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Long Term Care Clinical Scholars Program (LTC-CSP)

Summer Nursing Internship

A collaboration between

UW-Madison School of Nursing

and

Edgewood College School of Nursing

Description of the program

The Long Term Care Clinical Scholars Program is designed to provide a twelve week summer

internship experience for baccalaureate nursing students in a nursing home setting. The

program consists of supervised clinical experiences, classroom workshops and independent

study for classroom preparation.

Faculty:

Dr. Barbara Bowers Dr. Colleen Gullickson

UW-Madison School of Nursing Edgewood College SoN

Phone: 263-5185 Phone: 574-5380

E-mail: bjbowers@wisc.edu E-mail: cgullickson@edgewood.edu

Additional Instructors and Staff:

Kim Nolet, MS, Program Coordinator, UW-Madison School of Nursing

Brenda Ryther MS, RN, Researcher, UW-Madison Ctr for Health Systems Research & Analysis

Tonya Roberts MS, RN, UW-Madison Doctoral student

Andrea Gillmore MS, RN, UW-Madison Doctoral student

Rachel Roiland MS, RN, UW-Madison Doctoral student

Program Goals

1. Increase the appeal of long term care for new baccalaureate prepared nurses and

baccalaureate nursing students by creating positive experiences showing nursing homes as

welcoming, interesting, and innovative places to work where RN nursing skills are used and

valued.

2. Increase feelings of preparedness in caring for older adults in nursing homes for nursing

students entering the workforce.

3. Increase complex nursing skills in care of older adults for baccalaureate nursing students.

4. Increase the leadership abilities in care of older adults for baccalaureate nursing students.

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Learning Expectations:

This intern experience is based on the following assumptions*:

Learning is a collaborative process characterized by active engagement. All clinical scholars

share the responsibility for making the internship a meaningful and productive experience.

We are here to learn with, from, and about one another.

Preparation prior to workshops, attendance, and participation will make for the most fruitful

interaction. All of us together will likely be more knowledgeable than anyone of us alone.

Learning is enhanced by sharing diverse ideas. Clinical scholars are encouraged to critique

others’ thinking, and to remember that ideas, rather than individuals, are open to challenge.

Questions represent opportunities for learning and are indicative of engagement with the

subject matter. One individual’s questions often lead to clearer understanding for all.

Enthusiastic involvement in all learning opportunities is a desired goal. Clinical scholars are

encouraged to give the class facilitator and one another feedback, especially as regards

ways of improving the learning environment.

Only if you are willing to honestly, fairly and constructively address internship concerns do

you retain the right to complain about them.

*adapted from EC NRS 340 Professional Nursing; Long-term Health Issues course syllabus

Program Structure

The Clinical Scholars Program is a twelve week guided internship experience consisting of

both clinical work and workshop learning opportunities.

Workshops: Workshops will be held every Wednesday from 2:30 to 4:30 p.m. (see

schedule). Some classes are group workshops designed for you and interested staff

members from the participating homes. Other classes are for the clinical scholars only.

Workshop format: Open discussion and dialogue are vital components of all workshops.

Instructors will limit their presentation of content to approximately 15 minutes. The

remaining class time will be spent in active dialogue and activities designed to

maximize application of classroom content to your clinical experiences. As such,

preparing for workshops by completing readings and other activities is vital. Without

this, your class contributions will be very limited.

You will be assigned some brief activities to complete at your worksite during the course

of the internship and these will be discussed at workshops. See the weekly schedule of

this syllabus for details. You will need to read each week’s pre-workshop activities well in

advance to assure you have time to complete the activity.

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Clinical work experiences: The clinical component consists of at least three shifts working as

a nurse tech in your matched nursing home each week. Your exact schedule will be

determined by your worksite. You may need to spend additional time on-site to complete

required program experiences (see pre-workshop clinical activities for each weekly

workshop). This is similar to clinical “prep” time in your undergraduate program. You will not

be paid for this additional on-site time.

Clinical work format: You will use a Tracking Worksheet to guide your learning

experiences. Weekly entries on this document are required to focus and direct your

clinical development. Self-evaluation is an important component of professional growth

and will be an important vehicle by which you and your preceptor determine your clinical

experiences and progression.

Work expectations: Professional behavior and courtesy are expected at all times.

Unprofessional behavior can be interpreted as lack of interest and reflects poorly on the

Clinical Scholars Program. You are an employee of the nursing home and are expected

to follow all work rules and guidelines provided to you by the home. When you are not on

paid time, but are on-site to complete other activities, you are also expected to be on

your best professional behavior and adhere to employee guidelines. Remember, no

chewing gum, texting, or phone calls on work time!

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Absences

Clinical work absences:

You are an employee of the long term care facility and therefore are required to follow the

workplace policies regarding absences from your scheduled clinical work. You must contact the

appropriate person at your worksite to inform them of your absence. If you will miss a meeting

with your preceptor or someone else at the home, you must also notify that person of your

absence. If you do not follow workplace policies, you be subject to their normal disciplinary

policies.

Workshop absences:

Clinical Scholars have been selected as part of a competitive application process. Therefore, it

is important each clinical scholar fully participate in the internship program to which you applied.

It is expected you attend each weekly workshop. If it is necessary to miss a workshop, you

must notify Kim Nolet, Program Coordinator at 262-8146 or kanolet@wisc.edu. You must

also contact the workshop instructor/s as soon as possible to arrange to make up

content you will be missing.

Successful Program Completion

The Clinical Scholar Program is not a course, therefore a grade is not assigned. Successful

completion will entitle you to a Clinical Scholar Program certificate of completion that details the

program offerings. This is anticipated to give clinical scholars a competitive edge when applying

for nursing jobs. Successful completion entails:

Attending all Clinical Scholar Program weekly workshops (and completing special

assignments to a satisfactory level if absent for any workshops).

Completing assigned workshop readings.

Completing assigned clinical work experiences related to the workshops.

Working your assigned shifts at your matched nursing home and complying with

workplace rules and guidelines.

Completion of the CSP Tracking Worksheet in collaboration with your preceptor.

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Workshop Schedule and Details

Week 1: June 8th Interns Only, 2:30-4:30 p.m.

Topics 1) Time Management 2) Polypharmacy

Instructors Andrea Gilmore, MS, RN & Barbara Bowers, PhD, RN

Objectives Objectives:

1. Demonstrate ability to prioritize care and effectively manage time in

complex situations.

2. Demonstrate an understanding of age-related changes that contribute

to pharmacologic complications in the elderly population.

3. Identify common adverse drug reactions in the elderly.

4. Demonstrate an understanding of strategies to examine possible

adverse reactions in clinical practice including addition and withdrawal

of medications.

Required

Readings

1. Up To Date Drug Prescription for Older Adults:

http://www.uptodate.com/contents/drug-prescribing-for-older-adults

2. Beer’s Criteria: https://www.dcri.org/trial-participation/the-beers-list

Suggested

Readings

1. If you are not familiar with age-related physiological changes, please visit http://consultgerirn.org/topics/normal_aging_changes/want_to_know_more and familiarize yourself with this information.

Required

Clinical

Activities Pre-

Workshop

Pre-Workshop Activities:

1. Consider the following questions that will be discussed during the

workshop:

a. What should you use as a guide to make decisions about care

prioritization?

b. What is important when considering how you prioritize care?

c. What do you think about when you consider ways to effectively

manage your time?

d. What does time management involve?

e. What is necessary to have effective time management?

f. How can you anticipate the consequences of the decisions that

you make?

Week 2: June 15th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only

Topic Resident Quality of Life

Instructors Tonya Roberts, MS, RN and Barbara Bowers, PhD, RN

Objectives 1. Discuss the importance of addressing quality of life for ltc residents.

2. Distinguish the relevance of quality of life for different populations.

3. Discuss the intersection of quality of care and quality of life.

Required Readings

1. Cohen-Mansfield, J. & Taylor, J. W. (2004). Hearing aid use in

nursing homes part 1: Prevalence rates of hearing impairment

and hearing aid use. Journal of the American Medical Directors

Association, 5, 283-288.

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2. Kane, R., Kling, K., Bershadsky, B., Kane, R., Giles, K.,

Degenholtz, H., et al. (2003). Quality of life measures for

nursing home residents. The Journals of Gerontology: Series

A, 58(3), M240.

3. Kracker, J., Kearns, K., Kier, F. J., & Christensen, K. A. (2011).

Activities preferences and satisfaction among older adult in a

veterans administration long-term care facility. Clinical

Gerontologist, 34(2), 103-116.

Suggested

Resources &

Readings

Check intern website for any suggested readings.

Required Clinical

Activities Pre-

Workshop

Find out if your facility has a resident council and when they meet. If

there will not be a meeting prior to this workshop, find out who

coordinates the meetings and ask if they have notes from previous

meetings you could review. Think about the nurse's role in the issues

that resident’s discuss.

or

Review a long term resident’s plan of care. Think about how the plan

addresses the resident’s quality of life. Now think about a family

member, maybe a grant parent, and ask yourself whether you would

be happy with such a plan of care in terms of overall quality of life.

Week 3: June 22nd Interns Only, 2:30-4:30 p.m.

Topic Communicating with Team Members & Families

Instructors Melanie Krause, PhD, RN, Andrea Gilmore, MS, RN and Barbara

Bowers, PhD, RN

Objectives 1. Decide when to initiate communication with physicians/NPs

and demonstrate ability to gather and prepare relevant

information.

2. Demonstrate ability to effectively and concisely communicate

gathered information with physicians/NPs.

3. Demonstrate ability to effectively provide feedback to

coworkers and engage in conversations with unlicensed staff in

a supervisory capacity.

4. Understand family dynamics and coping and demonstrate

ability to communicate with residents and family members in

ways that foster shared decision making.

Required Readings

1. Colorado 5 Million Lives Campaign, Sample SBAR (Situation-

Background-Assessment-Recommendation) Communication

Tool [electronic]:

http://www.colorado5millionlives.org/repository/Pdfs/INTERVE

NTION/SBAR/GenericReportToPhysician.pdf

2. University of Pittsburgh (2003). Principles of Effective

Feedback [electronic]:

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http://www.pacwcbt.pitt.edu/Curriculum/533%20Preparatory%2

0and%20Beginning%20Phases%20of%20CW%20Supervision/

Handouts/HO18%20%20Principles%20of%20Effective%20Fee

dback.pdf

3. Gladstone, J. & Wexler, E. (2002). Exploring the relationships

between families and staff caring for residents in long-term care

facilities: family members’ perspectives. Canadian Journal on

Aging., 21(2), 39-46.

Suggested

Resources &

Readings

Check intern website for any suggested readings.

Required Clinical

Activities Pre-

Workshop

Before you contact a physician yourself, observe a nurse information

exchange with a physician (your preceptor can help you identify this

learning opportunity). What kinds of questions did the physician have?

Was the nurse prepared to answer those questions? How did the

nurse communicate information from the physician back to staff and/or

family? This activity will prepare you for workshop discussions and to

interact independently with physicians.

Week 4: June 29th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only

Topic Achieving and Maintaining Resident Function

Instructors Barb King, PhD, RN and Barbara Bowers, PhD, RN

Objectives 1. Understand the factors contributing to unnecessary functional

decline in nursing home residents

2. Identify practices in their environments that contribute to

resident functional decline

3. Analyze how the system they work in could be altered to

prevent functional decline where possible

Required Readings

1. Fitzsimmons, S. (2010). Physical functioning: Maintaining,

improving, and preventing decline. Activities Directors’

Quarterly for Alzheimer’s & Other Dementia Patients, 11(1):15-

21.

2. Bell, A. (August, 2002). Restored function, renewed hope.

Provider. 57-60.

3. Connelly, D (2000). Resisted exercise training of

institutionalized older adults for improved strength and

functional mobility: A review. Geriatric Rehabilitation,15(3): 6-

28.

Suggested

Resources &

Readings

Check intern website for any suggested readings.

Required Clinical

Activities Pre-

Workshop

1. Contact an admission nurse to see if you can work with him/her when a new resident is admitted. What information is provided on the admitting notes regarding ambulatory status? Does the

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plan of care reflect a thorough understanding of the resident’s potential? How will the plan of care maximize this potential?

OR

2. Look at the PT or OT plan for a resident. This could be a resident currently receiving PT or OP services or one whose formal PT/OT plan has ended. What is the plan for improving ambulation? How was potential assessed? Is the staff following through on improving ambulation? If not, what are the barriers? If yes, what is being done? Is walking ability important to the resident? How do you know? Is the nursing staff continuing the plan effectively for those whose OT/PT has expired?

Week 5: July 6th Interns Only, 2:30-4:30 p.m.

Topic Diabetes, Swallowing and Nutrition

Instructors Colleen Gullickson, PhD, APNP, RN

Objectives 1. Demonstrate sound decision-making skills in a variety of

resident situations addressing diabetes management.

2. Recognize diabetic emergencies and appropriate interventions

to resolve them.

3. Demonstrate appropriate assessment skills in the early

recognition of nutritional problems including swallowing.

4. Implement evidence based strategies in optimizing nutritional

care for older

Required Readings

1. Review diabetes care from your med/surg and pharmacology

texts.

2. Amella, E., Lawrence, J., (2007). Eating and feeding issues in

older adults with dementia: Part II interventions. Try This: Best

practices in nursing care to older adults. Issue D11.2. Hartford

Institute for Geriatric Nursing, NY.

3. Metheny, N. (2007). Preventing aspiration in older adults with

dysphagia. Try This: Best practices in nursing care to older

adults. Issue 20, Hartford Institute for Geriatric Nursing, NY.

4. Mentes, J. (2006). Oral hydration in older adults. AJN, 106(6),

40-48.

Suggested

Resources &

Readings

Check intern website for any suggested readings.

Required Clinical

Activities Pre-

Workshop

1. Review your facilities hypoglycemic protocol. Is it evidence

based? What suggestions would you make to improve this

protocol? How is intake recorded & reported?

2. Review your facilities most recent survey results related to

nutrition. What corrective action(s) have been implemented

since the survey?

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3. How is the interdisciplinary team utilized once a resident has

been identified as having a swallowing problem?

Week 6: July 13th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only

Topic Assessing and Managing Changes in Cognition

Instructors Colleen Gullickson, PhD, APNP, RN

Objectives 1. Identify evidence based assessment tools that can be utilized to guide resident care.

2. Explore multidisciplinary management strategies for individuals with cognitive impairments.

3. Develop a cadre of interventions to assist in caring for individuals with dementia.

Required Readings

1. Smith, M. & Buckwalter, K. (2005). Behaviors associated with

dementia. AJN, 105(7), 40-52.

2. Perry, J., Galloway, S., Bottorff, J., & Nixon, S., (2005). Nurse-

patient communication in dementia. Journal of Gerontological

Nursing, April, 43-52.

Suggested

Resources &

Readings

1. Rader, J, Barrick, A., Hoeffer, B., Sloane, P., McKenzie, D.,

Talerico, K., & Glover, J. (2006). The bathing of older adults

with dementia. AJN, 106(4), 40-48.

2. Amella, E. (2007). Eating and feeding issues in older adults

with dementia: Part 1: Assessment & Part II: Interventions.

Try this: Best practices in nursing care to older adults with

dementia, Hartford Institute for Geriatric Nursing, NY.

Required Clinical

Activities Pre-

Workshop

1. Review your facilities policy/protocol for when a resident’s

MMSE decreases below 15.

How is the HCPOA activated?

What is the procedure for obtaining consent for care?

2. Review your facilities psychotropic protocols related to

mandated ‘washout’ periods.

Week 7: July 20th Interns Only, 2:30-4:30 p.m.

Topic Change in Condition: Assessment and Care Planning

Instructors Brenda Ryther, MS, RN & Tonya Roberts, MS, RN

Objectives 1. Discuss change of condition and how it can be recognized by nursing home staff.

2. Understand the importance of communicating and responding to change of condition.

3. 3. Identify care planning strategies to address change of condition.

Required Readings

1. Boockvar, K.S. & Lachs, M.A. (2003). Predictive value of nonspecific symptoms for acute illness in nursing home residents. JAGS, 51: 1111-1115.

2. Taunton, R.L., Swagerty, D.L., Smith, B., Lasseter, J.A., & Lee, R.H. (2004). Care planning for nursing home residents: incorporating the Minimum Data Set requirements into practice.

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Journal of Gerontological Nursing, 30(12): 40-49.

Suggested

Resources &

Readings

1. Boockvar, K., Brodie, H.D. & Lachs, M. (2000). Nursing assistants detect behavior changes in nursing home residents that precede acute illness: development and validation of an illness warning instrument. JAGS, 48(9).

2. Amella, E.J. (2004). Presentation of illness in older adults. AJN, 104(10): 40-51.

Required Clinical

Activities Pre-

Workshop

1. Attend a care conference to observe care team discussion, including resident change of condition. Note which disciplines attended the care conference. Follow-up with the care team to learn how the information and plans discussed are translated and communicated into daily practice.

Week 8: July 27th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only

Topic End of Life Care

Instructors Colleen Gullickson, PhD, APNP, RN & Rachel Roiland, MS, RN

Objectives 1. Utilize therapeutic presence and professional communication

skills in providing end of life care.

2. Advocate for resident and family requests in providing end of

life care.

3. Demonstrate an understanding of the nurse’s role in providing

spiritual care.

4. Apply basic pathophysiologic principles related to pain

management and nutrition at end of life.

Required Readings

1. ANA position statement: Pain management and control of distressing symptoms in dying patients.

2. Liao, S., & Ackermann, R., (2008). Interdisciplinary end-of-life-care in nursing homes. Clinical Gerontologist, 31(4). 83-96.

3. Sheehan, D.K., & Schirm, V. (2003) End- of-life care of older adult. AJN, 103(11), 48-59.

4. Kruse, B.G., Ruder, S., & Martin. L. (2007). Spirituality and coping at the end-of-life. Journal of Hospice and Palliative Nursing, 9(6). 296-304.

Suggested

Resources &

Readings

Check intern website for any suggested readings.

Required Activities

Pre-Workshop

1. Review your facility’s protocols end of life pain management, nutrition management, and/or comfort cares.

2. Review your facility’s protocol for the activities that should be

completed after an individual has passed away. What activities

will be expected of you and other staff?

3. Check to see if your facility has any resources that provide information about end-of-life cultural practices. Review them if they are available.

4. On a piece of paper or note card, write two questions you would like answered during class. (Bring them with you.)

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Week 9: August 3rd Interns Only, 2:30-4:30 p.m.

Topic Resident Comfort and Pain Management

Instructors Andrea Gilmore, MS, RN & Tonya Roberts, MS, RN

Objectives 1. Demonstrate an understanding of age-related changes that contribute to increased prevalence of chronic pain in the elderly population, generational considerations, and common acute syndromes that contribute to pain in the elderly population.

2. Demonstrate an understanding of pain and the nurse’s role in its identification, assessment, and treatment.

a) Identify a variety of non-pharmacological, evidence based strategies to promote resident comfort.

b) Utilize the multidisciplinary team to optimize resident comfort.

3. Demonstrate the ability to make clinical judgment about pain management and resident comfort in persons with limited communicative ability and dementias.

Required Readings

1. Gran, et al. (2009). Alone with my pain – it can’t be explained, it

has to be experienced. A Norwegian in-depth interview study of

pain in nursing home residents. International Journal of Older

People Nursing, 5(1), 25-33.

2. Strategies for Success: Pharmacologic management of

persistent pain in the older adult. Clinical Advisor ,October

2010.

3. GeriatricPain.org: Analgesic Trial (1 page, skim over)

4. GeriatricPain.org: Recommendations Pain Assessment with

Cognitive Impairment (2 pages, skim over)

Suggested

Resources &

Readings

1. If you are not familiar with age-related physiological changes,

please visit

http://consultgerirn.org/topics/normal_aging_changes/want_to_

know_more and familiarize yourself with this information.

2. Cultural Aspects of Pain management:

http://www.eperc.mcw.edu/fastFact/ff_78.htm

3. Pseudoaddiction: http://www.eperc.mcw.edu/fastFact/ff_69.htm

4. Pain scales in multiple languages:

http://www.britishpainsociety.org/pub_pain_scales.htm

Herr, K., Bursch, H., Ersek, M., Miller, L. L., Swafford, K.

1. Geriatricpain.org

2. ConsultGeriRN.org

3. City of Hope Pain Resource Center: http://prc.coh.org/

Required Activities

Pre-Workshop

1. Prior to attending this workshop, examine your facilities pain

management practices and protocols. Does your facility have a

specific protocol? What is the process for acquiring and

distributing controlled substances? How do these practices

influence resident care and pain management?

2. Talk to nurses and nursing assistants about the pain

management practices in the facility. Do they have ideas about

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how it could be improved? Are there general guidelines that are

followed?

Week 10: August 10th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only

Topic Nursing Leadership and Management

Instructors Barbara Bowers, PhD, RN

Objectives 1. Understand the staff nurse’s role and expectations as a leader

in nursing homes

2. Describe the impact of staff nurse leadership on nursing home

quality

3. List desirable leadership qualities for long term care nurses

4. Develop strategies to improve staff nurse to CNA delegation,

communication and coaching and mentoring

5. Select leadership strategies and skills to practice and improve

upon in the workplace

Required Readings

1. Boockvar, K. S., Gruber-Baldini, A. L., Burton, L., Zimmerman, S., May, C., & Magaziner, J. (2005). Outcomes of infection in nursing home residents with and without early hospital transfer. Journal of American Geriatric Society, 53(4), 590-596.

2. McGillis-Hall, L., McGilton, K. S., Krejci, J., & Pringle, D. (2005). Enhancing the quality of supportive supervisory behavior in long-term care facilities. The Journal of Nursing Administration, 35(4), 181-187.

3. Maxwell, J. C. (1993). The quickest way to gain leadership: Problem solving. In Developing the Leader Within You (pp. 75-95). Nashville: Thomas Nelson.

Suggested

Resources &

Readings

Check intern website for any suggested readings.

Required Clinical

Activities Pre-

Workshop

1. Review the most recent Survey findings for your facility. Select one citation from the survey, or another quality issue your facility has recently tried to improve. Read the Plan of Correction (if a Survey citation) or QI plan (if another quality issue).

2. Briefly interview a charge nurse (that was employed at the home at the time of the last survey) about the issue.

Do they know about the issue from the survey or other

quality initiative you are discussing?

How do they view their role?

Have they tried to change CNA practices around this

issue? How? Have their strategies worked?

Have they encountered any challenges?

3. Bring your notes to the workshop for our 30 minute post-workshop debrief.

Week 11: August 17th Interns Only, 2:30-4:30 p.m.

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Topic RN Decision Making in LTC and Practice Change

Instructors Colleen Gullickson, PhD, APNP, RN, Guests

Objectives 1. Describe some current innovations in LTC. 2. Discuss how to select and implement practice change.

Required Readings

1. Koren, M. J. (2010). Person-centered care for nursing home residents: the culture-change movement. Health Affairs, 29(2), 312-317.

2. Tobin, S. S. (2003). The historical context of “humanistic” culture change in long-term care. In A. S. Weiner & J. L. Ronch (Eds). Culture Change in Long-Term Care: Haworth Social Work Practice Press, New York.

Suggested

Resources &

Readings

Check intern website for any suggested readings.

Required Clinical

Activities Pre-

Workshop

1. Be prepared to discuss situations you’ve encountered during the internship which could benefit from change

Week 12: August 24th Group, 2:30-3:30 p.m. workshop; 3:30-4:30 Internship Celebration!

Topic Creating a Safety Culture

Instructors Andrea Gilmore, MS, RN and Brenda Ryther, MS, RN

Objectives 1. Understand the factors that contribute to a culture of safety

2. Analyze the relationship between adverse events and the

culture of a specific work setting

3. Understand the specific challenges for patient safety

encountered in long term care settings

4. Understand the basic components of a safety culture.

Required Readings

1. Scott-Cawiezell, J. et al. (2006). Moving from a culture of blame

to a culture of safety in the nursing home setting. Nursing

Forum, 41(3) 133-140.

2. Pearson, A (2005). Minimizing errors in health care: Focusing

on the 'root cause' rather than on the individual. International

Journal of Nursing Practice, 1:141.

Suggested

Resources &

Readings

1. AHRQ Patient Safety Survey Tool:

http://www.ahrq.gov/qual/nhsurvey08/nhsurvey.htm

Required Activities

Pre-Workshop

1. Consider the following questions:

What are the organizational factors that promote a culture

of safety?

How do nursing homes differ from other environments in

terms of the factors contributing to a safety culture?