College of Nursing
UNIVERSITY OF WISCONSIN-MILWAUKEE
COLLEGE OF NURSING
Graduate Course Syllabus
Spring 2015
Title: NURS 754: COMPREHENSIVE ASSESSMENT OF HEALTH:
IMPLICATIONS FOR CLINICAL DECISION MAKING
Credits: 3 units; G
Comprehensive Assessment of Health: Implications for Clinical Decision Making. it is a graduate level 3-credit course. The lecture portion of the course is 2 credits, and the co-requisite laboratory is 1 credit (2 contact hours).
Prerequisites: Grad st; admis to Nursing degree program; Nurs 753(P); or cons instr.
Enroll in LEC 401 & LAB 802 or 803.
Faculty: Dr. James Bockeloh, DNP, RN, FNP-BC, APNP
e-mail:
Office: Cunningham 522
UWM Ph#414 229-5556
Cell Ph# 262-880-6415
Office Hours: By Appointment
Lab Instructors: Kristen R. Swanson MSN APNP
Email
Cell 414.312.2773
Program Director : Dr. Julie Darmody, Ph.D., RN, ACNS-BS
Email:
Office: (414) 229-5558
Cunningham Hall 691
Class meetings times and location:
Lecture: Meets 5:00-6:50 PM Tues 01/26/15 – 05/07/15, CUN G40
LAB: 802: Meets 3:00 – 4:50 PM Tues 01/26/15 – 05/07/15, CUN NLRC
803: Meets 7:00-8:50 PM Tues 01/26/15 – 05/07/15, CUN NLRC
Catalog Description: Comprehensive assessment of health in individuals and aggregates, including measurement of health status, appraisal of needs, analysis of environmental contexts, and development of diagnostic strategies.
Course Description: This course is designed to provide an in-depth analysis of approaches to the assessment of health in individuals, families, and populations. Emphasis will be placed on theories, research findings, and practice guidelines as they relate to measurement of health status, appraisal of health needs and concerns, analysis of environmental contexts, and clinical decision-making.
Course Objectives: Upon successful completion of the course, the student will be able to:
1. Apply selected theories, research, and clinical practice guidelines related to health assessment and diagnostic strategies.
2. Evaluate the health status of individuals and populations, synthesizing data derived through various health assessment strategies, including clinical status, cultural beliefs and behaviors, and environmental factors.
3. Demonstrate advanced assessment of health status of individuals across the lifespan, using comprehensive and focused approaches.
Textbooks and Readings:
Required:
Goolsby, M., Grubbs, L. (2011). Advanced assessment: Interpreting findings and formulating differential diagnoses. Philadelphia: F. A. Davis.
A physical assessment text. We suggest:
Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., Stewart, R.W. (2014), Seidel's Guide to Physical Examination, 8e (Mosby's Guide to Physical Examination (Seidel))
* Shadow Healthcare Digital Clinical Experience Program Information.
Digital Clinical Experience [Computer software]. Gainesville, FL: Shadow Health.
Student Account Setup
Students can create their accounts by visiting http://app.shadowhealth.com/and enroll with this course-specific PIN: January2015-6866-4705-0836-7347
* For registration and purchase, follow the guide at https://shadow.desk.com/customer/portal/articles/980991-how-to-register-with-shadow-health. You will need to copy and paste the unique PIN above to register in your fall course.
* Shadow Health recommends using headphones to access the concept labs in which you will practice identifying normal and abnormal sounds.
* Technical Requirements - http://bit.ly/Shadow_Requirements
* After registering, access Shadow Health assignment at app.shadowhealth.com
Recommended:
If you do not already have a current handbook for diagnostic testing, we recommend purchasing one for this course and for your upcoming clinical experiences.
Agency for Healthcare Research and Quality. (2008). Guide to clinical preventative services. Rockville, MD, AHRQ. Can be accessed online at: http://www.ahrq.gov/clinic/pocketgd1011/pocketgd1011.pdf
Seidel (Ed.)(2011). Mosby's physical examination handbook (7rd ed.). St. Louis: Mosby.
Wright, W. (2008). Physical Assessment & Health History of the Adult Examination (6h ed.).
North Andover, MA: Fitzgerald Health Education Associates. (can be found at www.FHEA.com)
There is also a wealth of assessment information and tools available online and in the 3rd floor NLRC. (We will discuss some of the available on-line resources in class).
Assignments and Evaluation:
1. Evaluation/Grading
Your course grade will be based on both lecture and laboratory evaluations. The evaluation components will consist of the following:
q Focused health & aggregate assessment presentation (25 points)
q Graded case studies & documentation (2 @ 10 points each=20 points)
q Observed performance of a focused physical examination (30 points)
q Shadow Health On Line Assessment Exercises (25 points)
q Total Course Grade = 100 points
2. Description of assignments .
Focused Health and Aggregate Assessment Presentation
Students will be required to work in small groups (3-4 people) to research and write up a common “focused” clinical problem. This focused assessment will include pertinent history and physical examination findings, proposed diagnostic testing and a prioritized list of differential diagnoses. Students will also provide pertinent background, aggregate and epidemiological information about the problem. This assignment is preparation for the practical final examination and will be evaluated using the Scoring Guide: Focused Assessment. 5 points will be deducted for students who do not participate in the class presentation activity.
Practice Component
On-campus laboratory experiences will emphasize skills necessary for assessing the most commonly encountered health problems/conditions in clinical settings and for delivering preventive, curative, and rehabilitative services. The packet Scoring Guides for Health Assessment provides tools for you to use in practicing and faculty to use in evaluating assessment skills.
Students will have opportunity to obtain feedback on their advanced health assessment skills under the direct supervision of a faculty member during your clinical laboratory sessions. The laboratory will include the following activities:
Observed basic physical examination. In order to continue with the in-depth comprehensive assessment, students must demonstrate that they can do a basic head to toe examination within 20 minutes. This will be completed after the second lab session, and will be practiced during the first two lab sessions. The grading tool “BASIC ADULT PHYSICAL EXAMINATION: Observed” is found in the “Scoring Guides” portion of this packet. Students may bring one index card with notes on one side for reference during the test if they choose. Students must satisfactorily complete at least 83% of the components to pass. An unsatisfactory performance (<83%) will require students to practice and repeat the PE. The student who does not pass the examination on first attempt is responsible for his/her own remediation, but resources are available in the NLRC. Students who are unable to complete the basic physical examination upon the 2nd attempt will meet with Dr. Bockeloh to determine if they should continue in the advanced assessment course.
Case studies & Documentation. This course will use multiple case studies to integrate students’ previous clinical knowledge with Advance Practice Nurse level critical thinking, history taking and documentation skills. Students will have multiple case studies to choose from, work through during lab and document using SOAP format. Although two write-ups will be graded, students are encouraged to present practice write-ups to their lab instructor for critique of history taking and documentation skills and recommendations for improvement (if any). Critiqued documentation may not be submitted for a grade. Write-ups to be graded should be uploaded to the course D2L site drop box under the lab instructor’s name by the due date. Late case studies will receive one letter grade lower for each week they are late (A to A-; A-to B+).
Gynecological-genitourinary training. A training session with professional patients will occur during lab time towards the end of the semester in order to learn how to perform the female gynecological examination and a male genitourinary/rectal examination. For each examination, you will work in small groups with one course faculty and a professional patient. You will have an opportunity to perform the examination with the coaching and guidance of the faculty and the professional patient and to observe 2-3 other examinations.
Practical final assessment. Near the end of the semester, students will schedule a 20-minute time slot with their lab instructor for their lab final physical exam. Students will be given a scenario and be asked to perform a focused assessment, eliciting pertinent history and completing exam components appropriate to the patient’s clinical presentation. This exam utilizes professional patient models, with whom the student will interact and examine. Students must also select diagnostic tests to be done and provide a list of differential diagnoses in their documentation, no other treatment plans will be required.
Shadow Health Care On Line Digital Clinical Experience (DCE). The Shadow Health™ Digital Clinical Experience™ (DCE) provides a dynamic, immersive experience designed to improve your skills and clinical reasoning through the examination of digital standardized patients. Although these patients are digital, each one breathes, speaks, and has a complex medical and psychosocial history. We will be completing Shadow Health assignments throughout the course.
You can explore concept labs for the Respiratory, Cardiovascular, and Abdominal systems. We will be using these concept labs you students to review the anatomy of each system and practice identifying normal and abnormal sounds. You will complete these assignments after reviewing course content, reading the course textbook, and attending lecture.
With Tina Jones, you can practice taking a detailed health history and performing physical assessments in system-by-system assignments. All of these assignments take place during a single visit for Tina that begins at 8 a.m. We will be using these assignments to practice relevant skills and apply content knowledge prior to our hands-on practice sessions or lab. You will complete these assignments after reviewing course content, reading the course textbook, attending lecture, and completing the concept lab if applicable.
The focused exams allow you to respond to patients’ chief complaints. You will perform focused exams in which you will demonstrate a mastery of skills relevant to multiple body systems and professional communication. The Shadow Health DCE is worth 15 points of the final course grade.
3. Grading Scale:
95-100 A / 87-90 B / 79-82 C / 72-74 D93-94 A- / 85-86 B- / 77-78 C- / 70-71 D-
91-92 B+ / 83-84 C+ / 75-76 D+ / 00-69 F
4. Course Attendance Policy: Because the lectures/discussions and other types of class sessions are critical components of successfully completing the course, attendance is required. If you will be absent from class, please notify the course coordinator and or the lab instructor in advance as soon as possible. If you will miss a class, it is recommended that you arrange to have a classmate take notes for you and/or collect any handouts.
5. Course Expectations:
A. Required Readings
Students will be expected to complete all assigned readings from the textbooks prior to class. Students will be expected to read any additional assigned articles and online national practice guidelines as specified as well.
B. Grading Policy
Any assignment that is submitted after the due date according to the class schedule will be reduced by one letter grade (e.g., A- to B+) for each week, including the first week that the assignment is late.
Content Outline and Assigned Readings
Week 1, Jan 27:
Lecture: Overview of class, Assessment of Individuals, Aggregates & Communities; Data Resources
Lab: Intro to lab, Basic PE review/practice.
Pre-Class Prep: Read assessment text & Goolsby chapters re: assessment/clinical decision making and documentation.
Week 2, Feb 3:
Lecture: Clinical Decision-Making, Diagnostics and Documentation; Focused assessment presentation topics will be assigned in class
Lab: Basic PE Check Off Review/Practice.
Pre-Class Prep: Review relevant text chapters.
Week 3, Feb 10:
Lecture: Dermatologic, HEENT
Lab: Interview, History & Documentation practice, basic PE check-offs
Pre-Class Prep: Review common lab/diagnostic tests and be prepared to discuss. Consider bringing a diagnostic testing (lab) reference to class, Practice basic physical exam
Week 4, Feb 17:
Lecture: Chest (Breast, Respiratory & Cardiovascular) Clinic; Turn in Adult Screening History write-up (Drop Box)
Lab: Dermatologic, HEENT, Basic PE Checkoff
Pre-Class Prep: Review relevant text chapters. Case Study #1 Due.
Week 5, Feb 24:
Lecture: Musculoskeletal Assessment
Lab: Chest (Breast, Respiratory & Cardiovascular) Clinic
Pre-Class Prep: Review relevant text chapters.
Week 6, Mar 3:
Lab: Musculoskeletal Assessment
Lecture: Neurological Clinic; Focused Assessment Presentations
Pre-Class Prep: Review relevant text chapters.
Week 7, Mar 10:
Lab: Neurological Clinic
Lecture: GI Assessment
Pre-Class Prep: Review relevant text chapters.
Spring Break March 15-22, No Classes
Week 8, Mar 24:
Lab: GI Assessment
Lecture: GU/GYN, Reproductive Clinic
Pre-Class Prep: Review relevant text chapters. Case Study #2 Due.
Week 9, Mar 31:
Lab: GU/GYN, Reproductive Clinic
Lecture: Abdominal, GU/GYN, Reproductive Assessment & Documentation
Pre-Class Prep: Review relevant text chapters
Week 10, Apr 7:
Lab: GU/GYN Assessment, Professional Models
Lecture: Mental Health Clinic
Pre-Class Prep: Review relevant text chapters, GU/GYN exam videos
Week 11, Apr 14:
Lab: GU/GYN Assessment, Professional Models
Due: Group Focused-Assessment Presentation and Reference materials posted on D2L Discussion area.
Lecture: Spiritual Health Assessment; Focused Assessment Presentations
Pre-Class Prep: Review relevant text chapters
Week 12, Apr 21:
Lab: Focused Assessment Practice
Lecture: Focused-Assessment Presentations
Pre-Class Prep: Review relevant text chapters
Week 13, Apr 28:
Lab: Focused-Assessment Check Offs
Lecture: Focused-Assessment Presentations
Pre-Class Prep: Review relevant text chapters
Week 14, May 5:
Lab: Focused-Assessment Check Offs, PE Kit Turn In
Lecture: Course Evaluations, Semester Wrap-Up
Pre-Class Prep: Material as needed
Shadow Healthcare DCE Assignment Time Estimates (Can be completed at any time during the semester).
Assignment / Approximate TimeDigital Clinical Experience™ (DCE) Orientation / 10 - 15 minutes
Health History(Tina Jones) / 75 minutes - 115 minutes
HEENT(Tina Jones) / 90 minutes - 145 minutes
Respiratory Concept Lab / 25 minutes
Respiratory(Tina Jones) / 50 minutes - 125 minutes
Cardiovascular Concept Lab / 25 minutes
Cardiovascular (Tina Jones) / 45 minutes - 125 minutes
Abdominal Concept Lab / 25 minutes
Abdominal (Tina Jones) / 35 minutes - 120 minutes
Musculoskeletal (Tina Jones) / 50 minutes - 105 minutes
Neurological (Tina Jones) / 50 minutes - 105 minutes
Psychological (Tina Jones) / 30 minutes - 100 minutes
Clinical Decision Making(Tina Jones) / 60 minutes
ACADEMIC CONDUCT
Students are expected to demonstrate academic integrity in all course activities. Academic integrity requires honesty concerning all aspects of academic work including: