NURS 5606

2 Credit Hours

8 Contact Hours

Course Information:

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Course Description:

This clinical course is designed to provide the student with opportunities to deliver advanced nursing care to children and adolescents in families and communities.  In collaboration with nursing faculty and clinical preceptors various primary care settings will be employed for clinical practice. 

Course Objectives:

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

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

2. Perform comprehensive and developmentally appropriate health assessments on children and adolescents;

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

4. Manage the health care of children, adolescents, 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 children and adolescents;

6. Collaborate with other health professionals to provide comprehensive health services for children and adolescents;

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

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

Prerequisites and Corequisites:

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

Corequisite: NURS5605 FNP III

Care provided to pediatric clients will encompass those topics addressed in the didactic content (NURS5605 FNP III). These include:

• Friedman's Family Theory

• Pediatric Clients in the Family, Community, and Cultural Context

• Assessment of Health Status

• Health Promotion and Illness Prevention

• Chronic Health Alterations

• Acute Health Alterations

• Common Pediatric Disorders

Specific Course Requirements:

1. Knowledge and Skill in WebCT

 

2. Students must complete a total of 120 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 rather than condensed into a shorter period of time.

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

A pediatric practice is the preferred clinical setting; however, a family practice setting where providers care for a high volume of pediatric patients is acceptable. The student will spend 120 hours with pediatric patients during this term. At the request of the student and with faculty approval certain activities may be allowed to count towards pediatric practice hours (not to exceed 30 hours). There must be a minimum of 90 direct patient care clinical hours in this course. Specialty practices (e.g. a practice that focuses on ear, nose, and throat) are discouraged for a primary practice setting because they limit the student's exposure to a diversity of experience.

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 the approved practice site to the course faculty via email within one week of the beginning of the course and before attending clinical. The contract for this site must have been approved through the system in the previous semester. In addition, the clinical information must have been  previously sent to the RODP and the Clinical Coordinator. 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)

• Credentials of preceptor (FNP, MD, DO)

• Name and address of practice site

• Type of patients served at practice site (e.g., pediatric practice, family practice)

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

Textbooks, Supplementary Materials, Hardware and Software Requirements

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

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Students may find a PDA with medical reference applications very helpful. 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)

The minimum requirements can be found at http://www.rodp.org/students/hardware_software.htm.

A microphone is also required for the course.

The minimum requirements can be found at http://www.rodp.org/students/hardware_software.htm.

Additional software requirements for this course include Microsoft Office (Word, PowerPoint), Acrobat Reader, and supporting software for video and/or audio conferencing.

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

There are no written tests in this clinical course.

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

• Pediatric Health Promotion Project - 35%

• Clinical Reflection/Discussion - 35% (7% each for 5 reflections)

• SOAP documentation - 30% (10% each for 3 SOAP notes)

In addition, the student must maintain satisfactory clinical performance as evidenced by preceptor evaluations of the student. Additional non-graded submissions are required for passing this course. See "Assignments and Participation" below. To summarize, the student must maintain satisfactory clinical performance as evidenced by the preceptor evaluations of the student and must participate in all scheduled asynchronous clinical conferences.

Clinical Evaluation by Clinical Preceptor                  Pass/Fail

Clinical Skills Inventory                                        Pass/Fail

Clinical Log                                                          Pass/Fail

Friedman Family Theory Assignment                      Pass/Fail

A = 93-100

B = 85-92

C = 77-84

D = 70-76

F = <70

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 and Participation

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 or under Evaluation Tools.

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.

Clinical Log

Students are required to log all patient encounters. The patient encounter log should be typed and uploaded to WebCT with 72 hours of each clinical day or portion of a day spent in the clinic.

 

Every two weeks, you must send a copy of the signed forms to the Concentration Coordinator and the Course Instructor.

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.  It is useful to maintain contact with the instructor (at least) on a weekly basis. A student who fails to contact the instructor on a regular basis may miss important updates for the course.  

Clinical Skills Inventory

Students are required to use the clinical skills inventory to track procedures performed in the clinical setting. Students must fill out the clinical skills inventory prior to beginning the FNP III clinical. Review the completed form with your preceptor, then upload to the assignment dropbox. Throughout the semester, continue to update this form as you perform new clinical skills or improve established skills. Seek opportunities to expand and develop the skills listed on the inventory. At the end of your clinical rotation, review with your preceptor and upload the final completed inventory to WebCT. Keep a copy for your records. You will continue to add to this inventory in your other FNP clinical courses. 

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.

Course Ground Rules

• 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

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.

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 right 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 RODP Help Desk by calling

1-866-550-7637 (toll free)

or go to their website at:

http://askrodp.custhelp.com

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.

DRESS

Professional dress (usually a lab coat) and visible identification badge is required.  There may be certain sites/situations where 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

Assignments

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

Pediatric Health Promotion Project

Clinical Reflection/Discussion Assignment

The Clinical Reflection/Discussion assignment specifically addresses course objectives 1, 5, and 8. Additional objectives may be addressed as various topics are explored.

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This assignment, similar to an asynchronous clinical conference, will take place on the discussion board. Topics to be discussed will be provided by course faculty. One student may be assigned to begin and/or facilitate each discussion.

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Grading Guidelines

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Points	Criteria
4	An initial post is made within the first week of discussion. All discussion topics are addressed. Enters into dialogue by responding to at least two posts made by colleagues and by replying to questions and/or comments by colleagues or faculty. Responses reflect excellent critical thinking skills. Posts are clear, logical, and complete. There are no glaring errors in grammar or spelling.
3	An initial post is made within the first week of discussion. All discussion topics are addressed. Enters into dialogue by responding to at least one post made by a colleague and by replying to most questions and/or comments by colleagues or faculty. Responses reflect good critical thinking skills. Posts are understandable but could be clearer. There may be 1-3 errors in grammar or spelling.
2	All discussion topics are addressed. Responses reflect basic knowledge. Minimal attempt to engage in discourse through replying to questions and comments by colleagues or faculty. Major errors in grammar or spelling.
1	Either of the following will decrease criteria to a score of "1": Failure to respond to all discussion topics. An initial post is made within 24 hours of the deadline to end discussions.
0	Failure to submit an initial post before the deadline to end discussions .

SOAP Documentation Assignment

.The SOAP Documentation assignment addresses course objectives 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 pediatric 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.

Grading Guidelines

Points	Objective 1 Criteria
5 Exceptional	Documentation is clear and well organized. Appropriate medical terminology is used. Redundant (repetitious) words, phrases, and other distracting information are omitted. Format follows a standard. Narratives such as the HPI and Exam have a logical flow.
4.25 Above Average	Documentation meets criteria for "exceptional" but there is occasional redundant information.
3.85 Average	Documentation meets criteria for clarity but needs to be better organized. Documentation occasionally strays from standard format for SOAP documentation. Narratives such as the HPI and Exam occasionally stray from logical sequence but the reader is able to determine findings with minimal difficulty.
3.5 Below Average	Documentation is not as clear or does not meet expectations for the graduate level as evidenced by either of the following. Lay terminology or slang is used once or twice rather than appropriate medical terminology. One to two misspelled words and/or grammatical errors are present. Sequencing of documentation requires that the reader extract and sequence information independent of the written record in order to gain an adequate representation of assessment and management.
3.0 Unacceptable	Documentation is unclear and/or unorganized and/or inappropriate as evidenced by any of the following.  Absence of appropriate medical terminology Frequent use of lay terminology or slang Misspelled words and/or poor grammar are common (>2). Contains repetitious information that creates distractions. Format does not follow a standard format for SOAP documentation. Narratives such as the HPI and Exam are haphazardly written.
Points	Objective 2 Criteria
5 Exceptional	Subjective and objective assessments of health status are fully explicated CC and HPI are targeted toward the reason for presentation without the inclusion of extraneous information. CC is succinct. HPI is fully developed and includes location, duration, timing, character, severity provocative/palliative factors and/or other features appropriate for the reason for presentation. Physical exam includes vital signs, height and weight for all children and for others as appropriate, and any relevant developmental data related to assessment of CC. Elements of the PMH, FH, and ROS that expand on the CC and HPI are included yet irrelevant information is excluded. Appropriate diagnostic tests are performed/ordered.
4.25 Above Average	Subjective and objective assessments meet all criteria above. Information that is needed from the PMH, FH, and/or ROS is not included
3.85 Average	Either the subjective or objective assessment is missing an element needed for adequate evaluation of the patient's problem. Includes irrelevant information Selection of diagnostic tests is too broad or expensive for evaluating the presenting problem OR Selection of diagnostic tests is inadequate to address the presenting problem
3.5 Below Average	Two or more elements needed for adequate evaluation of a patient's problem is missing from the subjective and/or objective assessment.
3.0 Unacceptable	Either the subjective or objective assessment is not developed and/or the assessment is inappropriate for the patient's age, gender, and/or inappropriate for the presenting problem.
Points	Objective 3 Criteria
5 Exceptional	Diagnosis has coherence, adequacy, and parsimony.* Management plan is appropriate for the diagnosis and accurately addresses the problem identified. Management plan is economically sound. Management plan includes plans for evaluation/follow-up care (as appropriate). Management plan is individualized to the patient's age and development, culture, religion, family, environment, education, and/or any other unique concerns uncovered in assessment.
4.25 Above Average	Diagnosis has coherence, adequacy, and parsimony.* Management plan is appropriate and meets above criteria but is "generic" rather than individualized to the patient.
3.85 Average	Diagnosis has coherence, adequacy, and parsimony.* Management plan is appropriate for diagnosis and addresses the problem identified but has one of the following problems: Is too expansive (thus expensive) or overwhelming for the client or healthcare system OR Needs to consider alternative features for optimal outcomes
3.5 Below Average	Diagnosis lacks either coherence, adequacy, or parsimony. Management plan is appropriate but inadequate to fully address the identified problem.
3.0 Unacceptable	Diagnosis and/or management plan is inappropriate.
Points	Objective 8 Criteria
5 Exceptional	Authoritative and peer-reviewed references are used to guide decisions regarding diagnosis and treatment. All research articles and references are less than three years old.
4.25 Above Average	Authoritative and peer-reviewed references are used to guide decisions regarding diagnosis and treatment. Some research articles and references are greater than three years old but less than five years old.
3.85 Average	Relies on nursing journal articles that are not "scholarly" and/or are written for nurses not in advanced practice (includes articles from AJN, RN, and similar journals) and/or relies on unreliable research.
3.5 Below Average	One reference is from a consumer, nonprofessional, or non-authoritative website or magazine, or is not peer-reviewed.
3.0 Unacceptable	Two or more references are from consumer, non-professional, or non-authoritative websites or magazines, or are not-peer reviewed or are less than the required three minimum.
_____	Total Points
_____	Grade = (Total Points Earned ÷ Total Points Possible) x 100

* The diagnosis has coherence if the patient's findings are consistent with the signs/symptoms typical for the diagnosis; it is adequate if it accounts for all the patient's findings; it is parsimonious if it is the simplest and most logical explanation for the patients findings. Reference: Dains, J. E., Baumann, L. C., & Scheibel, P. (2003). Advanced health assessment & clinical diagnosis in primary care (2nd ed.). St. Louis: Mosby.

Clinical Performance Evaluation

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

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

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Guidelines for Evaluating Competence:

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Met	Not Met	Assessment
		1.  Obtains an accurate health history.
		2.  Completes a problem focused physical exam.
		3.  Completes a comprehensive well child or adult physical exam.
		4.  Identifies 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. Initiates 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 special learning needs of clients, families/caregivers.
Met	Not Met	Professional Role
		1. Demonstrates commitment to caring for patient and family.
		2. Maintains standards of professional behavior, dress, and decorum.
		3. Relates well to patients and their family/significant others, 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.