Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
1 Clinical competency and hours 807 2017
MSU College of Nursing NUR807: Clinical Decision Making Summer 2017
Documentation of CNS Clinical Competencies, Activities, and Hours
Student Name: Kelly Ashcraft
Date (range for submission) Start: 5/22/2017 End: 7/30/2017
Preceptor: Melanie Miller MSN, RN ACNS-BC
Agency: Harper University Hospital
Clinical Faculty: Linda Hansen MSN, RN, ACNS-BC-AG
Clinical Faculty Email: [email protected]
Total Cumulative Internship hours (at time of submission): 100.5 (to be entered by
student)
This Section for Preceptor Use Only
Preceptor Validation of student competency documentation, activities and clinical hours as noted
on this document. Your typed/electronic signature indicates you have reviewed and agree with
the student’s documentation of competency achievement and clinical hours as written.
Preceptors, once validated, please email directly to the clinical faculty named above.
This Section for Student Documentation
Students are to document how each competency listed below was achieved, label with the
corresponding sphere of influence (patient/patient care, nurse/nursing personnel,
organization/systems) and the date of entry. Statements are to be brief, outcome statements,
providing evidence of completion and associated dates. When the evidence of competency
achievement is the completion of a course assignment (example: history and physical) it is
appropriate to document that as part of the outcome statement.
Course Objectives:
At the end of this course, students will: 1) Apply decision theory to formulate differential diagnoses.
2) Formulate differential diagnosis based on evidence for nursing and medical diagnoses of common problems.
3) Develop mutually agreed upon diagnostic strategies for working diagnosis based on evidence, knowledge of the individual’s age, gender and cultural values.
4) Analyze the implications of diagnostic decisions relative to cost and efficacy within the health care system.
5) Compose a researchable clinical question and synthesize the literature related to this topic in the Problem/Intervention/Comparison/Outcome/Time (PICOT) format.
2 Clinical competency and hours 807 2017
Provide 2-3 personal objectives for achieving course objectives:
Personal Objective with Planned Learning Activities / Required Resources:
Integrate advanced nursing knowledge and
clinical assessment skills to create a plan of
care and differential diagnoses for a complex
patient population.
Planned Learning Activities and Required
Resources
• Collaborate with preceptor while
completing patient assessments
• Participate in multidisciplinary rounding
of patients
• Review patient outcomes from previous
weeks to determine if my plan of care or
differential diagnosis was accurate for
successful patient outcomes
• Utilize course information to improve
skills
• Complete Shadow Health assignments
Evidence of Achievement (including date): 5/15/17: Successfully completed shadow
health assignments.
6/26/17: Patient Sphere
I have consistently displayed improvement
in my assessment skills of complex patients.
The differential diagnoses presented to my
preceptor align with the patient’s plan of
care.
7/6/17: Patient Sphere
Conducted an assessment of a returning
patient from previous clinical weeks, who
was transitioning to palliative care.
Advocated for patient and family needs
during multidisciplinary rounding with case
management, social work, nursing, and
medical staff.
Personal Objective with Planned Learning Activities / Required Resources:
Summarize the use of diagnostic testing and
plans of care and the financial implications to
the intercity patient population.
Planned Learning Activities and Required
Resources
• Discuss with preceptor the considerations
included while devising a plan of care
• Collaborate with social work regarding
the Medicare Medicaid patient population
• Utilize journal searches to review
evidence based processes while
developing a plan of care
• Identify cost effective strategies for a
patient hospitalization
• Familiarize self with the cost of studies
ordered for my patients
Evidence of Achievement (including date): 7/6/17 – Patient & Systems Sphere
I have become more active and engaged in
progressive discharge planning with nursing
staff, physicians, and case managers on the
unit. I collaborated with the case manager to
learn more about the Medicare discharge
appeal process and the implications on the
patient and hospital. Patients who appeal the
discharge are not comfortable with the
discharge plan, in turn contacting Medicare.
Medicare reviews the plan of care and
determines if discharge is appropriate. If
discharge is deemed appropriate the patient
must consent to discharge by noon or will be
responsible for the cost of hospitalization.
Collaborated with pharmacy and case
management on cost effective home
antibiotic therapy for a patient discharge.
3 Clinical competency and hours 807 2017
Required Clinical Competencies and tasks for NUR807
Direct Care Competencies:
Conducts comprehensive, holistic wellness and illness assessments using known or innovative evidence-based techniques, tools, and direct and indirect methods. Includes those who are non-verbal, developmentally, functionally, and/or cognitively impaired.
Evidence of Achievement (date):
• 6/23/17 – Patient Sphere
Conducted a comprehensive history and assessment on a patient with progressive multiple
sclerosis, extensive pressure injuries, and moderate dysphagia with aspiration pneumonia.
Completed wound assessment and care and participated in the consultation documentation in
the electronic medical record. Provided nutritional counseling when assisting the patient eat
lunch.
Assess physiological and functional changes associated with aging and development across the adult continuum necessary to formulate differential diagnosis (include both non-disease and disease related factors).
Evidence of Achievement (date):
• 6/12/17 – Patient Sphere Completed a comprehensive physical exam for an 85 year-old patient with severe dementia.
Utilized different communications techniques such as empathy, asking permission, and
keeping questions simple, to engage her in conversation to determine differential diagnoses.
Differential diagnoses included advanced dementia with possible depression upon
completion of the assessment.
Employs evidence-based clinical practice guidelines to guide screening and diagnosis for age-specific and genetic risk factors.
Evidence of Achievement (date):
• 7/10/17 – Patient Sphere Researched the indications for Unna Boot application for patients with venous insufficiency
as requested by my preceptor prior to clinical in the vascular clinic. Preformed assessments
for vascular clinic patients including the effectiveness of Unna Boot therapy. Managed the
application of Unna Boot for several patients during clinical.
4 Clinical competency and hours 807 2017
Assesses the effects of interactions among the individual, family, community, and social systems on health and illness.
Evidence of Achievement (date):
• 6/23/17 – Patient Sphere
Effectively communicated with a patient experiencing an acute phase of schizophrenia. I
was successful in gaining trust which allowed for the medical team to give care which was
previously refused by the patient. This positive interaction resulted in the patient receiving
care appropriate to her needs.
Assesses the interaction between acute and chronic physical and mental health problems.
Evidence of Achievement (date):
• 6/23/17 – Patient Sphere Participated in the care of a patient who’s differential diagnoses included hepatic
encephalopathy or acute schizophrenia. Both diagnoses could impact the patient’s
presentation of agitation and altered decision making capabilities.
Identifies potential risks to patient safety, autonomy and quality of care based presence of co-morbidities and psychological issues that may impact optimal level of health.
Evidence of Achievement (date):
• 6/23/17 – Patient Sphere Provided a comprehensive assessment of an uncooperative, threatening patient who was at
risk for personal safety as well as staff safety. Recognized the potential causes of
presentation including psychiatric history and acute health status changes.
Assesses the impact of environmental/system factors on care
Evidence of Achievement (date):
• 6/12/17 – Systems Sphere, Nursing Sphere Provided assistance and guidance to staff during a busy shift. Noted the change in the
environment and relaxation of the nursing staff when they felt they had support throughout
the shift.
Uses reliable and valid age-appropriate assessment instruments to assess acute and chronic health concerns, including but not limited to mental status, delirium, dementia and pain.
Evidence of Achievement (date):
• 6/12/17 – Patient Sphere Utilized the Geriatric Depression Scale Short Form to assess for possible depression in an
elderly patient with a history of dementia. Frequently utilize the Nonverbal Pain Scale
(NVPS) when assessing patients.
5 Clinical competency and hours 807 2017
Assess for manifestations of health disorder or health disruptions, e.g. infection, adverse drug effect, dehydration, ischemia, and geriatric syndromes.
Evidence of Achievement (date):
• 6/12/17 - Patient Sphere Completed a physical assessment for an 85 year-old patient for signs of infection. Assessed
fluid volume status since she was not eating or drinking adequately.
Evaluates for common mental health disorders such as depression, dementia, anxiety, or substance-related disorders.
Evidence of Achievement (date):
• Patient Sphere Utilize the Geriatric Depression Scale Short Form when monitoring the geriatric population
for depression.
Recognizes signs and symptoms of anxiety such as anger, uncooperative behavior, and
crying related to stress of illness or hospitalization. Provide therapeutic techniques such as
active listening, asking permission, and including the patient in the plan of care to assist in
alleviating anxiety symptoms.
Conducts a pharmacologic assessment including polypharmacy, drug interactions, over-the-counter and herbal product use, and the ability to safely and correctly store and self-administer medications.
Evidence of Achievement (date):
• 7/28/17 - Patient Sphere Evaluated a patient admitted for pericarditis and non compliant with antibiotic treatment
plan. Evaluated a history of poly opioid use including heroin, and prescription. Considered
the patients ability to maintain medication compliance as she is homeless.
Assesses patient, caregiver, and family’s preferences in relation to cultural, spiritual, quality of life, and lifestyle choices.
Evidence of Achievement (date):
• 7/6/2017 - Patient Sphere Provided patient and family support when making decisions for end of life care. Discussed
hospice and palliative care options per the patient and family request and collaborated with
the multidisciplinary team to obtain information.
6 Clinical competency and hours 807 2017
Interprets values/results of laboratory and diagnostic tests with consideration of age, ethnicity and health status.
Evidence of Achievement (date):
• 7/3/2017 – Patient Sphere, Systems Sphere Interpreted laboratory and diagnostic imaging studies for a patient presenting with a
generalized complaint of abdominal pain. Through the diagnostic results I was able to
determine a diagnosis of cholecystitis and pancreatitis.
Synthesizes assessment data, advanced knowledge, and experience, using critical thinking and clinical judgment to formulate differential diagnoses for clinical problems amenable to CNS intervention.
Evidence of Achievement (date):
• 7/6/2017 - Patient Sphere, Systems Sphere Collaborated with infectious disease, medicine, and surgery physician teams to assess a
patient with multiple wounds with purulent drainage. Assisted in determining a plan of care
including antibiotic treatment, the need for further surgical debridement, and discharge
planning.
Determines diagnoses in the complex patient and takes into consideration:
• Physiologic and pathophysiologic changes
• Morbidities and co-morbidities
• Events across the life span
• Patient’s pharmacologic history Evidence of Achievement (date):
• 6/23/17, 6/26/17, 7/6/2017 – Patient Sphere Completed assessments and provided guidance to staff for a patient during several hospital
stays. Considered the physiologic complications or advancing multiple sclerosis and the
events leading to each hospital admission. Reviewed the patient’s home pharmacologic
treatment plan and discussed possible medication treatment plans to improve the patient’s
outcome.
Prioritizes differential diagnoses to reflect those conditions most relevant to signs, symptoms and patterns amenable to CNS interventions.
Evidence of Achievement (date):
• 6/23/17 – Patient Sphere Performed a complex patient assessment and presented differential diagnoses in order of
priority from aspiration pneumonia, to altered skin integrity.
7 Clinical competency and hours 807 2017
Ethical Decision-making, Moral Agency and Advocacy Competencies:
Evaluating the impact of legislative and regulatory policies as they apply to nursing practice and patient/population health outcomes.
Evidence of Achievement (date):
• 5/24/17 – Organization/Systems Sphere Examined current legislation introduced in the House regarding nurse to patient ratios.
Discussed the possible implications of this bill on a unit and system level with my preceptor
and nursing staff. As a result of this discussion I have agreed to follow up on the
progression of this bill and report to the unit leaders. The passing of this bill would require
changes in staffing and reporting to which leaders would have to prepare for.
Balances patient and family preferences, threats to patient safety, and risk/benefit analysis of interventions such as fall prevention, pain management, and treatment choices.
Evidence of Achievement (date):
• 7/6/2017 - Patient Sphere Provided patient and family support when making decisions for end of life care. Discussed
the possible risks for the patient if discharged home and provided information for hospice
and palliative care for the patient and family to make choices regarding plan of care.
Identifies ethical implications of complex care situations.
Evidence of Achievement (date):
• 5/24/17 – Patient Sphere Participated in a multidisciplinary meeting with a patient’s family regarding the continuation
of hospice/palliative care. Ethical implications of this conversation included the risk versus
benefit, and maleficence versus non-maleficence in continuing aggressive care.
Considers the impact of scientific advances, cost, clinical effectiveness, patient and family values and preferences, and other external influences.
Evidence of Achievement (date):
• 5/24/17 – Patient & System Sphere Participated in a multidisciplinary conversation regarding the effectiveness of care for a
patient with a poor prognosis requiring frequent admissions. Family preferences and
financial implications were included during decision making.
Engages in a formal self-evaluation process, seeking feedback regarding own practice, from
8 Clinical competency and hours 807 2017
patients, peers, professional colleagues and others.
Evidence of Achievement (date):
• Patient Sphere, Nursing Sphere
Consistently seek feedback on delivery of care, communication style, and skills from my
preceptor, nursing staff, patients and family. I encourage feedback to continue to improve
my skills.
Fosters professional accountability in self or others.
Evidence of Achievement (date):
• Patient Sphere, Nursing Sphere, Systems Sphere I maintain a professional appearance and professional relationships with patients and
hospital staff. I hold myself accountable for delivering safe, effective and compassionate
care. I assist with staff accountability by performing patient rounds and consulting with
nurses regarding patient plans of care.
Promotes a practice climate conducive to providing ethical care.
Evidence of Achievement (date):
• Patient Sphere, Nursing Sphere I consistently provide ethical care by maintaining patient privacy. I respect the privacy of
the staff and ensure conversations about performance remains confidential.
Coaching Competencies: Mentor health professionals in applying the principles of evidence-based care.
Evidence of Achievement (date):
• 7/10/17 Patient Sphere, Systems Sphere Provided evidence based research articles to medical students regarding Unna Boot
application while in the vascular clinic. Discussed what I had learned regarding Unna Boot
indications, assessment requirements, and application of, to medical students rounding in the
vascular clinic.
Research Competencies: Evaluation of Clinical Practice Facilitates the incorporation of evidence related to adults-older adults when formulating and reviewing age-specific policies, procedures, and protocols.
Evidence of Achievement (date):
• 6/26/17 Patient Sphere, Systems Sphere Participated in a meeting regarding patient falls and the evaluation of current fall prevention
protocols and strategies. Took ownership to conduct research on fall prevention strategies
including the use of a mobility team to piolet on my clinical, geriatric floor.
Evaluates innovative approaches to delivering care to the adult-older adult populations.
9 Clinical competency and hours 807 2017
Evidence of Achievement (date):
• 7/6/17 – Patient Sphere, Systems Sphere Presented research findings for the use of mobility teams to aid in the ambulation of adult
inpatients. Benefits of such team include a reduction of fall rates, a decrease in hospital
acquired pressure injuries and infection, decrease in length of stay, and increased patient
satisfaction. Proposed a piolet study of said team for my clinical geriatric unit.
Provides leadership in identifying gaps in data and analyses specific to age-related outcomes of care.
Evidence of Achievement (date):
• 7/6/17 – Patient Sphere, Systems Sphere In response to an increase of inpatient falls I assisted with the research and proposed plan to
piolet a patient mobility team for my clinical unit where a geriatric population is the
majority.
Participates in establishing quality improvement agenda for unit, department, program, system, or population.
Evidence of Achievement (date):
• 7/6/17 - Patient Sphere, Systems Sphere Participated in obtaining evidence based research and proposing a plan for a mobility team
trial.
Fosters an interdisciplinary approach to quality improvement, evidence-based practice, research, and translation of research into practice.
Evidence of Achievement (date):
• 6/1/17 – Patient, Nurse, and System Sphere Joined staff in TEMPO board rounding with bedside nurses, charge nurse, social work,
CNS, leadership and physicians. During these rounds, recent evidence based practice or
research is discussed in relation to applicable patients. TEMPO board rounding has been
known to decreased patient length of stay and readmission rates.
Research Competencies: Interpretation, Translation and Use of Evidence
Analyzes research findings and other evidence for their potential application to clinical practice.
Evidence of Achievement (date):
• 6/7/17 – Organization/System Sphere Participated in the critical appraisal of practice guidelines using the Agree II tool.
Facilitates the incorporation of evidence-based practices, products, and technology that are
10 Clinical competency and hours 807 2017
specific to adult-older adult populations, into clinical practice and policies.
Evidence of Achievement (date):
• 6/23/17 – Patient Sphere Utilized Aquacel Ag dressing to provide autolytic debridement of pressure related skin
injuries.
Interpretation, translation and use of appropriate best evidence to analysis of research findings and other evidence for their potential application.
Evidence of Achievement (date):
• 7/6/17 – Patient Sphere, System Sphere Conducted research review and presented findings from peer reviewed journals regarding
the use of a mobility team and its potential implications for my clinical units population.
Interpretation, translation and use of appropriate best evidence to disseminate expert knowledge.
Evidence of Achievement (date):
• 6/26/17 – Patient Sphere
Provided staff nurse with rationale for obtaining lactate levels for septic patients. Provided
additional literature regarding the sepsis cascade per request.
Identifies areas of inquiry relevant to the adult-older adult population.
Evidence of Achievement (date):
• 7/6/17 – Patient Sphere Conducted a literature review to inquire of possible interventions to decrease patient falls
and improve mobility for the admitted patient.
Identification of questions for clinical inquiry.
Evidence of Achievement (date):
• 7/28/17 – Systems Sphere Participated in the Joint Commission survey process and attended the leadership debriefing
of findings. Areas of inquiry included positive findings and areas for improvement.
Conduct of literature reviews.
Evidence of Achievement (date):
• 7/6/17 Systems Sphere Conducted a literature review regarding the use of mobility teams to decreased patient falls,
complications of pressure related injuries, and hospital acquired infections.
11 Clinical competency and hours 807 2017
Systems Leadership Competencies:
Participates in development, implementation, and evaluation of clinical practice guidelines that address patient needs across the adult age spectrum.
Evidence of Achievement (date):
• 6/7/17 – Organization/System Sphere Participated in the critical appraisal of practice guidelines using the Agree II tool.
Clinical Hours Tracking Calendar-draft
12 Clinical competency and hours 807 2017
Document clinical internship hours per date (ex. 6a – 2p) and briefly list activities (ex. Unit rounds, QI meeting, …)
~ May 2017 ~ Weekly Clinical Hours Sun Mon Tue Wed Thur Fri Sat
NOTES:
1
2
3 4
5
6
7
8
9
10
11
12
13
14 15
16 Course Opens
17
2000-2115 Clinical Seminar
via Zoom
18
19 20
1.15
21 22
23 Can start clinical as long objectives approved by Clinical Faculty
24
Clinical 0700-1700
2000-2115
Clinical Seminar via Zoom
25
26
27
11.15
28
29 NO CLINICAL
HOURS THIS DAY University Closed
Holiday
30
31
2000-2125 Clinical Seminar
Via Zoom
5 1.25
Total May Clinical Hours: 13.55
Clinical Hours Tracking Calendar-draft
13 Clinical competency and hours 807 2017
Document clinical internship hours per date (ex. 6a – 2p) and briefly list activities (ex. Unit rounds, QI meeting, …)
~ June 2017 ~ Weekly Clinical Hours Sun Mon Tue Wed Thur Fri Sat
NOTES: 1
Clinical 0700-1700
2
3
10
4
5
6
7
2000-2145 Clinical Seminar
Via Zoom
8
9
10
1.45
11 12
Clinical 0700-1700
13
14
2000-2100 Clinical Seminar
Via Zoom
15
16
17 11
11
18 19
20
21
2000-2125 Clinical Seminar
Via Zoom
22
23
Clinical 0700-1700
24 11
12.25
25
26
Clinical 0700-1700
27
28
2000-2220 Clinical Seminar
Via Zoom
29
30
11
12.20
Total June Clinical Hours: 46.9
Clinical Hours Tracking Calendar-draft
14 Clinical competency and hours 807 2017
Document clinical internship hours per date (ex. 6a – 2p) and briefly list activities (ex. Unit rounds, QI meeting, …)
~ July 2017 ~ Weekly Clinical Hours Sun Mon Tue Wed Thur Fri Sat
1
2
3
Clinical 0700-1700
4 NO CLINICAL
HOURS THIS DAY University Closed
Holiday
5 2000-2115
Clinical Seminar via Zoom
6
Clinical 0830-1700
7
8
19.45
9 10
Clinical 0730-1630
11
12
2000-2115 Clinical Seminar
Via Zoom
13
14
15
10.15
16 17
18
19
2000-2100 Clinical Seminar
Via Zoom
20
21
22
1
23
24
25
26
2000-2115 Clinical Seminar
Via Zoom
27
28
Clinical 0700-1530
29
9.45
30
31 NOTES:
Total July Clinical Hours: 40.5