Washburn University
School of Nursing
NU 608 Health Care Practicum III- Specialty (Family)
Clinical Performance Tool
(Completed by Student and Faculty)
Student__Anna Marshall______Semester___Fall 2012______
Agency__McLouth Medical Clinic______Instructor_Dr. Jane Brown___
Clinical performance is based on Universal Outcomes, End of Program Outcomes and National Organization of Nurse Practitioner Faculty Core Competencies of Nurse Practitioner Practice (2011). Nurse Practitioners must demonstrate care that is effective, patient-centered, efficient, timely, and equitable for the treatment of health problems and promotion of wellness.
Universal Outcomes: Evaluating Behavior
Universal Outcomes must be met in order to pass the course. Failure to meet any of the three Universal Outcomes will result in a grade of F. If an F is earned, the Core Competencies will not be considered
Universal Outcomes
Demonstrates honesty and integrity by submitting original work Met Not met
on assignments and accepting responsibility for own actions
taken/omitted
Prioritizes patient safety as the primary consideration in all care Met Not met
Maintains professional boundaries with patients, family and Met Not met
staff. Maintains confidentiality at all times
Nurse Practitioner Core Competencies
Students must achieve an 80% on the final clinical evaluation tool to be successful in the course. These outcomes are only evaluated if the three Universal Outcomes are met. Students who do not meet the competencies within the required practicum hours may be required to successfully complete additional hours before a final grade will be awarded. Points are assigned as follows:
Please rate your own performance using the descriptors listed below:
0 = no opportunity to experience
1 = defined as not meeting expectations; failing to initiate learning experiences; arriving late and unprepared; failure to effectively communicate with the patient, family, preceptor, staff and faculty
2 = defined as inconsistently meeting expectations; requires much faculty/preceptor guidance in learning experience/support
3 = defined as routinely meeting expectations yet requires more faculty/preceptor direction in learning experiences
4 = defined as routinely meeting expectations with minimal support from faculty/preceptor
5 = defined as consistently meeting expectations with little guidance; proficient; can perform independently; initiates learning experiences; is well prepared for learning experiences.
Competency Narrative
The overall goal of the Clinical Performance Tool (CPT) is to assess the student’s progress throughout the practicum using a narrative description of each competency. To provide a description of the total progress, the student is expected to maintain a cumulative narrative of their performance.
With each competency and each submission, the student is expected to assign themselves a score from 0-5 (It is not expected that a student will have many scores of 4 or 5 with the first submission). Within the narrative, students are expected to briefly address the following 4 items:.
A. What does this competency mean? What challenges/strengths related to mastery of this competency are present at this point in time?
B. Give 2-3 examples from this practicum experience that best illustrate how you are performing the selected competency and which support the score you assigned yourself?
C. What do I need to gain additional skills to master this competency?
D. What references/clinical guidelines/point of care tools (if appropriate) have been helpful in achieving this competency?
Grading
The Clinical Performance Tool is completed and submitted by the student at the completion of 80 clinical hours, 160 clinical hours, and 225 for a total of three submissions. The first submission must address items 1-13. The second and final submission must address items 1-28. The final submission is graded.
NONPF competencies addressed in this course include Independent Practice, Leadership, Quality, Technology/Information Literacy, and Ethics. Competencies are founded on an understanding of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion, and disease prevention. Utilization of communication strategies, principles of quality care, information technology/literacy and ethical principles are expected. NP students are expected to demonstrate an investigatory and analytic thinking approach to clinical situations, professional behavior, effective communication, and a sensitivity and responsiveness to patient culture, age, gender, sexual orientation and ability.
First submission = X Second submission = X Third submission = X
NP students are expected to:
1. Develop individualized health promotion, disease □ □ □ X □ X □ X□
prevention and health protection services for patients
across the life span
First Submission 24 August-24 September 2012 - Developing individualized services for patients across the lifespan means taking into consideration every patients' health status at any particular point in time, the other factors influencing individual circumstances, as well as known risk factors. Individualizing care forces the practitioner to consider both what is evidence-based and what is effective. One challenge of the student practicum experience is that, initially, I am not familiar with any of the established patients, as my preceptor is, and do not always know best how to 'individualize' care. One of the beauties of primary care, is the relationship established between the health care team and the patient, seeing patients repeatedly, getting to know your patients, and what motivates them. I have spoken with numerous patients about routine lab results, and in particular, what to do about elevated lipids. One example involved a husband and wife who were in the room together for her appointment. The woman was 75 years old, and in relatively good health. In discussing her elevated lipids, she really did not want to start a medication to help lower cholesterol, and we agreed that it would be acceptable for her to try a dietary approach, rather than a medication. We talked about how this may be appropriate for her, but was not an appropriate approach for her husband, who also had elevated lipids, but was also diabetic, hypertensive, and had a history of CAD and bypass surgery. In primary care, counseling and health protection and promotion services are individualized; what may be acceptable for one patient may not be for another. When individualizing teaching about disease prevention for a young woman complaining of frequent urinary tract infections (UTI), I saw the opportunity to include not only teaching about ways to protect against UTIs, but also ways to protect against sexually transmitted diseases and avoiding unplanned pregnancy. In the future, I look forward to developing a patient population in a primary care setting, getting to know the patients as individuals, and providing meaningful services based on what I know about them.
Second Submission 25 September- 22 October 2012 - A. Both acute and chronic visits allow the opportunity for the practitioner to develop health promotion, disease prevention, and health protection services for patients across the life span. Listening to patients, asking questions, addressing known risk factors, and being aware of evidence-based guidelines, are some of the ways to build and improve upon this competency. One strength, specific to the rural health clinic site, is the small town atmosphere where 'everybody knows everybody', and it seems easier to get to know the patients in order to better individualize care. After having been at this site for about 2 months now, I have gotten to know some of the patients better by having seen them a few times. On the other hand, the rural setting also presents some specific challenges related to the distance people must travel for certain services, and the risks associated with the higher rates smoking and obesity. B. I have had opportunities to practice this competency by performing a number of well-child exams and well adult (mostly women) exams throughout this period of time. This is generally a good time to talk about recommended health promotion and protection and disease prevention services for that individual. For example, a woman was asked about some moles that I noticed during a well woman exam. She was encouraged to come back or go to a dermatologist to have them excised because they were suspicious-looking and she was unsure about whether they had grown or changed. She did and one turned out to be malignant melanoma. Also, in patients who are being seen for follow-up discussion about annual lab work and with elevated lipids, I routinely talk with people about their dietary patterns, and incorporate information on low-fat, low-cholesterol diet into the patient education section of the discharge instruction paperwork. C. In the future, I will continue to reference guidelines for evidence-based recommendations, and will continue to read and study to stay abreast of changes. I hope to work in the primary care/family practice setting, and will work on developing individualized services with my own clientele, as I get to know individuals and available resources in the area. D. For these types of services, I refer to the guidelines and recommendations published by reputable sources, such as the US Department of Health and Human Services (USHHS), through the AHRQ, the CDC, the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG), using the information as a guide, but allowing individual circumstances to drive care.
Third submission 23 October - 19 November - A. Throughout this clinical experience, I have had numerous opportunities to develop health promotion, disease prevention, and health protection services for patients across the life span. I have been flexible and creative in developing individualized services, and have followed sound recommendations with the goals of protecting and promoting health and preventing disease. My preceptor has given me progressively more independence in this process, as I have gained confidence, gotten to know patients, and have progressed through this final clinical experience. B. Examples of this competency include one 23 year old patient who had come to the PAP clinic for a routine well-woman exam. She reported no concerns or complaints, but did wonder when she should begin getting mammograms since her mother had died at age 32 years of malignant breast cancer. She was instructed on the importance of performing regular self-breast exams, advised her to find out more information about the kind of breast cancer her mother had, and other pertinent family history (sisters, aunts), and that she should definitely not wait until the age of 40 to have her first mammogram, regardless. Since she was uninsured, she was also advised on assistance programs for getting an affordable mammogram (ie. EDW). Another example, a patient was given personalized information on reducing soda intake and the potential health benefits of doing so in effort to protect her health. About a month later, I followed up with the patient, and she told me that she had since significantly reduced her intake of soda beverages from about 10 a day to 1 or 2 at the most. C. Strategies for improving upon this competency in the future include ongoing efforts to see patients as individuals and understand their individual circumstances when designing care. I will make efforts to not get into a routine to the degree that I am not able to individualize care or become immune to individual factors. I will stay abreast of current recommendations for health promotion/protection services and disease prevention strategies as defined by reputable sources such as D. (USHHS), AHRQ, CDC, ACS, and ACOG, as mentioned above. Others include National Center for Chronic Disease Prevention and Health Promotion, KanQuit, Ferri's Clinical Advisor 2012 and more.
2. Develop individualized anticipatory guidance and □ □ □X □ X □ X□
health counseling for patients across the life span
First Submission 24 August-24 September 2012 - Information gained via patient interviews, knowledge about human development, and epidemiology are some of the main factors that guide the development of anticipatory guidance and health counseling for patients across the life span. Valuable information can be gathered from a person's family, social and personal history. Well-child examinations, and other health maintenance visits for adults provide excellent opportunities to introduce and individualize anticipatory guidance and health counsel. I counseled the parents of a six month old child, during a well child visit, about upcoming developmental milestones to anticipate and prepare for, and ways to promote safety in their home environment. I also had the opportunity to counsel a patient with history of congestive heart failure about doing daily weight checks and calling in the event of weight gain greater than 5 pounds within a few days or a week. I provided the health counseling to a 38 year old woman who was being newly diagnosed as diabetic. At the visit, we reviewed her laboratory results, talked about diabetes and the associated long-term complications possible if not controlled. Anticipatory guidance and health counseling began with a discussion of long-term treatment goals, and the importance of blood sugar control. The discussion was individualized to her needs, as far as how and how much information was given initially, and how aggressively to begin with pharmaceutical therapy. In future practice, I hope to be able to be creative in individualizing services, and insightful in providing anticipatory guidance and health counseling to patients of all ages.
Second Submission 25 September- 22 October 2012 - A. Developing individualized anticipatory guidance and health counseling for patients across the life span means that the practitioner must have a firm grasp on the expected developmental stages of the human life, and the activities associated with the various stages, being able to identify and make sense of variations from the expected, and counsel patients effectively. The advanced practice nursing role provides the opportunity to provide guidance and counsel to patients and families in anticipation of things to come, based on the known probability of how most people progress through the stages of life or through some other activity, or lifestyle change, such as smoking cessation. The availability and accessibility of evidence-based resources and tools that are helpful in achieving this competency is one strength of practicing in this time. B. Examples include the opportunity I had to counsel a 15-year-old girl who came in complaining of urinary symptoms, after she revealed to me that she had been sexually active, that she needed to have a pelvic exam with pap smear, and about the importance of guarding against pregnancy and sexually transmitted infections. I have had numerous opportunities to talk with patients with chronic low back pain about the efficacy of various treatments, including physical therapy and the importance of weight loss, when indicated. This fall, I have performed several physicals on young girls, ages 12-13, who were having pre-participation sports physicals done, prior to the start of the volleyball and basketball seasons at the local middle school. At this age, the opportunity presented in a comprehensive physical exam, for the APRN to provide anticipatory guidance and health counsel to the girls on topics such the onset of menses, and other issues related to sexual maturation must be used. C. In order to gain additional skills to master this competency, I will need to decide what set of tools I find most helpful to my practice, for both assessment and counseling purposes, adopt them for use, based on the specific setting and patient population being served. I will continue to read and learn about some of the various factors at play in these interactions, such as health literacy, the complexity of behavior modification, and the effectiveness of the various methods of patient education, applying this knowledge in an effort to make the greatest impact on the health and well-being of my patients.