Mary L. Heye, PhD, RN, APRN, BC 

E-mail: heye@uthscsa.edu                 

Phone: (210) 567-5831

Pager: (210) 220-8973

Office: 2.142

Office Hours:  Tuesdays 1:00 pm - 4:00 pm

Cheryl A. Lehman, PhD, RN, CRRN-A, BC

E-mail: LehmanC@uthscsa.edu

Phone: (210) 567-5870

Pager: (210) 235-0021

Office: 2.212

Office Hours: Tuesdays 1:00 pm - 4:00 pm

Acute Nursing Care Department

Semester Credit

6 semester credit hours

Credit Hour Allocation                                    Clock Hour Allocation

3 semester hours class                                 3 clock hours class

semester hours clinical                                  9 clock hours clinical (135 hours clinical practicum)

                                                                NOTE:  6 hours of the 135 hours of clinical practicum will  be designated for 

                                                                             clinical conference, times and dates on course schedule.

Upon completion of this course, the student will be able to:

1. Demonstrate in-depth knowledge of pathophysiological processes, disease management and health promotion in adults with acute and/or chronic illness.
2. Analyze current practice issues, research, and technological advances that impact patients’ health and acute and chronic disease management.
3. Use diagnostic reasoning to make nursing and medical diagnoses.
4. Utilize evidence-based recommendations to develop interdisciplinary health care plans including pharmacologic and nonpharmacologic treatments.
5. Develop outcome criteria for evaluation of clinical practice.
6. Partner with patients* to develop and deliver customized care.
7. Evaluate the Clinical Nurse Specialist role in partnership with patients* and other health care providers.
8. Demonstrate core professional values and ethical/legal standards in the implementation of the Clinical Nurse Specialist role.

*Patients (Individuals, Families, Aggregates, Communities, Society)

The purpose of the clinical practicum is to:

1. provide the opportunity to accomplish course objectives
2. apply course concepts, and
3. implement the diagnosis and treatment process with patients

Each student must complete 135 hours of clinical time.  Clinical hours are arranged between the student and the preceptor.  The student will work with a preceptor in an identified area to implement the role of the clinical nurse specialist and to complete course requirements.

The clinical grade will be based upon a Satisfactory/Unsatisfactory designation.  The clinical log, preceptor evaluation and faculty evaluation will be used to determine the clinical grade.  Students must satisfactorily complete the clinical portion of the course to receive credit for the course.

Clinical Objectives

1. Interpret findings from history and physical, including normal variants and pathological findings.
2. Formulate initial treatment plans, including appropriate laboratory tests, health maintenance recommendations, consults and plans for follow-up.
3. Demonstrate ability to make appropriate treatment decisions.
4. Effectively use consultation and referral sources to provide adequate care for clients.
5. Design effective pharmacological and other biological therapies for clients.
6. Demonstrate the ability to communicate effectively and efficiently with peers, colleagues, preceptors, other health care professionals, clients and their families.
7. Demonstrate ability to apply theory to care, using evidence-based practice.
8. Demonstrate competence in assessment of family and sociocultural aspects of care.
9. Analyze the implementation of the direct patient care role by the CNS in the context of the setting.

Students will be expected to:

1. Develop goals for the clinical experience and share them with the instructor and preceptor during weeks 1-2.
2. Participate in as many direct patient interactions as possible.
3. Relate course goals and objectives and apply class content in the clinical area.
4. Use a CNS/H&P/Episodic data collection tool or form used by the preceptor to complete H & Ps and episodic exams, and complete all documentation and submit to the clinical instructor for evaluation as directed.
5. Maintain a record of current number of clinical hours completed.  Clinical hours form will be signed by the preceptor and student at the end of the semester, and submitted to the course instructor.
6. Maintain an accurate clinical log of patients seen and clinical activities participated in as documentation and analysis of clinical experiences.  The clinical log will be submitted to the instructor every week.

Clinical practicum is graded on a pass/fail basis.  Clinical failure constitutes course failure regardless of course grade.  Students will complete a midterm and final evaluation using the clinical evaluation tool.  Examples of meeting the criteria are expected.  A final evaluation conference will be held at the conclusion of the clinical practicum.  Attendance at each clinical day is required.  If you are unable to attend a clinical experience, you must notify the clinical instructor and preceptor.

Bakerman, P., & Strausbauch, P. (2002). Bakerman's, ABC's of interpretive laboratory data. (4th ed.). Scottsdale:

             Interpretive Laboratory Data.

Gilbert, D.N., Moellering, R.C., & Sande, M.A. (2007). The sanford guide to antimicrobial therapy. (37th ed.).

             Hyde Park, VT: Jeb E. Sanford Publishers.

Guide to clinical preventive services: Recommendations of the US preventive services task force (USPSTF)
            (2007). Retrieved May 6, 2008, from http://www.ahrq.gov/clinic/pocketgd.htm  (can be ordered online
            for free)

 Tierney, L., McPhee, S., & Papadakis, M. (Eds.)(2007). Current Medical Diagnosis and Treatment. (46th ed.).
             New York: McGraw-Hill.

Tarascon pocket pharmacopoeia. (2008). Loma Linda: Tarascon Publishing.

Turkoski, B., Lance, B., Bonfiglio, M. (2009). Drug information handbook for advanced practice nursing.    
             (9th ed.). Hudson: LexiComp.

REQUIRED TEXTS FROM PREVIOUS SEMESTER:
Hamric, A.B., Spross, J.A., & Hanson, C.M. (Eds.). (2005). Advanced practice nursing: An integrative approach.
             (3rd ed.). St. Louis: Elsevier - Health Sciences Division.  

Ignatavicius, D. (2005). Medical-Surgical nursing: Critical thinking for collaborative care.                    
             (5th ed.). St. Louis: Elsevier Saunders. For Medical -Surgical CNS students

McKinley, M. (Ed.). (2007). Acute and critical care clinical nurse specialists: Synergy for best practices.  St. Louis:
             Elsevier Saunders.

Stevens, K.R. (2005). Essential competencies for evidence-based practice in nursing. San Antonio, TX: Academic
             Center for Evidence-Based Practice, the University of Texas Health Science Center at San Antonio.

Green, G. (2007). The washington manual of medical therapeutics (32nd ed.). Philadelphia: Lippincott, Williams               &  Wilkins.

Wells, B.G., Dipiro, J.T., Schwinghammer, T.L., & Hamilton, C.W. (2006). Pharmacotherapy handbook (6th ed.).            New York, NY: McGraw-Hill.

Web Site Resources

Board of Nurse Examiners:  Rules and Regulations (Rule 221 & 222)

http://www.bne.state.tx.us

Board of Medical Examiners: Rules and Statutes regarding Standing Delegation Orders (Chapter 193)

http://www.tmb.state.tx.us

Access to Clinical Practice Guidelines Web Sites:

• National Guidelines Clearing House: http://www.guideline.gov
• Agency for Healthcare Research & Quality: http://www.ahrq.gov/clinic/cpgonline.htm
• National Heart, Lung, & Blood Institute: http://www.nhlbi.nih.gov/guidelines/index.htm

Access to previous advanced practice nursing course references used for Advanced Pathophysiology and Advanced Health Assessment.

1. Diagnosis and management of common health problems related to the following systems: cardiovascular, respiratory, gastrointestinal, genitourinary, endocrine, neurological, hematological, immunological, and integumentary.
   
   (The following is only a partial listing of clinical problems or disorders covered under each system):
   Cardiovascular System
                 Management of dysrhythmias
                 Acute coronary syndrome (includes angina, ischemic heart disease)
                 Cardiovascular surgery
                 Heart failure
                 Hypertensive crisis
                 Shock/Hypoperfusion
   Pulmonary System
                 Acute Respiratory Distress Syndrome
                 Acute Respiratory Failure
                 Obstructive Pulmonary Disease
                 Respiratory infections
                 Thoracic Surgery
   Neurological System
                 Intracranial disorders: head injury, hemorrhage
                 Sensory and motor disorders
                 Neurovascular disease
   Renal System
                 Acute Renal Failure
                 Chronic Renal Failure
   Endocrine System
                 Endocrine Disorders: Thyroid & Pancreas - Type I and Type II Diabetes; Diabetic emergencies
   Hematological System
                 Hematological Disorders: Coagulation Disorders, Anemia
   Immunological System
                 Immunological Disorders: HIV/AIDS, Leukemia, drug resistant issues, autoimmune disorders
   Gastrointestinal System
                 Gastrointestinal Disorders: Acute GI Bleed, Liver Failure, Pancreatitis, GI Obstructive Disorders,               Inflammatory Bowel Disease, Esophageal Reflux
   Integumentary System
                 Integumentary Disorders: Necrotizing Disorders, Burns, Dermatitis
   Musculoskeletal System
                 Musculoskeletal Disorders: Fractured Bones, Low Back Pain
   Perioperative Nursing: Surgical Care
   Systemic Inflammatory Response Syndrome and Multiorgan Dysfunction Syndrome
   Organ Transplantation
   
2. Use of evidenced-based practice related to patient health, disease management and limited prescriptive authority.
3. Diagnostic reasoning
4. Prescriptive authority regulation and issues
5. Ethical, legal and professional standards of advanced practice nursing as it pertains to limited prescriptive authority.