in the technical aspects of care. Observing other providers can help to refine one’s own “style” of patient interactions. You will be required to observe a health care provider or one of your classmates (via video) interacting with a patient and to then critique the encounter using the Patient Interview Evaluation form (Appendix A in syllabus). Please include a paragraph discussing the important components of the visit; role of the provider, unique practice issues, the reason for the visit, important exam and test findings, clinical decision making, diagnosis and plan. Be prepared to discuss your interview evaluation in class on the assigned date Grading: 20 points for complete documentation evaluation of video using the Patient Interview Evaluation Form. *Clinical Experience for NURS 6140 The clinical assignment of 30 hours must be satisfactorily completed in order to pass 6140 and 6130 courses. Students are required to have preceptors complete the Clinical Competencies Evaluation Form for each clinical rotation (Appendix H) Clinical experience will be 60 hours in a patient care setting mutually arranged with faculty and students. Board certified nurse practitioners, physicians assistants or physicians will serve as preceptors and provide the following: 1. 2. 3. 4. 5. 6. 7. 8. Provide patients and space for Nurse Practitioner student’s clinical practice. Confirm, correct, or add to the student’s findings in the history and physical exam. Retain medical responsibility for patients seen by the student. Discuss diagnostic and management plans for specific (selected) patient problems with student. Schedule conferences with the student to review progress and problems. Call the faculty advisor with questions or problems not resolved with student. Discuss progress of student with faculty during clinical site visits by faculty. Participate in student’s selection and focus of projects for class assignments. Final evaluation and assignment of student grades will remain the responsibility of the faculty. Clinical assignments include the clinical log, initial site visit, clinical evaluation site visit, clinical write-up. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Students will formally write up select interactions in the form of a history and physical examination or SOAP note, schedule a clinical site visit with their preceptor and clinical faculty to mutually identify strengths and weaknesses, and develop a plan for improvement. The clinical log will be kept and will serve as a self-audit tool as to the people and diversity of patient encounters. Students will also have experience presenting cases to their peers at clinical conferences. The case presentation provides: An opportunity for students to gain experience in organizing and presenting clinical data to a group. An opportunity for students to receive feedback from peers and faculty regarding skill in data collection, synthesis and organization, presentation style, assessment and management plans. An opportunity to critically appraise a peer’s case presentation. Clinical Activities: Clinical Notes (Put in Drop box or mail to your faculty advisor) See syllabus for assignments and due dates. Clinical Competencies Evaluation Form. Should be completed by the preceptor prior to faculty site visit and again at the end of the clinical rotation. Clinical Log: The student will maintain a clinical log of patients seen on the clinical log sheet. This log should include the pts age, gender, and problem, as well as indicate what exams, procedures or other interesting components of the visit as well as the assessment and plan. The student indicates total time spent in the clinical setting for each clinical experience. Number of minutes spent with each patient, in consultation does not need to be tracked. Clinical logs must be maintained throughout the semester. Timely clinical documentation is a reflection of professional accountability. The clinical log is not graded. Completion of the clinical log is a course requirement. Student are required to submit to faculty and the nursing office the total hours spent in the clinical environment during the semester. Please fax or deliver in person a COPY of your log after each clinical session. Clinical Evaluation Site Visit: Faculty will conduct a visit to evaluate the student’s ability to : 1. Collect a comprehensive health history 2. Perform a complete physical examination safely 3. Develop appropriate problem list 4. Demonstrate knowledge of health maintenance 5. Provide patient education relative to health promotion and disease prevention 6. Jointly identify with student and preceptor areas of strength and weakness in the clinical setting. 7. Evaluate the student’s problem solving ability based on the following criteria: a. Interaction with patient b. History and physical exam c. Problem list with rationale of priorities, and emphasis on health maintenance issues d. Organized oral presentation of significant/pertinent subjective and objective data for priority problems e. Formulation of plans relative to priority problems Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix D Patient Interview Evaluation Guidelines Student:___________________________________________________Date_______ Patient age:___________Gender:__________ Setting:_______________________ Evaluate the following criteria indicating whether the item was performed well, missing, or not performed well. Include enough detail to justify your responses. Grade_______/ 10 points Please include a paragraph discussing the important components of the visit; role of the provider, unique practice issues, reason for the visit, important exam and test findings, clinical decision making, diagnosis and plan. (1 point) Getting Started (.5 point) Introduction Purpose of interview made clear Confidentiality Interview Style (1 point) Positioning: eye-level, patient comfort Open to focused questions Restates to encourage elaboration Summary statements Use of silence Empathy Notetaking/Computer Maintains focus of interview Sensitive to pt. age/development/education Closing (of interview/encounter) (.5 point) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Summary and conclusion Content of the Interview (1 point) Organization Completeness Present Problem (1 point) Chief Complaint (Concern) History of Present Illness (Pertinent ROS, PMH, FH, SH, etc.) Dimensions of a Symptom (1 point) Onset Location Duration Character Aggrevating/Associated Factors Timing Severity Past Medical History (1 point) Organization Completeness Family History (1 point) Organization Completeness Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Social History (1 point) What aspects of the social history were addressed? (habits, economics, living situation, relationships, safety, etc.) Overall Evaluation (1 point) Strengths: (what went well) Weaknesses: (what would you do differently & why) Additional Reactions or Comments Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix E GUIDELINES FOR COMPLETE HISTORY WRITE UP For this assignment you will obtain a complete health history from a patient in your clinical setting, or in one of your other clinical experiences, or if you are obtaining a health history from a child, a non-family member, i.e. neighbor would be acceptable. In order to pass you must include all the required components of the history outlined in the guidelines (or provide an explanation why an item was not included). You may be required to resubmit this assignment. I. Identifying Data (narrative) A. B. C. D. E. F. Sex Age Ethnic background Significant relationship status Occupation Geographic location II. Source and Reliability III. Chief complaint/concern or client’s request for care. Brief statement of patient’s symptom and duration IV. History of Present Illness (narrative) A. Includes seven variables: 1. Chronology 2. Body location 3. Quality 4. Quantity 5. Setting 6. Aggravating or alleviating factors 7. Associated manifestations B. Includes pertinent family history, past history, and negatives of related systems V. Past Medical History A. Childhood illnesses (dates, complications) B. Immunizations Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 C. Adult illnesses (list in chronological order with dates, type of illness, and any complications. Include hospitalizations, operations, injuries and psychiatric illness) D. Medications 1. Prescription 2. Home remedies 3. Over-the counter E. Allergies 1. Environmental 2. Ingestion 3. Drug F. Transfusions G. Habits 1. Sleep 2. Exercise 3. Caffeine (coffee, tea, cola, other beverages) 4. Tobacco 5. Environmental 6. Alcohol & Drug 7. Safety—seat belts, helmets, guns, CO and smoke detectors working. H. Screening Tests VI. Nutritional History A. Past 24 hour intake (amt. fruit/veg/protein/fats) B. Past nutritional problems VII. Family History (genogram) A. Health status of nuclear family B. Illnesses of environmental, genetic, or familial nature in blood relatives C. Ages and positions of extended family VIII. Psychosocial History (narrative) (include meaning and degree of satisfaction) A. Developmental data 1. Summary of development to date 2. Current developmental function – stages, tasks Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 B. Relationships with family 1. Role in family 2. Relationships with parents, children and spouse, and significant others 3. Relationships with extended family 4. Family developmental stage and tasks being accomplished C. Present living arrangements D. Sexual adjustment 1. Lifestyle 2. Satisfaction 3. Effect of illness E. Occupational history 1. Past and present employment 2. Hazards 3. Satisfaction F. Economic Resources 1. Sources 2. Perception of limitations 3. Effect of illness G. Daily profile 1. Rest/activity 2. Social activities 3. Travel 4. Hobbies/recreation H. Coping mechanisms I. Significance of religions J. Support systems K. Impact of illness 1. Attitude 2. Limitations 3. Patterns of health care 4. Values and goals IX. Review of Systems (see Seidel et al. for specific symptoms) General Skin, Hair, Nails Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Head Eyes Ears Nose and sinuses Mouth and throat Neck Breasts Respiratory Cardiac Gastrointestinal Urinary Genito-reproductive Musculoskeletal Peripheral vascular Neurological Psychiatric Endocrine Hematologic Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 APPENDIX F Grading Rubric for SOAP Note ____ Subjective Data (3 point) Organizes data pertinent to problem addressed Uses patient words as appropriate ____ Objective Data (3 points) Organizes data pertinent to problem addressed Uses correct medical terminology Incorporates lab, x-ray data when appropriate ____ Assessment (1 point) States assessment concisely Presents clear rationale for assessment ____ Plan (3 points) Formulates plan specific to priorities identified Safety of plan: meds, allergies, consequences of plan Identifies areas where information lacking Identifies how to obtain information safely Identifies patient goals Includes diagnostic plans with rationale Includes therapeutic plan indicating need For consultation Includes complete plan for patient education Includes principles of primary prevention in Health maintenance Total: ______/10 points Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 APPENDIX G Grading Rubric Complete History I. History (10 points) Critical Requirements Uses a systematic process to obtain history. Family hx includes grandparents, parents, siblings, children. Subjective data appropriately Documented only in history section Objective data documented only in exam section. Recording Conciseness Completeness Terminology Organization of data Biographical Data Age, sex, race, religion, reliability Chief Complaint States reason for seeking health care in client’s own words History of Present Illness Records in sequential narrative, uses appropriate terminology Utilizes 7 variables Includes negative and positive review of pertinent Systems medications Past Medical History Medical illnesses-childhood, adult Hospitalizations and surgeries Allergies Immunizations Comments (1 points) (1 points) (1 points) (2 points) (1 points) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Blood Health Habits Medications Family History Diagrams family Constellation Family Illnesses Psychosocial History/Patient Profile Life style Mental status Reaction to stress Summary Quality of data Riview of Systems Identifies onset, duration, relief & treatment Notes pertinent negatives General Skin HEENT Breasts Respiratory Cardiovascular Genitourinary GYN Musculoskeletal Endocrine Neurological Emotional (1 point) (1 points) (2 points) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 APPENDIX H Grading Rubric for Final Clinical Exam Final Exam: Clinical Test-out. Below are 9 categories (I-IX) Each colored box represents an exam or parts of an exam. AS you can see, some are less involved than others. Students will be asked to complete one or two categories for their clinical test out exam. I have included a brief description of what is expected in each category. * Note Everyone will be graded on category I. I. EVERYONE WILL BE EXPECTED TO COMPLETE Provide privacy Wash Hands Obtain proper lighting Adequate patient instructions down) (don’t talk TOO much, as it slows you Ensure visualization of each body part as it is examined Overall organization & flow Timeliness of exam Vital Signs (verbalize VS findings obtained by attendant previously) II. SKIN/HAIR/NAILS/HEAD/FACE Skin: Hands & nails ( excess palm lines? Nail fungus, pitting, clubbing, splitting?) Color and pigmentation Texture/Turgor (dry? dermatitis? tenting?) Lesions (ie nevi, eczema, birthmarks) Head/Face: Inspect & Palpate head & scalp Inspect face/ symmetry/ motion (CN VII = smile/frown, puff cheeks, move eyelids against resistance) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Palpate TMJ (tender? click?) III. EYES/EARS/NOSE/THROAT/MOUTH/CERVICAL LYMPH NODES Eyes: (report Snellen visual acuity as obtained by attendant previously) Inspect external eye (lids, sclera, conjunctiva, iris, pupil, cornea) Visual fields (confrontation = wiggle fingers to check peripheral vision) EOM’s (CN III, IV, VI – check with wide H for symmetry and nystagmus) Pupillary Accomodation (focus on finger [constrict] and distant object [dilate]) Cover-Uncover/ Alignment (as eye uncovered, watch for movement of esotropia or exotropia) Pupil response to light (direct and consensual) Corneal light reflex (check balance of EOMs by noting reflection of light on pupils) Opthalmascope – note red reflex (light reflecting off retina, to R/O cataract) Ears: Inspect & palpate external ear, mastoid (tender? lesions?) Inspect canals (clear? edema? moisture? excessive cerumen?) Inspect tympanic membranes (boney landmarks? cone of light? fluid? color?) Test hearing: Finger rub or Voice at 3 ft Weber (tuning fork on top of head to evaluate for lateralization of sound) Rinne (fork on mastoids – time to ensure Air Conduction>Bone Conduction 2:1) Nose / Sinus: Palpate or Percuss frontal and maxillary sinuses (assess tenderness) Test patency of nostrils (pt occludes one nare at a time and inhales) Inspect nasal mucosa, turbinates, septum (with otoscope and speculum) Mouth and Throat: Inspect buccal musosa, dentition, gingivae, palate, floor of mouth (use tongue blade to move cheeks. Observe for lesions, edema, erythema) Inspect posterior pharynx, tonsils, uvula (grade tonsils 0-4, note exudate, lesions) Evaluate gag reflex (CN IX, X) (present if pt can swallow. NO need to gag!) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Inspect tongue movement (CN XII) (symmetrical? Full ROM?) Cervical lymph nodes Inspect for symmetry, lumps & pulsations Palpate lymph nodes: Preauricular Postauricular Occipital Tonsillar Submandibular Submental Superficial (anterior) cervical Deep cervical Posterior cervical Supraclavicular Infraclavicular IV. THYROID/NECK/TRACHEA Palpate trachea (midline?) Palpate thyroid (here or from behind pt later) Palpate carotid pulses Neck ROM , muscle strength, shoulder shrug, chin resistance V. CHEST AND LUNGS Posterior inspection of thorax, skin, A/P diameter Respiratory expansion (symmetric?) Palpate for tactile fremitus, tenderness, masses Percuss posterior lung fields (x6 areas, evaluate side to side for resonance) Percuss for costovertebral angle tenderness (ie “CVAT” to bilateral flanks) Auscultate posterior & lateral breath sounds (x6-8 areas, side to side) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Move to Front of Patient Lungs cont’d: Auscultate anterior lungs (4-6 areas) Cardiac: Inspect and palpate for cardiac pulsations, thrills, heaves. Palpate apical impulse (or Point of Maximal Impulse) (PMI location estimates myocardial size -- should be in 5th intercostal space, midclavicular line) Auscultate heart sounds with diaphragm and then bell 5 areas – Aortic, pulmonic, Erbs point, tricuspid, and mitral valves Assess for S1, S2, murmurs, rubs, and gallops Auscultate carotid arteries for presence or absence of bruits Repeat auscultation in all 5 areas with pt. supine using diaphragm & bell) Inspect neck vessels (evaluate for jugular venous distention) VI. ABDOMINAL EXAM Inspect contour, symmetry, skin characteristics (ie scars), umbilicus, pulsations Auscultate: 4 quadrants (for bowel sounds) Auscultate for aortic, renal, and iliac bruits Percuss: all 4 quadrants (note tympany of gastric bubble and intestines, dullness of organs, stool, or full bladder) Percuss liver span at right MCL (nml 6-12 cm) Percuss spleen (posterior to L MAL. Determine size. Also percuss lowest intercostal space in L AAL for tympany with both inspiration and expiration of breath.) Palpate: all 4 quadrants lightly (using one hand, and assessing for tenderness) Palpate all 4 quadrants deeply (use lower “feeling” hand, with pressure of top “pushing” hand to assess for masses.) Palpate lower liver border (press hand against lower L costal margin. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Assess liver as pt takes deep breath) Abdominal Exam (con’t) Palpate for spleen (normal not to feel), aorta (just L of midline in epigastric area), and kidneys (rarely felt) Describe palpation technique for inguinal nodes and femoral pulses. VII. EXTREMITIES Lower extremities: Inspect symmetry, skin, hair distribution Palpate popliteal, posterior tibial and dorsalis pedis pulses Palpate skin temperature, assess for pretibial edema ROM and muscle strength: Hips, knees, ankles, feet/toes (grade strength to hips and knees on +5/5 scale) Patient Sits Up Upper Extremities: Inspect symmetry, skin, hair distribution Palpate pulses (radial, brachial) and epitrochlear nodes ROM & muscle strength: shoulder, elbows, wrists, hands/fingers (grade strength to shoulders, elbows and grip on +5/5 scale) VIII. NEURO &MUSCULOSKELETAL EXAM DTR’s: upper & lower extremitiesbiceps, triceps, brachioradialis, patellar, Achilles Babinski Finger to finger or finger to nose (tests proprioception / cerebellar function) Heel to shin (tests cerebellar function) Touch (cotton wisp x3 on face – tests sensory function) Pain (sharp x3 and dull x3 on extremities) Vibration (both great toes, one bony prominence on each hand) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Patient Moves to Standing Neuro con’t & Musculoskeletal Gait- normal walking, on heels, on toes Tandem walking (heel to toe) Romberg sign (pt with eyes closed maintains balance before and after light push) Inspect and palpate spine ROM of spine Touch toes (check for flexibility and scoliosis asymmetry, humps, etc) Shallow knee bend or “duck walk” (notes strength of hips, knees, ankles) IX. Male GU: TSE: Describe comprehensive testicular exam- (do not actually examine for purposes of this course) Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix I ST. CATHERINE UNIVERSITY DEPARTMENT OF NURSING MASTER’S DEGREE PROGRAM ADULT/GERIATRIC NURSE PRACTITIONER PROGRAM CLINICAL COMPETENCY EVALUATION Student _____________________________________________ Preceptor________________________________________________ Clinical Site (name)________________________________________ COURSE OBJECTIVES (First Clinical Rotation) Upon completion of this course, you will be able to: 1. Incorporate the concepts of epidemiology, growth and development, family development, stress and coping into the health protection/promotion framework. 2. Critique approaches/programs for promoting healthy lifestyles. 3. Communicate effectively with clients and professional colleagues to facilitate data collection and identification of health needs. 4. Perform screening and health assessments using a systematic process. 5. Develop educational plans and counseling strategies for individuals, families, and aggregates. 6. Demonstrate a problem-solving approach to promote the health of individuals, families, and communities. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 In the first clinical rotation emphasis is placed on health promotion, communication, patient relationship and critical thinking. Student Name__________________ CLINCAL COMPETENCY EVALUATION First Clinical Rotation More Understands Demonstrates Education Concepts Competence Needed The student is knowledgeable of the recommended screening, counseling and preventive medications/therapeutics in client-specific populations The student provides counseling/education to client specific populations regarding strategies to prevent illness and promote health. The student demonstrates an understanding of the concepts of social justice, and how race, socioeconomic status and education influence health. The student obtains a concise, detailed patient history. (includes 8 attributes of a symptom, pertinent past medical history, family history and social history, current meds and allergies). The student performs appropriate physical exam demonstrating sound techniques. The student demonstrate communication skills that facilitate effective interpersonal relationships Student communicates with preceptors in a systematic concise manner regarding patient findings. The student demonstrates professionalism through honest communication, punctuality. The student works to develop diagnoses/assessments of the presenting problem(s), through the development of a wide list of differential diagnoses. The student formulates a plan of care that is based on current research evidence. Comments: Preceptor Signature:____________________________________________Date_____ Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 ST. CATHERINE UNIVERSITY DEPARTMENT OF NURSING MASTER’S DEGREE PROGRAM ADULT/GERIATRIC NURSE PRACTITIONER PROGRAM CLINICAL COMPETENCY EVALUATION Student _____________________________________________ Preceptor________________________________________________ Clinical Site (name)________________________________________ COURSE OBJECTIVES (Intermediate Clinical Rotation) 1. Analyzes clinical problems using the epidemiological approach as it relates to secondary prevention. 2. Demonstrates knowledge of pathophysiology of minor/acute alterations in health commonly encountered in the advanced nursing practice/primary care. 3. Demonstrates comprehensive case management for clients with minor/acute alterations in health commonly encountered in advanced nursing practice/primary care. 4. Utilizes selected theory and strategies to educate clients and their families/significant others. 5. Analyzes the contribution of research to advanced nursing practice as it relates to increasingly complex alterations in health. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 CLINICAL COMPETENCY EVALUATION The intermediate clinical rotations build on the objectives of the first rotation to include identification of various alterations in health and the formulation of strategies aimed at improving the health of patients with acute/chronic health conditions. Student Name:___________________________ In addition to the competencies from the first rotation, the student in the second clinical rotation: Intermediate Clinical Rotation More Understands Demonstrates Education Concepts Competence Needed The student analyzes patient data (current and past), incorporates pertinent physical exam activities and utilizes appropriate diagnostics to identify and treat asymptomatic, at risk patients. The student formulates secondary prevention strategies grounded in current evidence based recommendations. The student articulates an understanding of the pathophysiologic basis for common acute and chronic health conditions. The student demonstrates an understanding of the pathophysiologic basis for common acute and chronic health problems by appropriately providing anticipatory guidance for health maintenance, prevention and promotion, as it relates to selected acute/chronic health conditions. The student formulates a plan of care (that appropriately includes family/SO) based on selected theories, and applies the best strategies for optimizing individual patient health. The student actively seeks out current research data to guide practice. Comments: Preceptor Signature:_________________________________________Date:___________ Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix I ST. CATHERINE UNIVERSITY DEPARTMENT OF NURSING MASTER’S DEGREE PROGRAM ADULT/GERIATRIC NURSE PRACTITIONER PROGRAM CLINICAL COMPETENCY EVALUATION Student _____________________________________________ Preceptor________________________________________________ Clinical Site (name)________________________________________ COURSE OBJECTIVES (final semester) Upon completion of this course, you will be able to: 1. Synthesizes epidemiological data for relevance to advanced nursing practice/primary care 2. Demonstrates knowledge of pathophysiology of commonly encountered chronic/complex alterations in health. 3. Demonstrates comprehensive, collaborative management of clients with multifaceted alterations in health. 4. Compares and contrasts alternative approaches to therapy within the scope of advanced nursing practice. 5. Integrates an ethical perspective into the advanced nursing practice role. 6. Analyzes legal and professional practice standards as they apply to specific primary care practices. 7. Identifies areas requiring additional research including research regarding the delivery of advanced nursing practice/primary health care. 8. Evaluates the importance of contextual factors in the provision of advanced nursing practice/primary health care. 9. Evaluates the implications of selected health care policies for advanced practice nurses, client populations, and the health care system. 10. Develops and analyzes strategies for implementing change in health policy and health care delivery. 11. Analyzes selected quality evaluation methods in relation to advanced nursing practice and primary care settings. 12. Applies case management processes to clinical practice and outcomes, health care systems coordination and integration, fiscal management and reimbursement patterns. Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 The final clinical rotation builds on the objectives of the second rotation and includes patient care in the context of health care policy, third party reimbursement, legal/ethical considerations, professional practice standards and risk management. Patient care of complex chronic health conditions incorporating an inter-professional case management processes. CLINICAL COMPETENCY EVALUATION Final Clinical Rotation Student Name___________________ More Understands Demonstrates Education Concepts Competence Needed The student appropriately formulates patient diagnosis(es), plan of care, followup and educational strategies for individual patients with complex chronic health conditions. The student demonstrates knowledge of health care system policies and complies with requirements for coding and reimbursement. The student practices within the legal scope of NP practice and in accordance with professional standards. The student identifies appropriate care initiatives/strategies for tertiary prevention of chronic disease (meeting disease specific parameters, avoid/minimize hospital or ER, advanced directives, palliative care, etc.) The student demonstrates appropriate referrals to and consultation with, specialists for patients with complex chronic health conditions. Comments: Preceptor Signature:_____________________________________Date:___________ Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016 Master’s Degree Program Syllabus NURS 6140 Appendix J ST. CATHERINE UNIVERSITY DEPARTMENT OF NURSING MASTER’S DEGREE PROGRAM ADULT/GERIATRIC NURSE PRACTITIONER PROGRAM CLINICAL LOG Student Name_________________________________________Date_____________ Preceptor Name and Title___________________________Clinical Site___________ Advisor’s Name______________________________________________________ Pt. Initials Date Age Sex Reason for Visit/Procedures done, M/F teaching plan, Diagnosis CPT/ ICD code And any other interesting findings 1 2 3 4 5 Preceptor Signature:______________________________________Date________________ Number of clinical hours worked for this date___________ Please fax form to 651-690-6941 *IMPPORTANT (keep a copy of your clinical log for your files Master’s Degree Program Department of Nursing: St. Catherine University 3/17/2016