Washburn University
School of Nursing
NU 608 Health Care Practicum III- Specialty (Family)
Clinical Performance Tool
(Completed by Student and Faculty)
Student__Tracy Hill______Semester___Fall 2012______
Agency_HealthCare Access and Pediatric & Adolescent Medicine, P.A.
Instructor__Bobbe Mansfield______
Clinical performance is based on Universal Outcomes, End of Program Outcomes and National Organization of Nurse Practitioner Faculty Core Competenciesof Nurse Practitioner Practice (2011). Nurse Practitioners must demonstrate care that is effective, patient-centered, efficient, timely, and equitable for the treatment of health problems and promotion of wellness.
Universal Outcomes: Evaluating Behavior
Universal Outcomes must be met in order to pass the course. Failure to meet any of the three Universal Outcomes will result in a grade of F. If an F is earned, the Core Competencies will not be considered
Universal Outcomes
Demonstrates honesty and integrity by submitting original work MetNot met
on assignments and accepting responsibility for own actions
taken/omitted
Prioritizes patient safety as the primary consideration in all careMetNot met
Maintains professional boundaries with patients, family and MetNot met
staff. Maintains confidentiality at all times
Nurse Practitioner Core Competencies
Students must achieve an80% on the final clinical evaluation tool to be successful in the course. These outcomes are only evaluated if the three Universal Outcomes are met. Students who donot meet the competencies within the required practicum hours may be required to successfully complete additional hours before a final grade will be awarded. Points are assigned as follows:
Please rate your own performance using the descriptors listed below:
0 = no opportunity to experience
1 = defined as not meeting expectations; failing to initiate learning experiences; arriving late and unprepared; failure to effectively communicate with the patient, family, preceptor, staff and faculty
2 = defined as inconsistently meeting expectations; requires much faculty/preceptor guidance in learning experience/support
3 = defined as routinely meeting expectations yet requires more faculty/preceptor direction in learning experiences
4 = defined as routinely meeting expectations with minimal support from faculty/preceptor
5 = defined as consistently meeting expectations with little guidance; proficient; can perform independently; initiates learning experiences; is well prepared for learning experiences.
Competency Narrative
The overall goal of the Clinical Performance Tool (CPT) is to assess the student’s progress throughout the practicum using a narrative description of each competency. To provide a description of the total progress, the student is expected to maintain a cumulative narrative of their performance.
With each competency and each submission, the student is expected to assign themselves a score from 0-5 (It is not expected that a student will have many scores of 4 or 5 with the first submission). Within the narrative, students are expected to briefly address the following 4 items:.
A.What does this competency mean? What challenges/strengths related to mastery of this competency are present at this point in time?
B.Give 2-3 examples from this practicum experience that best illustrate how you are preforming the selected competency and which support the score you assigned yourself?
C.What do I need to gain additional skills to master this competency?
D.What references/clinical guidelines/point of care tools (if appropriate) have been helpful in achieving this competency?
Grading
The Clinical Performance Tool is completed and submitted by the student at the completion of 80 clinical hours, 160 clinical hours, and 225 for a total of three submissions. The first submission must address items 1-13. The second and final submission must address items 1-28. The final submission is graded.
NONPF competencies addressed in this course include Independent Practice, Leadership, Quality, Technology/Information Literacy, and Ethics. Competencies are founded on an understanding of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion, and disease prevention. Utilization of communication strategies, principles of quality care, information technology/literacy and ethical principles are expected. NP students are expected to demonstrate an investigatory and analytic thinking approach to clinical situations, professional behavior, effective communication, and a sensitivity and responsiveness to patient culture, age, gender, sexual orientation and ability.
NP students are expected to:
Red and * represents first submission reflections at 80 clinical hours (9/21/2012)
Purple and * represents second submission reflections at 160 clinical hours (10/24/12)
Green and * represents third and final submission reflections at 225 hours (11/26/12)
0 1 2 3 4 5
1.Develop individualized health promotion, disease □ □ □ □xX X
prevention and health protection services for patients
across the life span
I assess each patient to determine specific needs regarding health promotion, disease prevention, and health protection services. For example, every day at home, at work and in my clinical settings, I promote hand-washing as one of the best ways to prevent illness. I promote this by demonstration and encouraging those who are healthy or ill and their families to cover their cough with their arm and to wash hands to prevent the spread of illness. Additionally, I regularly have the opportunity to educate patients with UTI’s on ways to prevent UTI’s in the future, including: wiping front to back, good hand-washing, urinating before and after intercourse (when age appropriate), drinking plenty of fluids, and urinating often to prevent urinary stasis.I have seen at least10 patients with dx of UTI (ICD 9- 599.0) and regardless of age, I give them the same educational information on ways to prevent UTI’s. This education occurs naturally regardless of the setting, and is true for all patients across the lifespan. I believe I have demonstrated this outcome effectively and will continue to do so. Another example includes discussing with patients current recommendations of colonoscopies every 10 years starting at age 50.
In addition, I continue to assesspatients to determine age specific evidence based screenings that are needed, including mammograms. According to the American Cancer Society (ACS, 2012), yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health, a clinical breast exam (CBE) should be done about every 3 years for women in their 20s and 30s and every year for women 40 and over. Also, women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is also discussed for women starting in their 20s. This educational information is shared with each patient, as appropriate.
The pediatric office also has a weight management clinic. At risk pediatric patients are screened using BMI and other risk factors as indicators. They see the NP or MD and a nutritionist regularly, and child psychiatrist as well, if needed. We monitor not only their BMI, but their lipids and nutrition and activity levels and meet with them regularly. I recently had an 8 y.o. male pt with a BMI that was off the chart for his age and weight. It’s often tough to talk with kids in this age range and their parents about eating habits and exercise without discouraging the patient. Our first step wasto obtain labs and set up a meeting with the onsite nutritionist and hope that the patient keeps his appointments.
I feel fairly well versed in evidence based screenings without having to rely heavily on reference materials, although in the pediatric setting, there are so many developmental changes to assess for at each well-child visit that it is difficult to remember everything. The computerized documentation systems used today in many settings allows for reminders of what to ask and when. For example, I saw a patient for their 1 year old check-up; many developmental questions were prompted during the initial check in time with the nurse because the EMAR template asks age-specific questions/details. My job is to verify those answers and do the PE.Templates provided via EMARs are great additions to the PE! Both the pediatric office and HealthCare Access utilize EMAR, and although they are different systems, they are each useful and support the PE well.
This time of year both clinics are pushing influenza vaccines. Every patient is asked to get a flu vaccine when they come in to HCA, regardless of the reason for their visit. At the peds office, there are daily flu vaccine clinics, where a patient/parent can call and sign up for a time to come in, and those patients who present for other appointments are asked if they would like the vaccine while they are there. I have seen good promotion of the vaccine at my clinical sites. I plan to continue to promote vaccines, contraception management and other screenings when appropriate. I also try to mention key points such as smoking cessation when appropriate.
I plan to continue to expand my knowledge of health promotion and disease prevention and health protection services for patients across the life span. This will likely develop further by seeing increasingly complex patients and being challenged to expand my skills.
10/24/12- Since my last submission I have continued to provide age appropriate health promotion, disease prevention, and health protection services based upon needs that are identified on an individualized basis with each visit. Such needs are identified by presenting patient risk factors, age, gender, history, and life style. The strengths related to mastery of this competency present at this point in time include the diversity of the population served at current clinical sites, including taking care of individuals across the lifespan with working in the pediatric office to working with individuals until age 65 at HealthCare Access, when patients become eligible for Medicare. In the pediatric setting, this includes individuals from birth to age 26, with all forms of insurance, including state health plans and Medicaid. At HealthCare Access, this includes patients without insurance coverage. Patients of all ages are seen with multiple risk factors, including family history of health problems, to having difficulty with financial, social, economic and cultural risk factors. The challenge in these populations is not seeing individuals over age 65. Other than those individuals over age 65, this clinical rotation has allowed me opportunities to master this competency.
I continue to improve in this area on a daily basis. I continue to promote disease prevention by proper hand washing each time I enter the patient’s room and before I leave. According the CDC website (2012), “Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others.” One way to encourage patients to have good and frequent hand washing is by properly demonstrating good hand hygiene, which I do regularly and will continue to do throughout my career. Patients who see their providers wash their hands, either with approved hand sanitizers, or a soap and water technique, are more likely to wash their hands as well to prevent the spread of germs. Continuing to promote the influenza vaccination remains important during this clinical rotation.These late fall months are the most common months for patients to receive influenza vaccines. According to the CDC website (2012), a yearly flu vaccine is recommended as the first and most important step in protecting against flu viruses and while there are many different flu viruses, the flu vaccine protects against the three viruses that research suggests will be most common. I continue to promote the influenza vaccine to my all my patients over 6 months of age, when appropriate, and will continue this practice as I continue my career. At HealthCare Access, we encourage all patients to obtain an influenza vaccine and provide vouchers to each patient so they may receive their vaccine at no cost at the Douglas County Health Department. At the pediatrics office, we continue to offer flu vaccine clinic times on a daily basis, and if a patient is seen in the clinic for another reason (i.e. “sick clinic”, or “well-child exam”), if they do not have a fever, then we offer them the vaccine at that time. We also offer the vaccine to other pediatric family members who may be present at the time of that visit as well. Basically, we do not turn away patients who want a flu vaccine – we also offer the flu vaccine in a flumist form as well, for those patients who meet the requirements of receiving the flumist. I also continue to ensure pediatric patients are up to date on their immunizations. I also attempt to encourage patients be up to date on their Tdap booster. According to the CDC website, “As of October 18, 2012, more than 32,000 cases (of pertussis) have been reported across the US, including 16 deaths. The majority of deaths continue to occur among infants younger than 3 months of age.”(CDC, 2012).As of September 20, 2012, Kansas, at 17.2/100,000 persons, is among the states with incidence of pertussis the same or higher than the national incidence, which is 9.3/100,000 persons (CDC, 2012).
I continue to discuss with patients current recommendations of colonoscopies every 10 years starting at age 50, and yearly mammograms starting at age 40 and continuing for as long as a woman is in good health, and a CBE every 3 years for women in their 20s and 30s and every year for women 40 and over.
Patients who present to HCA with HTN, whether they are at their initial or a follow-up visit, are common. According to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), HTN diagnosis is based on the average of two or more properly measured, seated BP readings on each of two or more office visits ( Icontinue to educate new and established patients on facts about HTN, including that, according to the AHA website (2012) “most of the time there are no symptoms, but when high blood pressure goes untreated, it damages arteries and vital organs throughout the body. That's why high blood pressure is often called the "silent killer."
I plan to continue to promote vaccines, contraception management and other screenings when appropriate. I plan to continue to expand my knowledge of health promotion and disease prevention and health protection services for patients across the life span. I will continue to seek opportunities to see increasingly complex patients that will challenge me and expand my skills.
11/26/12- Since my last submission, as previously stated, I have continued to provide age appropriate health promotion, disease prevention, and health protection services based upon needs that are identified on an individualized basis with each visit. Such needs are identified by presenting patient risk factors, age, gender, history, and life style. Other than those individuals over age 65, I continue to feel that this clinical rotation has allowed me opportunities to master this competency. I have been flexible and creative in developing individualized services, and have followed sound recommendations with the goals of protecting and promoting health and preventing disease. My preceptor has given me progressively more independence in this process, as I have gained confidence, gotten to know patients, and have progressed through this final clinical experience. I continue to counsel patients who present for WWE on the importance of mammograms when age and risk factor appropriate, and something I’ve done more of is promote immunological fecal occult blood test (iFOBT) screening for colorectal cancer in patients over 50. This is a screening that I feel many patients are unaware of so it was a good educational opportunity. I also had a patient whom I educated on the influenza vaccine. All patients at HCA are asked about receiving the influenza vaccine, and if they are interested, we give them a voucher so they can get it free of charge at the Douglas County health department. I had a gentleman who had stated that he didn’t want to get the flu vaccine because “we have all already had that this year”, meaning “the flu”. I was pretty sure they didn’t have “influenza” based on the timing, and it turned out his family members had probably had gastroenteritis. I educated the patient on “influenza”, and he ended up getting the flu vaccine that day! Another life saved!
Since my last submission I have had many opportunities to practice more independently and feel I am ready to practice my skills in a family practice setting. As always, additional opportunities increase confidence and continued development of skills. I plan to stay abreast of current recommendations for health promotion/protection services and disease prevention strategies as defined by reputable sources such as AHRQ, CDC, ACS, and ACOG, as mentioned above. Others include National Center for Chronic Disease Prevention and Health Promotion, KanQuit, Ferri's Clinical Advisor 2012 and more.
2. Develop individualized anticipatory guidance and □ □ □ □ X X
health counseling for patients across the life span
Each patient at HCA is given a wellness questionnaire on arrival and it is reviewed with the patient at that visit. HCA is fortunate enough to have a counselor on staff to meet with patients almost immediately as they need or desire it. This questionnaire also prompts discussions about exercise, health, wellness and depression. Clients are also able to meet with a wellness counselor quickly as well, who is also on staff at HCA. It’s crucial in this setting to anticipate what the client needs, as they may not come back for a while, if ever, thus the ability to have social workers and wellness counselors on site is highly beneficial.