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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)
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. Communication
a. 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 team
1) 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.
6) Completes documentation in a timely manner and as per agency policy.
2. Critical Thinking and Knowledge
a. Demonstrates knowledge and understanding of:
1) Pathophysiology, course, and treatment of health conditions encountered in practice
2) 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 knowledge
1) 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 accountability
a. 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 necessary
g. 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 Standards
a. Maintains confidentiality.
b. Promotes patient choice.
c. Demonstrates advocacy for patients and families.
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 Performance
a. 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 hours
Missing 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 Policy
The 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 screens
3. 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 schedules
5. Answering questions in person or on the phone from friends and family about thepatient’s
medical condition
CLINICAL ASSIGNMENTS
Clinical Grading
The 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 50
2. Care Plans (2 x 30 points each) – Signature Assignment 66
3. Case Study Presentation 30
4. 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.
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.
<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.
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