Family Nurse Practitioner II Clinical

NURS 5604

4 credit hours

16 contact hours

Course Description:

This course focuses on advanced practice nursing and healthcare management of adults and older adults in diverse populations. Course content includes developmental, physiological, pathological, and psychosocial changes relative to health maintenance, acute and chronic illnesses and life transitions

Course Objectives:

Upon completion of this course, the student will be able to:

1.   Demonstrate appropriate and effective oral and written communication with adult and older clients, their families, and other health  professionals;

2. Perform comprehensive and developmentally appropriate health assessments on adults and older adults;

          3. Develop management plans for health promotion, disease prevention, and acute and chronic illnesses in adults and older adults;

4.   Manage the health care of adults and older adults, and their families incorporating ethical, legal, cultural, economic, political and psychosocial principles;

5.   Evaluate the effectiveness of interventions and management strategies in improving the health status of adults and older adults;

6.   Collaborate with other health professionals to provide comprehensive health services for adults and older adults;

7.   Teach individuals, families, and groups skills and behaviors to promote health, prevent disease, and manage acute and chronic illnesses in adults and older adults; and

8.   Implement current research related to diagnostic and treatment protocols to improve the delivery of health care to adults and older adults.

Prerequisites and Co-requisites:

Admission to the RODP MSN program or permission from the department chair.

Prerequisites:  NURS 5101/5102 Advanced Health Assessment; NURS 5103 Advanced Pathophysiology; NURS5104 Advanced Pharmacology

Co requisite:  NURS 5604 FNP II Clinical

Course Topics:

The emphasis of this course is the care of adults and older adults. The content will encompass those topics addressed in the companion didactic course (NURS 5603). These will include:

      I.            Friedman’ s Family Theory

II.                   Overview of Issues related to the Care of Adults and Older Adults

III.                Promotion and Wellness and Self Care of Adults and Older Adults

IV.                Comprehensive Assessment and Screening of Adults and Older Adults

V.                   Management of Common Acute and Chronic Problems

Specific Course Requirements:

Knowledge and skill in WebCT

          1.  Students must complete a total of 240 clinical hours over the course of the semester. In order that the student will benefit from ongoing evaluation and feedback of SOAP notes and progress, this experience must be spread out over the course of the semester.

          2.  Preceptor licensure will be verified at http://www2.state.tn.us/health/licensure/index.htm. Students are expected to verify current licensure of a requested preceptor to make certain that information submitted to faculty contains correct spelling, etc. in order to expedite the verification process.

          3. Submit the following:

                       *  Name of preceptor

                       * Credentials of preceptor (FNP, MD)

                       * Vitae of Preceptor

                       * Name and Address of practice site

                       * Type of patients served at site (e.g., family practice, OB/GYN practice, etc)

The student CAN NOT begin the clinical experience until approval is received from the faculty and the preceptor agreement is signed. Students are expected to contact faculty if difficulty is experienced locating a preceptor.

4.            Geriatric Assessment

5.            Geriatric Health Promotion Project.

6.            Clinical Reflections/Discussions

7.            Every 2 weeks, turn in clinical logs for all practice hours.

8.             SOAP notes for at least three clinical cases. (for review of documentation, planning and decision-making). Three of these will be graded (see evaluation methods below).

9.             Clinical Skills Inventory Sheets

10.         Preceptor evaluation.

Preceptors:

Students will need to arrange for a nurse practitioner or physician to precept this primary care adult and geriatric health experience.  Nurse practitioners must be minimally prepared at the Master's level.

Clinical practice experience with an approved NP or MD preceptor in a community setting for 240 hours during the term.  A family / primary care practice is the preferred clinical setting; however, a practice setting where providers care for a high volume of adults (including geriatric care) is acceptable. Specialty practices (ENT, Endocrinology, etc.) are discouraged because they limit the student's exposure to a diversity of experiences. This experience should include 90 (ninety) hours should be done with a geriatric population.

Preceptor licensure will be verified at http://www2.state.tn.us/health/licensure/index.htm Students are expected to verify current licensure of a requested preceptor to make certain that information submitted to faculty contains correct spelling, etc. in order to expedite the verification process.

The student will submit a practice site proposal to the course faculty via email within four weeks of the beginning of the course. In the subject of the email write "Preceptor Information" In the body of the email include:

·         Name of preceptor (as officially listed on the verification site above)

·         Curriculum Vitae and Credentials of preceptor (WHP, FNP, MD)

·         Name and address of practice 

·         Type of patients served at practice site (e.g., primary care, internal medicine, family practice.

      THE STUDENT CANNOT BEGIN THE CLINICAL EXPERIENCE UNTIL APPROVAL IS RECEIVED FROM FACULTY. STUDENTS ARE EXPECTED TO CONTACT FACULTY IF DIFFICULTY IS EXPERIENCED LOCATING A PRECEPTOR. 

Textbooks, Supplementary Materials, Hardware and Software Requirements

Textbooks:

Please visit the Virtual Bookstore to obtain textbook information for this course:  http://rodp.bkstr.com

Supplementary Materials:

Students are expected to purchase their own lab coat(s), stethoscope with both bell and diaphragm (or stethoscope with a floating diaphragm), goggles and a watch with a second hand. Students may need to purchase an otoscope/ophthalmoscope set or other equipment, if this is not provided at the clinic site.

Students may find a PDA with medical reference applications very helpful. This is not mandatory. Two programs that may be particularly useful are Epocrates DX for PDA (http://www2.epocrates.com) and Merck Medicus for PDA (http://www.merckmedicus.com

Hardware Requirements:

The minimum requirements can be found at http://www.rodp.org/students/hardware_software.htm. Specific hardware requirements for this course include...

Software Requirements:

The minimum requirements can be found at http://www.rodp.org/students/hardware_software.htm. Specific hardware requirements for this course include...(A list of software the student is required to purchase or download for the course, Real Player, Media Player, Acrobat Reader, Microsoft Office, etc).

Instructor Information

Click on the "Faculty" link located in the left frame of each page inside this course to find instructor contact information.

Assessment and Grading

Testing Procedures:

There are no written tests in this clinical course.

Grading Procedure:

Grades on the following assignments constitute the grade for this course. Specific requirements for each assignment are detailed at the end of this syllabus:

·         Geriatric assessment assignment 10%

·         Geriatric Health Promotion assignment 30% (10% for application; 10% for presentation; 10% for write-up)

·         SOAP documentation 45% (15% each for 3 SOAP notes – one SOAP note on individual on adult 20-40, one SOAP note on individual 41- 69 & one SOAP note on individual above 70).

·         Clinical Reflection/Discussion   15% (3% per entry)

In addition, the student must maintain satisfactory clinical performance as evidenced by preceptor evaluations of the student and must participate in all scheduled asynchronous clinical conferences.

Clinical log                                                Pass / Fail

Clinical Skills Inventory                              Pass /Fail

         Clinical Evaluation by Clinical Preceptor       Pass / Fail

Grading Scale:

A = 93-100

B = 85-92

C = 77-84

D = 70-76

F = <70

Assignments and Participation

Late Assignments:

Late assignments will receive a 10% grade deduction for each day or portion of a day that the assignment is late - even if the portion of a day is only one minute. Central standard time will be used as the standard in this course.

Assignments

Information regarding assignments is detailed in the sections that follow. All assignments must be submitted to the Assignment Dropbox unless otherwise indicated.

Completion of all graded assignments and projects (as mentioned above) determines the course grade. Assignment guidelines and the rubrics used for grading these assignments are provided at the end of this document.

In addition to graded assignments, there are other pass/fail components, which must be completed as part of course requirements. Failure to complete these requirements can result in failure of the course.

Geriatric Assessment Assignment

Identify a patient with a suspected cognitive, neurological or depressive disorder. The comprehensive psychological assessment - cognitive, affective are found in your geriatric book (Burke & Laramie pages 11-14). Perform the assessment and ask the patient to complete a Geriatric cognitive assessment form (the Geriatric Depression Scale (GDS) or the Beck Depression Inventory (BDI) or any other appropriate form in your book or at your facility and the mini mental scale (provided in forms) or any other affective mental assessment form  – available in the course or at your preceptor facility). Please have the patient complete both forms on the same day. Compare and contrast the responses and scores.  Present your findings as an anonymous (or name changed) case study in the Discussion Area. 

Guidelines for Grading:

Criteria

Points Possible

Points Earned

Documentation is clear. Appropriate medical terminology is used. Irrelevant and redundant words, phrases, and other distracting information are omitted.  (course objective #1)

1

 

Documentation is well organized. Format follows the standard. Narratives such as the HPI and Exam have a logical flow. (course objective #1)

1

 

Subjective and objective assessment of health status is complete and appropriate for age and presenting problem(s).  (course objectives #2)

1

 

Management plan addresses age-appropriate health promotion, disease prevention, and/or acute and chronic illnesses.  (course objective #3)

1

 

Current (less than 3 years old) research articles and references are used to guide decisions regarding diagnosis and treatment. (course objective #8)

1

 

Total Points

5

 

Conversion for percentage of grades is as follows:

5 points = 100%; 4 points = 80%; 3 points = 60%; 2 points = 40%; 1 point = 20%

Geriatric Health Promotion Assignment

Geriatric Health Promotion Project

  GUIDELINES:

 Purpose:

 To provide an integrative, holistic approach project that benefits a group of older adults.

  Method:

The student will develop a holistic community service project to be used for health promotion, health prevention, or health education.

  Process:

The student will identify a problem in their community setting related to older adult health. The problem will be clearly identified and the best solution of the problem will be described. The project will include an interactive time with the group of older adults (no more than 4 –6 hours). The project will be implemented utilizing teaching tools, such as a brochure or handout as part of the intervention. The intervention will include teaching about health promotion, health prevention, or health education.

The student will present the problem and solution. The student will answer the following about the problem and the solution.

  Proposal

  Assessment

  I.                What is the problem and how is it determined to be a problem?

  II.               How does this problem affect the group of older adults? Describe the participants.

  III.              What are the possible solutions to the problem?

  IV.              How will the solution reach these older adults?

V.                         What is the best content and design to implement the solution?

VI.              Describe in detail what the project will involve.

THE PROPOSAL WILL BE SENT TO THE FACULTY MEMBER FOR PERMISSION BY THE SECOND WEEK OF THE SEMESTER FOR APPROVAL BEFORE PROCEEDING.

  The student will implement the project in the clinical setting during the semester.

  Implementation

  I.     Implement and evaluate the community service project that addresses an identified need;

  II.     What was the service provided by you as an advanced practice nurse?

  III.     What will the impact be on the overall population being served?

   Evaluation

  I.   Develop a program evaluation plan for the service project.

 The student will present the project to the class on-line and turn in a written paper using APA (5th edition) guidelines describing the project (4-6 pages). The presentation and paper will address the questions about the problem, the solution and an evaluation of the project after implementation.

  Guidelines for Grading:

Criteria

Points Possible

Points Earned

Project development and implementation:

   

·         Proposal of project submitted on time

2

 

·         Definition and description of the problem  -- Address and describe the geriatric health problem to address (course objective # 2, #3, #6)

2

 

·         Description of possible solutions – Identify alternatives to address the problem (course objective #2, #3)

2

 

·         Description of implementation -- Collaborate with other health professionals to provide a community health project for a group of older adults (course objective #1, #6)

2

 

·         Design of the project -- Management plan addresses health promotion, disease prevention, and/or acute and chronic illnesses.   (course objective #1, #3)

2

 

·         Delivery of the project -- Teach individuals, families, and groups skills and behaviors to promote health, prevent disease, and manage acute and chronic illnesses that affect older adults (course objective # 7)

2

 

·         Evaluation of the problem Evaluate the effectiveness of the project  (course objective #5)

2

 

Written Presentation

   

·         Written skills -- Documentation is clear. Appropriate medical terminology is used. Irrelevant and redundant words, phrases, and other distracting information are omitted.   (course objective #1)

2

 

·         Organization Documentation is well organized. Format follows a standard and has a logical flow (course objective #1, #3)

2

 

·         APA format and references                                                                                             Current (less than 3 years old) research articles and references are used to guide decisions regarding diagnosis and treatment (course objective #1, 8)

2

 

  On-line presentation

   

·         Presentation  -- Professionally present your community service project, make sure that documentation is clear, appropriate medical terminology is used, irrelevant and redundant words, phrases, and other distracting information are omitted.  (course objective # 1, # 3)                                                                                                                              

10

 

Total Points

30

 

Conversion for percentage of grades is as follows:

30points = 100%; 28 points = 90%; 26 points = 80%; 24 points = 70%; 22 points = 60%; 

20 points = 50% 18 points = 40%; 16 points = 30 %; 14 points = 12 points; 10 point = 10%  

 < 10 points = 0%

Clinical Hours

Students who want to meet the certification requirements for family nurse practitioner need to complete the required number of practicum hours. These hours are distributed throughout each semester.  The breakdowns of these hours are as follows:  FNP I Clinical - 120 hours; FNP II  Clinical - 240 hours, FNP III Clinical -120 hours & FNP IV 240 - hours.  If the student has declared the intent to be certified as a family nurse practitioner, all clinical hours must be completed during the semester enrolled in that specified course.  Hours may not be accumulated between semesters or after completion of the clinical courses.  Ninety (90) of the hours must be with pediatric patients. Ninety (90) of the hours need to be with geriatric patients.

SOAP Documentation Assignment

The SOAP documentation assignment directly addresses course objective 1, 2, 3, and 8.

.

Three SOAP Notes will be submitted over the course of the semester. For each, the student will write up– one SOAP note on individual on adult 20-40, one SOAP note on individual 41- 69 & one SOAP note on individual above 70). patient encounter using the SOAP Documentation Form. The SOAP Documentation Form and instructions for its completion are found in the Assignment section of this course.

Guidelines for Grading:

Criteria

Points Possible

Points Earned

Documentation is clear. Appropriate medical terminology is used. Irrelevant and redundant words, phrases, and other distracting information are omitted.  (course objective #1)

1

 

Documentation is well organized. Format follows a standard. Narratives such as the HPI and Exam have a logical flow. (course objective #1)

1

 

Subjective and objective assessment of health status is complete and appropriate for age and presenting problem(s).  (course objectives #2)

1

 

Management plan addresses age-appropriate health promotion, disease prevention, and/or acute and chronic illnesses.  (course objective #3)

1

 

Current (less than 3 years old) research articles and references are used to guide decisions regarding diagnosis and treatment. (course objective #8)

1

 

Total Points

5

 

Conversion for percentage of grades is as follows:

5 points = 100%; 4 points = 80%; 3 points = 60%; 2 points = 40%; 1 point = 20%

Clinical Log

Students are required to log all patient encounters using the Clinical Log tool. All encounters must be submitted to WebCT within 24 hours of each day or portion of a day spent in the clinic. The clinical log is located under forms within the course.

General Clinical Guidelines

CONDUCT

Professional conduct in the clinical site is expected.

Problem/disagreements are to be handled in a quiet, professional manner, away from the patient.

If any problem arrives, you MUST contact the clinical faculty in a timely manner.

Professional dress (usually a lab coat) and visible identification badge is required.  There may be certain sites/situations where white lab coats may not be desired (i.e. pediatrics).  No sandals, or open toe shoes, or jeans should be worn to clinical.

ABSENCES/DELAYS

 Arrive on time at all clinical sites.  If there is an unanticipated delay call the preceptor as soon as possible.  Notify the preceptor  of any anticipated absence prior to the start of the clinical day.  Failure to notify the preceptor of any delay or absence as stated above may result in an unsatisfactory grade for the clinical experience.  Arrangements must be made with the clinical coordinator for any make-up time for absences.

 EQUIPMENT

Students are expected to bring any equipment not supplied by the clinical site (i.e. stethoscope, otoscope/opthalmascope, pen light, percussion hammers, etc.). VALUABLES

 Avoid bringing valuables into the clinical site. Neither the home school nor the clinical site is responsible for valuables.

 MEDICATIONS/MEDICAL PROCEDURES

 Students may not administer medications or perform medical procedures without prior approval of the preceptor.

Class Participation:

Students are expected to participate in all interactive aspects of the course. Students should check the course bulletin board at least twice a week for any announcements and ongoing discussions. It is especially important for students in an on-line course to maintain contact with their instructor.  The instructor must hear from every student at least once a week; if during a given week, a student fails to make contact in some way (by submitting an assignment or participating in a chat or discussion), he or she must email the instructor, even if the student is sick or out of town. A student who fails to contact the instructor on a regular basis may miss important updates or even fail the course

Clinical Conferences

Students are expected to participate in all scheduled clinical conferences. These will take place on the Discussion Board after the clinical preceptorship begins.

Clinical Skills Inventory

Students are required to use the clinical skills inventory to track procedures performed in the clinical setting. Students are expected to seek out opportunities to develop all skills listed. The clinical skills inventory is located under forms within the course.

Clinical Performance Evaluation

The preceptor will use the Clinical Performance Evaluation Tool to evaluate clinical competence. Because this tool measures competency, criteria are evaluated as pass/fail. All items must be passed for the student to satisfactorily complete this course and advance in the program. The clinical performance evaluation is located below and under forms within the course

Clinical Performance Evaluation

The Clinical Performance Evaluation is an evaluation of competency based on the National Organization of Nurse Practitioner Faculty (NONPF) Competency Guidelines. It addresses course objectives 2, 3, 4, 5, 6, and 7.

.

The Clinical Performance Tool is use to evaluate student competence. This will be evaluated by the clinical preceptor. .

Guidelines for Evaluating Competence:

.

Met

Not Met

 Assessment

   

1.  Obtains accurate health history.

   

2.  Completes a problem focused physical exam.

   

3.  Completes a comprehensive well child or adult physical exam.

   

4.  Recognizes age, gender and cultural differences.

   

5.  Assesses support resources for patient and/ or caregiver.

   

6.  Selects age and condition specific diagnostic tests and screening procedures.

Met

Not Met

 Diagnosis

   

1. Identifies signs and symptoms of common physical and emotional illnesses.

   

2. Appropriately analyzes collected historical, physical and diagnostic data.

   

3. Differentiates relevant from irrelevant diagnostic cues.

   

4. Formulates differential diagnoses.

Met

Not Met

Plan and Implementation

   

1. Identifies interventions based on select patient outcomes.

   

2. Plans appropriate non-pharmacological interventions.

   

3. Prescribes appropriate medication therapy- properly written and legible.

   

4. Therapeutic plan allows for differences in age, gender and culture.

   

5. Plans care in the context of safety, cost, and appropriateness.

   

6. Promotes self-care for individuals as appropriate.

   

7. Initiates referrals to other disciplines based on patient’s need.

   

8. Implements the therapeutic plan for the assigned patient(s).

Met

Not Met

Evaluation

   

1. Uses outcome measures to evaluate effectiveness of therapeutic plan.

   

2. Follow-up calls and visits documented.

   

3. Modifies plan of care based on evaluation.

Met

Not Met

Patient Relationship

   

1. Establishes therapeutic rapport with patient/ family.

   

2. Assists patient in resolving troubling issues.

   

3. Assists patient with health promotion decision making.

Met

Not Met

Teaching

   

1. Provides anticipatory guidance, teaching, counseling, and information to patients.

   

2. Provides patient specific educational materials, as appropriate.

   

3. Identifies learning needs of high-risk clients.

Met

Not Met

Professional Role

   

1. Demonstrates commitment to caring for patient and family.

   

2. Maintains standards of professional behavior and decorum.

   

3. Relates well to patients, staff and preceptors/ faculty.

   

4. Accepts responsibility for own actions and learning.

Met

Not Met

Communications

   

1. Language is appropriate for client’s age and culture.

   

2. Oral report to preceptor is effective and accurate.

   

3. Written record is complete, organized, and legible.

Portfolio:

Library

The Tennessee Virtual Library is available to all students enrolled in the Regents Degree Program. Links to library materials (such as electronic journals, databases, interlibrary loans, digital reserves, dictionaries, encyclopedias, maps, and librarian support) and Internet resources needed by learners to complete online assignments and as background reading must be included in all courses.

Course Ground Rules

Students are expected to:

  • Learn how to navigate and use tools in WebCT
  • Keep abreast of course announcements
  • Use WebCT for all communication UNLESS problems occur with online delivery of the WebCT course
  • Contact technical support for any WebCT problems (number provided below)
  • Notify faculty of any difficulties related to the preceptor, clinical issues, or other factors affecting participation or performance in this course

Guidelines for Communications

Email:

  • Always include a subject line.
  • Remember without facial expressions some comments may be taken the wrong way. Be careful in wording your emails. Use of emoticons might be helpful in some cases.
  • Use standard fonts.
  • Do not send large attachments without permission.
  • Special formatting such as centering, audio messages, tables, html, etc. should be avoided unless necessary to complete an assignment or other communication.
  • Respect the privacy of other class members

Discussion Groups:

  • Review the discussion threads thoroughly before entering the discussion. Be a lurker then a discussant.
  • Try to maintain threads by using the "Reply" button rather starting a new topic.
  • Do not make insulting or inflammatory statements to other members of the discussion group. Be respectful of other’s ideas.
  • Be patient and read the comments of other group members thoroughly before entering your remarks.
  • Be cooperative with group leaders in completing assigned tasks.
  • Be positive and constructive in group discussions.
  • Respond in a thoughtful and timely manner.

Chat:

  • Introduce yourself to the other learners in the chat session.
  • Be polite. Choose your words carefully. Do not use derogatory statements.
  • Be concise in responding to others in the chat session.
  • Be prepared to open the chat session at the scheduled time.
  • Be constructive in your comments and suggestion

Students With Disabilities

Qualified students with disabilities will be provided reasonable and necessary academic accommodations if determined eligible by the appropriate disability services staff at their home institution. Prior to granting disability accommodations in this course, the instructor must receive written verification of a student's eligibility for specific accommodations from the disability services staff at the home institution. It is the student's responsibility to initiate contact with their home institution's disability services staff and to follow the established procedures for having the accommodation notice sent to the instructor.

Syllabus Changes

The instructor reserves the left to make changes as necessary to this syllabus. If changes are necessitated during the term of the course, the instructor will immediately notify students of such changes both by individual email communication and posting both notification and nature of change(s) on the course bulletin board.

Technical Support

If you are having problems logging into your course, timing out of your course, using your course web site tools, or other technical problems, please contact the Eduprise Help Desk by calling 1-866-550-7637 (toll free) or go to their website at: http://askrodp.custhelp.com