CLEVELAND STATE UNIVERSITY



CLEVELAND STATE UNIVERSITY

BACCALAUREATE NURSING PROGRAM

NUR 326

SECONDARY PREVENTATIVE STRATEGIES

FOR CHILDREN EXPERIENCING STRESS

CLINICAL LABORATORY

Fall, 2004

COURSE NUMBER: NUR 326

COURSE TITLE: Secondary Preventative Strategies for Children

Experiencing Stress - Laboratory

FACULTY: Coordinator: Marilyn Weitzel Ph.D., R.N.

Clinical Faculty:

COURSE CREDITS: 3 Credits

COURSE HOURS: 10 Hours per week in a Clinical Laboratory

2 Hours in lab/recitation session

COURSE PLACEMENT: Spring Semester, Junior year

PREREQUISITES: Junior level standing in the Nursing Major or permission of the instructor.

COURSE DESCRIPTION: Focuses on the use of the nursing process in a structured setting to plan care for children who have diseases of adaptation. Emphasis is the student's ability to provide secondary preventative care to children and their families. Psychomotor skills unique to providing care for children will be practiced in a skills laboratory prior to performance in the clinical laboratory.

COURSE OBJECTIVES: By the end of the course the student will:

1. Apply the stress framework to the management of pediatric clients experiencing diseases of adaptation.

2. Demonstrate the use of the nursing process while providing nursing care to pediatric clients experiencing selected diseases of adaptation.

3. Use scientific rationale to support nursing intervention in providing nursing care for pediatric clients.

4. Develop facilitative relationships with the child, family, peers, colleagues, and members of the interdisciplinary health team.

5. Assume responsibility for nursing actions while caring for children with diseases of adaptation.

6. Demonstrate the relationship between planned learning opportunities and professional growth.

REQUIRED TEXTS:

London, M.L., Ladewig, P.W., Ball, J.W., & Bindler, R.C., (2003). Maternal- Newborn & Child Nursing: Family Centered Care, Upper Saddle River, New Jersey, Prentice-Hall.

Student Study Guide

Teaching/Learning Strategies:

Clinical experience in an acute care pediatric facility and in a primary or tertiary community setting.

Evaluation:

Clinical evaluation = 75%

Written evaluation = 25%

Written Assignments:

Paper work = 25% of course grade

Secondary Preventive Care (in acute care hospital sites)

Weekly skeletal care plans 120 points

(20 each week)

Clinical seminar

Week 3, 4, 5, 6, 7 50 points

Nursing Care Plan 100 points

Due as assigned week 5, 6, or 7

Primary Preventive Care (in community sites)

Family Assessment 100 points

WebCT assignment due Week 5

Process Recording 75 points

Due Thursday of the week for Glenville High School

experience

Teaching Plan 40 points

Due Thursday of the week of the Day Care experience

DDST II 15 points

Due Thursday of the week of the Day Care experience

TOTAL POINTS 500 points

Computing grades

Clinical percentage grade multiplied by 0.75 = -------

Plus Written percentage grade multiplied by 0.25 = --------

Equals-----------------------------------Course Grade = ----------

Sample of distribution of written assignments

First Day Second Day

Week 1 Orient Orient

Week 2 wscp

Week 3 seminar; wscp

Week 4 seminar; wscp

Week 5 seminar; wscp; Family assessment

Week 6 DDST II; Teaching Plan

Week 7 Process Recording

Clinical experience:

MetroHealth: Assignments for direct care

Recitation at hospital after clinical

Submission of papers.

OR

Health Hill Hospital: Assignment for direct care

Recitations at hospital after clinical

Submission of papers.

OR

Community sites such as Glenville High school, day care centers, Berean Home for Profoundly MR/DD

Alternative Clinical Experiences as available in clinical site -- including -- Outpatient Care, Pediatric Intensive Care, Juvenile Court Visitation, Child Life Observation, Day Care, Pediatric UrgiCare and others that your particular site may have available.

RECITATION SESSION:

Purpose: to provide an opportunity for students to integrate knowledge from didactic and clinical component on NUR 325/326 through:

1. Group discussion seminars that focus on patient care issues.

2. Discussion or role play of care situation for the purpose of generating alternative approaches to nursing care problems.

3. Demonstration of pediatric skills in performing nursing care tasks.

4. Participation in peer review conference.

EVALUATION METHODS:

1. Evaluation of skills in performing specific patient care tasks.

2. Attendance, punctuality and thoroughness of clinical assignments; patient care and written work.

3. Participation in clinical seminars.

4. Participation in peer review conferences.

5. Presentation of one Clinical seminar.

6. Nursing care plans, clinical log.

7. Teaching plan.

8. Family Assessment

9. Other written work.

10. All students are required to take the ATI Peds/OB assessment exam at the end of the semester.

GRADING: Satisfactory Completion of:

1. Nursing care plan and clinical logs

2. Clinical seminar - See Evaluation form in Appendix

3. DDST (Denver Developmental Screening Test)

4. Process Recording - See Evaluation form in Appendix

5. Teaching Plan

6. Other Papers: ** ALL PAPERS MUST BE TYPEWRITTEN or word processed**

Self Evaluation:

Midterm Self Evaluation -- Schedule with individual faculty member.

End of Course Self Evaluation -- Bring to scheduled End of Course Evaluation meeting with faculty member.

** NO COURSE EVALUATION WITHOUT SELF EVALUATION **

** NO GRADE WILL BE SUBMITTED WITHOUT AN EVALUATION CONFERENCE**

GRADING:

1. Clinical Care 75 %

2. Paper Work 25 %

Clinical log 120 points (20 points/week)

Clinical seminar 50 points

DDST 15 points

Family assessment 100 points

Nursing Care Plan 100 points

Process recording 75 points

Teaching Plan 40 points

500 points possible

95%-100% 475-500 = A

92%-94% 465-474 = A -

89%-91% 450-464 = B+

86%-88% 435-449 = B

83%-85% 420-439 = B-

80%-82% 405-419 = C+

75%-79% 375-404 = C

65%-74% 325-374 = D

0%-64% 000-324 = F

Students are expected to attend each clinical day. Any clinical absence jeopardizes successful completion of the course. Should one absence be necessary, please follow policy and procedure outlined in the Student Handbook.

Tardiness is not acceptable in professional careers. Three times tardy will count as one absence. Any student tardy over 30 minutes will not be allowed on the clinical unit. Any absence for more than one day for illness requires written permission from the physician to return to the clinical area.

NUR 326 Seminar

Week #1: GROWTH AND DEVELOPMENT

PHYSICAL ASSESSMENT

CLINICAL DAY #1 ORIENTATION TO COURSE

OBJECTIVES: GROWTH & DEVELOPMENT

1. State four ways in which knowledge about childhood development contributes to the practice of pediatric nursing.

2. State seven principles of child development and give at least one example showing how each principle relates to nursing care.

3. Describe how a nurse can use developmental norms and still design nursing care compatible with the uniqueness of each child and each family.

4. Define developmental task and give one example for each childhood age group (newborn, infant, toddler, etc.).

5. Name and describe the specific developmental issue or problem Erickson identified for each of his stages.

6. Name the four developmental stages identified by Piaget and describe the major characteristics of each stage.

7. Record a particular child's weight, height, and head circumference on a growth chart.

8. Compare a child of any age with the developmental norms for that age group and identify ways in which the child does and does not conform to the norms.

AUDIO-VISUALS: TBA

PHYSICAL ASSESSMENT

OBJECTIVES:

1. Discuss the developmental approach for performing physical assessments in the pediatric population.

2. Discuss the importance of length measurements in relation to weight and head circumference measurements.

3. List the historical questions that pertain to each body system.

4. Describe and list the normal findings.

5. Demonstrate the use of distraction in performing physical assessment of children at different ages.

Audiovisuals: View: Nsg 8025 DDST

Week #2: THE HOSPITALIZED CHILD PEDIATRIC NURSING PROCEDURES

OBJECTIVES:

1. Discuss the process involved in admitting a child to a pediatric unit.

2. Describe the effects of pain, sensory deprivation, and sensory over stimulation in the course of an infant's hospitalization.

3. Identify and elaborate on five factors which influence a toddler's response to hospitalization.

4. List four types of play activities which can be used in working with hospitalized preschoolers.

5. Identify four variables which affect the hospitalization of adolescents.

6. List and discuss all the components, of discharge planning.

Supplementary Materials: The following videos are available to enhance your learning. They can be found in RT 31, the ground floor of Rhodes Tower

Seminar SCHEDULE:

******Seminar topics will be assigned during Orientation. Outline with Objectives for Individual Seminars will be due in the second week of clinical for all seminars. A reference list will be submitted the day of the seminar.

WEEK 1: ORIENTATION by faculty

WEEK 2: MED CALCULATION AND SKILLS REVIEW by faculty

WEEK 3: SEMINAR: CHILDREN'S NUTRITION by students

WEEK 4: SEMINAR: CHILD ABUSE, NEGLECT,

and DEPENDENCY by students

WEEK 5: SEMINAR: EMOTIONAL DISORDERS by students

WEEK 6: SEMINAR: CHRONIC ILLNESS by students

WEEK 7: SEMINAR: MENTAL RETARDATION by students

APPENDICES

TABLE OF CONTENTS

A. Forms

1. Guidelines for daily skeletal care plans

2. Skeletal care plan form

3. Medication form

4. Developmental assessment form

5. Nursing Care plan form

6. Clinical log form

7. Family assessment form

8. Clinical Seminar Guidelines

9. Guidesheet: Exploring child day care centers

10. The Teaching Plan

B. Evaluations

1. Family assessment

2. Clinical seminar evaluation tool

3. Process recording evaluation tool

4. Clinical evaluation tool

Appendix A -1 Guidelines

Daily Skeletal Care Plans

1. Day one in the clinical agency will be an orientation to the nursing unit assigned.

2. Day two in the clinical agency, each student will be assigned to a staff nurse. The student will be able to collect data from the chart, kardex, staff, etc. On this day, students should become familiar with the unit, the types of patients, and the standard procedures used when providing care.

3. Day three in the clinical area and each day thereafter, the student is expected to have developed a beginning care plan using CSU format which will include the following:

a. Client profile

b. Normal growth and development for the client (use Development Assessment Form)

c. Brief summary (in student's own words) of the client's pathophysiologic condition

d. Medication cards or written explanation including calculation of safe dosage, use in this patient, action, side effects and nursing measures

e. Treatments

f. Lab data

g. Diet (discuss if special)

h. Basic list of objective/subjective data to be collected.

i. At least 1 nursing diagnosis

4. Each succeeding day that the student is assigned to the client, the information in #3 will be expanded to include:

a. Additional appropriate nursing diagnosis

b. Nursing orders and scientific rationale relevant to the nursing diagnosis

c. Evaluation of the effectiveness of the care plan

5. A clinical log will be expected for each clinical day

Form A-2

Skeletal Care Plan

Student:____________________________ Date of Assignment: __________

Guide for Clinical Preparation:

Patient Name: ____________________________ Age:___________________

Ht. _______________ Wt. _________________ H.C. ___________________

Interpretation the measurement taken____________________________________________________

Date of Admission _____________________ CC: ______________________

Medical Diagnosis ________________________________________________

Nursing Diagnoses ______________________________________________

Pathophysiology:

Diet: ___________________________________________________________

________________________________________________________________

Interpretation of Diet: ______________________________________________

Activity: _________________________________________________________

Vital Signs over last 24 hours:

_________________________________________________________________

Interpretation and Comparison with Normal for Age:

_________________________________________________________________

Medications: (Follow up medications with check for safe dosage. Include patient initials, name of medication, action, side effects, and nursing measures (See medication form:(Form A-3)

IV Therapy

Special Procedures:

Family:

Pertinent Lab Data:

Name: Values: Norm: Interpretation

Form A - 3

Medication Form

Student:________________________________ Date:___________________

This form may be used or another as assigned by clinical instructor. (3x5 card is appropriate)

Medications

Medication Name, Dosage, Time of Administration:

Safe Dosage or Usual Dosage (source)

Calculation of Safe Dosage:

Administration: Guidelines -- if an IV medication -- Discuss dilution, diluent, and time over which medication must be administered.

Use in this patient:

Action :

Side Effects:

Nursing Measures:

Form A - 4

Developmental Assessment Form

Student:________________________________ Date:___________________

Child's Initials ________ Age ________ Sex ________

Height ______________ Weight __________

Head Circ. __________

Interpretation___________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Motor Skills:

Gross:

Fine:

Psychological:

Erickson Expected Stage:

Child's Stage:

Language:

Play: Expected:

Actual:

Effects of Illness/Hospitalization: Expected:

Actual:

_______________________________________________________________________

Form A - 5

Nursing Care Plan

(Incorporates all of skeletal plan plus following)

Name: _____________________________________ Date: ______________

Diagnosis: _______________________________________________________

_________________________________________________________________

Goal: ___________________________________________________________

Outcome Criteria: __________________________________________________

_________________________________________________________________

Interventions:

Evaluation:

Form A - 6

Clinical Thought Journal

Name: _______________________________

Week Number: ________________________

Dates: _______________________________

Incorporate throughout areas of satisfaction or concern. For the first three weeks, incorporate responses to those objectives set forth earlier in the syllabus. In addition, reflect upon and respond to each item below.

1. Utilization of interpersonal skills (with patient and family, instructor, peers, staff on unit).

2. Ability to identify priorities of care and organizational abilities.

3. Performance of physical care and procedures.

4. Ability to perform accurate physical, developmental, and family assessments.

5. Demonstration of accountability (clinical preparation, reporting to pertinent persons, participation in conference, handing in assignments on time).

6. Identify methods through which your instructor can facilitate your learning (be specific).

7. Learning objectives for next week.

Form A - 7

Family Assessment

Family assessment should be approached using the CSU conceptual framework

1. Assess all GRRs

2. Use book's description of family assessment.

Include each of the following topics:

Duvall's Development Stage of the Family

Family Structure (Family composition)

Use the Double ABCX model to assess the family’s GRD’s and GRR’s

Home and community environment

Occupation and education of family members

Cultural and religious traditions

Family Function (Family interactions and roles)

Power, decision making, and problem solving

Communication

Expression of feelings and individuality

Some consideration of parenting

Pedigree chart

Ecomap

3. Conclusions must be drawn from the data and possible nursing diagnosis stated.

Example: Family coping: potential for growth related to appropriate social support and resources available as evidence by the child's mother asking the nurse how to improve the child's nutrition and her asking the Child Life Specialist what would be the best activities for the child.

______________________________________________________________________

Form A-8

Clinical Seminar

Each student will present one clinical seminar or case study during the semester. A list of possible topics and dates will be discussed during the first clinical session. The student will select a topic of interest at that time, and will have the opportunity to be leader or co-leader for that topic.

The following guidelines will be utilized for the clinical seminar presentations. The student will:

1. Develop behavioral objectives for the presentation.

2. Identify content for topic.

a. appropriate content for topic.

b. at least two additional references along with text.

3. Present outlines (with objectives) to clinical instructor during the second week of the course.

4. Meet with clinical instructor at ten days prior to date of presentation.

5. Select teaching/learning strategies appropriate to the topic.

6. Be familiar with roles of group members as outlined in discussion guide.

7. Dress appropriately for professional presentation.

8. Provide copies of revised objectives and required/suggested readings to class members and the instructors at least one week prior to the presentation.

9. The clinical seminar will be evaluated using the Leader/Seminar evaluation form found in the Appendix.

Form A-9

Guidesheet: Exploring Child Day Care Centers

PURPOSE: This experience will introduce the student to the role of assessing child care centers. Children attend day care more today than at any tine in our history. These patterns are not likely to change in the near future. families have increased demands placed on them and the need for single parents to work and/or both parents to work is increasing. Parents sometimes become concerned about their children's care and ask questions of community based nurses about what to expect from child care centers and what criteria to use in choosing one. Nurses need to be aware of state regulations, types of child care centers and criteria for determining quality. This experience provides an opportunity for the student to observe several day care environments and discuss the role of the community based nurse in these environments.

DESCRIPTION OF ACTIVITY: During the assigned time at a day care center, each student will observe the normal routines and schedules of the children. The project will focus on observing child care centers and staff and their relationships with the children.

STUDENT OUTCOMES:

Performance: The final due date of the written report and evaluation of this project will be due as determined by the faculty. (No later than the last clinical day of the course.) Professional attire is dependent upon clinical site and is determined in collaboration with the clinical faculty.

Product: A written evaluation of the project must be submitted to the clinical faculty one week after completion of the project. List all references and resources used. The written report should be in sentence form and will. be evaluated for content as well as sentence structure, grammar, and spelling You will not be penalized for negative comments or if you include suggestions for change. All objectives included below should be addressed.

OBJECTIVES: During the observation and completion of the written evaluation of the project, the following should be considered:

1. Describe the appropriateness of the child care center for the children enrolled.

2. Identify the state regulatory agencies that license child care centers.

3. List the amount of time children spend in the center weekly.

4. List 5-7 state regulations the child care centers need to implement.

5. List 3-5 ways a community based nurse could meet needs of families through child care centers.

6. Summarize the overall effectiveness of the project.

7 How does this assignment relate to role of the pediatric nurse that you have seen this quarter in the hospital and the community?

Form A-10

THE TEACHING PLAN

Goal: Formulation and implementation of a teaching plan for an assigned client.

Directions: Each student will be responsible for the development and implementation of a teaching plan for a client assigned during which a need is identified for teaching. Topics for this project will vary widely but must result from the student's assessment of the client's needs.

When possible, the written plan for the material to be taught should be reviewed with the clinical faculty prior to implementation. This allows feedback from the faculty prior to the actual teaching experience. The final plan, and the actual outcomes of the teaching experience should be submitted to the faculty person following the experience, and prior to the next clinical day.

The teaching plan should include:

Identification of learner needs.

A clearly worded problem statement (Nursing - Diagnoses in the

PES format)

Learner objectives

Content outline of material to be discussed/presented.

Teaching strategy(ies) specific for plan proposed.

Expected outcomes.

Evaluation methods.

If you plan to include a pre and post test, please include with the materials given to the faculty as well as a report of learner performance. An example of a teaching plan can be found in your Med/Surg Text and syllabus.

APPENDIX B-1

EVALUATION FORMS

Family Assessment Tool

1. All GRRs assessed

Artifactual GRR 0 1 2 3 4

Cognitive/Emotional GRR 0 1 2 3 4

Interpersonal GRR 0 1 2 3 4

Valuative/Attitudinal GRR 0 1 2 3 4

Macrosociocultural GRR 0 1 2 3 4

Physical-Biochemical GRR 0 1 2 3 4

2. Includes:

Duvall's Developmental Stages

of the Family 0 1 2 3 4

Stage of Growth and

Development of Family Members

(especially parents) 0 1 2 3 4

Family Structure

(Family Composition) 0 1 2 3 4

Pedigree Chart 0 1 2 3 4

Ecomap 0 1 2 3 4

Home and Community

Environment 0 1 2 3 4

Occupation and Education

of Family Members 0 1 2 3 4

Cultural and Religious

Traditions 0 1 2 3 4

Family Function (Interactions

and Roles) 0 1 2 3 4

Power, Decision Making, and

Problem Solving 0 1 2 3 4

Communication 0 1 2 3 4

Expression of Feelings and

Individuality 0 1 2 3 4

Some Consideration of

Parenting 0 1 2 3 4

3. Conclusions

Family Nursing Diagnosis 0 2 4 6 8

Discusses Strengths and

Weaknesses 0 1 2 3 4

Discusses Parenting 0 1 2 3 4

Each item in order 0 1 2 3 4

Each item labeled 0 1 2 3 4

Total Possible Points = 100

Form B2

Evaluation Tool for Clinical Seminars

Name _______________________________ Date _______________________

Seminar ____________________________

The following scale will be used to evaluate each item below. Items are ranked on a scale of 0 - 4.

A = Needs improvement (1)

B = Somewhat weak (2)

C = Adequate or O.K. (3)

D = Strong or effective (4)

E = Exceptionally strong

or very effective (5)

1. Preparation. A B C D E

Outline to Instructor, Students

2. Behavioral Objectives A B C D E

3. Overall organization of presentation A B C D E

4. Leader's knowledge of the content and material

presentation A B C D E

5. Leader's effectiveness in responding to

questions from participants A B C D E

6. Leader's poise A B C D E

7. Intellectual challenge provided by the

presentation A B C D E

8. Leader's ability to stimulate discussion A B C D E

9. Leader's use of summarization A B C D E

10. Clarity with which important ideas, concepts

and information were communicated A B C D E

Total Possible Points = 50

________________________________________________________________________

Form B - 3

PROCESS RECORDING EVALUATION

Student _______________________ Client ____________________________

Date __________________________

Reason for Contact

1. States purpose for interaction 1 2 3 4 5

2. Describes defining characteristics, including

physical appearance of person with whom

interacting. 1 2 3 4 5

3. Describes situation and setting of the

interaction. 1 2 3 4 5

4. Describes any necessary nursing diagnosis

central to understanding interaction. 1 2 3 4 5

Planning

5. States goal(s) of interaction for client. 1 2 3 4 5

6. Write goal in behavioral terms. 1 2 3 4 5

Interaction-Intervention

7. Records nurse and client verbal communication. 1 2 3 4 5

8. Records facial expressions of nurse and client. 1 2 3 4 5

9. Notes body movements of nurse and client. 1 2 3 4 5

10. Records spatial aspects of the physical setting

in which the interaction takes place. 1 2 3 4 5

11. Notes thoughts and feelings about self and

toward client. 1 2 3 4 5

12. Identifies thoughts and feelings about content

of the interaction. 1 2 3 4 5

13. Correctly identifies the communication

techniques used by the nurse. 1 2 3 4 5

Other Pertinent Behaviors

*14. Summarizes major points of present interaction

with client. 1 2 3 4 5

15. Evaluates if identified goal(s) for interaction

were met. 1 2 3 4 5

TOTAL _______

7/7/04/mw

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