Comprehensive Exam Orientation Spring 2013

Roxanne Garbez, RN, PhD, ACNP-BC, CNS

Outline of Comp ProcessDescription of the projectThe Comprehensive Exam HandbookQualifying for the examinationImportant datesTechnical requirementsResources

The AssignmentThe purpose of this paper is to evaluate your ability to:Critique research as it applies to your area of specializationApply advanced clinical and theoretical knowledge to practiceUtilize writing skills to disseminate nursing information using a scholarly paperDemonstrate you can be a consumer of research

Critical PointsThirty (30) page paper (maximum)

Three exam optionsResearch ProposalCritical Literature Review Problem-solving

The HandbookYou can download a copy of the Comprehensive Examination Handbook from the UCSF School of Nursing website

How to Qualify for the ExaminationYou are eligible in the last quarter you are enrolled in course and clinical work.If you have completed ALL course work with the exception of the comp exam you may submit the exam while on filing fee status for a reduced fee.

Filing Fee StatusTalk with your advisorYou may not take courses of any type if you are on Filing Fee status Apply and pay filing fee to OARMost frequently used for second time comp exam submission Filing fee status can be used only once. If you pay filing fee then do not submit your comp you must pay full tuition for the subsequent quarter you submit your comp

Advance to CandidacyBefore you can be issued your individualized Comp Number, YOU MUST ADVANCE TO CANDIDACY.Advance to Candidacy forms are available from the Office of Admissions and Registrar. Forms can also be downloaded online.After you submit your form Graduate Division notifies Office of Student Affairs. OSA will then generate your Comp Number.

The Last Quarter of Course and Clinical WorkAdvance to Candidacy any time before the first week of the quarter in which you plan to turn in the compOne incomplete on record allowedPayment of fees required for number

Know the Important Dates- Spring 2013Number pick up date: Between April 9 and April 22Submit comp by NoonApril 23Notification of resultsMay 23

Technical and Procedural PointsFormatSubmission Scoring

Formatting ExpectationsAPA 6th Edition formatMargins 1 inch on all 4 sides of pageCan separate syllables at the end of a line30 pages of text, not counting title page, reference list and appendicesTitle should reflect contentNo abstractDouble-spaced, 12 point uncompressed font (Acceptable font examples: Times New Roman, Arial)

Submission RequirementsOne single-sided original of the comprehensive examination plus three double sided copies Next fall submission likely PDF, no hard copiesCompleted face sheetSeparate paper with students name, address, home and work number, and other pertinent information that facilitates the student being contacted if necessaryIt is the students responsibility to ensure that the comprehensive exam is submitted by 12 noon on the due date

*Face SheetIn order to pick up your number you must complete the face sheet and return itList your specialtyTopic Suggested readersID number is given to you to be placed on your comp

Reading and ScoringStudent may select up to five preferred readers (not required)Student is not guaranteed a preferred readerReaders use a standard scoring systemStudent will be given the faculty comment sheets at the end but not the scoring sheets

Plagiarism

Evidence of plagiarism results in a failure of the comprehensive exam.Plagiarism can become grounds for dismissal from the School of Nursing.

A Comp Does Not PassOne pass and one fail from two readers goes to a third reader for decisionExam fails if two readers fail itMay re-submit exam once within 5 quarters of first submission

Vital ResourcesVital resourceDepartment Administrative AssistantsCHS Kathryn Young PN James NegriFHCN Kathryn KeihlSBS Brandee Woleslagle Comprehensive Exam CoordinatorsCHS Beth Phoenix & Dana Drew-NordPN Roxanne GarbezFHCN Karen Duderstadt & Barbara HollingerSBS Susan Chapman

Additional ResourcesAdvisors- topic and formatSpecialty facultySample comps on reserve Office of Student Affairs for tutors and editors, contact Judy Martin-HollandConsider other arrangementsTypistPaid tutors and editorsPeers as editors and proofreadersCreate a timelineSee sample provided

Comprehensive Exam 2012-2013SEPOCTNOVDECJANFEBMARAPRMAYJUNJULAUGIdentifying the phenomenon of interestRefine topic outlineAdvance toCandidacyTopic generationFaculty input re: topicLiterature reviewFaculty input re:topic outlineDraft #1Colleagues read paperfor clarity and organizationDraft #2Pick upComp #EditSubmitComp Advance to Candidacy: Before end of Winter Quarter Pick up Comp # from Departments: From 4/09/13 to 4/22/13 Submit Comp to Departments: 4/23/13

WORK HARD, DO WELL!Extensions, examination by mail, summer comps, oral exam are available only by special arrangement. Read the corresponding section of the comp handbook.

*Sample ExaminationsOn reserve in each of the departments

Ask your advisor and/or your department's comprehensive examination coordinator

*Other ResourcesUCSF SON website

*Choosing a TheoryA theory should further clarify, support and explain your topic

Nursing theory not required

Explain your theory in the textdont depend on diagrams in the appendix

*Theory or Conceptual FrameworkTheory is the format that enables you to explain a phenomenon. There is no right or wrong theory--it is all in how you want to frame the argument you want to make.

*Possible Mechanisms Underlying the Increased Risk of Type 2 Diabetes in People on Atypical Psychotrophics

PhysiologicalHPA axis and sympathetic nervous system hyperactivity resulting in overproduction of cortisol.GeneticsDiabetes only occurs in those with a genetic predisposition.Co-moridityThe diabetes is really due to alcoholism or binge eating.Socio-culturalDue to socioeconomic, disability, marital status, access to health careHealth careProviders fail to adequately monitor overall health.BehavioralInactivity, diet, smoking due to the psychiatric illnessMedication Side effects, appetite stimulation and subsequent weight gain

*Possible Titles The Relationship Between Atypical Psychotropic Use and Diabetes Mellitus: The role of GeneticsSociocultural Factors in the Development of Diabetes Mellitus in Patients with Severe Mental Illness

*Types of ExaminationsResearch Proposal (check with your advisor as early as possible)

Critical Literature Review

Problem-solving

*Research ProposalTo evaluate a students ability to identify a significant research question relevant to nursing practice, and to design a methodology for addressing the question.Study does not have to be implementedMust have access to UCSF faculty with research experience to mentor you

Research ProposalGood choice if you plan to build on this topic for future research or doctoral workCould be taken back to your workplace for implementation if approval given by institution

Research Proposal ScoringTotal Points 330 Area 1 Study and Context 63 Conceptual Framework and Literature Review - 126 Methodology 126 Technical (grammar, organization, use of APA format) 15

The Comprehensive Exam is Pass/FailPoints needed to pass - 231

*Critical Literature ReviewChoosing a TopicPose a question Do initial searchingThere is enough research, but no clear synthesis of findings or clear direction You want to argue a point that has some evidence, but is not established practice

*Critical Literature ReviewTopic or IssueClarity of topic or purposeState in 1 sentence!The purpose of this paper is to examine the literature related to the efficacy of using BNP to diagnose patients with heart failure

*Topic or IssueSignificance of topic4.8 million in US have HF, 50% are rehospitalized in 6 mos., there is no lab test for diagnosing HF, BNP might provide better method for effective evaluation of SOB than symptoms

*Some evidence exists, but practice is not well delineatedShould diabetics use ACE inhibitors to prevent renal impairment ?

This is well-established by scientific study and standard of practice in most settings. Is it safe to give people with stage 4 kidney disease ACE inhibitors to prevent progression?Practitioners have been hesitant to give people with stage 4 CKD ACE inhibitors for fear of increasing creatinine or potassium to dangerous levels.

*Literature Review Theoretical DiscussionQuality of ReferencesElements of CritiqueQuality of Critique

*Literature ReviewTheoretical DiscussionMust address the foundation of your question or problemExample: Sepsis and EGDTUse Physiologic theory to explain why EGDT is appropriate for septic patientsUse Change Theory if you want to implement EGDT in a new setting that manages septic patients

*Literature ReviewQuality of ReferencesReferences significant to the problem area classic & current while noting gaps in research literature if anyAvoid multiple articles from the same overall study (different purposes but same sample, methodology, statistics, etc.)

*Literature ReviewOrganization of reviewRationale for selected articles, describe how you organized your paperThe journal articles were chosen because they include.and the oldest is reviewed first.How many articles should you critique?Use well written AND perhaps not so well written research articles the heart of the critique process is identifying why they may have similar study questions and yet end up with different results

*Literature ReviewElements & Quality of Critique Articulate Main PointsSampleDesignProcedureMeasuresResultsConclusions

*Literature ReviewDiscussion and ApplicationCritical and original analysisIntegration and synthesis of research articlesImplications for practiceFuture research

*Literature Review CritiqueSynthesis and interpretationYOUR ASSESSMENT OF THE STUDIESToo small of a sample size to have power to find a difference between those with and without HFAuthors were biased b/c they knew the BNP level and may have changed treatmentOnly generalizable to men

*Make a Table!Organize your literature into a table to compare and contrastDescribe each study

*Identifies gaps in literature, implications for practice, need for further researchSTICK your neck out there! Make your opinion known, however you must base it on the critique of the literature you presented rather than your opinion.

*Technical CriteriaGrammar and spellingOrganization of paperAPA format

*Literature Review ScoringTotal Points - 330Area 1 Topic or Issue - 70Area 2 Literature Review - 165Area 3 Discussion & Application - 80Area 4 Technical (grammar, organization, APA) 15

LITERATURE REVIEW IS50% OF THE PAPER

*Problem-solving CompPurpose: To evaluate the students ability to effectively communicate the resolution of a problem in an area of specialization.Describes an identified need stemming from a discrepancy between what is or what could/should be.

*Choosing a Problem-solving TopicCan be a problem on an individual or a systems level.Must be appropriate to the clinical situation Think of a situation that is challenging to youMust be feasible!Must be measurable!

*Examples of Problem-Solving TopicsInitiating an Oral Care Program in a Nursing HomePost-Partum Depression: Transition to MotherhoodICU Nurses Knowledge Deficit Regarding Hemodynamic MonitoringLoss of Venous Access and Dialysis Delay in End Stage Renal Disease Patients

*Problem-solving CautionsInstituting a delirium treatment program in acute care settingIs delirium identified? Multiple etiologieswhat will the intervention be? How will you measure this?Improving parenting skills by identifying temperament in toddlers in preschoolsWhat is meant by parenting skills? How will you get access to preschools? Is there literature that indicates that identifying temperament will change parenting behavior?

*Criteria for Scoring CompClarity of the Problem Significance of the Problem Clarity of Setting Clarity of Roles and inter-relationships

*The Problem and its Environmental Context Clarity of the ProblemWho is solving the problem APNWhere the problem occurs ICUWhat is to be accomplished Improve Nurses KnowledgeTarget population ICU Nurses

*The Problem and its Environmental Context Significance of the ProblemImportance of the problem to patients or professionAccurate Hemodynamic Monitoring is essential for ICU patients

*The Problem and its Environmental ContextClarity of the SettingHome, hospital, nursing homeIntensive Care Unit

*The Problem and its Environmental ContextClarity of Roles & Inter-relationshipsDescribes functions of individuals sig to problem, their roles and influence on the settingICU nurses, Clinical Nurse Specialist, Head Nurse

Literature ReviewQuality of theoretical discussionQuality of referencesAddresses elements of critiqueQuality of critique and interpretation

*Intervention, Implementation & EvaluationExpected OutcomesClarity & Appropriateness of Intervention ImplementationClarity & Appropriateness of Evaluation ProcedureDefensibilityRealism

*Intervention, Implementation & EvaluationClarity of Expected OutcomesImprovement of Nurses Knowledge evidenced by improvement on post-test scores

*Intervention, Implementation & EvaluationClarity & Appropriateness of ImplementationOutline procedures for implementing the intervention and ensuring they are appropriateEducational intervention was three-foldSelf-study, then 4 hour mandatory class, bedside guides developed

*Intervention, Implementation & EvaluationClarity & Appropriateness of Evaluation Delineates specific measurable and appropriate evaluation criteriaPretest and post-test measure of ICU nurses knowledge is measuredNumber of incident reports are analyzed regarding monitoring

*Intervention, Implementation & EvaluationDefensibilityDemonstrates intervention has potential for substantial improvement in the problemRealismFeasibility of interventionWill an educational intervention be possible?

*CaveatsDo not wait until the end to decide on method of evaluation

When writing, do not always start with the beginning of the paper and progress to the end or your evaluation will suffer.

*Problem-solving ScoringTotal Points - 330Area 1 The Problem - 105Area 2 Literature Review - 105Area 3 Intervention, Implementation, Evaluation - 105Area 4 Technical (grammar, organization, APA) -15

EACH SECTION IS EQUALLY WEIGHTED SO PLAN FOR 10 PAGES PER SECTION!

Most common reasons why comps failStarted too late to put in necessary time and effortDid not meet with advisor to make sure you are on trackDid not follow the advice of your advisorPrimary editor was someone whose English composition skills were not adequate to give you appropriate feedback on your writing

*I PASSED!

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