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NR402

SHEPHERD UNIVERSITY

Associate Degree Nursing Program

NR 402 GERONTOLOGY/COMMUNITY HEALTH NURSING

CLINICAL ASSIGNMENT WORKBOOK

FALL 2017

For I know the plans I have for you, declares the LORD, plans to prosper you and not to harm you, plans to give you hope and a future (Jeremiah 29:11)

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GUIDELINES FOR CLINICAL PREPARATION

Clinical Performance: Each student will be responsible for reviewing all clinical objectives and expectations as presented in the course syllabus and the criteria for determining the grade of satisfactory credit for clinical performance.

Each student is accountable for all previously introduced concepts and skills. Clinical evaluation is based on the continued application and integration of previously learned material within the current clinical learning experience.

Clinical faculty will evaluate student progress in a variety of ways, including planned and incidental observation of patient assessment, problem identification, care plan development, and implementation and evaluation of patient care as outlined in the course clinical objectives; other written assignments; and the clinical performance evaluation tool. Students will receive ongoing feedback and a written midterm and final review of their performance. If, at the end of the semester, the student demonstrates less than satisfactory on any clinical objective, a failing grade will be assigned for the course and the course will need to be repeated.

1. Communicationa. Within a nurse-patient relationship

1) Listens to and learns from patients.2) Creates a climate for and establishes a commitment to healing.3) Provides emotional and information support to individuals and their families.4) Demonstrates therapeutic communication techniques, verbal and nonverbal.5) Understands the influences of own beliefs, values and life experiences on the therapeutic

use of self.6) Understands and interprets human responses to distress, such as fear, anger, anxiety, grief,

humor, helplessness, hopelessness.7) Supports patient’s coping abilities by supporting and augmenting the patient’s sense of self

esteem, power and hope.8) Provides supportive care to the patients significant others.9) Provides anticipatory guidance regarding the patient’s situational needs (e.g. Assists

patients in identifying changes in daily living requirements created by a transition from hospital to community care).

b. Within a collegial relationship with the health team1) Communicates verbally, and in writing, all aspects of care provided (including

assessments, medications and treatment administration, teaching, and any other relevant information obtained from the patient and family).

2) Engages in discussion/planning about patient/patient care with other members of the health team.

3) Initiates collaboration with health team members as necessary.4) Notifies preceptor and/or other staff as appropriate of significant changes in patients

condition in a timely manner.5) Notifies preceptor and/or other staff as appropriate when leaving the unit for breaks,

conference, or any other purpose and at the end of clinical day, ensuring that the responsibility for care has been passed on to another nurse.

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6) Completes documentation in a timely manner and as per agency policy.

2. Critical Thinking and Knowledgea. Demonstrates knowledge and understanding of:

1) Pathophysiology, course, and treatment of health conditions encountered in practice2) Appropriate monitoring guidelines (diagnostic procedures, lab tests, etc.) for patients

disruption and the attendant therapy.3) Classification, action, indication, contraindications, and complications of drugs taken by

patient/patient and the legal responsibility associated with administering drugs.4) Cultural and ethical issues surrounding patient/patient and family effects of lifespan

differences on illness experience and response to illness.5) Theoretical basis for nursing interventions.

b. Application of knowledge1) Uses appropriate knowledge and tools to guide assessments.2) Performs comprehensive and holistic assessments in accordance with knowledge and skill

level.3) Utilizes various techniques for data collection (including observation, chart review,

interview, physical assessment, and consultation with colleagues).4) Develops a plan of care which is comprehensive, reflects theoretical rationale for actions,

and is individualized to the patient/family.5) Uses relevant theoretical approaches when addressing cultural and ethical issues.6) Carries out interventions according to appropriate policies, procedures, and standards.7) Demonstrates competence in using a variety of nursing roles to provide care, shifting roles

as necessary.8) Analyzes and evaluates care provided and modifies practice accordingly.9) Demonstrates safety through appropriate use of aseptic/sterile technique.10) Demonstrates safety through appropriate use of body substance precautions.11) Manages increasingly complex nursing situations/workload.

3. Professional responsibility and accountabilitya. Initiates contact with preceptor/manager prior to commencing clinical practice, as appropriate.b. Participates in agency orientation as appropriate.c. Arrives on time at clinical setting. If unable, notifies agency and/or instructor appropriately.d. Dresses appropriate to institution/agency or policy.e. Completes negotiated care within appropriate time frame and with appropriate supervision.f. Identifies own limitations and seeks assistance, guidance, and supervision as necessaryg. Works collaboratively with other health team members.h. Demonstrates ability to share knowledge with fellow students and nursing colleagues.i. Demonstrates respect, caring, and genuine concern in interactions with patients and families.j. Demonstrates respect for differences related to factors such as race, gender, sexual orientation,

religion and socio-economic class.k. Demonstrates respect and consideration for nursing colleagues.l. Is reflective of own practice as demonstrated in clinical journal and discussions.

4. Confidentiality and Standardsa. Maintains confidentiality.b. Promotes patient choice.c. Demonstrates advocacy for patients and families.

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d. Utilizes faculty guidelines and agency policies to guide practice.e. Keeps preceptor and faculty informed regarding hours of practice (schedule) and any issues

which may arise in the clinical setting.f. Understands and works within limits of own role as student.g. Maintains HIPPA guidelines.

5. Unsafe Performancea. Unsafe performance is defined relative to course expectation. Unsafe performance in clinical

practice includes behavior that reflects a lack of knowledge, skill, or judgment, or disregard for the welfare of the patient/patient. Unsafe performance indicates that the student is unfit to continue in a course or courses or to continue as a student in the program.

Clinical absence/tardiness : 1) First Absence: student must make a learning contract and make up missed clinical hoursMissing clinical or practice laboratory class, the student will be unable to meet the course objectives and will receive an unsatisfactory for the clinical experience. Any additional absences will be reviewed by the AD Nursing Program faculty and the student will be subject to disciplinary action which may include dismissal from the program. Missed clinical or laboratory experience must be made up with student’s own fee. Assignments for missed clinical and laboratory work will be determined by the faculty through Learning Contract so students are expected to meet the clinical objectives for the each clinical experience. Make-up fee (which is $75 per hour) is student’s responsibility. However, the fee can be waived if medical clearance or doctor’s notes provided which will be determined by Director the validity; not acceptable for the regular medical check-up or doctor’s visit schedule, for example. Otherwise the fee should be paid once make-up activities are initiated.

2) Second Absence: student will be dropped from the clinical.Arriving late in the clinical site will be marked as a tardy and student will not be accepted to clinical site if arrives more than 15 minutes late. Three tardies equal one absence.Students are required to make up all missed clinical days through activities selected in conjunction with assigned clinical faculty. Clinical make-up can include remediation time in the Simulation Lab, community-based experiences, available conferences related to course objectives, and other faculty approved activities.

Health Insurance Portability and Accountability Act (HIPAA) provisions mandate that all health care personnel, support staff, students and volunteers protect Patient Health Information (PHI). Refer to the Student Handbook for additional information on Shepherd University HIPAA Compliance PolicyThe regulations that affect nurses providing direct and indirect patient care, including students, include the following:

1. Anyone who has access to medical records, including computerized records 2. Inadvertent displays of personal information on computer screens3. Use of publicly accessible “name boards” to note patient name, room number, nurse and physician, etc.4. Identification of patient by name and diagnosis on published operating room schedules5. Answering questions in person or on the phone from friends and family about the patient’s medical condition

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CLINICAL ASSIGNMENTS

Clinical GradingThe clinical component of the course is credit/no credit.The grade is composed of an evaluation of clinical performance and several clinical projects to demonstrate understanding of the concepts presented in the course.

Evaluation Methods Points Possible

1. Assignments:1. Find three best SNFs in the community 502. Care Plans (2 x 30 points each) – Signature Assignment 663. Case Study Presentation 304. Journals (3 x 12 points each) 36

Total Points 182(75%= 136.5 points)

2. Clinical Performance Evaluation (Final Evaluation) Total: 90(75%= 67.5 points)

Student must receive a 75% on both Assignments and Clinical performance to pass the clinical.

1. Choose THREE SKILLED NURSING FACILITIES

The purpose of these learning activities are:- to locate the best skilled nursing facilities (SNF) in the community- to be familiar with the medicare.gov internet site- to be able to counsel patients who are looking for the best SNF in the community

1) Search the internet (medicare.gov) to determine three (3) SNFs in your community. 2) Identify the community where you reside; specify why the three SNFs are chosen.3) Choose three SNFs with good state inspection results compare with other SNFs 4) Be prepared to report your findings at an assigned student conference.5) Submit an analyzed report (maximum 800 words following APA format) with evidence of the chosen sites from medicare.gov (attach a copy).

2. TWO CARE PLANS

The purpose of this learning activity is to be able to recognizing the changes associated with the aging process.

1. You may select any elder over 65 years of age for this project. The elder may be a resident/patient in a long-term care setting, a relative, a friend, or a neighbor.

2. Collect data by using the attached forms (Appendix II) and appropriate resource materials.3. NOTE: Not all items on the interview guide will be relevant to all patients; therefore, it may not

be possible to complete all the items on the guide.

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4. Analyze your collected data based on the patient’s developmental stage (Erikson) and healthcare needs.

5. Based on the analysis of the data, write a CARE PLAN describing the patient’s health concerns and identify needed services/interventions including nursing, medical, and ancillary services (e.g. PT, OT) that may be of benefit to the patient.

6. Cite all references utilized in the narrative.

During the clinical experience, you will examine assumptions about older adults; consider biological, psychosocial, and cultural variables affecting seniors; and assist elders/the agency in appropriate activities such as toileting, eating, checking vital signs, ADLs, etc. You’ll also consider the RN’s role in the agency and in the care of the geriatric populations. Information for the written assignment (which follows) should be gathered via direct interactions, interviews and observations of seniors.

3. CASE STUDY PRESENTATION

Each student will present a patient case study in post-conference. The emphasis of this assignment is on the application of pathophysiology, nursing theory, and evidence based research to a patient care. The case study presentation will be discussed during post-conferences.

4. JOURNALS

Write a journal with a total of 3 separate entries. The journal should reflect your feelings, experiences, and interventions during the clinical practice. Recognize your own and others’ attitude, values, and expectations about aging and their impact on care of older adults and their families. Describe the discrepancies between what you have learned in school and have experienced working in the field. How did you reconcile your expectations of nursing and the reality of working in the field? Which discrepancies are most difficult to reconcile?

Journal assignments may be completed by writing about any of the three clinical days you select.

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<APPENDIX I>

Where can you find all the followings? Name: ______________________________

(Clinical Practice the first day assignment #1)

Electric Generator: Main water shut off:

Main gas shut off: Main electric shut off:

Red electric outlet: Electric extension:

First aid kit: Crash Cart:

Vital Signs equipment Policy & Procedure binder

A binder for the state inspection result: State phone number:

Ombudsman phone number: Medication Administration Record (MAR):

Treatment Administration Record (TAR): Physician’s Order for Life Sustaining Treatment (POLST):

Face sheet: MDS:

Care Plan: Physician’s Order:

Nurses’ note: Bowel & Bladder Training record:

Intake & Output Record: Meal Intake %:

Clean linen storage: Fire extinguisher:

Soiled linen storage: Code red, blue, triage

Utility room: Central supply:

Oxygen room: Activity room:

Rehabilitation room: MDS room:

IDT members: Medication room:

Who are important people in managing the facility, name? DON, administrator, charge nurse, CNA, Dept of Head.

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<APPENDIX II> I. PATIENT CARE WORKSHEET

A. Patient Information

Student: Date of Care:

Patient Initial Admission Date:

Age: Height: Wt(kg): Unit /Room:

Sex: Allergies

Code Status Post-Op Day (POD):

1.Chief complaint on admission

2.Admitting Diagnosis

3.Current Diagnosis

4.Significant Medical History: (this should be comprehensive & describes the patients past & current condition; include surgeries / medical procedures)

5. Social History:

6.Brief Pathophysiology to explain the disease process

7.Prescribed Diet (include NPO status if applicable):

a. Enteral feeding (if applicable, incl. type- Glucerna, Nutrivent, etc.)

Rate: Average Residuals:

b. Parenteral nutrition (if applicable, TPN or PPN?):

Rate: Lipids: Y/N Rate

Rationale for above:

8. Respiratory care modalities

a. ETT (Size, cm@lip) _________________ TRACH (TYPE)_______ _______________

If intubated or trached, how many days?____ _ SAO2___________ _

Settings: Mode (AC, SIMV, etc.): _ Tidal volume (vT): ______ FiO2: _______PEEP: ______

b. Chest Tube : Y/N Location: Waterseal/Suction cm

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B. Physical Assessment Data

Body system Assessment Findings

Integumentary Skin color, temperature, vascularity, lesions, hydration, mobility, turgor, edema, massesNail color, capillary refills, angle, deformityHair texture, distribution, strength, quantity

Neurological Alert/oriented, Inspect facial expression, speech, mental status, eye contact CN II- XII Pupils (PERRLA), corneal light reflexes, EOMsPerform Romberg’s test - standing Test deep tender reflexesCoordination test & balance test

Cardiovascular Apical impulse (PMI)Aucultate aortic, pulmonic, Erb’s point, tricuspid, mitral area ( with diaphragm and bell)Peripheral pulses (carotid, radial, dorsalis pedis) Palpate temperature, edema

Respiratory Respiration rate, effort & use of accessory musclesChest configurationAuscultate systematically (min 6- 8 sites + Rt. Mid lobe)

GI/GU Inspect abdomen (skin, peristalsis, contour, pulsation, symmetry)Auscultate bowel sounds (4 quadrants)Percuss abdomen ( 4 quadrants) Palpate all 4 quadrants (light and deep)

Musculoskeletal (physical mobility)

Inspect gait, muscle mass, configuration, & joints, symmetry, posture,& mobilityPerform ROM with strength

Psychosocial Needs

Family support, employment, safety, speech, mental status

Educational Needs

Knowledge

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C. Lab Profile & Diagnostic Tests

HIGHLIGHT ANY ABNORMAL VALUESChemistry *

Labs: Result: Normal Range CBC w/ Differential *Electrolytes Labs: Result: Normal Range

Na+ 136 – 146 mEq/lRBC

♂ 4.4-5.8 ♀ 3.9-5.2 x108mclK+ 3.5 – 5.1 mEq/l

Cl- 98 – 107 mEq/l WBC 3.8-10.8 x103mclCa++ 8 – 11 mg/dl Hemoglobin ♂ 13.8-17.2

♀ 12.0-15.6 g/dlMg++ 1.8 – 2.4 mg/dl

PO4 2.8 – 4.5 mg/dl Hematocrit ♂ 41-50% ♀ 35-

46%Cardiac Function Platelets 130-400 x103mcl

ESR ♂ <20mm/hr ♀<15mm/hr Polys 35 – 80 %Bands 0 – 10 %

Troponin I <0.5 ng/ml Lymphocytes 20 – 50 %LDH 105 – 333 units/l Monocytes 2 – 12 %

CPK ♂ 38 – 174 units/l♀ 96 – 140 units/l

Eosinphils 0 – 7 %Basophils 0 – 2 %

MB Index 0 – 3 Date (of lab): Clotting and Hepatic Function Time:

PTT 30 – 40 secondsPT 11 – 12.5 seconds

INR 2.0 – 3.0 Arterial Blood Gases *ALT 6 – 59 units/l Labs: Result: Normal RangeAST 10 – 34 units/l pH 7.35 – 7.45ALP 44 – 147 units/l pO2 80 – 100

Bilirubin 0.2 – 1.9 mg/dl pCO2 35 – 45Albumin 3.9 – 5.0 g/dl HCO3 24 – 28

Renal Function O2 Sat > 95%Bun 7-22 mg/dl Date (of lab):

Creatinine 0.8-1.3 mg/dl Time: Pancreatic Function

Glucose 70-110 mg/dlHgA1c 4 – 6 % Ventilator / Respirator Settings

Amylase 30 – 110 units/l Method FIO2 Lipase 7 – 60 units/l Mode LPM

Other Rate PEEP/PS CO2/HCO3 21 - 32 Suction Color

Date (of lab): Amount O2 Sat Time:

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* Normal ranges vary with each laboratory or hospital, normal values listed here may need to be changed to reflect specific laboratory/hospital guidelines.

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D. Medication Worksheet

II. NURSING CARE PLAN

Using the assessment data from preparation of the patient care worksheet, develop a care plan with at least 3 ACTUAL and potential NANDA-approved nursing diagnoses based on the identified problems, expected outcomes, interventions with rationale, evaluation, and revisions to plan of care.

All care plan should be type-written and follow the format below for each diagnosis. Provide appropriate citation and add your reference at the last page. Follow the APA format for citation and reference.

Nursing Diagnosis #1

Expected Outcomes (Measureable)

Nursing Intervention (include Education and Nutrition)

Rationale

Outcome Evaluation

Revised Care Plan (as needed)Nursing Diagnosis #2


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Medication Rationale


Rationale

Outcome Evaluation

Revised Care Plan (as needed)Nursing Diagnosis #3



Rationale

Outcome Evaluation

Revised Care Plan (as needed)Geriatric Specific InterventionsCommunicationCognitive changesFunctional Status (ADLs, hearing, sight,..)Skin integrity Safety Needs (precautions, restraints,…)Pain ManagementDischarge Planning

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GRADING CRITERIA

CLINICAL ASSIGNMENT #1

Topic: Best Skilled Nursing Facilities (50 points)

Students will write a 600-800 word essay describing three best skilled nursing facilities in the community.

Describe some of the factors why these facilities are considered “best” in your judgment.

Provide some of the benchmarks from government data (medicare.gov) that determines quality of care in the chosen skilled nursing facility.

Dimensions Poor Average Good Excellent Earned Points

I. Provide a brief description of the three best SNF chosen (number of beds, services offered, patient satisfaction survey etc.)

Absence of detail and understanding of three best SNF (2.5)

Minimal detail and no understanding of three best SNF (7.5)

Less accuracy in detail and understanding of three best SNF (10)

Explained in detail with accurate and in-depth understanding of three best SNF (15)

/15

II. Provide evidence why this particular SNF is “best” in your judgment. Cite Medicare data, benchmark report or DHHS survey report, and “hospital compare” website report.

No evidence why choose this particular SNF (2.5)

Missing partial evidence why choose this particular SNF (7.5)

Incomplete evidence why choose this particular SNF(10)

Provided evidence why choose this particular SNF (15)

/15

III. APA Style; follow rules of grammar, usage, and punctuation. All sentences must have structure that is clear and logical.

Many errors (2.5)

Some errors (<than 5) (5)

Few errors (<than 3) (7.5)

No errors (10) /10

IV. On time Submission Late submission – more than 3 days (2.5)

Late submission – 2 days (5)

Late submission – 1 day (7.5)

Submitted on time (10) /10

Total /50

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CLINICAL ASSIGNMENT #2

Topic: Nursing Care Plan (66 points = 33 points x 2)

Students will submit relevant data regarding interview with older adults. Guidelines for interview questions are provided in the course syllabus. Student will also provide a nursing care plan based on the data gathered from interview. Scholarly academic writing is expected.

Dimensions Poor Average Good ExcellentEarned Points

I. ContentA. History, Physical Assessment, and Diagnostic tests/ procedures

Absence of detail and understanding of chief complaints and presenting signs/symptoms of the disease process (1.5 points x 2)

Past medical history stated but with no explanation. Minimal detail and no understanding of chief complaints and presenting signs/symptoms of the disease process. (2 points x 2)

Less detailed explanation of past medical history. Less accuracy in detail and understanding of chief complaints and presenting signs/symptoms of the disease process. (2.5 points x 2)

Explained past medical history in detail. Explained in detail with accurate and in-depth understanding of chief complaints and presenting signs/ symptoms of the disease process (3points x 2)

/6

B. Pathophysiology, and laboratory result

Absence of pathophysiology of diagnosis. Discussion of diagnosis not related to the patient’s history and clinical manifestations. (1.5 points x 2)

Lack of discussion of pathophysiology of one or more diagnosis related to the patient’s history and clinical manifestations. (2 points x 2)

Pathophysiology of two or more diagnosis thoroughly discussed related to the patient’s history and clinical manifestations. (2.5 points x 2)

Pathophysio- logy for each diagnosis thoroughly discussed related to the patient’s history and clinical manifestations. ( 3 points x 2)

/6

C. Medications Listed few medications on MAR and discussion on patient’s diagnosis and nursing problems

Listed 50% of the medications on MAR and relevance to patient’s diagnosis and nursing problems.

Listed most of the medications on MAR and relevance to patient’s diagnosis and nursing problems.

Listed all MAR medications citing reason for use relevant to patient’s diagnosis and nursing

/6

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irrelevant. (1.5 points x 2)

(2 points x 2) (2.5 points x 2) problem. (3 points x 2)

D. Nursing Problems

Identifies nonrelevant NANDA-approved nursing diagnosis with no discussion of assessment, planning, or intervention. (3 points x 2)

Identified ONE prioritized NANDA-approved actual nursing diagnosis and discussed appropriate assessment, planning, intervention with details on independent nursing interventions (4 points x 2)

Identified TWO prioritized NANDA-approved actual nursing diagnosis according to NANDA format and discussed appropriate assessment, planning, intervention with details on independent nursing interventions(5 points x 2)

Identified THREE prioritized NANDA-approved actual nursing diagnosis and discussed appropriate assessment, planning, intervention with details on independent nursing interventions (6 points x 2)

/12

II. Organization- priority sequence

Illogical sequence(2point x 2)

Topic jumps back and forth (3 points x 2)

Mostly logical sequence according to nursing priority (4 points x 2)

Logical sequence according to nursing priority(5 points x 2) /10

III. ReferencesOne type onlySources are questionable (1 point x 2)

Somewhat limitedSome dated/peer reviewed (2 points x2)

VariedMost are timely/peer-reviewed (3 points x 2)

Wide varietyTimely/peer-reviewed (4 points x 2) /8

IV. APA Style Many errors (1 point x 2)

Some errors (<than 5) (2 points x 2)

Few errors (<than 3) (3 points x 2)

No errors (4 points x 2) /8

V. On time Submission

Late submission – more than 3 days (2 point x 2)

Late submission – 2 days (3 points x 2)

Late submission – 1 day (4 points x 2)

Submitted on time (5 points x 2) /10

Total /66

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CLINICAL ASSIGNMENT #3 Topic: Case Study Presentation

Dimensions Poor (0) Average (2) Good (2) Excellent (3) Earned Points

Context and Background Information

a. Relevant Data from Present Problemb. Relevant Data from Social Historyc. Clinical Significance

Did not identify relevant data related to present problem, social history, and clinical significance

Identifies some relevant data related to present problem, social history, and clinical significance

Identifies most relevant data related to present problem, social history, and clinical significance

Identifies all relevant data related to present problem, social history, and clinical significance

II. Critical Thinking

a. Relationship of past medical history and current medicationb. Clinical significance of lab/diagnostic results

Demonstrates little understanding of patient medical history, current medication and clinical significance of lab and diagnostic test.

Demonstrates some understanding of patient medical history, current medication and clinical significance of lab and diagnostic test.

Demonstrates a general understanding of patient medical history, current medication and clinical significance of lab and diagnostic test

Demonstrates a clear and deep understanding of patient medical history, current medication and clinical significance of lab and diagnostic test

Physical Assessment Data and Vital signs

Accurately documents few relevant data physical assessment, vital signs, and clinical significance

Accurately documents some relevant data physical assessment, vital signs, and clinical significance

Accurately documents most relevant data physical assessment, vital signs, and clinical significance

Accurately documents all relevant data physical assessment, vital signs, and clinical significance

Identifies Main Problem/sa. Discuss patient’s primary problem

Poor understanding of the patient’s primary problem

Identifies and understands some of the patient’s primary problem

Identifies and understands most of the patient’s primary problem

Identifies and understands all of the patient’s primary problem

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Group students’ participation

Students show a little understanding of underlying gerontological intervention of patient’s primary problem and no question or comments.

Students describe and demonstrate some understanding of gerontological intervention of patient’s primary problem and gave very few question or comments.

Students describe and demonstrate a general understanding of underlying gerontological intervention of patient’s primary problem and gave some question or comments

Students describe and demonstrate a clear and deep understanding of underlying gerontological intervention of patient’s primary problem and gave a lot of questions or comments

Identifies Nursing Priority ,Interventions, and Rationale

Nursing priority, interventions, and rationale are inappropriate and irrelevant to patient’s primary problem

Identify and explain nursing priority and 1 nursing interventions, and rationale



Case Study Analysis Lack insights of patient’s current medical management/ priority setting, educational/ discharge priorities and integration of theory of caring

Clearly provide a superficial analysis of patient’s current medical management/ priority setting, educational/ discharge priorities and integration of theory of caring

Clearly provide an thorough analysis of patient’s current medical management/ priority setting, educational/ discharge priorities and integration of theory of caring

Clearly provide an excellent and insightful analysis of patient’s current medical management/ priority setting, educational/ discharge priorities and integration of theory of caring

Presentation Speaker makes little or no eye contact.

Speaker looks at only one portion of the audience.

Speaker makes eye contact with most of audience.

Speaker makes eye contact with all individuals.

Vocal Delivery Speaker’s words are garbled.

Speaker slurs word endings.

Speaker has difficulty

Clear articulation of words demonstrated

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enunciating one or two words.

Timing Presented his/her part of the assigned project 14 mins early

Presented his/her part of the assigned project 10 mins. early

Presented his/her part of the assigned project 5 mins. early

Presented his/her part of the assigned project in a timely manner (15 minutes)

Total 0 10 20 30 /30

CLINICAL ASSIGNMENT #4 (36 POINTS= 12 POINTS X 3)

Topic: Journals

Student will write a minimum of 800 -1000 word essay describing personal feelings and experiences during long term care facility clinical practice.

Dimensions Poor Average Good Excellent Earned Points

I. Content; describe personal experience during long term care facility practice

No learning experience and theme poorly developed (3 x 3)

Addressed one learned experience andtheme needs expansion (4 x 3)

Addressed two learned experiences andcentral theme covered (5 x 3)

Addressed three learned experiences andcentral theme well outlined (6 x 3)

/18

II. APA Style; follow rules of grammar, usage, and punctuation. All sentences must have structure that is clear and logical.

Many errors (0.5 x 3) Some errors (<than 5) (1 x 3)

Few errors (<than 3) (1.5 x 3)

No errors (2 x 3)

/6

III. On time Submission

Late submission – more than 3 days (1.5 x 3)

Late submission – 2 days (2 x 3)

Late submission – 1 day (3 x 3)

Submitted on time (4 x 3) /12

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Total /36

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Shepherd University ADN ProgramNR 402_Clinical Performance Evaluation

Student Name: _____________________________________________________________________________

Rotation Dates: _____________________________________________________________________________

Clinical Instructor: ____________________________________________________________________________

Performance Scale: Each student will be responsible for reviewing all clinical objectives and expectations as presented in the course syllabus and the criteria for determining the grade for clinical performance. Clinical faculty will evaluate student progress in a variety of ways, including planned and incidental observation of patient assessment, problem identification, care plan development, and implementation and evaluation of patient care as outlined in the course clinical objectives; other written assignments; and the clinical performance evaluation tool. Students will receive ongoing feedback and a written midterm and final review of their performance. At midterm and final evaluation, the following criteria will be used to evaluate each clinical objective: satisfactory, needs improvement, or unsatisfactory. Students must receive “satisfactory (2 points)” on all objectives on the final evaluation to pass the course.

Satisfactory (S) 2 points

The student performs at the expected level. The student demonstrates competency in meeting the clinical objectives.

Needs Improvement (NI) 1 points

The student demonstrates inconsistent performance of the clinical objective. The quality of performance is often below the expected level of achievement, and the student often requires more than the expected amount of guidance by the clinical faculty or staff nurse.

Unsatisfactory (US) 0 point

The student demonstrates unsatisfactory performance of the clinical objective. The quality of performance is usually below the expected level of achievement, and the student usually requires more than the expected amount of guidance by the clinical faculty or staff nurse.

Clinical Learning Contract:Clinical faculty will provide the student with ongoing feedback regarding performance on clinical objectives. If the student is not meeting the clinical objectives or has “Needs Improvement” or “Unsatisfactory” ratings on any objective, a Learning Contract will be issued to the student. The contract will describe specific behaviors that must be demonstrated by the student and will provide a timeframe for completion of the contract to assist the student to meet the clinical objectives. If the criteria for the Learning Contract are not met, the student will fail the course.

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Patient Safety is Our First Criterion in Evaluation of Clinical Performance:

If at any time a student demonstrates behavior jeopardizing patient safety or practices nursing in a grossly negligent or incompetent manner, the student will be required to leave the clinical setting and be subject to faculty review. This could result in dismissal from the Program.

Criteria for Clinical Performance (based on Swanson’s caring framework)

Points = 90 Points (Final)

(Points) = Pass with 75% from total points

CLO #1: Utilize valid and reliable tools to assess the functional, physical cognitive, psychological, social, and spiritual status of older adults. (4 points)

SLOsPossible Points

Final Grade

1. Name tools that are frequently used in the assessment of older adults. 2

2. Describe some of the issues in relation to comprehensive assessment of older adults.

2

CLO #2: Manage geriatric syndromes common to older adults. (16 points)

SLOsPossible Points

Final grade

1. Discuss how to identify common disease of elderly and how to manage. 2

2. Differentiate dementia, depression, and delirium. 2

3. Apply basic principles to provide safe and effective care for persons with dementia.

2

4. Discuss strategies for minimizing adverse consequences of polypharmacy and enhancing medication adherence.

2

5. Describe the demographics and identify risk factors for falls in the elderly. 2

6. Discuss non-restraint interventions to prevent falls. 2

7. Explain common causes of delirium in older adults. 2

8. Develop a plan of care for managing anxiety and depression in an older person.

2

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CLO #3: Recognize and report elder mistreatment according to standard of care. (12 points)

SLOs Possible Points

Final grade

1. Identify risk factors and signs of abuse in the elderly. 2

2. Distinguish between elder abuse and self-neglect. 2

3. Describe several categories of the mistreatment of older adults. 2

4. Identify characteristics of perpetrators of mistreatment 2

5. Recognise signs that an older adult is being mistreated. 2

6. Discuss strategies to prevent the mistreatment of older adults. 2

CLO #4: Utilize effective & therapeutic communication skills in the care of older adults and their families. (10 points)


Final grade

1. Identify effective and ineffective communication strategies 2

2. Communicate effectively, respectfully, and compassionately with older adults and their families.

2

3. Understand how normal and pathological changes of aging effect communication

2

4. Describe communication strategies for older adults with common normal and pathological changes of aging.

2

5. Describe person-centered communication. 2

CLO #5: Recognize that sensation and perception in older adults are mediated by functional, physical, cognitive, psychological, and social changes common in old age. (10 points)


Final grade

1. Distinguish the signs and symptoms of cataracts, glaucoma, macular degeneration, and diabetic retinopathy.

2

2. Contrast management of the four most common eye disorders seen in the elderly.

2

3. Identify sensorimotor, cognitive, and psychological changes associated 2

Rev 6/2016 23

with aging.

4. Acknowledge the complex health and cost issues related to falls due to sensory deficit.

2

5. Describe older adults with a predisposition for falls related to sensory deficit.

2

CLO #6: Recognize one’s own and others’ attitudes, values, and expectations about aging and their impact on care of the older adults and their families. (10 points)


Final grade

1. Develop the beginnings of a personal philosophy of aging. 2

2. Critically evaluate successful aging. 23. Define key ethical constructs as they relate to the care of geriatric patients. 24. Recognize the influence of personal values, attitudes, and expectations about aging on care of older adults and their families/extended families.

2

5. Identify strategies for facilitating appropriate levels of autonomy and supporting the right to self-determination decisions in the care of geriatric patients.

2

CLO #7: Identify and use relevant cultural, economic, ethical, legal, political, social, and spiritual resources that affect the practice of nursing and the delivery of health care services. (12 points)


Final grade

1. Describe aging across different cultures. 22. Recognize differences between aging in the 21st century and aging in the past.

2

3. Cite cultural demographic trends in United States. 24. Discuss various interventions to provide culturally aware care to elders from culturally diverse groups.

2

5. Identify how nurse’s attitudes and beliefs about spiritually impact nursing practice in relation to holistically caring for the elder client.

2

6. Identify strategies that could assist the nurse to be productive in conducting a spiritual assessment with the older client.

2

CLO #8: Promote quality end-of-life care for older adults, including pain and symptom management, as essential, desirable, and integral components of nursing practice. (16 points)

SLOs Possible Final Rev 6/2016 24

Points grade1. Identify historical influences and attitudes toward death and dying 22. Recognize the choices of older adults and their families in directing their end-of-life care as well as the nurse’s role in support/implementation of the patient’s choice of care.

2

3. Compare curative care, hospice care, and palliative care. 24. Examine the goals/objectives of curative, palliative, and hospice care at end of life.

2

5. Discuss the nurse’s role at end of life using the preceding concepts of care. 2

6. Identify cultural traditions at end of life. 2

7. Describe ethical and legal issues common at end of life. 2

8. Recognize several aspects of care contributing to a “good death.” 2

Rev 6/2016 25

Clinical Performance Evaluation (Midterm/Final)

Strengths:

Areas for Growth:

Student Comments:

__________ _______________________________ _______

Date Instructor Signature Student Signature

Rev 6/2016 26

CLINICAL LEARNING CONTRACT

Check One:

Action Plan or Learning Contract

Student:

Faculty:

Date:

Beginning Date of Action Plan or Contract:

Ending Date of Action Plan or Contract:

Brief Description of the problem(s):

I. Nature of the problem: Supportive evidence of problem: A. Absenteeism (Class/Clinical) B. Tardiness (Class/Clinical) C. Disruptive classroom or clinical behavior D. Unprepared for clinical 1. Unsatisfactory plan for patient care 2. Had not researched patient problems or medications E. Unsafe clinical practice 1. Did not demonstrate mastery of basic skills 2. Could not calculate medication dosages, IV rates,

heparin drips, etc. 3. Cannot communicate clearly in or understand English 4. Other ________________________ F. Noncompliance with dress code, personal hygiene and H. Did not follow up on lab remediation recommendations I. Lacking in professional demeanor J. Written work deficit K. Health/BCLS/Malpractice requirements not complete L. Removal from clinical area by Agency M. Other

II. Requirements for overcoming the problems: (check all applicable)

Rev 6/2016 27

Improvement of study habits Seek counseling for personal issues Reduce outside work hours Improve writing skills Improve verbal and communication skills Must practice in college lab with faculty lab tutor or regular tutoring staff Other:

III. Contractual limitations/obligations: May not be late for or absent from clinical, lab, or class May not sleep during class Must be present in proper attire with appropriate equipment Must attend college laboratory remediation for

the following: Must come to clinical prepared with written care plan Must attend counseling sessions for behavior issues Must attend college writing lab and produce a satisfactory assignment May not administer meds without instructor being present. Must provide appropriate documentation of current health/BCLS/malpractice requirements to School of

Nursing before returning to clinical. Must have physical or psychological evaluation by health care professional Other:

IV. Other General Requirements or Comments:

V. Possible Consequences: Initiation of Action Plan or Contract (circle one)Continuation of Action Plan or Contract (circle one)Termination of Action Plan or Contract (circle one)Course FailureOther:

VI. SignaturesAfter the development of the action plan or learning contract (circle one), the instructor(s) and student will sign below:Signed (Student): Date:

Print Name:Signed (Faculty): Date:

Print Name:

Rev 6/2016 28

VII. Faculty notes on progressWhen an action plan or learning contract is instituted, the student and faculty should meet on a weekly basis to evaluate progress.

Date: Note:Student Initials

Instructor Initials

VII. OutcomesAction Plan:Date of Evaluation Termination of Action Plan

Continuation of Action Plan (initiate new form)Initiation of Learning Contract (initiate new form)Other:

Learning Contract:Date of Evaluation Termination of Contract

Continuation of Contract (initiate new form)Course failureOther:

VIII. Signatures

Once outcomes of the action plan or learning contract have been met (circle one), designated faculty and the student will sign below:

Signed (Student): Date:

Print Name:

Signed (Faculty): Date:

Rev 6/2016 29

Weekly Student Learning Outcomes (SLOs) Evaluation

NR402 FA2017

Name: _____________________________

ClinicalWeek

WeeklyStudent Learning Outcomes (SLOs)

EvaluationSatisfactory

(S)*Unsatisfactory

(US)1 1. Demonstrate leadership role by providing nursing care to

a group of elderly patients.2. Demonstrate proper delegation while performing team

nursing. 3. Demonstrate competency in providing total care in a

skilled nursing home setting utilizing evidence-based practice.

4. Demonstrate prioritizing competency when managing multiple nursing intervention utilizing critical thinking.

5. Provide appropriate teaching (including discharge instructions) to patients and family.

6. Demonstrate competency in providing emergency care/procedures for a variety of situations.

7. Demonstrate proper communication skills with patients, family, and other health care providers.

*Unsatisfactory is required to complete the Learning Contract

Comments:

Learning Contract: Yes___ (refer for the learning contract)

No___

_________________Student Signature

__________________

Rev 6/2016 30

Instructor Signature


NR402 FA2017

Name: _____________________________

ClinicalWeek



(S)*Unsatisfactory

(US)2 1. Demonstrate leadership role by providing nursing care to

a group of geriatric patients.2. Demonstrate proper delegation while performing team

nursing. 3. Demonstrate competency in providing total care in a

skilled nursing home setting utilizing evidence-based practice.

4. Demonstrate prioritizing competency when managing multiple nursing intervention utilizing critical thinking.

5. Provide appropriate teaching (including discharge instructions) to patients and family.

6. Demonstrate competency in providing emergency care/procedures for a variety of situations.

7. Demonstrate proper communication skills with patients, family, and other health care providers.


Comments:


No___


Rev 6/2016 31

__________________Instructor Signature


NR402 FA2017

Name: _____________________________

ClinicalWeek



(S)*Unsatisfactory

(US)3 1. Demonstrate leadership role by providing nursing care to a

group of geriatric patients.2. Demonstrate proper delegation while performing team nursing.

3. Demonstrate competency in providing total care in a skilled nursing home setting utilizing evidence-based practice. 4. Demonstrate prioritizing competency when managing multiple nursing intervention utilizing critical thinking. 5. Provide appropriate teaching (including discharge instructions) to patients and family. 6. Demonstrate competency in providing emergency care/procedures for a variety of situations. 7. Demonstrate proper communication skills with patients, family, and other health care providers.


Comments:


No___


Rev 6/2016 32



NR402 FA2017

Name: _____________________________

ClinicalWeek



(S)*Unsatisfactory





Comments:


No___


Rev 6/2016 33


Rev 6/2016 34


NR402 FA2017

Name: _____________________________

ClinicalWeek



(S)*Unsatisfactory





Comments:


No___



Rev 6/2016 35


NR402 FA2017

Name: _____________________________

ClinicalWeek



(S)*Unsatisfactory





Comments:


No___



Rev 6/2016 36


NR402 FA2017

Name: _____________________________

ClinicalWeek



(S)*Unsatisfactory





Comments:


No___



Rev 6/2016 37

NURSING CARE PLANInstructor Verification

Directions: The student must obtain approval from the instructor before completing a care plan. The instructor will select and review the chart to determine if the patient is appropriate for the assignment. It is the student’s responsibility to complete the form, have the instructor sign it, and attach it to the care plan before submission.

Student’s Name:_________________________________________ Date:_______________

Course Name: _____________________________________ Course Number: ___________

Patient Information:

Gender Identification: ___________ Age:_______ Ethnicity:_______________

Reason for Admission: __________________________________________________

Medical History: _______________________________________________________

_____________________________________________________________________

Medications: __________________________________________________________

_____________________________________________________________________

Allergies: _____________________________________________________________

Nursing Diagnoses: _____________________________________________________

_____________________________________________________________________

Instructor’s Name: ______________________________________ Date: ________________

Instructor’s Signature: _________________________________________________________

Comments:__________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Rev 6/2016 38

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