Download N377P Clinical Care Management Practicum at The University of Texas at Austin and more Lecture notes Nursing in PDF only on Docsity!
The University of Texas at Austin
School of Nursing
N377P Clinical Care Management Practicum
Spring 2011
Prerequisites
Prerequisites for N377P include the successful completion of N127P, N157P,
N224, N226, N227, N265, N266, N325, N325P, N355P, N356, N356P, N365P,
N366P, N455, & N377. The student is also required to be enrolled in N375P &
N278 concurrently, or has successfully completed them.
Course Hours
This course will meet for a total of 135 hours over 10 weeks. Time will be spent
as follows:
Orientation to Clinical 8 Hours
Weekly Clinical/Post-Clinical 100 Hours
Weekly Conference (Thursday 1:00-3:00 PM) 20 Hours
Preclinical Prep 7 Hours
135 Hours
Additional study time is required of the student for satisfactory clinical
performance.
Faculty and Office Hours
The Facilitator for N377P is Martha Meraviglia, RN, ACNS-BC, PhD; NUR
5.151, 512 - 232 - 6118; 512 - 970 - 5454; [email protected]. Individual
faculty will post their office hours, office & cell numbers, and e-mails.
Course Description
The Senior 2 Practicum in the nursing major is the laboratory application of
selected concepts and theories of management in the planning and delivery of
health care. Experiences include management of groups of patients in selected
health care settings.
Course Objectives
At the conclusion of this course the learner will be able to:
- Demonstrate increasing competency in organizing, managing, and delivering
complex nursing care.
- Apply concepts and theories learned in prerequisite courses in planning,
implementing, and evaluating care of individuals, families, and groups.
- Provide continuity of care through collaboration with other health care providers,
health care agencies, patients, and families.
- Analyze patient care delivery systems (work to be done, integration of people and
organization, structure and coordination).
- Based on analysis, develop strategies for change in patient care delivery system.
- Utilize current research findings in the practice setting.
- Practice nursing according to legal, ethical, and professional standards.
Teaching/Learning Methods
Teaching/learning is accomplished in numerous ways. Methods utilized include,
but are not limited to, simulations, actual experiences, case studies, lecture, group
discussion, and completion of written assignments.
The student will develop clinical holistic, critical thinking skills congruent with
baccalaureate education. This is facilitated through discussions, Socratic
questioning, case scenario presentations and grand rounds.
References
Students are required to use textbooks, research and other journal articles, and
other references as appropriate to prepare for and to evaluate experiences in
clinical laboratory. In addition, each clinical laboratory faculty member may
require special readings appropriate to the clinical setting in which the student is
practicing.
Optional Textbook
Silvestri, L. A. (20 11 ). Saunders comprehensive review for the NCLEX-RN examination
( 5 th ed.). Philadelphia: Saunders.
Methods of Evaluation and Grading Policy
The total grade for N377P is determined by:
Clinical Practice in Assigned Agency 80%
Assignments: Case Study & Presentation 20 %
Completion of HESI Exam Mandatory Requirement
Explanation of Total Clinical Grade
Faculty will determine clinical practice grades using a variety of sources. These include,
but are not limited to, instructor observation, evaluation from teaching assistants/staff,
input from clients/family, and student self-evaluation. Clinical grades are based on a scale
of 60-100%. The final grade will include the clinical practice grade averaged with the
written assignment grades specified above, and is as follows:
100 - 90 = A
89 - 80 = B
79 - 70 = C
69 - 60 = D
<60 = F
EXPECTATIONS IN CLINICAL LABORATORY FOR PRACTICUM
Students are expected to:
- Dress in accordance with The University of Texas at Austin School of Nursing
dress code policy or dress policy of hospital if assigned to a special unit.
- Wear name tags and appropriate identification.
- Arrive on time for clinical lab and clinical conferences.
- Notify agency and instructor in the case of illness, late arrival, or anticipated
absence.
- Turn all assignments in to instructor on time.
- Keep all appointments with clients, instructors, etc.
- Demonstrate non-judgmental verbal and nonverbal behavior toward an
individual’s philosophy, culture, religion, socioeconomic background, moral code
and life style.
- Notify instructor if the student is to be in other than the assigned area.
- All medications must be checked against the MAR with a licensed nurse prior to
administration. This is a mandatory policy.
- Attendance is mandatory at all Thursday classes. All excused and unexcused
absences will require makeup at the faculty's discretion.
If there is a serious infraction of any of the above, the student’s grade may be lowered
one letter grade. If there are serious infractions of more than one of these, the student
may receive a failing grade.
If there is a pattern of infractions, such as repeated lateness, the clinical grade may be
lowered one grade and/or there is potential for failure of this course.
Preclinical Preparation
Preclinical preparation will be determined by each individual faculty member based on
the units to be used, and the type of patients typically seen in that clinical area. Please
check with your clinical instructor to get a copy of the form to be used by your clinical
group.
THE UNIVERSITY OF TEXAS AT AUSTIN POLICY STATEMENTS
Honor Code:
The profession of nursing has a legacy of public respect and trust. We provide specialized
care for the health needs of individuals and the community with integrity, honesty,
compassion, and state of the art knowledge and skills. Learning and practicing
responsible and ethical professional behavior is a vital part of professional education. The
Institutional Rules on Student Services and Activities given in the General Information
Catalog (Chapter 11) and The University of Texas at Austin’s Honor Code apply to all
nursing students:
The core values of The University of Texas at Austin are learning, discovery, freedom,
leadership, individual opportunity, and responsibility. Each member of the University is
expected to uphold these values through integrity, honesty, trust, fairness, and respect
toward peers and community.
Additionally, the School of Nursing has its own honor code:
As a student in The University of Texas at Austin’s School of Nursing, I pledge myself to
be honest in all of my student activities including, but not limited to, all of my scholastic
work and interactions with patients, members of the community, faculty, and peers.
Furthermore, I will not use any substance prior to or during my interaction with patients
that could alter my judgment or ability to render safe care: this includes but is not limited
to any use of alcohol, illegal drugs, and prescription or over-the counter drugs that may
impair my mental and/or physical abilities required to perform safe patient care. I will
disclose to my instructor any violations of the above standards of conduct.
Medications Policy: As a requirement for clinical courses N425P, N455P, N465/466P,
and N377P, each student must pass a medication calculation/conversion and abbreviation
test with a grade of at least 90% on each section, each semester. Each student is expected
to utilize assigned and recommended learning resources to prepare for the test.
Calculators may be used for testing, but no programmable calculators are allowed. No
formulas, conversion tables, or personal data assistants (palm pilots or pocket PCs) will
be allowed.
If a score of 90% is not achieved on the first test, the student must meet with the
instructor to develop a learning contract. The agreed upon learning activities in the
contract must be completed prior to re-testing. Re-testing will be scheduled by the
instructor. If a score of 90% is not achieved after the first re-test, additional learning
activities and testing will be required until competency is achieved. Because accurate
calculation of drugs is essential to patient safety, students will not be allowed to give
medications in clinical settings until the medication test has been successfully passed.
Insufficient experience in medication administration in the clinical setting may affect the
achievement of clinical objectives and result in failure of the course.
Student Conduct Policy: Students and faculty in The School of Nursing each have
responsibility for maintaining an appropriate learning environment. Faculty have the
professional responsibility to treat students with understanding, dignity and respect and to
guide the teaching/learning process. Students are expected to refrain from verbal and
nonverbal behaviors in the classroom and clinical that may be distracting to others, such
as, but not limited to: arriving late or leaving early, side conversations, text messaging,
note passing, surfing the internet or answering e-mail on laptops, and answering cell
phone or pager. Students who persistently engage in behaviors that are disruptive to the
teaching/learning process may be required to leave the setting. For further information
refer to General Information, Institutional Rules on Student Services and Activities,
Chapter 11: Student Discipline and Conduct.
Scholastic Dishonesty Policy and Professional Integrity:
Refer to the General Information for information on the Scholastic Dishonesty Policy
Sec. 11-802. Scholastic dishonesty includes, but is not limited to cheating, plagiarism,
collusion, falsifying academic records, and misrepresenting facts. The Dean of Students
Office records acts of dishonesty and notifies the School of Nursing of each incident. In
addition to all of the University statements and policies relative to academic dishonesty,
the School of Nursing recognizes the strong link between honesty in academic work and
professional integrity. Any act of academic dishonesty, including fabrication of reports or
records of interactions with clients, is considered incompatible with ethical standards of
nursing practice. The School of Nursing does not admit students who have a record of
violations to the professional sequence. Students who engage in scholastic dishonesty
may be subject to dismissal and may jeopardize their eligibility for licensure as a
registered nurse.
Uniform Policy:
Students wear white uniform tops with the burnt orange longhorn on the collar and the
School of
Nursing patch above the left pocket. The pants are burnt orange scrub bottoms with either
an
elasticized or drawstring waist. UT uniforms are available at Co-op East.
Other notes about uniforms and professional appearance:
- T-shirts worn under the scrub tops must be plain white: long sleeves for cooler
winter months is OK, as long as they can be pushed up out of the way during
certain procedures and gloving.
- Public Health and Psychiatric settings usually do not require the standard uniform,
but suggest professional street clothes. Students should consult professors in those
courses for specific requirements.
- Lab coats must have the School of Nursing patch sewn on the right upper side,
and name tags are always required. Patches can be purchased at Co-Op East and
photo identification nametags will be available through the Learning Center.
Replacements or additional nametags will cost $5.00 each.
- A lab coat may be worn instead of the uniform in some situations. A three-quarter
length or full-length lab coat is required with the School of Nursing patch. When
a lab coat is worn, appropriate professional clothing should be worn underneath.
Shorts, low cut tops, or t-shirts with slogans and jeans are NOT considered
appropriate. In all clinical settings, students must project a professional image and
clearly be identified as a University of Texas student nurse.
- Shoes must be all white (white leather athletic shoes are OK as long as they are
clean and all white). Heels of shoes are not to exceed 2 inches in height. Socks
must be white. Hose must be worn if wearing a dress or skirt and support hosiery
is recommended. Clogs and cloth/canvas shoes are unacceptable.
- Hair must be worn above the collar at all times when in uniform. If hair is long, it
must be tied back securely or put up in a manner that prevents it from falling
below the collar. Hair must be a natural color (i.e., a shade of black, brown, red,
gray, or blonde). You may need to fasten hair back so that it will not drag over
open wounds or get in the way of sterile fields.
- Nails must be short enough to allow for deep palpation of the abdomen without
leaving fingernail marks in the client’s skin. Artificial nails and nail polish are not
permitted in clinical settings.
- Jewelry must be kept to a minimum. A watch with second hand is necessary.
Limit rings to one and it must not have large stones. Remember that hands will be
going into gloves, sliding under mattresses and giving care. Small stud-type or
small hoop earrings are acceptable in clinical. Large or dangling earrings may get
in the way and often attract small children and disoriented clients to catch hold
and pull them through the earlobe.
- Body piercings, other than earlobe, must not be visible while in clinical settings.
- Tattoos must not be visible as they detract from a professional image.
- No perfume, cologne, or heavily scented hair spray may be used.
The University of Texas at Austin
School of Nursing
N377P Clinical Care Management Practicum
Course Assignments
1. Case Study
As designated by the instructor, students will be expected to write one case study
using the Case Study Format (see next page). The purpose of this assignment is to
demonstrate critical thinking related to your patient’s health status and hospital
experience by applying, analyzing, and evaluating data and associated nursing
care.
Applicable readings from professional journals are to be incorporated into the
case study. The purpose is to reflect on the article and its application to the case
study content. Three articles, one of which is research, must be included in each
case study. APA format will be used to list the article. Articles from the internet
must be full text articles. Summaries or abstracts are not acceptable.
Due date for the case study will be set by the individual faculty members.
2. Evidence-based Practice (EBP) Presentation
Students will give an oral presentation on one patient situation, relevant nursing
intervention, and current EBP research during post conference. Format and
content for the presentation are described later in the syllabus. Due date for the
EBP presentation will be set by the individual faculty members.
a. Self-Evaluation
Written self-evaluations are due at the discretion of the individual instructor. The
format for the self-evaluation will be given by the individual instructor. The self-
evaluations allow the student an opportunity to communicate progress and
performance to their faculty. In turn, faculty will have the opportunity to review
perceptions, validate progress, give feedback and assist students in areas needing
additional practice and experience. Due dates for the self-evaluations will be
specified by the instructor.
4. Weekly Thursday Conference
Weekly conference will be held on Thursdays from 1:00-3:00 PM. Students are
required to attend all sessions. If the student cannot attend, he/she must notify the
instructor prior to class and make arrangements for class make-up. Failure to
notify the instructor will result in the student’s grade being lowered by one letter
grade.
The University of Texas at Austin
School of Nursing
Case Study Format
Cite references within the paper whenever using content from another source.
Patient's Initials: Room #: Age/Gender:
Admission Date: Date of Care: Allergies:
Admitting Diagnosis: Today’s Diagnosis:
Relevant additional Diagnoses:
____________________________________________________
Diet: Code Status: IV Solution & Rate/Saline Lock:
Activity Level:
- Description of why the patient was admitted and the events from admission to day
of care. Describe surgical procedures and related complications that occurred
during this admission. Describe findings from your physical assessment of the
patient. Include a summary of the overall collaborative plan of care.
- Significant past history: (include previous medical diagnosis(es), surgeries and
dates, and medications the client usually takes at home).
- Family, social, and community support: (Remember to include employment
status, sources of income, insurance, history of smoking &/or drinking)
- Concept map of Primary Medical Diagnosis. The concept map must have the
etiology, risk factors, pathophysiology , clinical manifestations (signs and
symptoms), collaborative care (treatments, diagnostic tests, meds, surgery, etc),
and complications. Include significant patient information such as lab values.
( Cite references with page numbers.)
- Describe nursing interventions and related rationale with references for the
pathophysiological condition (medical diagnosis) described in #4 above. Include
research evidence and rationale from multiple sources.
- Analyze trends of pertinent laboratory and other diagnostic findings. Include
nursing implications (How the results will impact your nursing care for this
patient, what you will do considering any abnormal findings?). Be sure to
consider EKG, x-ray, and other diagnostic methods.
Date Test Patient Findings Normal
Range
Indication for
Test
Rationale for Abnormal
Findings in This Patient
Nursing Implications:
Assessment,
Interventions,
Patient/Family
Education
The University of Texas at Austin
School of Nursing
N377P Clinical Care Management Practicum
Evidence-Based Practice Presentation
- Identify a nursing intervention that you would like to explore based on a recent
patient encounter or situation (i.e. fall, skin breakdown, hypoxia, inadequate or
inferior nursing care, patient or family crisis, development of a complication such
as DVT/PE, pneumonia, sepsis, dehiscence, wound infection, cardiac arrest).
- Develop an EBP research question about the nursing intervention (Does the
frequent use of an incentive spirometer prevent hypoxia and/or postoperative
pneumonia?)
- Search the research literature using one of the large databases (i.e. CINAHL,
PubMed) available online via our UT Library system for current (past 5 years)
original research-based articles on the nursing intervention you have chosen to
explore.
- Select 2 articles, one article that supports the benefit of the nursing intervention
and one article that shows contradictory findings or doesn’t support the
intervention.
- By Thursday of the week before your presentation submit the EBP research
question and the full citations (APA format) for both articles to your instructor via
email.
- During your ten minute presentation of the recent evidence on the nursing
intervention include:
a. Distribute a one paragraph synthesis of findings with article citations to
classmates & instructor.
b. Explain the patient situation that sparked your interest in examining the
literature.
c. Describe the research studies including research design, sample,
intervention, reliability/validity, specific findings, limitations, and
conclusions.
d. Compare and contrast the research findings to current nursing practice.
e. Explain how you will apply these findings to your nursing practice and/or
the patient situation that you selected.
POTENT MEDICATION LIST
POLICY: Students may be assigned to patients who are receiving continuous infusions
of vasoactive and antiarrhythmic medications. However, students cannot regulate
vasoactive or antiarrhythmic medications or give medications during a cardiac arrest. In
addition, students cannot administer intravenous paralyzing agents or drugs for
conscious sedation or IV sedative agents. Fibrinolytic therapy cannot be administered
by a student. Chemotherapeutic drugs can only be administered by Registered
Nurses who are certified in the administration of chemotherapy. STUDENTS MAY
NOT HANG BLOOD OR BLOOD PRODUCTS.
Students are responsible for doing related calculations and knowing drug facts on
all medications the patient receives.
Vasoactive Drugs (Partial List)
These are drugs that are given intravenously and are potent vasoconstrictors or
vasodilators. Students may not regulate continuous infusion rates (i.e. may not titrate
dosage).
Dobutamine
Dopamine
Epinephrine
Milrinone (Primacor)
Natrecor
Nitroglycerine
Nitroprusside
Norepinephrine
Vasopressin
Antiarrhythmic medications (partial list).
Student may give only under direct supervision. Student may not regulate a continuous
infusion of these medications.
Intravenous Medications :
Adenosine
Amiodarone
Atropine
Calcium Chloride
Cardizem
Digoxin
Isoproterenol
Lidocaine
Magnesium sulfate
Procainamide
Verapamil
Tikosyn (oral medication); may not administer.
The University of Texas at Austin
School of Nursing
N377P Clinical Care Management Practicum
Spring 2011
Clinical Evaluation Tool
STUDENT NAME DATE
FACULTY SEMESTER/CLINICAL SITE
The following three criteria are critical elements in the student's evaluation. If the clinical
instructor observes behaviors, which in her/his judgment indicate that the student is not
meeting any one of these three criteria at a passing level, the student will not receive a
passing grade, regardless of the behaviors assessed in the remainder of the tool.
YES NO
- (Safety) Delivers nursing care that prevents real or
potential personal harm to clients and their families.
- (Knowledge) Demonstrates and applies theoretical
knowledge in clinical practice.
- (Communication) Demonstrates the use of
communication skills appropriate for the situation.
Comments:
Students should use the clinical evaluation tool to evaluate themselves after their clinical
experiences. Behaviors are rated on a percentage scale. Data regarding the clinical
behaviors are provided by the student to the instructor through written work (e.g. nursing
process report, client fact sheet, calculation of dosage problems, through verbal
discussions and through performance of client care. Data may also be provided by clients
and nursing staff. The faculty will review clinical evaluation behaviors with the students
at mid-semester and at the end of the semester.
N377P Spring 2011
CLINICAL BEHAVIORS SCORE
(%)
COMMENTS
TECHNICAL COMPETENCE
N325P, J
- Performs basic nursing skills with reasonable dexterity and effective strategies to provide safe, and
timely patient care, aimed at specific therapeutic goals.
- States principles, implications and evidenced based practice as a basis for nursing actions.
- Documents accurately and timely, according to legal principles.
N355P, J
- Consistently performs nursing skills with dexterity and organization in a safe manner, aimed at specific
therapeutic goals.
- Uses principles and evidenced based practice to guide nursing actions.
- Documents a complete, accurate account of care, applying legal principles.
N377P, S
- Safely performs a variety of basic and advanced nursing skills with organization, dexterity,
timeliness and flexible approaches in order to achieve therapeutic goals.
- Incorporates analytical approaches, standards, principles and evidence-based practices in
nursing actions.
- Documents a complete, accurate account of care, applying legal and nursing principles by a
variety of modes.
APPLICATION OF KNOWLEDGE
N325P, J
- States scientific rationale when performing beginning nursing care, minimizing risks and preventing
errors and threats to patient safety.
- Uses appropriate resources and research to enhance the care of the patient and family.
N355P, J
- Applies scientific and nursing knowledge to enhance nursing care, while minimizing risks, preventing
errors, and threats to patient safety.
- Demonstrates clinical reasoning through the articulation of the relationship between pathophysiology,
assessment data, medications, labs and diagnostics.
- Uses intra-agency resources to enhance collaboration in providing patient centered care.
N377P, S
- Uses an evidence-based analytical approach as the basis for decision making in practice.
- Demonstrates accurate clinical reasoning based on emerging assessment data,
pathophysiology, interventions and diagnostics.
- Is able to articulate to the patient and the interdisciplinary health care team rationales for
nursing action.
- Autonomously uses intra-agency resources for patient referrals.
N377P Spring 2011
CLINICAL BEHAVIORS SCORE
(%)
COMMENTS
NURSING PROCESS
N325P, J
- Accurately collects data, as directed, in a systematic manner.
- Develops and prioritizes nursing diagnoses based on collected data and supports with scientific rationale.
- Plans and delivers individualized care with assistance.
- Evaluates outcomes of care with assistance.
N355P, J
- Accurately collects appropriate data in a systematic manner.
- Develops and prioritizes nursing diagnoses based on collected data and supports with scientific rationale.
- Independently plans and delivers individualized nursing care.
- Revises care plan based on evaluation process.
- Provides effective theory based patient teaching, utilizing the nursing process.
N377P, S
- Accurately collects data from a variety of sources in an organized and systematic manner.
- Is autonomous in developing and prioritizing nursing diagnoses based on collected data, scientific
knowledge, and evidence-based practice.
- Consistently plans and delivers individualized nursing care.
- Independently evaluates care and outcomes and revises plans appropriately.
- Provides effective patient teaching consistent with the individual needs of the patient and family
utilizing the nursing process.
INTERPERSONAL SKILLS/CARING
N325P, J
Communicates effectively with patient and family and discusses plan of care.
Demonstrates caring behaviors through nursing practice.
Identifies appropriate care according to philosophical, religious, and cultural beliefs of the individual.
Communicates, collaborates, and coordinates patient care with the health care team.
N355P, J
- Engages patients and families in active partnerships that promote health, safety and well being, and self-care
management.
- Provides appropriate care according to philosophical, religious, and cultural beliefs of the individual.
- Listens and responds to expressed needs and concerns of patients and families.
- Communicates, collaborates, and coordinates patient care with health care team.
N377P, S
- Utilizes effective communication (assertiveness, negotiation, delegation and collaboration in dealing
with individuals, groups of patients and the healthcare team.
- Collaborates with patients and their family to provide health care that is empathetic, sensitive and
therapeutic.
- Responds appropriately to expressed and implied needs of patients, family, and team members.
- Promotes professional boundaries among members of the healthcare team.
N377P Spring 2011
Clinical Competency Criteria
Competency Standard Quality of Performance Level of Mastery
Independent
Safe
Accurate
Effect/Affect – Each time
Proficient; coordinated, confident
Occasional expenditure of excess energy
Within an expedient time period
No supporting cues needed
Supervised
Safe
Accurate
Effect/Affect – Each time
Efficient; coordinated; confident
Some expenditure of excess energy
Within a reasonable time period
Occasional supportive cues
Assisted
Safe
Accurate – Each time
Effect/Affect – Most of the
time
Skillful in parts of behavior
Inefficiency and uncoordinated
Expends excess energy
Within a delayed time period
Frequent verbal and
occasional physical directive
cues in addition to supportive
ones
Marginal
Safe but not alone
Performs at risk
Accurate – Not always
Effect/Affect – Occasionally
Unskilled; inefficient
Considerable expenditure of excess energy
Prolonged time period
Continuous verbal and
frequent physical cues
Dependent Unsafe
Unable to demonstrate
behavior
Unable to demonstrate procedure/behavior
Lacks confidence, coordination, efficiency
Continuous verbal and
physical cues
