Family Nurse Practitioner I Clinical NURS 5602 2 credit hours Course Description: The focus of this clinical course is delivery of advanced nursing care to women. Various clinical settings with diverse populations may be employed for clinical practice. Course Objectives:. Demonstrate appropriate and effective oral and written communication with women, their families, and other health professionals 2. Conduct comprehensive health assessments of women 3. Develop management plans for health promotion, disease prevention, and acute and chronic illnesses in women 4. Collaborate with other health professionals to provide comprehensive health services for women 5. Manage the health care of women, and their families incorporating ethical, legal, cultural, economic, political and psychosocial principles 6. Teach individuals, families, and groups skills and behaviors to promote health, prevent disease, and manage acute and chronic illnesses in women 7. Incorporate current research related to diagnostic and treatment protocols to improve the delivery of health care to women 8. Evaluate the effectiveness of interventions and management strategies in improving the health status of women Prerequisites and Corequisites: Admission to the RODP MSN program or permission from the department chair. Prerequisites: NURS 50/502 Advanced Health Assessment; NURS 503 Advanced Pathophysiology; NURS 504 Advanced Pharmacology Co requisite: NURS 560 FNP I Course Topics: The emphasis of this course is the care of women. The content will encompass those topics addressed in the didactic content (NURS 560). These will include: I. Current Status and Issues in Women's Health Care II. Clinical Assessment and Management across the Lifespan A. The Child-Bearing Years B. Post Child- Bearing Years III. Clinical Assessment and Management Related to Selected Conditions IV. Nurses' Role in Recognition and Management of Psychosocial Crises in Women
Specific Course Requirements: Knowledge and skill in D2L. Students must complete a total of 20 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 (WHP, 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. Assignments: Graded Assignments SOAP NOTES # #2 and # 3 Dropboxes 60% (20% each) (Practice SOAP optional) 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). Women s Health Project Proposal 5% Women s Health Proposal Assignment 5% Module Assignments # # 2 #3 # 4 20% PASS/FAIL Assignments in Dropbox. Clinical Documentation Requirements 2. Plan to Complete Clinical 3. Clinical Goals and Objectives 4. Women s Health Project Topic Approval 5. Clinical Skills Inventory Dropboxes (OB and GYN) 6. Clinical conference/reflections/discussions # # 2 # 3 #4 and Wrap-up 7. Every 2-3 weeks, turn in clinical logs for all practice hours. Dropboxes # #2 #3 #4 #5 8. Preceptor Evaluation 9. Student Evaluation of Preceptor 0. Student Evaluation of SITE All assignments TOTAL 00% Preceptors: Students will need to arrange for a nurse practitioner or physician to precept this women's 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 20 hours during the term A obstetrical/gynecological practice is the preferred clinical setting; however, a family practice setting where providers care for a high volume of women (including gynecological care) is acceptable. Some of the hours may be obtained in a family planning clinic with permission of the clinical faculty. Specialty practices (ENT, Endocrinology, etc.) are discouraged because they limit the student's exposure to a diversity of experiences. Some hours (no more than 40) may be done in a Planned Parenthood Clinic (with permission of the faculty and a current contract). 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., ob/gyn practice, 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 Required 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 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 if this is not provided at the clinic site. 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) Hardware Requirements: The minimum requirements can be found at http://www.rodp.org/current-students/technical-support Software Requirements: The minimum requirements can be found at http://www.rodp.org/current-students/technical-support Specific hardware requirements for this course include: Microsoft Word Additional software requirements for this course include Microsoft Office (Word, PowerPoint, Excel), Acrobat Reader. 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 examinations in this 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: The course grade is based on the following: SOAP Notes (3) Women's Health Promotion Project () Module assignments (4) Clinical Conferences/Reflection/Discussion (5) Total 00% of final grade Completion of 20 hours of clinical practice -- Clinical hours MUST be documented daily by the clinical preceptor Clinical Log Pass/Fail Clinical Skills Inventories (OB and Gyn) Pass/Fail *Clinical Evaluations by Clinical Preceptor/Site/Student Pass/Fail In addition, the student must maintain satisfactory clinical performance as evidenced by preceptor evaluations of the student and must participate in scheduled asynchronous clinical conferences. Together all the assignments = 00% of grade Grading Scale: A = 93-00 B = 85-92 C = 77-84 D = 70-76 F = <70 Late Assignments: Late assignments will receive a 0% 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 Assignments and Projects: 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. All graded assignments are to be submitted to the assignment DROPBOX ONLY. (Documents sent by email cannot and will not be accepted for credit.) All assignments must be in APA 6th edition format. 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. 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. Clinical Conferences Students are expected to participate in all scheduled clinical conferences. These will take place on the Discussion Board. 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. 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 met/not met. All items must be passed for the student to satisfactorily complete this course and advance in the program. Assignment guidelines and the rubrics used for grading these assignments are provided at the end of this document. Clinical Log Students are required to log all patient encounters using the Clinical Log tool. All encounters must be entered within 24 hours of each day spent in the clinic. 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. Course Ground Rules Students are expected to: Learn how to navigate and use tools in D2L Keep abreast of course announcements Use D2L for all communication UNLESS problems occur with online delivery of the D2L course Contact technical support for any D2L 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 Library The TN Virtual Library at http://vl.rodp.org 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 Telephone and Online 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 -866-550-7637 (toll free) or go to their website at: http://askrodp.custhelp.com Assignments The requirements for all assignments are detailed in the sections that follow. All assignments must be submitted to the Assignment DROPBOX unless otherwise indicated. 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. If you are asked to leave a clinical site, you must leave immediately and contact your instructor. DRESS Professional dress (usually a lab coat) and visible identification badge is required. (ID badge must be
either your school ID in a protective badge holder or a created badge from an Office type store that states. Name, student credentials, home school and RODP.) 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. Women's Health Promotion Project Assignment A Women's Health Promotion Project Guidelines Purpose: To provide an integrative, holistic approach project that benefits a group of women. 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 women's 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 women. 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. Your topic and proposal must be approved before you begin your project. This project will not be done in your clinical site. The student will present the problem and solution. The student will answer the following about the problem and the solution. Proposal Questions I. What is the problem and how is it determined to be a problem? II. How does this problem affect the group of women? Describe the participants. III. What are the possible solutions to the problem? IV. How will the solution reach the women? V. What is the best content and design to implement the solution? VI. Describe in detail what the project will involve. The student will implement the project in the clinical setting during the second half of the semester.
Implementation Questions (Project completion) I. Implement and evaluate a community service project that addresses an identified need. II. What was the service provided? 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 (6th edition) guidelines describing the project. 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 Project development and implementation: Definition and description of the problem -- Address and describe a woman s health problem to address (course objective # 2, #3, #6) Description of possible solutions Identify alternatives to address the problem (course objective #2, #3) Description of implementation -- Collaborate with other health professionals to provide a community health project for a group of women (course objective #, #6) Design of the project -- Management plan addresses health promotion, disease prevention, and/or acute and chronic illnesses. (course objective #, #3) 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 women (course objective #7) Evaluation of the problem Evaluate the effectiveness of the project (course objective #5) 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 #) Organization Documentation is well organized. Format follows a standard and has a logical flow (course objective #, #3) 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 #, #8) On-line presentation Points Possible 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 #, #3) Total Points 0 Points Earned Conversion for percentage of grades is as follows: 0 points = 00%; 9 points = 90%; 8 points = 80%; 7 points = 70%; 6 points =60%; 5 points = 50% 4 points = 40%; 3 points = 30 %; 2points = 20 points; point = 0%
Clinical Hours Students who want to meet the certification requirements for family nurse practitioner need to complete the required number of practicum hours (720 hours). These hours are distributed throughout each semester. The breakdowns of these hours are as follows: FNP I Clinical - 20 hours; FNP II Clinical - 240 hours, FNP III Clinical -20 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. SOAP Documentation Assignment The SOAP documentation assignment directly addresses course objective, 2, 3, & 8. Three SOAP Notes will be submitted over the course of the semester. For each, the student will write up one women's health 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 (Rubric) If the instructor disagrees with the student regarding any element of the diagnostic reasoning process, the student must be prepared to discuss rationales for decisions and respond to any questions asked. The decision of faculty, once made, is final. Faculty may require rewrites of SOAP notes for purposes of clarity or other elements of documentation. If revisions are required, they should be submitted within 7 days. Guidelines for Grading: Points Objective Criteria Documentation is clear and well organized. Appropriate medical terminology is used. 5 Exceptional 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 3.85 3.5 Below 3.0 Unacceptable Points 5 Exceptional Documentation meets criteria for "exceptional" but there is occasional redundant information. 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. 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. 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. Objective 2 Criteria 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
4.25 Above 3.85 3.5 Below 3.0 Unacceptable Points 5 Exceptional 4.25 Above 3.85 3.5 Below 3.0 Unacceptable Points 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. Subjective and objective assessments meet all criteria above. Information that is needed from the PMH, FH, and/or ROS is not included 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 Two or more elements needed for adequate evaluation of a patient's problem is missing from the subjective and/or objective assessment. 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. Objective 3 Criteria 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. Diagnosis has coherence, adequacy, and parsimony.* Management plan is appropriate and meets above criteria but is "generic" rather than individualized to the patient. 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 Diagnosis lacks either coherence, adequacy, or parsimony. Management plan is appropriate but inadequate to fully address the identified problem. Diagnosis and/or management plan is inappropriate. Objective 8 Criteria Authoritative and peer-reviewed references are used to guide decisions regarding 5 Exceptional diagnosis and treatment. All research articles and references are less than three years old. Authoritative and peer-reviewed references are used to guide decisions regarding 4.25 Above diagnosis and treatment. Some research articles and references are greater than three years old but less than five years old. Relies on nursing journal articles that are not "scholarly" and/or are written for nurses 3.85 not in advanced practice (includes articles from AJN, RN, and similar journals) and/or relies on unreliable research. 3.5 Below One reference is from a consumer, nonprofessional, or non-authoritative website or magazine, or is not peer-reviewed. 3.0 Two or more references are from consumer, non-professional, or non-authoritative
Unacceptable 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 00 Recommendations for Improvement: * 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 patient s 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. 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. FNP I Student: Date: Preceptor: Clinical Performance Evaluation: Students should be evaluated before the end of the rotation. Guidelines for Evaluating Competence: Met Not Met Assessment. 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. 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. 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. 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. 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. 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. 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. 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.