Spring 2018

NURS 6110-001 Advanced Health Assessment and Clinical Reasoning: Clinical Application

All students are responsible for checking their UTHSCSA Livemail account regularly (i.e., daily or several times every week) to obtain Official University Communication regarding their courses, program and student status.

COVID-19
Students are expected to follow all policies related to COVID-19 found on the university webpage: https://wp.uthscsa.edu/coronavirus/.

NOTE: Our campus has enabled the CANVAS MOBILE LEARN application. CANVAS tools such as discussions, quizzes or videos May or May NOT function on all mobile devices. This is because mobile devices are available with rapidly changing and different configurations. Hence, students must not depend on only a mobile device to access course materials. Students must have access to a laptop or desktop device to access course materials and complete assignments.

This course is Web Enhanced with WebCT icon
Please be sure to check the Current Computer Requirements

Welcome to NURS 6110 Advanced Health Assessment Clinical Application!!!

We look forward to working with you over the course of the semester as you improve and refine your health assessment skills.

The Course Introduction video (located in Week 1 Course Orientation module) is required viewing PRIOR to the first day of class. You are also responsible to review all online materials, module resources, and readings before every class. Please explore the Canvas course shell so that you are familiar with the course layout. 

This is a busy semester with lectures, labs, and sim center activities. This course explores the foundational health history and physical examination skills needed by all advanced practice nurses. This course requires many hours of time and effort but is very rewarding.  

You can find the NURS 6110 course packet, which includes a course calendar for NURS 6110 and 6210 on the homepage in Canvas. All the information concerning meeting dates, times, and locations (along with readings and assignment due dates) are included in this document.

Before the first HEB Clinical Skills Center standardized patient event, you will be responsible to purchase a 3/4 length white lab coat personalized with your name and the UT Health San Antonio School of Nursing Logo.  Lab coats are available at local uniforms stores. Please verify they have the most recent official logo (picture below). It may take 2 to 3 weeks for the lab coats to be customized so please purchase now. You will be expected to wear your lab coat for the first simulation center encounter.

                        


FACULTY CONTACT INFORMATION

Section 01: Tracey Smith Page, DNP, RN, FNP-BC 

(Course Coordinator)

Assistant Professor / Clinical

Email: paget@uthscsa.edu 

Office Phone:  210-567-5822

Office Room:  2.336

Office Hours:  Tues 1400-1700

Office of Faculty Affairs and Diversity 


Section 02 Rita Hannah, MSN, RN, FNP-BC, CPNP

Assistant Professor / Clinical

Email: hannahr@uthscsa.edu

Office Phone:  210-567-5305

Office Room:  2.364

Office Hours:  Wed and Thur 0900-1200

Office of Faculty Affairs and Diversity 


Section 03: Wendy Lee, DNP, FNP-BC, FAANP

 

Clinical Associate Professor

E-mail: leewj@uthscsa.edu

Office Phone: 210-567-5102

Office Room: 2.358

Office Hours: Tuesday 2-5pm and by appointment

Office of Faculty Affairs and Diversity 


Section 04: Ken Miller, PhD, MJ, RN, CFNP, FAAN, FAANP


Endowed Professorship

Email:  millerkp@uthscsa.edu

Office Phone:  210-567-3822

Office Room:  2.506

Office Hours:  Wednesday 8-10am, Thursday 9-10am

Office of Faculty Affairs and Diversity 

 

Section 05: Heidi Worabo, DNP, RN, FNP-BC


Assistant Professor / Clinical

Email:  worabo@uthscsa.edu

Office Phone:  210-567-5867

Office Room:  2.380

Office Hours:  by appointment

Office of Faculty Affairs and Diversity 


All office hours are subject to change. Please verify office hours with your assigned faculty. 




COURSE DESCRIPTION

Students will apply advanced health assessment techniques in the performance of focused and comprehensive health assessments of clients across the lifespan. Clinical reasoning, analysis, and synthesis of history and physical assessment data and diagnostic reasoning skills are developed.


CREDIT AND TIME ALLOCATION

Credit Hour Allocation:  1 semester credit hours
Clock Hour Allocation:   60 clock hours lab


PREREQUISITES

Prerequisite
NURS 6338 Advanced Pathophysiology



Concurrent
NURS 6210 Advanced Health Assessment and Clinical Reasoning


PROGRAM OUTCOMES

Upon completion of the Master of Science in Nursing Program (MSN) students will:

  1. Integrate scientific findings from nursing and related sciences, including genetics and genomics, into the delivery of advanced nursing care to populations in diverse settings.
  2. Demonstrate organizational and systems leadership to assure ethical and critical decision-making at all systems’ levels for quality and patient safety.
  3. Incorporate performance improvement strategies for quality, safety, and patient-centered care delivery.
  4. Use improvement science to achieve optimal patient care and care environment outcomes.
  5. Integrate meaningful and usable information systems and healthcare technologies to support safe, quality patient care and healthcare systems effectiveness.
  6. Advocate for policy changes that influence healthcare at appropriate levels.
  7. Lead interprofessional teams using collaborative strategies to effect quality patient care and population health outcomes.
  8. Analyze and incorporate broad ecological and social health determinants to design and deliver evidence-based clinical prevention and population healthcare and services to individuals, families, and aggregates/identified populations.
  9. Integrate the advanced competencies expected of a master’s prepared nurse to design, deliver, and evaluate outcomes of systems of care for individuals, families, and diverse populations.

COURSE OUTCOMES

N/A

CLINICAL OUTCOMES

1.  Apply a holistic patient-centered approach to the collection, synthesis, and communication of data gathered, both oral and written. (DNP Essential VIII; NONPF Competencies: Practice Inquiry 1, 2; Ethics 2, 3; Independent Practice 1, 2 4) 

2.  Collect a comprehensive database, including age-appropriate history, physical examination, laboratory and diagnostic studies. (DNP Essential VIII;; NONPF Competencies: Practice Inquiry 2,3; Independent Practice 1,2 3)

3.  Adapt history and physical examination data, and screening according to age, developmental status, culture, language, and patient needs, preferences, and values. (DNP Essential VIII; NONPF Competencies: Practice Inquiry 3; Ethics 2,3; Independent Practice 1, 2, 4, 8)

4.  Formulate a summary of the database including prioritized differential diagnoses and problem list based on interpretation of a comprehensive assessment. (DNP Essential VIII; NONPF Competency: Independent Practice 1, 2, 3, 5, 8)

5.  Construct an organized and complete oral and written summary of the database, including a prioritized differential diagnoses and problem list. (DNP Essential VIII; NONPF Competency: Independent Practice 1, 2, 3, 5, 8)

6.  Formulate prioritized differential diagnoses and problem lists. (DNP Essential VIII; NONPF Competency: Independent Practice 1, 2, 3, 8)

7.  Utilize motivational interviewing skills. (DNP Essential VIII; NONPF Competencies: Ethics 1, 2, 3; Independent Practice 1, 2, 4, 5)

 


GRADING SCALE FOR GRADUATE COURSES

A = 4 points (90-100)
B = 3 points (80-89)
C = 2 points (75-79)
D = 1 point (66-74)
F = 0 points (65 or below)

CRITERIA FOR EVALUATION / GRADES


Digital Clinical Experiences                 10%

 

Skills Labs Participation                        5%


Self Assessments                                10%


Episodic SOAP Notes

        HEENT                                          5%

        Cardiovascular or Pulmonary        5%

        Musculoskeletal                             5%

        

Final Episodic SOAP Note                   10%


HEB Clinical Skills Center Simulation Episodic Events

        HEENT                                         10%

        Cardiovascular or Pulmonary       10%

        Musculoskeletal                            10%

       

HEB Clinical Skills Center Simulation Center Final Event 

         Final  Physical Exam                   20%

 

Total                                                      100%

 

Digital Clinical Experiences:  You must earn an 80% or better to receive any credit in each module. Anything less an 80% will be given a zero and anything above an 80% will be given the % score earned. You may repeat the module as often as you want to before the deadline for a higher score.


Skills Labs Participation:  Your participation/attendance is imperative to success in this course. You must complete all assigned readings (textbook and lab skill sheets) prior to the skills lab and arrive prepared to perform the skills of that day.  If a skills lab is missed, it is your responsibility to acquire the information outside of class. 


Self Assessments:  Self Assessments are assigned prior to clinical lab experiences and are based on the lab instruction materials posted in Canvas. You will have the opportunity to take the quiz more than once for a higher score. See the course calendar for dates.   


Episodic SOAP notes: If you earn a grade of less than 80%, you may resubmit within 72 hours of the grade posting. The resubmission will earn no more than 80%. You are responsible for monitoring your grades.


Episodic Physical Exam:  If you earn a grade of 70% or less on the Episodic Events, you may repeat the graded exam at your expense. Repeated physical exam observations will have a maximum score of 80%. All observation remedials must be scheduled within 72 hours after the grade posting and coordinated with faculty and HEB Clinical Skills Center availability. You are responsible for monitoring your grades.


Final Episodic SOAP Note: If you earn a grade of less than 80% on the Final Episodic Note, you are required to resubmit with corrections within 72 hours of grade posting. You are responsible for monitoring your grades.

 

Final Physical Exam: If you earn a grade of 70% or less on the Final Physical Exam, you are required to repeat the graded exam at your expense. Repeated physical exam observations will have a maximum score of 80%. All observation remedials must be scheduled within 72 hours after the grade posting and coordinated with faculty and HEB Clinical Skills Center availability.  You are responsible for monitoring your grades.

 

*A cumulative grade of 80% or better is required to pass the course.

 

Grading Scale

 

Pass/Not Pass

 

Course Policies

Class Schedule:

The clinical labs will follow class lectures.  Please refer to the course calendar for dates and times. 

Attendance:

Students will be expected to attend all scheduled lectures, labs, and simulation events. The student will come to class prepared through extensive reading and thoughtful contemplation of daily content/topics. Whenever possible, case examples from practice and reading will be added to discussions. Students will be responsible for their own learning and the enlightenment of others. Graduate students, as professionals, are expected to arrive for class at least 10 minutes before class time and be settled in their seats before class. Late arrivals interrupt faculty and guest speakers. All pagers, cell phones, Bluetooth earbuds are to be off during class. Class attendance is required. In case of emergency or illness, students should contact the course coordinator and your assigned faculty clinical group leader as soon as possible.


Assignments:

 

Must be submitted by the designated time on the date due in the designated Assignment Drop Box inside Canvas. Students are strongly encouraged to prepare their assignments and submit them in the correct assignment drop box inside Canvas before the due date and time since waiting until the last minute may result in the drop box closing and the assignment failing to be uploaded.  Alternative forms of submission will not be accepted. In the event (emergency situation) that a written assignment cannot be submitted by the due date in the designated Assignment Drop Box, the student may petition the course coordinator or faculty clinical group leader for consideration of an extension before the due date of the assignment. All petitions must be in writing (e-mail is acceptable).  All petitions must be received no later than 5:00 pm the day before the due date of the assignment. Late assignments will not be accepted for grading and will be given a score of zero, unless the course coordinator or faculty clinical group leader grants permission in advance. It is the student's responsibility to make sure that their respective faculty member has received their assignment by the due date.

 


 

 

CLASSROOM ATTENDANCE

Attendance in class is an expectation of each student.

CLINICAL ATTENDANCE

The School of Nursing faculty expects that its students will recognize that they have entered a profession in which commitment to full participation in clinical experiences is an essential component as students are considered to be part of the nursing team. Therefore, regular attendance in clinical, laboratory and simulation experiences is mandatory.

Missed hours can prevent adequate development and assessment of the required knowledge, skills, attitudes and clinical judgment. Absence from clinical/lab/simulation jeopardizes the student’s ability to successfully meet the required clinical course outcomes and competencies.

Punctuality is expected in professional workplaces. Students are expected to arrive on time for clinical/lab/simulation experiences and stay for the entire time allotted for that clinical/lab/simulation experience. Important information affecting patient care is communicated to students at the start of clinical experiences. Therefore, tardiness for clinical/lab/simulation experiences jeopardizes the student’s ability to give safe nursing care.

CLINICAL ABSENCES:
Absences from clinical experience are closely monitored by faculty and should occur only in rare circumstances. Clinical absences will be evaluated on an individual basis. If the student has any clinical absences during the semester, clinical may be made up through a plan developed by the clinical/lab instructor. However, the opportunity to make up absences may not be possible, depending on the length of the clinical rotation, the availability of the faculty and/or the agency to which the student is assigned and may result in inability of the student to meet course outcomes.

If it is determined by the faculty team that a student will be unable to meet course objectives due to clinical absences or if a pattern of absence develops or excessive absences exist, the appropriate course coordinator will refer the student the Associate Dean for Undergraduate Studies to determine progression in the program.
 
NOTIFICATIONS:
A student who is unable to attend a clinical experience must contact the clinical faculty personally prior to the beginning of the clinical experience. Leaving a message or e-mail for the faculty is not acceptable. Faculty will share specifics regarding appropriate means of communicating during orientation.

Travel to surrounding communities may be necessary.

PATIENT SAFETY:
Students are expected to demonstrate achievement of clinical objectives by the end of a clinical course. If, in the instructor‘s professional judgment, a student is consistently unable to provide safe nursing care to patients and cannot remedy the deficit in the given clinical time, the student will receive a grade of ―F for the course. Faculty, or staff in the clinical agency, has
the right to remove a student from the clinical area at any time for any cause.

CLINICAL PASSPORT:
Students are required to maintain a clinical passport and have this on their person at all times while in the clinical setting.

CPR REQUIREMENT:
Students are required to maintain American Heart Association Health Care Provider Basic Life Support certification.

WRITTEN ASSIGNMENTS

  1. If written assignments are made in a course they are required.
  2. Students are expected to submit written work on the scheduled date and time.
  3. The student must notify the course coordinator prior to the scheduled due date and time if they are unable to submit the written work as scheduled. Failure to make this notification in advance will result in a "zero" for that written work.
  4. If the excuse is accepted as reasonable and necessary, arrangements will be made for an alternative due date and time.
  5. Each student is responsible for making sure that he or she has completed the written work prior to submission.
  6. Late work will be accepted with consequences as outlined per course syllabi.

APA GUIDELINES

The APA Publication Manual 7th edition is required for use in all nursing school programs. 

SCHOLASTIC DISHONESTY

Students are expected to be above reproach in all scholastic activities. Students who engage in scholastic dishonesty are subject to disciplinary penalties, including the possibility of failure in the course and dismissal from the university. "Scholastic dishonesty includes but is not limited to cheating, plagiarism, collusion, and submission for credit of any work or materials that are attributable in whole or in part to another person, taking an examination for another person, any act designed to give unfair advantage to a student or the attempt to commit such acts." Regents Rules and Regulations, Part One, Chapter VI, Section 3, Subsection 3.2, Subdivision 3.22.



PROFESSIONAL CODE OF CONDUCT

Students who are nurses or are preparing to enter the profession of nursing are expected to treat others with respect and compassion. “The principle of respect for persons extends to all individuals with whom the nurse interacts. The nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise and to resolving conflict. This standard of conduct precludes any and all prejudicial actions, any form of harassment or threatening behavior, or disregard for the effects of one’s actions on others” (American Nurses Association Code for Nurses, Interpretive Statement 1.5).

The students, faculty, Department Chairs, Associate Deans, and the Dean of the School of Nursing of the University Texas Health Science Center San Antonio subscribe to the highest standards of conduct. Our aim is professional behavior beyond reproach. Failure to abide by the signed code of professional conduct may lead to suspension and/or permanent dismissal from the UTHSCSA SON. In particular, we subscribe to the provisions of the Code of Ethics for Nurses (http://bit.ly/1mtD5p2) and the following points of conduct.

http://catalog.uthscsa.edu/schoolofnursing/policiesandprocedures/

School of Nursing Netiquette Guidelines for Online Interaction

Netiquette guidelines provide information for behaving properly online, when using email, tweets or texts so that you may successfully communicate your thoughts in a manner that is respectful and avoids misunderstandings with others.

ADA ACCOMMODATIONS

Any student seeking reasonable accommodations through the Americans with Disabilities Act (ADA) should contact either the Associate Dean for Admissions and Student Services within the first week of the semester or schedule a meeting with the UTHSCSA ADA Compliance Office so that appropriate accommodations may be arranged. A request for accommodations (Form ADA-100: http://uthscsa.edu/eeo/form100-Faculty-student-resident.pdf) must be completed and submitted to the Executive Director of the ADA Compliance Office before accommodations can be provided. Additional information can be provided in the Student Success Center, Room 1.118 or through the ADA Compliance Office website: http://uthscsa.edu/eeo/request.asp.

REQUIRED TEXT / REFERENCE

Shadow Health® Digital Clinical Experience™ course:Advanced Health Assessment: Clinical Applications - Spring '18 .

Please create your account by visiting http://app.shadowhealth.com/and enrolling in your course with this course-specific PIN:

Janauary2018-4387-7694-6043-7402

Helpful Resources:

The Shadow Health® Support Team is here to help address anytechnical issues or questions that you might have. Support can be reached viasupport.shadowhealth.com, through email at support@shadowhealth.com, or bycalling (800) 860-3241. 

These are the same textbook requirements as in NURS 6210

Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S. & Stewart, R.W. (2015). Seidel’s guide to physical examination. 8th ed.  St. Louis, MO: Elsevier Mosby.  ISBN: 978-0-323-11240-6

 

Gawande, A. (2014). Being Mortal. New York: Metropolitan Books. ISBN: 978-0-8050-9515-9


Hagan, J.H., Shaw, J.S., & Duncan, P.M. (Eds.).Bright Futures: Guideline Pocket Guide. 4th ed. American Academy of Pediatrics. ISBN-13:  978-1610020824. 


Seller, R.H. & Symons, A.B. (2011). Differential diagnosis of common complaints (6th ed.). St. Louis, MO: Elsevier.  ISBN: 978-1-4557-0772-0

 



 


RECOMMENDED (OPTIONAL) TEXT / REFERENCE

American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, D.C.: American Psychological Association.

Ball, J.W., Dains, J.E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Student Laboratory Manual for Seidel's Guide to Physical Examination (8th ed.). St. Louis, MO: Elsevier. ISBN: 978-0-323-16952-3


CONTENT OUTLINE


1.  Review of Health History 

2.  Cultural Diversity and Explanatory Model

3.  HEENT

4.  Neurology and Mental Health

5.  Cardiology/EKG Workshop

6.  Pulmonary/Xray Interpretation

7.  Dermatology/Suture Lab

8.  Musculoskeletal

9.  Male and Female GU and Breast Exam

11. Special Populations Pregnant, GYN, and women

12. Abdomen/Renal and Lymphatic System

13. Special Populations: Pediatrics and Newborn

14. Special Populations: Older Adult



CALENDAR - 1st Day Only

Please check the schedule for recent updates on Class Dates & Room.

For full calendar and details, please refer to information posted in the course packet in CANVAS






DATE & LOCATION

NURS 6210







NURS 6110

Assignments for NURS 6110 and

Discussion Board for NUR 6210

DUE DATES







PREPARATION

WK 1 –

Jan 9, 2018
Lecture Room  SON: 1.463

8:00 am-9:50 am

Course Introduction Orientation [presented online Dr. Wendy Lee]



The Complete Health History, Clinical Reasoning and Documentation. [Rita Hannah]



Tour of Clinical Skills lab



Safe Space Training by Dr. Peter Guarnero



Online:

Cultural Diversity Explanatory Model r/t Health History- [presented by Dr. Adelita Cantu]

Course Orientation video




1. Ball, et al. (2015): Chapters 1, 2, 3, 25, 26

Lecture Room  SON: 1.463

1000-1250


Demonstration of history and report to preceptor




HEB Clinical Skills Center: orientation




Tour HEB Clinical Skills Center



Meet with your assigned clinical faculty to review report to preceptor and differential diagnoses





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