UNIVERSITY OF WISCONSIN-MILWAUKEE
COLLEGE OF NURSING
Graduate Course Syllabus
Spring 2013
Title: NURS 754: COMPREHENSIVE ASSESSMENT OF HEALTH:
IMPLICATIONS FOR CLINICAL DECISION MAKING
Credits: 3 units; G
Comprehensive Assessment of Health: Implications for Clinical Decision Making it a graduate level 3-credit course. The lecture portion of the course is 2 credits, and the co-requisite laboratory is 1 credit (2 contact hours).
Prerequisites: Grad st; admis to Nursing degree program; Nurs 753(P); or cons instr.
Enroll in LEC 401 & LAB 801..
Faculty: James Bockeloh, DNP, RN, FNP-BC, APNP
e-mail:
Office: Cunningham 522
UWM Ph#414 229-5556
Cell Ph# 262-880-6415
Office Hours: By Appointment
Lab Instructor : Susan A. Fontana, PhD, APRN, FNP-BC
Associate Professor and Family Nurse Practitioner-Board Certified
University of Wisconsin-Milwaukee
PO Box 413
Milwaukee, WI 53201
Program Director : Kim Litwack PhD RN APNP FAAN
Email address:
Office phone number: 414-229-5098
Class meetings times and location:
Lecture: Meets 7:00 PM-8:50 PM Tue 01/22/12-05/09/12, CUN G40
LAB: Meets 5:00 PM-6:50 PM Tue 01/22/12-05/09/12, CUN 608
Catalog Description: Comprehensive assessment of health in individuals and aggregates, including measurement of health status, appraisal of needs, analysis of environmental contexts, and development of diagnostic strategies.
Course Description: This course is designed to provide an in-depth analysis of approaches to the assessment of health in individuals, families, and populations. Emphasis will be placed on theories, research findings, and practice guidelines as they relate to measurement of health status, appraisal of health needs and concerns, analysis of environmental contexts, and clinical decision-making.
Course Objectives: Upon successful completion of the course, the student will be able to:
1. Apply selected theories, research, and clinical practice guidelines related to health assessment and diagnostic strategies.
2. Evaluate the health status of individuals and populations, synthesizing data derived through various health assessment strategies, including clinical status, cultural beliefs and behaviors, and environmental factors.
3. Demonstrate advanced assessment of health status of individuals across the lifespan, using comprehensive and focused approaches.
Textbooks and Readings:
Required:
Goolsby, M., Grubbs, L. (2011). Advanced assessment: Interpreting findings and formulating differential diagnoses. Philadelphia: F. A. Davis.
A physical assessment text. We suggest:
Seidel, H., Ball, J., Dains, J., & Benedict, G. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis: Mosby.
Recommended:
If you do not already have a current handbook for diagnostic testing, we recommend purchasing one for this course and for your upcoming clinical experiences.
Agency for Healthcare Research and Quality. (2008). Guide to clinical preventative services. Rockville, MD, AHRQ. Can be accessed online at: http://www.ahrq.gov/clinic/pocketgd1011/pocketgd1011.pdf
Seidel (Ed.)(2011). Mosby's physical examination handbook (7rd ed.). St. Louis: Mosby.
Wright, W. (2008). Physical Assessment & Health History of the Adult Examination (6h ed.).
North Andover, MA: Fitzgerald Health Education Associates. (can be found at www.FHEA.com)
There is also a wealth of assessment information and tools available online and in the 3rd floor NLRC. (We will discuss some of the available on-line resources in class).
Assignments and Evaluation:
1. Evaluation/Grading
Your course grade will be based on both lecture and laboratory evaluations. The evaluation components will consist of the following:
q Adult Screening History write-up (30 points)
q Focused health & aggregate assessment presentation (20 points)
q Graded case studies & documentation (3 @ 10 points each=30 points)
q Observed performance of a focused physical examination (20 points)
2. Description of assignments
Adult Screening History write-up.
Students will be required to perform a screening or annual History on an adult client (age 18) outside of class time and document it. The History should be type written, single-spaced, with appropriate double spacing between headings. The goal is to be complete, yet succinct. Identifying information should maintain the anonymity of your patient. Course faculty will evaluate this assignment using the Scoring Guide: Adult Screening History.
Focused Health and Aggregate Assessment
Students will be required to work in small groups (3-4 people) to research and write up a common “focused” clinical problem. This focused assessment will include pertinent history and physical examination findings, proposed diagnostic testing and a prioritized list of differential diagnoses. Students will also provide pertinent background, aggregate and epidemiological information about the problem. This assignment is preparation for the practical final examination and will be evaluated using the Scoring Guide: Focused Assessment. 5 points will be deducted for students who do not participate in the class presentation activity.
Practice Component
On-campus laboratory experiences will emphasize skills necessary for assessing the most commonly encountered health problems/conditions in clinical settings and for delivering preventive, curative, and rehabilitative services. The packet Scoring Guides for Health Assessment provides tools for you to use in practicing and faculty to use in evaluating assessment skills.
Students will have opportunity to obtain feedback on their advanced health assessment skills under the direct supervision of a faculty member during your clinical laboratory sessions. Autotutorial media will be available weekly to facilitate cognitive and psychomotor skills related to advanced health assessment. The laboratory will include the following activities:
1. Observed basic physical examination. In order to continue with the in-depth comprehensive assessment, students must demonstrate that they can do a basic head to toe examination within 20 minutes. This will be completed during the second lab session. The grading tool “BASIC ADULT PHYSICAL EXAMINATION: Observed” is found in the “Scoring Guides” portion of this packet. Students may bring one index card with notes on one side for reference during the test if they choose. Students must satisfactorily complete at least 83% of the components to pass. An unsatisfactory performance (<83%) will require students to practice and repeat the PE. The student who does not pass the examination on first attempt is responsible for his/her own remediation, but resources are available in the NLRC. Students who are unable to complete the basic physical examination upon the 2nd attempt will meet with Dr. Kako to determine if they should continue in the advanced assessment course.
2. Case studies & Documentation. This course will use multiple case studies to integrate students’ previous clinical knowledge with Advance Practice Nurse level critical thinking, history taking and documentation skills. Students will have multiple case studies to choose from, work through during lab and document using SOAP format. Although three write-ups will be graded, students are encouraged to present practice write-ups to their lab instructor for critique of history taking and documentation skills and recommendations for improvement (if any). Critiqued documentation may not be submitted for a grade. Write-ups to be graded should be uploaded to the course D2L site drop box under the lab instructor’s name by the due date. Late case studies will receive one letter grade lower for each week they are late (A to A-; A-to B+).
3. Gynecological-genitourinary training. A training session with professional patients will occur during lab time towards the end of the semester in order to learn how to perform the female gynecological examination and a male genitourinary/rectal examination. For each examination, you will work in small groups with one course faculty and a professional patient. You will have an opportunity to perform the examination with the coaching and guidance of the faculty and the professional patient and to observe 2-3 other examinations.
3. Practical final assessment. Near the end of the semester, students will schedule a 20-minute time slot with their lab instructor for their lab final. Students will be given a scenario and be asked to perform a focused assessment, eliciting pertinent history and completing exam components appropriate to the patient’s clinical presentation. Students must also select diagnostic tests to be done and provide a list of differential diagnoses in their documentation, no other treatment plans will be required.
3. Grading Scale:
95-100 A / 87-90 B / 79-82 C / 72-74 D93-94 A- / 85-86 B- / 77-78 C- / 70-71 D-
91-92 B+ / 83-84 C+ / 75-76 D+ / 00-69 F
4. Course Attendance Policy: Because the lectures/discussions and other types of class sessions are critical components of successfully completing the course, attendance is required. If you will be absent from class, please notify the course coordinator and or the lab instructor in advance as soon as possible. If you will miss a class, it is recommended that you arrange to have a classmate take notes for you and/or collect any handouts.
5. Course Expectations:
A. Required Readings
Students will be expected to complete all assigned readings from the textbooks prior to class. Students will be expected to read any additional assigned articles and online national practice guidelines as specified as well.
B. Grading Policy
Any assignment that is submitted after the due date according to the class schedule will be reduced by one letter grade (e.g., A- to B+) for each week, including the first week that the assignment is late.
Content Outline and Assigned Readings
Week 1, Jan 22:
Lab: Intro to lab, Basic PE review/practice
Lecture: Overview of class, Assessment of Individuals, Aggregates & Communities; Data Resources
Pre-Class Prep: Read assessment text & Goolsby chapters re: assessment/clinical decision making and documentation.
Week 2, Jan 29:
Lab: Basic PE Check Offs
Lecture: Clinical Decision-Making, Diagnostics and Documentation
Pre-Class Prep: Review relevant text chapters.
Week 3, Feb 5:
Lab: Interview, History & Documentation practice, basic PE check-offs
Lecture: Dermatologic, HEENT
Pre-Class Prep: Review common lab/diagnostic tests and be prepared to discuss. Consider bringing a diagnostic testing (lab) reference to class, Practice basic physical exam
Week 4, Feb 12:
Lab: Dermatologic, HEENT, Basic PE Checkoff
Lecture: Chest (Breast, Respiratory & Cardiovascular) Clinic; Turn in Adult Screening History write-up (Drop Box)
Pre-Class Prep: Review relevant text chapters. Case Study #1 Due.
Week 5, Feb 19:
Lab: Chest (Breast, Respiratory & Cardiovascular) Clinic
Lecture: Musculoskeletal Assessment
Pre-Class Prep: Review relevant text chapters.
Week 6, Feb 26:
Lab: Musculoskeletal Assessment
Lecture: Neurological Clinic; Focused assessment presentation topics will be assigned in class
Pre-Class Prep: Review relevant text chapters.
Week 7, March 5:
Lab: Neurological Clinic
Lecture: GI Assessment
Pre-Class Prep: Review relevant text chapters.
Week 8, March 12:
Lab: GI Assessment
Lecture: GU/GYN, Reproductive Clinic
Pre-Class Prep: Review relevant text chapters. Case Study #2 Due.
Spring Break March 17-24, 2013, No Classes
Week 9, March 26:
Lab: GU/GYN, Reproductive Clinic
Lecture: Abdominal, GU/GYN, Reproductive Assessment & Documentation
Pre-Class Prep: Review relevant text chapters
Week 10, Apr 2:
Lab: GU/GYN Assessment, Professional Models
Lecture: Mental Health Clinic
Pre-Class Prep: Review relevant text chapters, GU/GYN exam videos
Week 11, April 9:
Lab: Mental Health Assessment, Interview
Lecture: Spiritual Health Assessment
Pre-Class Prep: Review relevant text chapters Due: Group Focused-Assessment Presentation and Reference materials posted on D2L Discussion area.
Week 12, April 16:
Lab: Focused Assessment Practice
Lecture: Focused-Assessment Presentations
Pre-Class Prep: Review relevant text chapters, Case Study #3 Due
Week 13, April 23:
Lab: Focused-Assessment Check Offs
Lecture: Focused-Assessment Presentations
Pre-Class Prep: Review relevant text chapters
Week 14, April 30:
Lab: Focused-Assessment Check Offs
Lecture: Focused-Assessment Presentations
Pre-Class Prep: Review relevant text chapters
Week 15, May 7:
Lab: Focused-Assessment Check Offs, PE Kit Turn In
Lecture: Course Evaluations, Semester Wrap-Up
Pre-Class Prep: Material as needed
ACADEMIC CONDUCT
Students are expected to demonstrate academic integrity in all course activities. Academic integrity requires honesty concerning all aspects of academic work including:
· Correct procedures for citing sources of information, words, and ideas
· Ways to properly credit collaborative work with project team or study group members
· Strategies for planning and preparing for examinations, papers, projects and presentations.
Students are encouraged to consult with faculty regarding any questions about appropriate behaviors to maintain academic integrity. Any violation of academic integrity will result in a zero on the assignment and may result in additional sanctions consistent with university policy
University Policies:
http://www.uwm.edu/Dept/SecU/SyllabusLinks.pdf
There are two additional policies:
1. Inclement weather: UWM student should contact the University at 229-4444 (UW- Parkside, 262-595-2345) or check the appropriate website to ascertain the status of class cancellation due to inclement weather. Even when classes are canceled, University offices and services remain available, unless the entire University is closed by the Governor. http://www4.uwm.edu or http://www.uwp.edu
2. Safety: Safety techniques and strategies are described in College of Nursing Student Handbooks for undergraduate and graduate students distributed to all nursing students upon entering the program. Copies are available in the Office of Student Affairs. Information about UWM campus safety is found at http://www4.uwm.edu/current_students/student_services/safety.cfm
3. Technology and Social media: See student handbook
4. Tape Recordings: Should you wish to tape record a lecture, it is a professional courtesy to request permission from the lecturer
Lab Guide for
NURS 754
Advanced History Taking
Upon completion of this unit the student will be able to:
1. Understand the components of a comprehensive health history and physical examination.
2. Discuss culturally competent approaches to taking a health history and performing a physical examination.
3. Identify how to assess a patient problem by proper application of symptom analysis and review of systems.
3. Define the components used in recording a comprehensive health history and physical examination.
Advanced Assessment of the Skin, Hair, and Nails
Upon completion of this unit the student will be able to:
1. Identify the specific cues obtained from the client that indicate the need for a history related to the skin, hair, or nails.
2. Describe the appropriate analysis of a symptom for a problem related to the skin, hair, or nails.
3. Identify and perform the physical examination for a problem related to the skin, hair, or nails.
4. Identify and discuss appropriate diagnostic testing for a problem related to the
skin, hair, or nails.
5. Describe findings from the history, physical examination, and appropriate diagnostic testing that indicate deviation from normal skin, hair, or nails.
6. Discuss universal precautions guidelines to be used in providing health care.