Nursing Division

COURSE PREFIX & NUMBER: NUR 206

Clinical Skills Application

CLINICAL SCHEDULE: VARIES

LEAD INSTRUCTOR: Beverly C. Bradley

Office: HSc Building 630, Room 202-A

Office Telephone: 574-6401

E-mail: beverly.bradley@tridenttech.edu

Fax: 574-6545

OFFICE HOURS: Office hours vary daily.

Students are requested to call for an appointment.

SUMMER 2003

www.tridenttech.edu/nursing

TABLE OF CONTENTS

Signature Sheet.................................................................................................................................. ii

Text Books....................................................................................................................................... 1

Clinical Objectives............................................................................................................................. 1

Grading System................................................................................................................................. 2

Guidelines for Journaling.................................................................................................................... 5

Format for Journal............................................................................................................................. 7

Time Line........................................................................................................................................ 10

Clinical Evaluation Tool.................................................................................................................... 11

SIGN AND RETURN TO INSTRUCTOR

BY END OF FIRST WEEK OF CLASSES

STUDENT SIGNATURE SHEET

I have reviewed the syllabus for Clinical Skills Application (NUR 206) in its entirety.

I understand that I am accountable for all of the information in the syllabus and

am responsible for clarifying any areas that I do not understand.

I have been given the opportunity to clarify any questions that I have.

Print Name:

Student's Signature:

Social Security #:

Date:

COURSE SYLLABUS

COURSE TITLE:	Clinical Skills Application	PREFIX & NUMBER:	NUR 206
LECTURE HOURS:	0	LAB HOURS:	6 (10 weeks); 12 (5 weeks)
CONTACT HOURS:	90	CREDIT HOURS:	2

CATALOG DESCRIPTION:

This course involves the application of nursing knowledge, skills and abilities in the clinical setting.

Prerequisites: Basic Nursing Skills (NUR 102), Nursing Care Management I (NUR 104).

Pre or Corequisites: Anatomy and Physiology II (BIO 211), Growth and Development
(PSY 203)

TEXTBOOKS:

Harkreader, H. (2000). Fundamentals of Nursing: Caring and clinical judgment. Philadelphia: W.B. Sanders.

LeMone, P., & Burke, K. (2000). Medical surgical nursing (2nd ed.). Menlo Park, CA: Addison-Wesley Nursing.

McKinney, E.S., Ashwill, J.W., Murray, S.S., James, S.R., Gorrie, T.M., & Proske, S.C. (2000). Maternal-child nursing. Philadelphia: W. B. Sanders.

Riley, J. (2000). Communication in nursing (4th ed.). St. Louis: Mosby.

South Carolina State Board of Nursing. (1999). Laws governing nursing in South Carolina.

Student Nurse’s Handbook/Course Materials (2002-2003). Trident Technical College, Nursing Division.

CLINICAL OBJECTIVES:

Upon completion of this course the student will:

1) Demonstrate competence in psychomotor skills.

2) Using the nursing process, manage care for a group of patients.

3) Establish caring communications and relationships (relationship centered skills) with patients (individuals), families, significant support person(s) and other health care workers.

4) Practice within the ethical, legal and regulatory frameworks of nursing standards of nursing practice.

5) Use critical thinking skills to conceptualize and apply information in the clinical setting.

6) Experience current nursing practice on a clinical unit in an acute care setting.

7) Participate in activities that promote life long learning.

JOURNALING

Students must complete ongoing Journals summarizing the clinical experience. Journals must be submitted to the instructor when 45 hours of the clinical experience is completed and when 90 hours of the clinical experience is completed. Journals will be graded as satisfactory complete (SC) or unsatisfactory (U). See Guidelines for Journaling. Journals will be graded and returned to students within one week (5 work days) following submission of the Journal.

The student must review the Clinical Evaluation Tool and meet with the instructor by day three (3) of the clinical experience to discuss the instructor’s performance expectations. The student must also provide the instructor a copy of his/her personal objectives and request the assistance of the instructor in meeting these objectives. Personal objectives should focus on strengths and areas of improvement identified by previous clinical instructors. A copy of these personal objectives, signed by the student, must accompany the journal.

Upon completion of 45 hours of clinical experience, the student must request a meeting with the instructor and discuss his/her progress toward meeting performance evaluation expectations and his/her personal objectives. The student will also discuss plans for improving or strengthening clinical performance. A summary of this conference will be required in the Journal.

CLINICAL EXPERIENCES:

Clinical experiences are designed to simulate actual clinical practice in an acute care setting. Assignments will be equivalent to assignments for unlicensed personnel on the assigned unit. The instructor will post assignments, lunches and breaks prior to the beginning of the shift. Students are expected to dress professionally at all times.

· talks with the nurse in charge of his/her patients to discuss plans for patient care for the day.

· makes rounds on all assigned patients to be sure the patients’ urgent needs are met.

· talks with the instructor, who will serve as a resource for immediate questions and assess the student’s preparedness to complete the patient assignment.

· looks up any information about the patient with which he/she is not familiar.

· reports changes or important patient information to the nurse assigned to the patients.

· accompanies patient(s) to off-unit activities (operating room) when possible and if the activity has never been observed by the student.

· arranges for patients to be covered by another student nurse if off the unit for any reason, including lunch and breaks. Notifies the instructor if off the unit for any reason.

· answers questions posed by the instructor on disease process, treatments(s) and medications.

· gives report to the oncoming shift, including I & O, changes in patient status, etc.

· remains on the unit until the shift is completed and all patient care is accomplished.

There are no pre or post conferences. Conferences may, however, be called at the discretion of the instructor to discuss important issues. These conferences will be called during the shift and not exceed 30 minutes.

MEDICAL CONDITION STATEMENT:

For your safety, if you have a medical condition that results in seizures, blackouts, etc. (e.g., from epilepsy or diabetes), please inform your instructor. This information will be kept confidential. If you wish to seek accommodations due to a disability, please contact Services for Students with Disabilities, Building 410, Room 210.

The College will make reasonable accommodations for persons with documented disabilities. Students should notify the Counselor for Students with Disabilities (located in Counseling and Career Development, Building 410, Room 210) and their instructors of any special needs. Instructors should be notified on the first day of classes.

Students may not carry activated personal electronic devices while in the work setting.

FACULTY AVAILABILITY:

The instructor will provide his/her telephone number, e-mail address and the nursing division’s telephone number to the student and to the nurse manager.

Purpose: This assignment is designed to stimulate critical thinking and exploration of knowledge presented in previous courses.

1. Made following completion of each 18 hours of work for a total of four (4) entries.

2. Inclusive of a summary of the conference held with the instructor to discuss the performance appraisal and personal objectives and a summary of the conference with the nursing instructor following 40-45 hours of work.

5. Submitted to the instructor within 48 hours following completion of 40-45 hours of work. May be submitted in person or e-mailed to the instructor.

6. Submitted to the instructor within 48 hours following completion of the second 40-45 hours of work (at the conclusion of 80-90 hours of work).

To be graded as Satisfactory Complete (SC), Journals must meet all of these guidelines. Journals submitted which do not adhere to all of these guidelines will receive an Unsatisfactory. An Unsatisfactory rating on the Journal will result in an Unsatisfactory rating for the course.

For each course objective, answer all of the questions related to the objective. Journal entries must address all course objectives.

A. What psychomotor (technical) skills did you perform during the last 18 hours of work?

B. Did you improve your technical competence in any of the skills? Which one (s)? How do you know you improved your technical competency?

C. What references (sources) did you use to ensure that you were performing your psychomotor (technical) skills competently?

Course Objective 2: Using the nursing process, manage care for a group of patients.

A. How many patients did you care for each time you worked during the last 18 hours worked? Describe their level of care.

B. What did you do to ensure that you provided excellent patient care? How do you know you provided excellent nursing care?

D. What changes will you make in your organization to achieve increased efficiency in your work while maintaining excellence in patient care.

Course Objective 3: Establish caring communications and relationships (relationship centered skills) with patients (individuals), families, significant support person(s) and other health care workers.

A. Describe a caring moment that you created for a patient, family member, significant support person or other health care worker during the last 18 hours worked. Throughout your Journal, be sure to focus on each of these relationships at least one (1) time.

B. Describe the feelings your experienced as you were creating this caring moment. How did you experience and perceive the feelings of the individual receiving the caring moment?

Course Objective 4: Practice within the ethical, legal and regulatory frameworks of nursing standards and nursing practice.

A. Choose one situation that you experienced during the last 18 hours of work and explain how your values and beliefs influenced your actions. In what way was the ANA Code of Ethics helpful to you?

B. Describe one situation with legal implications that you experienced during the last 18 hours of work. Throughout your Journal, include specific reference to the Nurse Practice Act at least three (3) times.

Course Objective 5: Use critical thinking skills to conceptualize and apply information in the clinical setting.

A. In what way did the theories you learned in psychology (including lifespan), anatomy and physiology and English composition influence the nursing care you provided during the last 18 hours you worked?

B. How did your knowledge about a patient’s pathophysiology, medications, and treatment of a medical condition influence your decisions about nursing care during the last 18 hours of work?

Course Objective 6: Experience current nursing practice on a clinical unit in an acute care setting.

A. Choose an experience that you had during the last 18 hours of work. Given a similar situation in the future, what would you do differently? Why?

B. Describe an observation of teamwork on the nursing unit where you are assigned. What worked well? What worked poorly? What would you have changed to improve the teamwork?

Course Objective 7: Participate in activities that promote lifelong learning.

A. Which of your personal objectives did you meet during the last 18 hours of work? Explain how you accomplished these objectives.

B. Describe an event that occurred during your last 18 hours of work that raised a question, posed a problem and/or caused you to think about it after it occurred. What was it about the event that made it stand out in your mind? What was your resolution?

Adapted from: Bratt, M.M. (1998). Reflective journaling: Fostering learning in clinical experiences. Deans Note’s,20 (2), 1-2. November 1998.

Dates Worked: Shift: Student’s Name:

For each course objective, answer all of the questions related to the objective. Journal entries must address all course objectives.

Course Objective 2: Using the nursing process, manage care for a group of patients.

Course Objective 3: Establish caring communications and relationships (relationship centered skills) with patients (individuals), families, significant support person(s) and other health care workers.

B. Describe the feelings your experienced as you were creating this caring moment. How did you experience and perceive the feelings of the individual receiving the caring moment?

Course Objective 4: Practice within the ethical, legal and regulatory frameworks of nursing standards and nursing practice.

Course Objective 5: Use critical thinking skills to conceptualize and apply information in the clinical setting.

Course Objective 6: Experience current nursing practice on a clinical unit in an acute care setting.

Course Objective 7: Participate in activities that promote lifelong learning.

Adapted from: Bratt, M.M. (1998). Reflective journaling: Fostering learning in clinical experiences. Deans Note’s,20 (2), 1-2. November 1998.

BEFORE COURSE BEGINS

· Review the NUR 206 Syllabus and Clinical Evaluation Tool.

· Begin thinking about personal objectives you would like to accomplish.

BY THE END OF THE SECOND CLINICAL DAY

· Meet with the instructor to discuss personal objectives and performance appraisal (Clinical Evaluation Tool).

· Enter a summary of this conference in the Journal and attach a copy of your personal objectives.

· Make Journal entry I addressing all course objectives.

FOLLOWING 36 HOURS OF WORK

· Make Journal entry II addressing all course objectives.

BY THE END OF THE FIFTY CLINICAL DAY

· Meet with the instructor to discuss progress toward meeting performance evaluation and personal objectives.

· Summarize this conference in the Journal.

FOLLOWING 54 HOURS OF WORK

· Make Journal entry III addressing all course objectives.

FOLLOWING 72 HOURS OF WORK

· Make Journal entry IV addressing all course objectives and submit entire journal to instructor within 48 hours.

FOLLOWING 81 HOURS OF WORK

· Submit to the instructor a complete self-evaluation using the NUR 206 clinical Evaluation Tool.

FOLLOWING 90 HOURS OF WORK

· Meet with the instructor to discuss strengths and areas for improvement in clinical performance.

Clinical Evaluation Tool

NUR 206

Clinical Skills Application

An “S “(Satisfactory) rating indicates that the student’s clinical performance consistently meets expectations.

An “NI” (Needs Improvement) rating indicates that the student’s clinical performance does not meet expectations.

An “*” (Asterisks) indicates that the criterion is critical and must be rated “S” in order to receive an overall satisfactory clinical rating.

There are 49 criteria on this Clinical Evaluation Tool. In order to achieve an overall “S” rating, clinical performance on 46 (95%) of the criteria must be evaluated as “S”. If this percentage is not achieved, the overall rating will be “NI”. Additionally, clinical performance in all critical criteria must be rated as “S”. A rating of less than “S” in a critical criterion will result in an overall rating of “NI”.

An overall rating of “NI” on clinical performance constitutes a grade of “F” in the course regardless of the other grades.

	S	NI
2. Expresses a caring and empathetic connection with patients/families/significant support person(s) in order to provide compassionate and sensitive care. Example(s) of caring behaviors:
3. Maintains dignity of the patient/family/significant support person(s).
4. Participates as a team player, demonstrating caring behaviors toward peers and other members of the health care team. Example(s) of caring behaviors:

Health

	S	NI
5. Teaches basic health promotion and maintenance to a patient/family/significant support person(s) from a designated teaching plan. Example(s) of patient teaching:
6. Relates theoretical concepts to clinical practice and explains rationale for nursing interventions to instructor. Example(s) of diagnoses of patients cared for: Example(s) of concepts discussed:
7. Provides nursing care with consideration of psychosocial, cultural and spiritual determinants of health. Identify culture(s) or religious preference(s):

Critical Thinking

	S	NI
8. Verbalizes to instructor the classification, drug action, usual dosage, side effects, purpose and nursing implications for all medications prescribed.
9. Applies problem-solving skills when implementing the plan of care.
10. Uses feedback from instructor to develop and implement a plan to meet self-learning needs. See attached list of strengths/weakness and plan for improvement.
11. *Completes written clinical assignments as specified in the syllabus. Specify assignments and grades:

	S	NI
12. Listens attentively to speaker, making clear and relevant comments, and maintaining good eye contact.
13. Maintains appropriate professional boundaries in the nurse-patient/family/significant support person(s) relationship.
14. Provides appropriate explanation(s) to patients/families/significant support person(s) prior to procedures and nursing interventions.
15. Establishes an environment conducive to therapeutic communication.
16. Identifies nonverbal communication in self and patients. Example(s):
17. Recognizes defense mechanisms used by patients and self. Example(s):
18. Recognizes and manages own emotions and anxiety effectively.

Individual, Family, Community

Legal, Ethical

	S	NI
20. Ensures direct RN supervision for all invasive procedures.
21. Observes and reports patient responses to nursing interventions to appropriate personnel.
22. Documents patient data, nursing interventions, patient responses and progress toward goals (outcomes) in accordance with agency policy.
23. Adheres to the nursing code of ethics, Patient Bill of Rights and agency/divisional policies.
24. Demonstrates accountability for own ethical behavior. Example(s) of ethical behavior(s):
25. Takes appropriate action when a breach of professional ethics occurs. Example(s):
26. Safeguards the rights of individual patients.
27. Commits no acts which are grounds for disciplinary action as set forth in 40-33-935 and R91-19-C of the South Carolina Nurse Practice Act.
28. Maintains confidentiality in accordance with agency and divisional policy.
29. Demonstrates accountability for nursing care given by self and/or delegated to others.
30. Practices within the parameters of individual knowledge and experience. And, seeks guidance/supervision/consultation when clinical problems fall outside current knowledge or scope of practice.
31. Prepares for clinical assignment.
32. Exercises promptness in meeting commitments and obligations. Number of clinical tardies: Number of times late to post-conference: Number of late clinical papers:
33. Exhibits a positive, professional image.

Legal, Ethical (Cont)

	S	NI
36. Follows standard precautions.
37. Provides a safe physical and psychosocial environment. And, follows verbal and written instructions.
38. Applies principles of medical asepsis.
39. Applies principles of surgical asepsis. Example(s) of use of surgical asepsis:
40. Uses proper body mechanics.
41. Performs nursing skills competently. List skills performed:
42. Adheres to agency policies when performing skills.
43. Demonstrates competence with current technologies. Identify technologies used:
44. Assists in collecting patient data using information from the chart, care plan, hospital staff, observation, patient/family/significant support person(s) interview, and a standard protocol tool.
45. Implements nursing interventions designed by the RN to meet desired patient goals (outcomes).
46. Prioritizes nursing interventions when implementing the plan of care.

	S	NI
47. Contributes to the nursing care plan.
48. Organizes time to complete assignments for groups of patients within the allotted time. Number of patients assigned:
49. Suggests ideas to decrease patient costs. Example(s) suggested by student:

Loquist, R.S., & Bellack, J.P. (1999). A model for differentiated entry level nursing practice by educational program type. Journal of Nursing Education, 38 (7), 301-303.

National League for Nursing. (2000) . Educational competencies for graduates of associate degree programs. Sudbury, Massachusetts: Jones and Barlett.

	S	NI
1. Applies Erikson’s Stages of Development when providing care for groups of adult patients in acute care settings.