academic unit: school of nursing nur 345, nur 345l

1

Academic Unit: School of Nursing Course Prefix: NUR 347L Course Title: Adult Health and Illness II Practicum Term Offered: Fall and Spring Credit Hours/Clock Hours: 4 credits (180 clinical hours) Course Prerequisite: NUR 345, NUR 345L

Co-requisites: NUR 347, NUR 349, NUR 349L Mode of Instruction: In-person Practicum Instructor Name: Instructor Contact Information: Instructor Availability: Course Description: This course continues the focus on nursing care of adults experiencing health-illness transitions. Course Purpose: Adult Health & Illness II Practicum continues the focus of the adult health clinical experience. The course challenges the student’s critical reasoning skills while caring for the critically ill patient. This is a required course, taken during the third semester in the nursing program. Skills and knowledge are brought forward and built upon from previous courses.

2

Course Student Learning Outcomes:

NUR 347L Course Outcomes

Clinical Practice and Prevention • Applies sound nursing judgment to clinical situations using standards of care, critical thinking, clinical

reasoning, research evidence, and prioritization and delegation skills. • Applies an expanding range of knowledge to promote health and well-being and prevent

complications in adults experiencing illness and disease. • Applies the nursing process to increasingly complex patient learning needs.

Communication • Demonstrates professional and therapeutic communication skills in all learning situations.

Critical Reasoning • Utilizes nursing knowledge, information technologies and research evidence to construct and

implement safe, effective, patient-centered nursing care.

Leadership • Applies principles of collaboration, delegation, and advocacy to manage safe patient care.

Professionalism and Professional Values • Demonstrates professionalism in all clinical situations. • Applies professional values and their associated behaviors to the practice of nursing. • Applies ethical and legal principles and professional standards to nursing practice. • Applies caring’s affective characteristics into patient-centered care and with other healthcare

professionals.

Global Health • Collaborates with patients and families to identify mutually agreed upon goals and health care

outcomes four culturally reinforcing care. • Identifies how nurses and institutions can impact environmental health and sustainability in diverse

health care settings.

Clinical Description

1. Focus is on nursing care to promote healthy transitions for individuals and families with health conditions in acute care settings. Emphasis is on continued development of critical thinking, clinical judgment, skills and time management concepts.

2. In addition to caring for patients in an acute care setting, you will be required to complete a variety of written activities and exercises to demonstrate that you are able to apply your knowledge.

3. Over the course of the semester, you will complete approximately 180 clinical hours. Your clinical time will be spent in the skills lab, at an acute care facility, mandatory laboratory hours, and completing simulated clinical experiences with SIM-MAN. You will be expected to review some skills on-line and in your books as part of your homework for this course.

3

4. You will be expected to complete two self-evaluations of your performance this semester. These forms will be provided to you in advance of the due date.

5. You will need to bring your skills checklist to all clinical experiences so that your clinical instructor can sign you off for each skill performed during your clinical experience and monitor any skill needs that you may have.

6. New nursing skills that are introduced in NUR 347L: central venous access devices and advanced intravenous medication administration, epidural and patient controlled analgesia, blood administration, heparin drip algorithm and administration, advanced respiratory care, nasogastric tubes, and advanced cardiac care and monitoring.

Clinical Approach

This clinical practicum provides the opportunities to develop skills, and to practice the integration of theory content, skills, critical reasoning in simulated and actual patient care activities. With laboratory, simulation, and clinical learning, nursing practice is fostered with the mentorship and guidance of faculty members and other professional nurses. While the faculty will provide guidance and consultation, the student is responsible for identification of learning needs, self-direction, seeking consultation and demonstration of clinical objectives. The clinical experience in this course will be completed at hospitals in Arizona. NURSING SUPPLIES: As part of being prepared for clinical, students must bring NAU name tag, hospital name tag, a pair of bandage scissors, a pair of hemostats, a stethoscope, a black pen, a penlight, a watch with a second hand and EKG calipers. The calipers can be purchased at the NAU bookstore. CLINICAL PRACTICUM Attendance, safe and professional clinical performance with a demonstration of critical thinking skills as

both demonstrated in safe and efficient care and in your nursing care plans. CLINICAL HOURS

1. At least 180 clinical hours. 2. All clinical, lab, simulation, prep work, and clinical site training requirements must be completed

in order to complete the minimal number of required clinical hours. 3. NUR 347L Clinical is 10 hours on assigned day with any exceptions noted in the Lab and

Simulation Schedule. 4. Students are expected to attend all assigned lab and simulation experiences outlined in the Lab

and Simulation Schedule. 5. Students are expected to complete any additional experiences as assigned.

SIMULATION Attendance and participation during the lab: See schedule at end of syllabus. ASSIGNMENTS

1. Assignment due dates are printed on the clinical schedule or will be directed by the clinical faculty.

2. Late assignments will not be accepted unless prior arrangements have been made with the faculty. All assignments are to be completed by each student individually without the help of others unless specifically identified as a group project. Assignments include written paperwork,

4

the math exam, the portfolio, the evidence based practice project, simulation preparation and any other assignments.

3. All clinical written assignments must be satisfactorily completed to receive a passing grade in nursing 347L; the best two scores of complete care plans will be recorded.

4. It is expected that students will complete clinical paperwork weekly unless otherwise notified by their faculty. Faculty will direct you regarding due dates and times.

Student Clinical Portfolio: Maintaining and updating your Student Clinical Portfolio is a clinical requirement beginning in NUR 225, continues in NUR 347 and will continue each semester throughout the Nursing Program. Your portfolio will be reviewed at the beginning and end of the semester. The end of semester review is what will be evaluated for your course grade; everything must be included and up to date to receive the points. The portfolio is due with your final self-clinical evaluation. Students with incomplete portfolios will receive zero points. Math Exam: The first attempt for the math exam will be given the first day of clinical. A score of 90% or greater in two (2) attempts is passing. Failure to pass the exam with 90% on the first attempt will result in structured remediation. If the exam is not passed after two (2) attempts, the student is not permitted to pass medications in the course and, therefore, unable to achieve the ability to score “3” or higher on the clinical competence and/or the critical thinking strand of the clinical evaluation. This will result in failure of NUR 347L. Evidenced Based Practice Project: See details on page 19. Report Sheet & Journal Entries: A patient report sheet and journal must be completed each week. Clinical faculty may require additional paperwork at his or her discretion. Simulation Preparation: Preparation for all simulation scenarios is expected and is due immediately following the simulation scenario. You will be provided with preparation responsibilities based on your role for the specific scenario. Grading consists of preparation, participation in the scenario, participation in debriefing, and all documentation (narrative notes, MARs, care plans, etc.). Students may also be required to complete an incident report. See the simulation rubric.

Other Assignments: Students are required to complete any additional assignments as designated by their clinical faculty, including computer training and computer based trainings. Failure to do so will result in paperwork not being accepted. In addition, students may be awarded scores lower than three (3) on the clinical practice and prevention, communication, critical reasoning, and professionalism and professional values sections of the clinical evaluation form and, therefore, will not pass clinical. Finally, clinical and agency evaluations are expected to be completed at the end of the semester. Your professional, constructive feedback is appreciated. NOTE: PLEASE BRING YOUR SKILLS CHECKLIST TO CLINICAL AND SKILLS LAB EACH WEEK TO HAVE SKILLS SIGNED OFF

Grading System

Evaluation Tool Points Clinical portfolio 5 Math exam (90% required in order to pass meds & continue in clinical course)

5

Care plans (complete 3 and best 2 scores recorded, 25 points each) Concept Map TBD

50

EBP Day Poster Presentation 10 Skills Check Off (Must pass in order to attend clinical rotation in hospital)

10

Evidence Based Practice 10 Overall Professionalism 10 Total 100

Grading System

Grades will be calculated from the assessments above, and grades posted according to the standard School of Nursing grading scale:

A = 93-100 points B = 84-92 points C = 78-83 points F = below 78 points

Clinical Hour Break Down: Skills Lab: 20 hours Skills Videos: 4 hours (pre skills lab assignments) Simulation: 32 hours (pre/post assignments, and sim hours) Hospital Hours: 120 hours Computer training: 4 hours 180 hours

Evaluation Methods In order to pass NUR 347L, the student must achieve the following:

1. An overall course grade of 78% or higher. 2. A final evaluation score of three (3) or higher in all elements of the Clinical Evaluation tool; students who

do not achieve a three (3) in all elements of the Clinical Evaluation will receive an F for the course regardless of course points achieved.

3. Satisfactory completion of a math exam with at least 90%; students who do not achieve 90% on the math exam cannot pass medications and will be unable to receive three (3) on the Clinical Evaluation Tool. Students will be given a second opportunity to take the math exam if they are not successful at the first attempt. Students must complete Kaplan remediation prior to taking the second exam; (Kaplan Basic Math A and Kaplan Level II Math A). Students that take the second math exam must score above 90% to pass and will earn half the assigned course points.

4. Completion of all required clinical requirements, including, but not limited to, clinical hours, patient education brochure, care plans, skills check offs, simulation experiences, clinical portfolio, the math exam and additional assignments required by clinical faculty.

5. Satisfactory demonstration of selected skills in laboratory, simulation, and clinical experiences. 6. All students will complete a skills check at the beginning of the semester. Students must pass the skills

check off prior to starting the hospital rotation. Students who do not pass the skills check off on the first attempt will be required to attend remediation and repeat the failed skills. Students will receive half of the assigned points on the skills check off if required to complete remediation. Students who do not pass the second skills check off will not receive “3” or higher on the Clinical Evaluation Grid and, therefore, fail NUR 345L

Various activities will be used to assess student learning and mastery of content across the semester. These include simulations, clinical experiences, care plans, an evidence based practice project, clinical portfolio, skills check offs, and other assignments from clinical faculty.

REQUIRED BOOKS AND MATERIALS: Past laboratory books and videos from Fundamentals and NUR 345 including drug book and lab and diagnostic book. Lewis, S.L., Dirksen, S.R., Heitkemper, M.M & Bucher, L. (2017). Medical-Surgical Nursing:

Assessment and Management of Clinical of Clinical Problems (10th ed.). Mosby/Elsevier. ISBN: 9780323065801

Potter, P. A., Perry, A.G., Stockert, P.A. & Hall, A.M. (2013). Fundamentals of nursing (9th ed.). St. Louis:

Mosby/Elsevier. RECOMMENDED TEXTBOOKS: **YOU MAY USE ANY NURSING DRUG OR LABORATORY/DIAGNOSTIC RESULTS BOOK AS LONG AS IT IS NOT OVER TWO YEARS OLD

Skills and Simulation Schedule:

January 17, 2018 NAU Lab 0900-1300

Introduction to 347L. New Skills: Ventilators, Chest Tubes, Oral Airways, Arterial Lines Readings: Lewis: Ch 65 Videos: Chest tube care

January 22, 2018 NAU Lab 0900-1400

New Skills: Trach Care & Suctioning Review skills: Foley cath placement, NG placement and IV placement. Medication administration: PO, IM, IV, SQ, NG. Central Lines Videos: Suctioning (all videos), Tracheostomy Care REVIEW: Medication (all videos), Catheterization (all videos), NG (all videos)

January 24, 2018 NAU Lab 0900-1600

*Sign up for group and test time required Skills Check off

Simulation NAU Lab TBA

Simulation: Respiratory


Simulation: Cardiac


Simulation: Neuro

EBP Poster Day TBA

Mandatory All Day Attendance

Clinical Schedule:

January 29, 2018

• MATH EXAM • Goals for Clinical Experiences due • EBP Assignment groups and topic due • Portfolio Due-initial review • Computer training 1pm-3pm Tankersly Lab

February 5, 2018 • Weekly journal February 12, 2018

(weekly journal)

February 19, 2018

(weekly journal)

February 26, 2018

(weekly journal) • Care Plan #1 due

March 5, 2018 (weekly journal)

March 12, 2018 (weekly journal) • Student Midterm SELF-evaluations due • EBP paper due

March 26, 2018

(weekly journal) • Midterm Evaluations

April 2, 2018 (weekly journal) • Care Plan #2 due

April 9, 2018

(weekly journal)

April 16, 2018

(weekly journal)

April 23, 2018

(weekly journal) • Care Plan #3 due • Student Final SELF-evaluations due

April 30, 2018 (Weekly journal) • Portfolios due • Goals for Clinical Experiences-Evaluation section due • Final Evaluations

TBA • Campus EBP Poster Presentation TBD

Course Expectations

NURSING CARE We are looking for growth throughout the semester. The nursing care you provide to your assigned patient(s) will be evaluated each week in view of the course objectives relating to competency, critical thinking, communication, culture, caring, health, environment, learning-teaching, and professionalism. Your assessment, planning, implementation, and evaluation of nursing care (the nursing process) will be self-evaluated and faculty-evaluated each week. If your nursing care is not satisfactory, the clinical instructor will advise you. Strategies for improvement of your nursing care will be discussed. This means that if your instructor writes a comment in your clinical work/forms that suggests “add this” or “need to work on this” that we expect you to make the changes AND maintain that level of performance for the duration of the semester. If there is a need for improvement, a written contract may be implemented delineating the areas for improvement.

Failure to improve identified areas of concern by faculty can result in failure of the clinical component of NUR 347L. PROFESSIONALISM Professional behavior is expected in all aspects of NUR 347L. Professionalism includes behaviors addressed in the ANA Code of Ethics, the Arizona State Board of Nursing Unprofessional Conduct, Unfitness to Practice Nursing, Department of Nursing Undergraduate Student Handbook (current edition) and Northern Arizona University Student Handbook (current edition). Unsafe or unprofessional conduct will constitute failure of NUR 347L e.g. medication errors, failure to identify critical situations, physical or mental impairment, etc. Please note it is possible to fail NUR 347L at any point during the semester for unsafe or unprofessional conduct – even if only one incident has occurred. In addition, if the clinical faculty determines that you are unsafe in the clinical area, it will be at the discretion of the clinical instructor to send you home. If you are sent home, you will not be eligible to make up those hours and will be at risk for failing to meet course objectives and competencies at a “3” or greater. ANY breach in patient confidentiality will result in failure of the clinical portion of the course.

ADDITIONAL REQUIREMENTS FOR NUR 347L Required Documentation for the Clinical Agency: In keeping with the Department of Nursing policy and the clinical agencies' requirements, no student will be allowed to attend clinical experience until proof of current MMR or titer, CPR certification, liability coverage, TB skin test, Hepatitis B vaccine and health insurance are on file in the department office. Additionally, you may be required by State law to provide fingerprints to the clinical agency where we will be working. This will be discussed further in class but, if this is necessary, plan on incurring an additional expense for this. Failure to adhere to this requirement will result in your not being able to attend clinical and you will need to make up the missed time at the convenience of the instructor.

NORTHERN ARIZONA UNIVERSITY POLICY STATEMENTS

NAU’s Safe Working and Learning Environment Policy prohibits sexual harassment and assault, and discrimination and harassment on the basis of sex, race, color, age, national origin, religion, sexual orientation, gender identity, disability, or veteran status by anyone at this university. Retaliation of any kind as a result of making a complaint under the policy or participating in an investigation is also prohibited. The Director of the Office of Affirmative Action & Equal Opportunity (AA/EO) serves as the university’s compliance officer for affirmative action, civil rights, and Title IX, and is the ADA/504 Coordinator. AA/EO also assists with religious accommodations. You may obtain a copy of this policy from the college dean’s office or from the NAU’s Affirmative Action website nau.edu/diversity/. If you have questions or concerns about this policy, it is important that you contact the departmental chair, dean’s office, the Office of Student Life (928-523-5181), or NAU’s Office of Affirmative Action (928) 523- 3312 (voice), (928) 523-9977 (fax), (928) 523-1006 (TTD) or [email protected]. STUDENTS WITH DISABILITIES If you have a documented disability, you can arrange for accommodations by contacting Disability Resources (DR) at 523-8773 (voice) or 523-6906 (TTY), [email protected] (e-mail) or 928-523-8747 (fax). Students needing academic accommodations are required to register with DR and provide required disability related documentation. Although you may request an accommodation at any time, in order for DR to best meet your individual needs, you are urged to register and submit necessary documentation (www.nau.edu/dr) 8 weeks prior to the time you wish to receive accommodations. DR is strongly committed to the needs of student with disabilities and the promotion of Universal Design. Concerns or questions related to the accessibility of programs and facilities at NAU may be brought to the attention of DR or the Office of Affirmative Action and Equal Opportunity (523-3312). ACADEMIC CONTACT HOUR POLICY Based on the Arizona Board of Regents Academic Contact Hour Policy (ABOR Handbook, 2-224), for every unit of credit, a student should expect, on average, to do a minimum of three hours of work per week, including but not limited to class time, preparation, homework, studying.

mailto:[email protected]

ACADEMIC INTEGRITY Integrity is expected of every member of the NAU community in all academic undertakings. Integrity entails a firm adherence to a set of values, and the values most essential to an academic community are grounded in honesty with respect to all intellectual efforts of oneself and others. Academic integrity is expected not only in formal coursework situations, but in all University relationships and interactions connected to the educational process, including the use of University resources. An NAU student’s submission of work is an implicit declaration that the work is the student’s own. All outside assistance should be acknowledged, and the student’s academic contribution truthfully reported at all times. In addition, NAU students have a right to expect academic integrity from each of their peers. Individual students and faculty members are responsible for identifying potential violations of the university’s academic integrity policy. Instances of potential violations are adjudicated using the process found in the university Academic Integrity Policy. RESEARCH INTEGRITY The Responsible Conduct of Research policy is intended to ensure that NAU personnel including NAU students engaged in research are adequately trained in the basic principles of ethics in research. Additionally, this policy assists NAU in meeting the RCR training and compliance requirements of the National Science Foundation (NSF)-The America COMPETES Act (Creating Opportunities to Meaningfully Promote Excellence in Technology, Education and Science); 42 U.S.C 18620-1, Section 7009, and the National Institutes of Health (NIH) policy on the instruction of the RCR (NOT-OD-10-019; “Update on the Requirement for Instruction in the Responsible Conduct of Research”). For more information on the policy and the training activities required for personnel and students conducting research, at NAU, visit: http://nau.edu/Research/Compliance/Research-Integrity/ SENSITIVE COURSE MATERIALS University education aims to expand student understanding and awareness. Thus, it necessarily involves engagement with a wide range of information, ideas, and creative representations. In the course of college studies, students can expect to encounter—and critically appraise—materials that may differ from and perhaps challenge familiar understandings, ideas, and beliefs. Students are encouraged to discuss these matters with faculty. CLASSROOM DISRUPTION POLICY Membership in the academic community places a special obligation on all participants to preserve an atmosphere conducive to a safe and positive learning environment. Part of that obligation implies the responsibility of each member of the NAU community to maintain an environment in which the behavior of any individual is not disruptive. Instructors have the authority and the responsibility to manage their classes in accordance with University regulations. Instructors have the right and obligation to confront disruptive behavior thereby promoting and enforcing standards of behavior necessary for maintaining an atmosphere conducive to teaching and learning. Instructors are responsible for establishing, communicating, and enforcing reasonable expectations and rules of classroom behavior. These expectations are to be communicated to students in the syllabus and in class discussions and activities at the outset of the course. Each student is responsible for behaving in a manner that supports a positive learning environment and that does not interrupt nor disrupt the delivery of education by instructors or receipt of education by students, within or outside a class. The complete classroom disruption policy is in Appendices of NAU’s Student Handbook. Effective Summer 2014 Approved UCC – 1/28/14 Approved UGC – 2/12/14

COURSE POLICIES

Policies and guidelines in the NUR 347L course syllabus apply to all aspects of this course. You are responsible for review and compliance with NUR 347L, NAU School of Nursing, and NAU policies. You are also responsible for review and adherence to the professional standards and rules of the Arizona Nurse Practice Act, the State Board of Nursing, and the American Nurses’ Association Code of Ethics. For full descriptions of policies, visit these websites:

• Current NAU SON BSN Handbook: http://nau.edu/uploadedFiles/Academic/CHHS/Nursing/BSN_Handbook.pdf

• Arizona Nurse Practice Act: https://www.azbn.gov • American Nurses Association Code of Ethics:

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses.aspx • Social Media Guidelines: https://www.ncsbn.org/NCSBN_SocialMedia.pdf

ATTENDANCE: Clinical schedules are posted in advance so students can arrange work, other classes, and personal matters. Attendance of all on-campus and off- campus clinical experiences is required for students to be able to achieve clinical competencies. Should an absence be unavoidable, notification of faculty via phone (not text or email) must be done at least 1 hour prior to the start of the clinical day. Students are considered tardy if they arrive even one minute after the beginning of clinical. Tardiness of more than 30 minutes will be considered a clinical absence. Tardiness or absence without faculty notification may result in dismissal for the clinical day or other consequences as determined by faculty. Please note: there may not be opportunities to make up missed clinical hours and faculty are not required to make arrangements for additional clinical hours. Additional policies: • Students are expected to be in the clinical area at designated times unless contagious or if there has been a

catastrophic life event. Clinical absence may result in failure to meet course objectives and, therefore, failure of NUR 347L. Notification must be made by phone (not text or email); we do not have access to e-mail at the clinical sites. Students will be expected to consult faculty about making up any missed clinical days. Missing more than 10% of clinical hours will result in clinical failure.

• Failure to notify faculty of absence from clinical (including hospital experiences, lab, simulation, and pre/post conference) prior to missing or being late will be considered unprofessional conduct and will be handled as such. Being a no call/no show to clinical, lab or simulation is a serious offense and will result in writing a ten page research paper about the impact of no call/no show absences on patient care and morale in the work setting. At least two citations are required, one being a research article. In addition, students are in danger of receiving scores lower than three (3) on the professionalism and professional values and communication section of the clinical evaluation form and, therefore, will not pass clinical. Second offenses will result in failure of clinical.

• Students are expected to be punctual to all clinical experiences, including post-conference. Students are expected to arrange travel to avoid tardiness. Extenuating circumstances will be evaluated on a case by case basis. More than one tardy will result in completion of a 3 page paper regarding the impact of tardiness on patient care and staff morale with a minimum of two references, one being a research article. If you are tardy following this assignment, you will be sent home from clinical and required to meet with an advisor. In addition, students may be awarded scores lower than three (3) on the professionalism and professional values and communication sections of the clinical evaluation form and, therefore, will not pass clinical.

• While in clinical, you may accompany your patient to PT, OT, or Speech therapy without informing your instructor. Make sure the RN you are working with knows where you are. Please contact your instructor if you have the opportunity to accompany your patient to any procedural area.

• Your clinical faculty AND your staff nurse need to know when you take a break (you are allowed one 15 minute break for each 4 hours and one 30 minute break for lunch/supper; you may not combine breaks to have an hour lunch/supper break). You may not leave the facility for a break as you may need to be available if something were to happen to your patient. Not being available could result in your patient not receiving care in a timely fashion and could be construed as patient abandonment (translation – unsafe practice!). You

http://nau.edu/uploadedFiles/Academic/CHHS/Nursing/BSN_Handbook.pdf

http://www.azbn.gov/NursePracticeAct.aspx

http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses.aspx

https://www.ncsbn.org/NCSBN_SocialMedia.pdf

will also need to report off to your staff nurse and instructor at the end of your clinical shift. As the instructors cannot leave the building until all students have left, failure to report off to the staff nurse AND clinical faculty will also be viewed as unsafe practice.

PROFESSIONAL APPEARANCE IN THE CLINICAL SETTING: Please review the Uniform Policy in the NAU Student Handbook. Professional appearance in the clinical setting promotes client confidence in your skills, identifies you as a nursing student, and generally reflects on the profession of nursing. Requirements for dress/appearance while in outside clinical agencies include: • You must wear your NAU uniform with NAU name badge (and hospital ID where required); you will be sent

home for failure to wear name badge and/or hospital ID and this will result in a clinical absence. Clean white or black shoes. Uniforms should always be clean and pressed. (In cold weather, long-sleeved white or yellow shirts are acceptable under your uniform.)

• Body tattoos and/or piercing must be hidden from view. If piercing is on your face or tongue or any other place that cannot be concealed, it MUST be removed for the clinical setting – NO EXCEPTIONS.

• Only a single simple post earring in each lobe may be worn. • Wedding bands or a single simple ring may be worn; all other jewelry (necklaces, pins, bracelets, etc.) should

be avoided in the clinical area. Jewelry of any kind (except a watch) is discouraged though for infection reasons.

• Finger nails need to be short (NO artificial nails – this is a NAU facility policy). Any nail polish must be in a neutral shade.

• Make-up should be simple and conservative. • Hair should be clean and neatly groomed. Hair that is shoulder-length or longer must be secured up and off

the collar in a manner that is both professional-looking and should not interfere with patient care. • Avoid the use of “fragrances” such as perfume or colognes – many people are sensitive to the different scents

and it can cause them respiratory problems. CONFIDENTIALITY STATEMENT: Students must maintain client confidentiality at all times. No discussion regarding clients is acceptable outside the classroom or clinical setting. In clinical conferences and in the classroom references to actual client experiences, refer to the client by their initials only. You may not remove from the clinical setting ANY part of a medical record that staff may tell you is “extra” and “you just have to cross out their name” (i.e. medication administration record back copies). These forms contain other identifying information on them and therefore should stay in the facility to avoid violating patient confidentiality. Also, please be careful what you say in halls, elevators and bathrooms while in clinical.

Client records are not to be photocopied under ANY circumstances.

Failure to adhere to this policy can result in removal from the clinical experience, the course, and/or referral in accordance with the communication of concerns process in the NAU School of Nursing Student Handbook. CELL PHONES: Cell phones are not permitted in the patient care areas. Cell phones should be turned off during all clinical experiences and put away in backpacks and purses unless otherwise directed. Non-emergency cell phone use is not allowed during the clinical shift unless you are off of the floor on break. If you expect an emergency call (such as a sick child), you must get your instructor’s approval before you may carry the phone, and then it must be on vibrate

mode. Make sure day cares, schools, etc. know how to reach you on clinical days. Please check with your instructor regarding the use of cell phone apps to look up medications and labs. WITHDRAWAL POLICY: If a student is unable to attend the course or must drop the course for any reason, it will be the responsibility of the student to withdraw from the course before the withdrawal deadline (see current NAU Schedule of Classes for deadline). PLAGIARISM, CHEATING, AND ACADEMIC DISHONESTY: Refer to Academic Integrity Policy (https://policy.nau.edu/policy/policy.aspx?num=100601) for definitions, policies, penalties, and procedures related to various forms of academic dishonesty. CLINICAL PERFORMANCE EVALUATION CRITERIA Performance ratings must be 3 or above in all clinical evaluation areas to receive a passing grade for the course. Please see the following criteria.

Northern Arizona University School of Nursing Clinical Performance Evaluation

Scale/label Performance of Nursing Care

Degree of Direction Performance capability

4 PASSING Self- directed

Safe Accurate Competent Efficient

Minimal cues

Consistently meets criteria using self-directed approach to learning. 1. Accurately assesses clients, formulates appropriate interventions

and evaluates outcomes using the nursing process. 2. Organizes and plans care safely and efficiently. 3. Integrates research-based knowledge and skills to provide

competent care. 3 PASSING Supervised

Safe Accurate Competent Efficient

Occasional cues and support

Frequently meets criteria with occasional input. 1. Accurately assesses clients, formulates appropriate interventions

and evaluates outcomes using the nursing process. 2. Organizes and plans care safely and efficiently. 3. Integrates research-based knowledge and skills to provide

competent care. 2 MARGINAL Guided MID TERM: AT RISK FINAL: FAILING

Inefficient Risk for Harm

Frequent cues and support *Develop Improvement Plan when indicated

Inconsistently meets criteria. Requires repeated guidance for the performance of nursing care at a safe level.

1. Inaccuracies in assessments, interventions and evaluations of nursing care.

2. At times, unorganized and inefficient when planning and providing care.

3. Gaps in integrating research-based knowledge and skills that could negatively affect patient outcomes.

1 FAILING Directed

Inefficient Unsafe

Constant direction and redirection *Initiate Learning Contract when indicated

Does not meet criteria. Requires constant instruction and intervention. 1. Unable to accurately assess clients, formulate appropriate

interventions and evaluate outcomes using the nursing process. 2. Lacks organization and time management skills. Unable to set

priorities. 3. Inadequate knowledge, preparation or skills to provide safe and

accurate nursing care.

Northern Arizona University School of Nursing NUR 347L -- Student Clinical Evaluation

Select One: Midterm Final Student Name: ___________________________ Course: ____________________ Semester: ________________ Evaluator Name: __________________________ Evaluator Position: Clinical Faculty ___ Course Faculty ___ Course Coordinator ___ RATING: The student's performance, related to each BSN outcome strand, will be rated using the criteria in the Clinical Evaluation Criteria rubric, on a 1 (directed) to 4 (self-directed) scale. Performance ratings must be 3 or above in all areas to receive a passing grade for the course.

Student has demonstrated required competencies (listed in clinical syllabus) derived from the following strands:

Ratings:

Self Faculty

Comments to support rating

Clinical Practice and Prevention

Communication

Critical Reasoning

Leadership

Professionalism and Professional

Values

Global Health

See the syllabus and BSN student handbook for detailed descriptions of clinical competencies for each specific nursing course. _____________________________________ _____________________________________ Student signature/date Faculty signature/date

Northern Arizona University School of Nursing Daily Clinical Evaluation Tool Date: _____________________ Student Name: ___________________________ NUR: _______ Assignment: ______________________________________________________

Comments: Clinical Instructor Signature: _______________________________________ Student Signature: ___________________________________

Situation Describe what is happening at the present time (Professionalism & Professional Values, Communication)

Was the student prepared for clinicals today (on time, ID, uniform, equipment-pen, stethoscope, watch, penlight, scissors, skills list, paperwork, and book)? Did they display a good attitude (communicate/collaborate professionally with staff/pt, receptive to constructive feedback, demonstrate non-judgmental behavior)?

Background Describe the circumstances leading up this situation (Critical Reasoning, Clinical Practice & Prevention)

Were there any unique situations where they student was either able to shine or did not do as well as was expected (self-motivated, utilized resources, recognized/intervened in situations/events that might have been a threat to patient safety, provided culturally sensitive care, applied age/developmentally appropriate teaching, utilized three checks and six rights of medication/procedure, ID and correlate physical assessment findings to pt diagnosis/meds/labs/procedures, used EBP guidelines for care)?

Assessment Data & other information related to the clinical day (Critical Reasoning, Clinical Practice & Prevention, Leadership)

Is this student at the level you would expect (care was organized and delivered time mandated by semester standard, nursing process was applied to pt situation, collected adequate/appropriate t data, outcomes/goals were identified, pt was adequately monitored, interventions were carried out at appropriate level, student able to verbalize rationale for meds/labs/procedures, preformed pre-checks for meds (K+, PT/INR, aPTT, pain levels, vitals, LOC), evaluates pt response to care, case was documented in pt chart by mandated semester standard)?

Recommendation Please identify what you believe could be done to improve

What could this student do better today (demonstrated professional conduct, accountable for actions, applied ethical standards and professional integrity, provided pt privacy, practiced safe care, follow up on VS/physical assessment/lab data/adverse reactions, improve hands-on skills/techniques)? What methods could be used to help the student be more successful (improve knowledge base through study/ prep time, skills practice, case study applications, scenario-based skills practice)? Please identify area to review

NUR 347L Portfolio

Here are the requirements for the clinical portfolio in NUR 347L. Please refer to the detailed portfolio information received in NUR 205 (225) for more information. All clinical documents must be current at the beginning of the semester for the entire semester or the student cannot attend clinical; forms must be current at the end of the semester in order to achieve points toward the course grade. All documents must be in the portfolio AND a copy must be given to Penny. See the School of Nursing Undergraduate Handbook for policies related to clinical documents.

Required Clinical Documents Expires/ Comments CPR Certification Liability Insurance TB skin test Fingerprint clearance card Student Health Insurance Physical Exam MMR – 1st dose MMR – 2nd dose Hepatitis B – 1st inoculation Hepatitis B – 2nd inoculation Hepatitis B – 3rd inoculation Varicella – 2 vaccinations or proof of immunity Tdap (Tetanus, Diphtheria, Pertussis) Flu shot Urine Drug Screen

To verify that NAU has all required clinical documents, the students may view their credentials by going to https://www5.nau.edu/chhs/credentials/ , clicking the “My Credentials” link and signing in with their NAU username and password.

Required Elements Comments Table of contents Clinical Agency Orientation (such as Lawson ID number, ACCU-Check test, or completed forms)

Nursing Therapeutics Skills List Goals for Clinical Experiences Completed Clinical Evaluations Portfolio Review Form

Optional Elements Comments Professional Development Community Service Activities Resume

Other comments:

https://iris.nau.edu/OWA/redir.aspx?C=1ZaDyaJKQU2oW_zwZULO4lrnzZ8Ays8IcAvTpCvct-iKJzdrGqt7q8NbuvZjk-ejboMqdQGaAhE.&URL=https%3a%2f%2fwww5.nau.edu%2fchhs%2fcredentials%2f

PORTFOLIO REVIEW FORM The signatures below indicate that the portfolio was reviewed by the student and the assigned clinical faculty member.

Course Student Signature Faculty Signature Midterm Final Midterm Final NUR 225L Beginning Final Beginning Final NUR 345L NUR 347L NUR 349L NUR 411L NUR 440L NUR 427L NUR 450

Evidence Based Practice Project-Clinical Assignment

Purpose To identify a 2018 Hospital National Patient Safety Goals, evidence based practice guidelines and a country of choice to compare with the United States. https://www.jointcommission.org/assets/1/6/2018_HAP_NPSG_goals_final.pdf Instructions

1. Self-select a group of 2-3 and select a 2018 Hospital National Patient Safety Goal and country. Inform your clinical instructor of your selections by your first clinical day (January 29, 2018).

2. Research the guidelines related to the safety goal. www.guideline.gov 3. Identify 1 professional reference related to the goal, 1 professional reference for the United States, and 1

professional reference for your country of choice—a total of 3 professional references are needed. 4. Discuss why your team's chosen safety goal is important. Compare and contrast the work being done

regarding your safety goal in the US and in your selected country. What are some US and your country statistics related to the goal? Compare and contrast the US and your country regarding overall achievement reports related to the goal. What does the US do well regarding the goal and what does the other country do well? What can be learned from the other country? This is an APA document. Turn in via Bblearn with all group members names included by (March 12, 2018)

5. Present findings on a poster board at Evidence Based Practice Day (TBD) Evaluation of Group Evidence Based Research Project Rubric: 10 total points Names of Presenters: _____________________________________________________________________________

Criteria Possible Points

Points Earned

Comments

Importance of Safety Goal 2 Guideline review (3 articles) 2 Significant Findings 2 Conclusion/Recommendations 2 Overall quality/cohesiveness 2

Total 10

https://www.jointcommission.org/assets/1/6/2018_HAP_NPSG_goals_final.pdf

http://www.guideline.gov/

GOALS FOR CLINICAL EXPERIENCES

Course Number and Title: ______Nursing 347L_____________________ Semester & Year: _____________________________________ Name: ____________________ Identify your strengths to date and provide examples: With regards to clinical competency (cognitive or psychomotor), attitudes, values, and beliefs, identify areas which need improving: Develop one or two specific behavioral goals for improving your clinical competency (cognitive or psychomotor), attitudes, values, and beliefs: Outline a specific plan for implementing your goals this clinical rotation: At the completion of this clinical rotation, evaluate how well you met your goals: Identify two written documents demonstrating your knowledge, skills and experience during this clinical rotation: Student’s Signature: Date: ____________ Faculty’s Signature: Date: ____________ This form is to be completed at the beginning of each clinical course and updates at the mid-term and final evaluation session for the clinical.

FACULTY SUPERVISION OF PROCEDURES Faculty supervision is required for the following procedures until competency is verified by faculty: All medications – calculations, administration, and documentation Sterile dressing changes Heparin or saline lock flushes Peripheral IV tubing changes Urinary catheterization Insertion of a nasogastric tube Tube feedings Administrations of controlled substances Any procedure with which the student is unfamiliar This means that UNLESS YOU HAVE BEEN SPECIFICALLY TOLD BY YOUR CURRENT CLINICAL INSTRUCTOR TO DO THE PROCEDURE WITHOUT FACULTY SUPERVISION, YOU MUST HAVE YOUR INSTRUCTOR SUPERVISE YOU DURING THE PROCEDURE. It is your current clinical instructor’s prerogative to set safe practice parameters at any of the clinical agencies. If your client needs nursing care which requires Registered Nurse supervision: 1. You may contact the clinical instructor for assistance, or the staff RN must be present for the procedure. 2. If the clinical instructor is not available, and the staff RN is not able to supervise the procedure, the staff

RN must complete the procedure. Faculty/Staff RN supervision is required throughout the clinical rotation for the following procedures: All medications – calculations, administration, and documentation IV starts Epidural and PCA management and documentation Central Line Management Port Access Transferring clients to or from any unit ALL narrative documentation in the client’s medical record Procedures NOT allowed under any circumstance: A STUDENT IS NEVER ALLOWED TO PERFORM THE FOLLOWING PROCEDURES: * Arterial sticks * Transcribe physician’s orders * Defibrillation * Dual verification of high risk medications * Administer chemotherapeutic agents * Intubation * Blood transfusions (dual verification) * Take verbal/telephone orders from a physician * Discontinuation of invasive lines (CVC, PICC, arterial lines, sheath, chest tubes, etc)

PRESCRIPTION FOR REMEDIATION At anytime during the clinical experience, your faculty feels that you need additional work or help with a specific skill (e.g. Foley insertion), the faculty will give you a Prescription for Remediation. You will need to sign-up with the lab coordinator to work on that specific skill. The lab coordinator will sign you off when they feel you are

proficient and then the coordinator will return the prescription to your clinical faculty. Failure to complete the prescription will result in a fail in the lab portion of NUR 347L.

Prescription for Remediation

NUR 347L

Student Name:______________________________ Date:______________________ Needs to work on:_________________________________________________________ Faculty Recommending Remediation:________________________________ Successfully Demonstrates Skill with Proficiency Date:____________________ Lab Coordinator:_______________________

NUR 347L Course pack

Clinical Forms

Name:_________________________________

Date:__________________________________

Clinical forms: Students will be expected to obtain all clinical forms from the NAU NUR 347L Web site. The student will be expected to copy as many forms as they will need to complete all the required worksheets during the clinical practicum. The following pages contain the clinical forms and guidelines for the clinical practicum for NUR 347L.

Completion of Clinical Forms Basic Instructions

Clinical Preparation 1. Begin collecting data using the computer to obtain PMH, HPI, medication information, lab data, plan of

care, and available computer information. 2. Read about the pathophysiology of the illness or disease of the assigned client, prepare medication data,

and recognize abnormal labs with plans to address these findings. 3. Clinical worksheets: Full worksheets to be completed as directed by the clinical instructor. The clinical

instructor will set the time and dates that completed worksheets will be due. 4. Special Clinical Experience worksheet must be completed for each department the student is in during the

clinical rotation. The clinical instructor will set the time and dates that completed worksheets will be due. 5. Late papers will not be accepted unless approved in advance by the clinical instructor. Clinical Form 1: Data Collection/ Assessment 1. Begin collecting data using the computer to obtain PMH, HPI, medication information, lab data, plan of

care, and available computer information. 2. The patient’s primary concern should be the chief complaint (or reason the patient states they were

brought to the hospital). 3. Thoroughly complete the data collection/ assessment form. 4. Physically assess each assigned patient before end of shift. Write your daily head-to-toe assessment data

in a narrative format. Be sure to include the following information: neurological, respiratory, cardiovascular, musculoskeletal, gastrointestinal/ nutrition, genitourinary, integumentary, and psychosocial/ roles (will the illness prevent the patient from fulfilling roles) and anything else relevant to your patient’s care.

5. Record VS, O2 saturations, and your pain assessment; include the time assessed. At least two measures should be completed during your shift. I & O are required for your shift– even if not ordered.

6. Address social and cultural considerations. For example; smoking, drinking alcohol, and any cultural issues.

7. Will the patient benefit from an interdisciplinary consult, such as social work or respiratory therapy. Why or why not?

8. List what you feel the 3 priority nursing diagnoses are for your patient and provide a rationale for why you chose those diagnoses.

Clinical Form 2: Pathophysiology 1. Describe in detail the pathophysiology for the patient’s current and chronic medical diagnoses, including

surgical procedures if applicable. Discuss whether your patient matches the textbook description and whether the diagnoses are interrelated. Be specific Include chronic diagnoses.

Clinical Form 3: Medication Worksheet 1. Begin filling in the collected data from the medication records for each assigned patient on the

medication list during your clinical preparation time. 2. Complete the required medication information utilizing a current Drug Handbook. 3. Classification does not mean “blood pressure medication” or “anti-infective: Be very specific: beta

blockers, penicillin, etc. Use the pharmacologic classification. 4. Discuss the textbook action of the drug. 5. State the specific reason (indication) that your patient is receiving each medication. 6. Discuss common side effects related to the drug. 7. State the important nursing assessment related to administering each medication. 8. Discuss teaching that should be done related to the drug. 9. Provide details related to drug administration. (ie. If po – Before meals? After meals?; if IV – diluted? How

much? Inject over how long? Compatibility concerns? Interaction concerns?) 10. Discuss whether the drug was effective for your patient. Did the drug work? For example, did the

medication lower the blood pressure or blood sugar levels? Provide specific values (labs, VS, etc). Clinical Form 4: Lab/Diagnostic Tests 1. During the clinical preparation time, begin filling in the collected data from the lab record. Look at

pertinent labs, not just labs done during your shift. Compare results found on admission as well as current or previous abnormal values. Make sure you include blood draw dates.

2. Complete the required lab information utilizing the hospital normal ranges and a current lab and diagnostic tests textbook.

3. Address the abnormal labs if they are decreasing or increasing. Analyze why the labs may be changing or are abnormal for your patient.

4. Address the necessary nursing assessments, and interventions in the care of this patient related to the abnormal lab results. What does it mean for the nurse if a patient’s lab values are elevated or decreased? Be specific.

Clinical Form 5: Nursing Care Plan 1. See guidelines/directions page in sample. 2. Assess the patient and identify relevant subjective and objective data. 3. Use a current Nursing Care Plan book, or NANDA NOC and NIC. You may use a NANDA format or problem

format to address the nursing plan of care for your client. 4. Generally, the nursing diagnosis should contain three parts; the nursing diagnosis, related to, as

manifested or evidenced by. Your nursing diagnoses should be based on your assessment findings and should contain one of the top three priority physiologic nursing diagnosis for that patient. "Risk for" nursing diagnoses may NOT be used in 347L.

5. Outcomes are what the client will accomplish. Outcomes must be measurable, for example; before the end of this shift, before discharge.

6. Interventions are what the nurse will assess, implement, or evaluate. 7. This is a plan of care, not just a statement of what you did, but also what you should have done. 8. Your instructor may wish for you to address two physiologic problems and one psychosocial problem.

Please check with your faculty. Clinical Form 6: Discharge Planning Form 1. Complete the form by answering the questions on the form. 2. Discuss any discharge needs the patient may have. Remember discharge planning begins the day the

patient enters the hospital. Clinical Form 7: Client Teaching Form 1. Address client teaching on this form, remember almost everything you will tell the client is new

information; this is a form of teaching. 2. Assessment and evaluation of teaching must include both objective and subjective data. Clinical Form 8: Weekly Clinical Evaluation and Journal 1. This form is for you to think about your learning and keep track of your clinical competencies. The guided

questions will help you reflect on whether and how you are meeting course outcomes, what skills you have completed, what goals you are meeting, and what you will do to improve. Please complete and turn in weekly. There is also a place for your instructor to make comments about your progress.

Clinical Form 9: Weekly Introduction Form and RN Information Sheet

1. The student will fill out a Weekly Introduction Form for every clinical day. This form is to be utilized to introduce the student to the nurse. This form will also be used to develop goals for each clinical experience. Please be specific in your goals.

NORTHERN ARIZONA UNIVERSITY SCHOOL OF NURSING

CARE PLAN EVALUATION FORM

Data Collection/Assessment – Basic Information, Pathophysiology, Learning Outcome, “To Do” List, Assessment, Culture, Priority Nursing Diagnoses and Rationale – 10 points

Points ________ ☐ Lists primary and all secondary dx ☐ Includes data or surgery if done on this admission ☐ Collects all pertinent data ☐ Complete head-to-toe assessment written and

organized ☐ VS/pain noted (baseline/adm and during shift) ☐ Culture section addressed ☐ Lists 3 appropriately prioritized nsg dx ☐ with

rationales for prioritization

☐ Not all secondary dx listed ☐ Did not include OR done or date of OR ☐ Missed pertinent data Assessment ☐ States something abnormal but not what

was done; ☐ States tube but doesn’t state what is draining; ☐ Components missing or not specific

☐ VS/pain not noted ☐ Cultural not addressed Nsg Dx ☐ Not prioritized ☐ Not nsg dx ☐ No

rationale for prioritization Pathophysiology– 10 points Points _______ ☐ Describes the altered physiology of primary dx ☐ Describes how chronic diseases may related to

current condition

☐ Only definition or s/s of patho dx ☐ Did not relate chronic conditions to dx

Medications – 10 points Points _______ ☐ All meds were listed with details (name, class, etc.) ☐ All pharmacologic actions listed

(onset,peak,duration) ☐ Indications correct for this patient ☐ Stated common and important life threatening SEs ☐ Stated important nursing interventions ☐ Stated pertinent administration details for all meds ☐ Gave specific details supporting regarding

effectiveness

☐ Not all meds listed or elements missing ☐ Did not include pharmacologic actions ☐ Indications not patient specific or inaccurate ☐ SEs not thorough or missing ☐ Missed important nursing interventions ☐ Did not adequately state important

information on how meds should be administered

☐ No/Insufficient details given demonstrating evaluation of effectiveness

Lab and Diagnostic Data – 10 points Points ______ ☐ All key laboratory values listed ☐ Listed important labs pertaining to patient dx

(admin, prev day, current day = trend) ☐Analyzed trend of lab values ☐ Identifies patient specific cause for abnormal labs ☐ Analyzes trends for abnormal labs ☐ Discussed nsg interventions for abnormal labs or

groups of labs

☐ Did not include key laboratory values ☐ Did not correlate abnormal labs related to

patient medical dx ☐ Did not adequately attempt to analyze

abnormal lab values ☐ Did not analyze lab value trends ☐ No nsg implications for abnormal labs or not

specific Nursing Diagnoses with Supporting Data – 10 points Points ________ ☐ 3 diagnoses identified

(2 physiological, 1 psychosocial) ☐ Stated in nursing terms (NANDA format) ☐ Related to is pathophysiologically based

☐ Did not have 3 dx; ☐ Dx not unique ☐ Not in NANDA format; ☐ related to not pathophysiologically based

☐ Not adequately supported by subjective data

☐ Supported by subjective data ☐ Supported by objective data

☐Not adequately supported by objective data ☐ Missing key baseline data

Goals and Outcomes – 10 points Points _______ ☐ Outcomes are related to the problem and ☐measurable

☐ Long-term outcome contains evaluation criteria related to resolution of the problem by discharge

☐ Short-term outcomes are identified that assist in the resolution of meeting the LT outcome and ☐measurable

☐ Outcomes are patient centered/individualized for the patient.

☐ Used SMART goals ☐ Includes both LT and ST outcomes

☐ Outcomes not related to the problem ☐ Outcomes are not patient centered LTOs are ☐ not specific; ☐ not

measureable; ☐ not attainable; ☐ not realistic; ☐ not timed

STOs are ☐ not specific; ☐ not measureable; ☐ not attainable; ☐ not realistic; ☐ not timed

☐ Missing LT or ST outcome

Interventions – 10 points Points _______ ☐ Interventions are ‘nursing’ actions ☐ Relate to that patient outcomes/goals ☐ Contain what, how much, where, when, who to do ☐ Are an exhaustive list individualized for the patient ☐ Could be completed by another nurse for the patient

☐ Are not something the nurse can do ☐ Are not related to assisting or assessing

for completion of the patient’s outcomes ☐ Do not contain all necessary components ☐ Are not thorough, important ones left

out Rationale – 5 points Points _______ ☐ Are based on valid theory ☐ States why the intervention is being done for this

specific patient and problem ☐ Includes references in APA format

☐ Are not based on valid theory ☐ Are not patient and problem specific ☐ No references listed ☐ References not listed in APA format

Evaluation – 10 points Points _______ LT and ST outcomes are evaluated by ☐ Stating if met or

not met; ☐ Gave specific data about how they were met or not met; ☐ Were evaluated based on outcome criteria

☐ Recommended changes related to interventions if necessary

☐ LT outcome was not evaluated ☐ ST outcomes were not evaluated ☐ Did not give specific supporting data

regarding why met or not met ☐ Evaluated interventions, not outcomes ☐ Did not make suggestion as to

continuation or changes to the plan Discharge Planning/Teaching - 10 points ☐ Identifies home safety issues ☐ Identifies needs of patient in the home setting ☐ Identifies at least 3 teaching points/topics that relate

to patient primary diagnosis ☐ Provides thorough explanation of content taught

related to the 3 identified topics. ☐ Assessment/Evaluation of learning includes objective

and subjective data ☐ A list of teaching topics that would be included in a

comprehensive teaching plan is provided.

Points ______ ☐ Home safety issues not provided ☐ Patient's home needs not addressed ☐ 3 teaching points not identified ☐ Explanation of teaching content not

thorough or missing ☐ Assessment of learning does not include

objective and/or subjective data ☐ Evaluation of learning does not include

objective and/or subjective data ☐ List of teaching topics for education plan

not comprehensive or missing Overall Clinical Reasoning/Critical Thinking/Spelling/Grammar/Punctuation – 5 points

Points ______ ☐ Demonstrated an ability to put all the pieces together ☐ Accurately analyzed each component

☐ Does not incorporate theory or patient specific data where applicable (ie. Patient

(pathophysiology, assessment data, laboratory data, medications)

☐ Developed a patient specific plan of care that demonstrated application of theory

☐ Plan of care was thorough and comprehensive

primary or secondary dx with lab values) ☐ Analysis of components is inaccurate or

incomplete ☐ Plan of care was not patient specific ☐ Plan of care did not demonstrate

application of theory ☐ Plan of care not thorough

Student Name:

Clinical Form 1: DATA COLLECTION/ ASSESSMENT Patient’s Initials: Room/unit number Advanced Directives Age _______

M or F Dates of patient care

Admission date: Date of surgery:

Allergies and reaction: Staff RN

Patient’s primary concern/ medical diagnosis: Surgeries done this admission (if applicable): Current medical diagnoses (include chronic conditions such as diabetes, COPD). 1. 2. 3. 4. Other Medical Diagnosis: Ht Wt

Wt Orders BMI Nutrition

VS Ordered Frequency Admission or Baseline Vital Signs

Diet Order and why receiving Oral Fluid Order Blood Glucose Monitoring Swallowing Problems Last BM

Respiratory Tubes Oxygen Order/Vent Settings O2 Sat Order:

Chest Tube Y or N Orders:

Foley NG Y or N Orders: JP

Incentive Spirometer Hemovac Feeding Tube Y or N Type: Orders:

Other:

Activity Dressings Orders Assistive devices Dressing Orders

Type of dressing Location of dressing Dressing appearance

TEDS

SCDs

Glasses

Hearing Aids

Intravenous/ Fluid status Other Information IV sites/ Date inserted: Site appearance: Ordered fluids/rate:

Scheduled diagnostic tests Labs to be checked during your shift

I&O last 24 hours: I&O your shift (required):

Consults done

Student Name:

Clinical Form 1: DATA COLLECTION/ ASSESSMENT, CONTINUED What is your learning outcome with this client? What will your assessment focus on?

REVIEW OF SYSTEMS/SUBJECTIVE DATA

General Survey (overall appearance, hygiene, dress, skin color, body structure, behavior, facial expressions)

Vital Signs (TPR, BP, MAP, Ht, Wt, BMI)

Pain (OLDCARTS/PQRST)

Psycho-Social Status (Support system, psychological health, patterns of coping, defense mechanisms, culture, religious/spiritual beliefs, socioeconomic concerns)

Mental Health (Affect, behavior, suicidal ideation, safety)

Integumentary System

Skin (color, temp, moisture, turgor, m/m, integrity, wounds (size, COCA, tissue color), dressings, tubes, drains

Hair (color, density, distribution)

Nails (Color, thickness, hygiene)

Neuro System

(Primary) (LOC, orientation, GCS, Pupils (size and PERRL), Extrem. Strength and sensation, speech, gait

(Secondary and PRN)

(Vision, EOMs, Corneal reflex, Nystagmus)(Facial Expressions, sensation, strength; swallowing, gag reflex, tongue movements)(Pronator drift, Romberg test, babinski’s sign, dermatomes) HEENT (Bleeding, drainage, lesions, other abnormalities)

Neck (Neck vessels, lymph nodes, thyroid, etc.)

Breasts (Lesions, nodules, drainage, etc)

Cardiovascular System

Heart (S1, S2; S3/S4/murmur; reg vs, irreg.; heart rate & rhythm, Rub)

Peripheral Vasculature (rate, rhythm, and quality of peripheral pulses (0-4); cap refill; edema (pitting(rate [+1 - +4)] vs generalized)

Respiratory System (Body position, rate, rhythm, depth, signs of resp distress [e.g. accessory muscle use, pursed lips, nasal flaring, retractions], cough/sputum (COCA), Smoking hx, immunizations; shape, symmetry chest wall movement, lung sounds ant and post bilat

Gastrointestinal System (Skin, guarding/splinting, shape/contour, N/V/D, Dysphagia, bowel habits, last bm, bowel sounds X 4

quads, results of palpation, masses?, rebound tenderness and location, drainage devices (NGT, colostomy, ileostomy), tube feeds, etc Genitourinary System (Urinating, incontinence, urine (color, amount, odor, turbidity), catheter/type, urinary sx?

Male (testicular pain/edema, penile d/c, itching/burning, lesions)

Female (LMP, urethral/vaginal d/c, itching/burning, lesions)

Musculoskeletal System (Height, posture, spine, wounds, joints, ROM, injuries, inflammation, muscles [tone, strength, size, tremors], distal CSMs

Time (baseline) Time (0800) Time (1200) VS VS VS

O2 Sats O2 Sats O2 Sats

Pain Pain Pain

Cultural practices and beliefs that might influence the plan of care.

Could this patient benefit from an interdisciplinary consult? Why or why not?

List your top three priority nursing diagnoses on this patient. Explain your rationale using one of the priority setting models (ABCs, Maslow, etc.).

Clinical Form 2: PATHOPHYSIOLOGY

Pathophysiology: Thoroughly describe the pathophysiology for the patient’s current and chronic medical diagnoses and surgical procedures performed. Discuss whether your patient matches the textbook description and whether the diagnoses are interrelated. Be specific. Discuss how ALL chronic illnesses and medical/surgical history may interrelate or impact current diagnoses. Use additional page as needed. Citation and reference required.

Clinical Course Pack – NUR 347L 39

Student Name: Allergies:

Clinical Form 3: Weekly Medication List Medication: Name

(Generic/Trade), Class (Therapeutic and

Pharmacologic), Dose, Route, Times, Onset, Peak, Duration

Pharmacologic actions and Indication for/Action on this

patient

Common Side Effects/Life

Threatening Side Effects

Nursing Care: 1. Assessment and

interventions(ie, lab monitoring, vitals)

2. Teaching 3. Administration (ie,

compatibilities, interactions)

Was this Drug Effective for your Patient? Be

Specific


Student Name:

Clinical Form 4: LAB/DIAGNOSTIC TESTS Diagnostic test Normal Range Client’s Results &

Date of Test Is the lab trending

up or down?

Why do you think this test result is abnormal for this patient

(Analysis)?

Nursing Implications

Date #1 Date #2

Chemistries/ Metabolic Panel

Na 135 – 145 mEq/l K 3.5 – 5.0 mEq/l Glucose 75-110 g/dl Cl 97 – 107 mEq/l CO2 23 – 29 mEq/l BUN 8 – 21 mg/dl Creatinine Male 0.6 – 1.2 mg/dl

Female 0.5-1.1 mg/dl

Calcium 8.2 – 10.2 mg/dl Magnesium 1.6 – 2.6 mg/dl Phosphorus 2.5 – 4.5 mg/dl Bilirubin (Total) 0.3 – 1.2 mg/dl Protein (Total) 6.0 – 8.0 g/dl Albumin 3.4 – 4.8 g/dl Hematology-CBC WBC 4.5 -11 x 103/mm3 Differential WBC Count Bands/Stab (%) 3-6 Segs/Polys (%) 50-62 Eosinophils (%) 0-3 Basophils (%) 0-1 Lymphocytes (%) 25-40 Monocytes (%) 3-7 RBC Male 4.71-5.14 x106/mm3

Female 4.20-4.87 x106/mm3

RBC Indices


MCV 82-98 mm³ MCHC 32-36 g/dl MCH 26-34 pg/cell HGB Male: 13.2-17.3 g/dl

Female: 11.7-15.5 g/dl

HCT Male 43-49% Female 38-44%

PLT 150 – 450 x 103 / µl/mm3 Coagulation Panel PT 10-13 seconds INR Ther: x2.0-3.0

Valve: x2.5-3.5

APTT 25-39 seconds Cardiac Studies Total Creatine Kinase (CK)

0-120 µg/mL

CK-MB 0-3 µg/mL CK index 0-3 Myoglobin <55 µg/mL Troponin < 0.4µg/mL Troponin I <0.35 µg/mL Troponin T <0.2 µg/mL Serum Lipids Cholesterol <200 mg/dL Triglycerides <150 mg/dL HDL 60 mg/dL or above LDL <100 mg/dL Other Cardiac Tests C-reactive protein <1.0 mg/dL BNP <100 pg/mL


Arterial Blood Gases pH 7.35-7.45 PaO2 80-95 mmHg PaCO2 35-45 mmHg HCO3 18-23 mEq/l Urine Tests pH 5.0-9.0 Specific gravity 1.010- 1.025* Protein Negative Glucose Negative Ketones Negative Leukocyte Esterace Negative WBC Less than 5/hpf RBC Less than 5/hpf Bacteria None

Other lab tests: Cultures: Radiology/Other Diagnostic reports:


Clinical Form 5: Nursing Care Plan Directions NURSING DIAGNOSIS WITH

SUPPORTING DATA

DESIRED OUTCOMES INTERVENTIONS WITH RATIONALE

EVALUATION OF DESIRED OUTCOMES WITH

SUPPORTING OBSERVATIONS

(REVISIONS PRN) Nursing diagnosis is based on assessment. Should be a priority patient problem either actual or potential problem. Nursing diagnosis: Client problem (use NANDA Diagnosis or problem statement related to etiology - cause of problem) 1. Etiology often relates to a

medical diagnosis. Needs to be stated in layman’s terms.

e.g. related to abdominal

surgery or related to unknown cause.

2. Etiology sometimes does not

relate to a medical diagnosis, e.g.

(a) Altered nutrition, less than

body requirements related to nausea and vomiting.

(b) Coping, ineffective related

to nursing home placement.

Desired patient outcomes. LTO Stated first outcomes expected at discharge. STO Immediate outcomes. Small steps to reach LTO. Start with patient will and action verb (do what) and criteria of performance (WHAT, WHEN, HOW).... 1. Relates to the nursing diagnosis. 2. Is measurable - states what,

how, when. 3. Is realistic, valued, congruent

with health care team plans. 4 Should be mutually set with

patient, if possible. Example: LTO: Patient will walk once around this room with supervision by discharge

All actions taken by the nurse which assists the patient to meet goals starts with “nurse will”. 1. Must relate to the patient’s

goals. 2. Must be congruent with health

care team and are safe. 3. Must be based on principles and

knowledge. 4. Must be specific, state what,

when, how. e.g. Nurse will turn patient q 2

hours per posted turn schedule. Rationale: Scientific principles/theory which relate to nursing diagnosis and/or outcomes. 1. Must be stated for each

intervention. 2. Reference and pages must be

identified.

1. Whether outcomes met. 2. Comparison of the expected

outcome response to the actual response. Patient’s progress toward the outcome as indicated by specific data such as observations, lab values, patient’s statements, etc.

3. Whether to continue the plan. 4. How to modify the plan. 5. Example: Outcome not met. Pt.

unable to ambulate. Pt. up in chair with maximum assist of 2. Continue plan of care.


3. Other considerations (a) If the problem cannot be

treated by nursing, it is not a nursing diagnosis (e.g. surgery for bowel obstruction)

(b) Should address only one

patient problem. (c) Patient problem and

etiology should not be the same.

STO: Patient will transfer to chair with supervision by evening.

3. Evidence-based interventions included here

Clinical Form 5: Nursing Care Plan Directions Continued

NURSING DIAGNOSIS WITH

SUPPORTING DATA

DESIRED OUTCOMES INTERVENTIONS WITH RATIONALE



(REVISIONS PRN) Incorrect: self care deficit related to bathing and grooming. Correct: self care deficit, bathing, grooming, related to right-sided paralysis (d) Should NOT serve as

a basis for legal action. e.g. Potential for injury related to poor nursing care.

4. Each nursing diagnosis must have supporting data as follows:


S(subjective data) Patient’s statements related to the

problem. e.g. “My back hurts”. O(objective data) Nursing observations and chart information relating to the problem e.g. Sacral area reddened after lying on back for 4 hours. Also, doctor’s reports, lab reports, x-rays, medications, and treatments ordered, other therapy reports, etc.


Student Name:

Clinical Form 5: Nursing Care Plan: Diagnosis 1


SUPPORTING DATA

DESIRED OUTCOMES

INTERVENTIONS WITH RATIONALE



(REVISIONS PRN)


Student Name:

Clinical Form 5: Nursing Care Plan Diagnosis 2


SUPPORTING DATA

DESIRED OUTCOMES




(REVISIONS PRN)


Student Name:

Clinical Form 5: Nursing Care Plan Diagnosis 3


SUPPORTING DATA

DESIRED OUTCOMES




(REVISIONS PRN)

51

Student Name:

Clinical Form 6: Discharge Planning Form

DISCHARGE PLAN OF CARE: 1. Where will you go upon discharge (d/c) and what arrangements have been made? 2. If going home, is home layout appropriate for pt’s needs? Yes No Describe 3. What support is needed (include financial, home health nurse, home 02, PT, meals on wheels)? 4. What d/c teaching does pt and/or family need (include follow-up care, activity level, new meds,

dressing changes, accucheck, diabetic care, special diet, etc.)? 5. If pt is going to a medical facility, what information is needed on the transfer form (include level of

care and specific treatments required)?

52

Student Name:

Clinical Form 7: Client Teaching Form

Client’s readiness to learn: ___________________________________ Client’s preferred method of learning: ___________________________

TOPIC/CONTENT Assessment of client/family knowledge level

Content taught and ‘method’ used*

Evaluation of learning

1

2

3

4

5

*Attach a separate sheet that indicates all the topics that should be included in a comprehensive teaching plan.

53

Northern Arizona University Medical-Surgical Nursing

CLINICAL FORM 8: WEEKLY SELF CLINICAL EVALUATION FORM

Student: ____________________________Unit: Date of Clinical: ______________ Student Evaluation of Course Competencies (rank self on 1-4 scale): Clinical Practice and Prevention Student ranking: _____

How did you apply standards of care, evidence, critical thinking and critical reasoning, prioritization and delegation to this clinical situation?

How did you apply nursing knowledge to prevent complications and promote the well-being of your patient?

How did you apply the nursing process in providing care?

Communication Student ranking: _____

Discuss your communication.

Critical Reasoning Student ranking: _____

How did you utilize nursing knowledge, technology and evidence to provide patient care.

Leadership Student ranking: _____

How did you apply principles of collaboration, delegation and advocacy for your patient?

Professionalism and Professional Values Student ranking: _____

How did you emulate professional behavior and caring? How did you apply professional values?

What ethical or legal issues did you note?

How did you apply caring’s affective characteristics into patient centered care with other professionals?

Global Health Student ranking: _____

How did you collaborate with your patient and family to develop mutually agreed upon, culturally appropriate goals and care?

54

Were you able to identify, during this clinical, any impacts on environmental health? Explain.

55

CLINICAL FORM 8: WEEKLY SELF CLINICAL EVALUATION FORM, CONTINUED Student: ____________________________ Unit: Date of Clinical: ______________ Student Self Evaluation (Objectives & Goals met/unmet): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Student Short Term Goals for Self Improvement: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Instructor comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Student Meets Clinical Objectives for the Dates of Clinical (instructor to complete): □ Yes □ No Student Signature_____________________________________________ Date:_________ Instructor Signature_____________________________________________ Date:_________

56

Northern Arizona University Nursing 347L

Weekly Introduction Form and RN Information Sheet 3rd semester (Intermediate) Med/Surg Student

Student: _____________________________ Date: ____________ Instructor: _____________________________Faculty Contact: ______________ Clinical time on floor: Day ____________ Hours __________________ Skills: The student will take care of at least one assigned patient. The student will complete the total patient care while collaborating with the RN & CNA/PCT. RN or Faculty Supervision is required for the following procedures: All medication administration Sterile dressing changes IV flushes IV tubing changes Urinary catheterization Tube feedings IV medications Blood transfusions Insertion of NG tube Transferring patients unit-unit Central line care/management Port Insertion/DC All narrative documentation Insertion of IV line Epidural Care A STUDENT IS NEVER ALLOWED TO PERFORM THE FOLLOWING PROCEDURES: Arterial sticks Defibrillation Chemotherapy Accepting practitioner orders Transcribe orders Invasive monitoring care Document on Medicare Forms Intubate Care for airborne diseases Dual RN verify medications or blood products Discontinue CVC, PICC, sheath, arterial lines, chest tubes Student’s goal/goals for this clinical experience: ___________________________________________ ____________________________________________________________ RN’s comments or suggestions during this clinical experience: _____________________________ _________________________________________________

Thank you for working with our student. Please return this form to the clinical instructor or send with the student to include in their clinical

paperwork.

57

School of Nursing

NUR 347L

Acknowledgment of Syllabus/Course/Clinical Requirements

Name (First)_____________________(Last)_________________________

(Please print) Phone number_________________________Email:______________________________ I acknowledge that I have reviewed and read the syllabus for NUR 347L. I understand the expectations and requirements for the lab, simulation, and clinical portions of this course. I agree to abide by the regulations, terms, and policies as set forth in the syllabus. I have provided documentation to the School of Nursing office of current CPR certification that will remain current at least through this semester, current malpractice insurance coverage that will remain in effect through this semester, a negative TB test or medical clearance for positive reactors that remains current during the course of this semester. Documentation of Hepatitis vaccination, MMR, health insurance coverage, varicella status and Tdap are also current through the semester and on file. In addition, I have reviewed again the School of Nursing Undergraduate Student Handbook, and understand the policies that are in place to support my continued education in Nursing. __________________________________________ __________ (Signature) (Date)