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Increasingly, health policymakers are becoming aware of the social determinants of health and the role they play in prevention disease and promoting health and wellness. In the “Frameworks for Action in Policy and Politics” chapter, examine Box 1-1 (Political Aspects of the Social Determinants of Health) and Figure 1-6 (The Who, What, Where, When, and Why of Nursing’s Policy Influence). Then compare these with the story about Lilian Wald’s work in New York City. Reflect on the “what” of Wald’s strategies. In your opinion, which did she use effectively?

Looking further at the “what” in Figure 1-6 and answer any one of the following questions:

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Discuss at least three competencies/strategies that you have used effectively.

Identify three competencies/strategies that you don’t currently use and discuss how you might incorporate them into your advocacy toolbox.

Simulations

The era of advanced technology has finally integrated its way into nursing programs across national and international shores. Nurse educators have found that simulations offered a unique way to bridge the gap between clinical experience for nursing student when finding adequate clinical sites poses as a challenge (Jefferies, Swoboda, & Akintade, 2016). Simulations portray real-world events in the form of activities or events. Simulations can be further categorized regarding low, medium, or high fidelity (the degree of realism associated with the simulation). Low fidelity includes methods such as role-playing or case studies to instruct nursing students about patient situations and what Eyikara & Baykara (2017) describes as a partial task trainer or static manikin. Examples include inserting an indwelling urinary catheter or performing central line dressing changes on a manikin using aseptic technique. Medium fidelity involves a two-dimensional active learning experience where nursing students are presented with situations that involves the recollection of learned concepts and apply these concepts to scenarios to problem solve. For example, nursing students being able to assess adventitious breath sounds on a manikin without being able to visualize the rise and fall of the chest. High fidelity simulations are highly sought after in the nursing school setting. It is considered the most realistic of simulations. High fidelity simulations involve the usage of full-body patient simulators, eSimulations (virtual reality), or standardized patients (i.e., stand-in actor or nursing faculty).

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Significance of Simulations

With the shortage of adequate clinical sites for undergraduate nursing program, many states have approved the use of simulations to replace nearly 50% of traditional clinical hours (Fey & Kardong-Edgren, 2017). Simulations are proven to enhance nursing students’ knowledge bases and skills. According to Eyikara & Baykara (2017), simulations bridge a link between theory and clinical application by presenting patient scenarios that closely mimic what could happen at the actual patient bedside. A well-constructed simulation (especially that of a high-fidelity caliber) has resulted in the improvement of nursing student levels of confidence and learner self-satisfaction as documented in numerous of research manuscripts. The overwhelming positive results associated with learner’s outcomes, simulations, and undergraduate nursing students has prompted researches to expand research into studying how to apply quality simulations to match the learner needs of graduate nursing students (Fey & Kardong-Edgren, 2017). Graduate level nursing clinical sites are also a challenge for even the most prestigious universities. If you combine this with the expansion of distance-learning nursing program you can see how simulations can prove to be beneficial to nurse educators, nursing students, and most importantly patients whose quality of care is partially dependent on the knowledge, skill, and expertise of the nurse clinician (regardless of the scope of practice).

Attributes to Simulations (Li, 2007)

Low and medium fidelity is considered User-friendly

Low fidelity simulations are considered suitable for 1
st
-year undergraduate nursing students

Low Cost (Low and Medium Fidelity)

Limited physical interaction (Low Fidelity)

Limited application of learning theories (Low Fidelity)

Allow for nursing students to work at their own pace

High Fidelity simulations are not cost-efficient; estimated cost $100,000.00

Limited access (high fidelity)

High Fidelity simulations are considered suitable for thi
rd
and 4
th
-year undergraduate nursing students

Nursing students experience with simulations is dependent on faculty expertise

 

 

Advantages and Disadvantages of Simulations as an Educational Tool

Simulations often require nursing students to work together in small groups which is a form of cooperative learning. Cooperative learning encourages active and reflective learning while cultivate a sense of comradery and teamwork amongst nursing students which is necessary for the development of interpersonal skills and communication (Phillips, 2016). Procedural knowledge is cultivated in nursing students by the use of simulations (especially those of low-fidelity methods). Simulations such as manikins used for nursing students to practice their intravenous insertion skills is an example of acquisition of procedural knowledge. Lastly, simulation all incorporates active learning by demonstration (Phillips, 2016). Video-taping simulations allow for reflective learning and evaluation of skill by performance feedback. Retention of performed skill increases when nursing students can dissect their performance with constructive feedback from peer, self, and nurse educators to understand the complexities problem-solving and critical thinking. In a qualitative study by Au, Lo, Cheong, Wang, & Van (2016) revealed that nursing faculty viewed simulations (with bias to high-fidelity simulations) as a unique tool to achieve learning outcomes while instilling the importance patient safety. Nursing students view simulations of high-fidelity tier as a bonafide learning experience. Qualitative data included nursing students expressing the desire to have high-fidelity simulations as a prerequisite before entering the clinical setting.

The experience nursing students receive during simulations unfortunately dependent on the expertise of the nursing faculty facilitating the learning activity. Nursing students feeling as if one person is not putting as much effort as the other could lead to a breakdown in communication, rise in stress levels, and the possibility group conflict leading to the non-retention of nursing concepts and applications. These barriers to learning can develop if the facilitator is ineffectively monitoring the simulation. Faculty not accounting for the difference in skill procurement amongst nursing students can lead to feelings of anxiety and inadequacy in students participating. High fidelity simulations are costly which can result in a limited equipment usage and practice time to preserve on the cost of restocking supplies and possible maintenance work related to high fidelity manikins and other advanced technology. Au et al. (2016) reported nursing students expressing feelings of anxiety and lack of communication between students and faculty during simulations. Since these simulations are represented as real-world situations, these negative experiences could cause students to correlate any poor performance during simulations with their ability to successfully transition into the role of the clinical nurse at the bedside (Au et al., 2016).

National League for Nurses: Nurse Educator Competencies

The National League for Nursing (NLN) developed eight competencies to offer guidance, framework, and role development in nurse educators. In this blog, I will highlight two of the eight competencies that is relatable to nurse educators implementing simulations in the classroom to meet the learner needs of nursing students. The first competency is nurse educators as facilitators of learning. The use of simulations requires nurse educators to possess content mastery regarding the content being taught to students (Halstead, 2007).  Simulations require the nurse educator to understand the flow of patient care including the correct course of action to take when things go astray. The nurse educator must possess clinical competency, content mastery, and be adaptable of various teaching styles to meet the learner needs of a diverse nursing student audience (Halstead, 2007).

The successful facilitation of simulations by nurse educators build confidence within the novice and experienced educator. A nurse educator competency presented by the NLN encourages nurse educators to aim for continuous quality improvement when teaching tomorrows nurses (Halstead, 2007). Faculty feeling inadequate in regards to technology is an identified barrier to the incorporation of simulation in the classroom. Nursing faculty, as well as nursing administration, should invest in the continuous enrichment of faculty. The investment in faculty will increase job satisfaction, reduce role strain, and increase faculty productivity (Halstead, 2007). Nurse educators must commit to being lifelong learners to ensure that tomorrow’s nurses enter the workforce prepared to withstand the ever-changing flow of healthcare and patient care.

References

Au, M. L., Lo, M. S., Cheong, W., Wang, S. C., & Van, I. K. (2016). Nursing students’perception of high-fidelity simulation activity instead of clinical placement: A      qualitative study. 
Nurse Education Today
, 3916-21.

Eyikara, E., & Baykara, Z. G. (2017). The importance of simulation in nursing education. 
World

Journal On Educational Technology: Current Issues
, 9(1), 2-7.

Fey, M. K., & Kardong-Edgren, S. (2017). State of research on simulation in nursing education

programs. 
Journal Of Professional Nursing
, 33(6), 397-398. doi:10.1016/j.profnurs.2017.10.009

Halstead, J. (2007). 
Nurse Educator Competencies: Creating an Evidence-Based Practice for

Nurse Educators .
 New York: National League for Nursing.

Jeffries, P., Swoboda, S., & Akintade, B. (2016). Teaching and learning using simulations. In D. Billings, J. Halstead, & 5th (Ed.), 
Teaching in Nursing: A Guide for Faculty
 (pp. 304-323). St. Louis, Missouri: Elsevier.

Li, S. (2007). 
The role of simulation in nursing education: A regulatory perspective
. Retrieved from National Council of State Boards of Nursing: 
https://www.ncsbn.org/Suling2.pdf

Phillips, J. (2016). Strategies to Promote Student Engagement and Active Learning. In D. Billings, J. Halstead, & 5th (Ed.), 
Teaching in Nursing
 (pp. 245-263). St. Louis, Missouri: Elsevier.

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

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Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.

Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.

Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

Review the Application Assignment Rubric found under Course Information

To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.

Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations

64B9-2.015 Standards of Nursing Education.

(1) Nursing Education programs shall have consistent organization and administrative procedures as follows:

(a) The parent institution shall be approved by the appropriate accrediting agency.

(b) There shall be an organizational chart for the nursing education program, which clearly delineates the lines of authority, responsibility and channels of communication.

(c) There shall be statements of purpose, philosophy and objectives/outcomes, which are consistent with those of the parent institution and Standards of Nursing Education.

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(d) There shall be written policies on admission, transfer, readmission, promotion, and retention, congruent with the parent institution, which are periodically reviewed and available upon request.

(e) There shall be evidence of financial support and resources to meet the goals of the nursing education program. Financial resources include adequate educational facilities, equipment and qualified administrative, instructional and support personnel.

(f) There shall be a system of records within the parent institution for the maintenance and issuance of student transcripts and final records.

(2) Resources. The parent institution shall provide financial and administrative support and resources to the nursing program that includes:

(a) Classroom space, laboratories, and office space for the nursing program.

(b) Nursing resource library holdings to include textbooks, journals and instructional media that are pertinent, recent, and have appropriate content and reading level.

A regular schedule for evaluation and deletion of outdated books and instructional media.

Teaching materials to include a variety of current technological aids for both group and self‑instruction.

(c) Secretarial, clerical, and other support personnel services.

(d) Counseling services and remedial assistance for students.

(3) Nursing Program Director Qualifications.

(a) The director of any nursing program shall be a currently licensed registered nurse in Florida (which may include practice under the terms of Rule 64B9‑3.009, F.A.C.). Notification of the appointment must be submitted to the Board.

(b) The director of a professional nursing program shall have a bachelor’s degree in nursing plus a masters or doctoral degree in nursing; and preparation in education and administration, 5 years of experience in academic, clinical, or administrative nursing, or any combination thereof. Past August 2006, incumbent directors will be exempted from meeting this standard.

(c) The director of a practical nursing program shall have a minimum of a Bachelor’s degree in nursing; and preparation in education and administration, 3 years of experience in academic, clinical, or administrative nursing, or any combination thereof. Past August 2006, incumbent directors will be exempted from meeting this standard.

(d) The director of the nursing program shall not be assigned curriculum instructional duties that would impair program administration.

(e) The director of the nursing program shall have authority to administer the program in accordance with the policies of the parent institution and in relation to:

Development and maintenance of an environment conducive to the teaching/learning process;

Leadership within the faculty for the development and implementation of the curriculum;

Faculty recruitment, development, and evaluation;

Liaison with the Board;

Establishment of clinical sites.

(4) Faculty.

(a) There shall be sufficient faculty with educational preparation and nursing expertise to meet the objectives and purposes of the nursing education program.

(b) Nursing faculty shall have the following qualifications:

Each nurse faculty member shall be currently licensed to practice professional nursing in Florida (which shall include practice under the terms of Rule 64B9‑3.009, F.A.C.).

By August 2009, sixty percent (60%) or more of the nursing faculty in a professional nursing program shall hold a bachelor’s degree in nursing plus a masters or doctoral degree in nursing. Each nursing faculty member who does not meet this requirement shall have a bachelor’s degree in nursing and meet one of the following requirements:

Have the equivalent of at least three years of full time experience in clinical practice as a registered nurse.

Be actively engaged in studies leading to the next highest degree for which eligible. The degree must be in nursing or a related field.

Have current certification as an A.R.N.P. in Florida.

Have at least two years of full time experience as a nurse educator.

Fifty percent (50%) or more of the nursing faculty in a practical nursing program shall hold a bachelor’s degree in nursing. Each faculty member who does not meet this requirement shall meet two of the following requirements:

Have the equivalent of at least two years of full‑time experience in clinical practice as a registered nurse;

Be actively engaged in studies leading to the next highest degree for which eligible. This degree must be in nursing or a related field;

Have the equivalent of at least two full‑time years of experience as a nurse educator;

Have current certification as an A.R.N.P. in Florida.

Faculty shall demonstrate theoretical and clinical competence for each assigned area of instruction.

Variances or waivers to the academic qualifications for nursing faculty shall be justified and must be approved by the Board in accordance with Section 120.452, F.S.

For practical nursing program faculty, an individual who is a RN but is not enrolled in a bachelors or higher degree in nursing program is limited to a maximum of three calendar years.

For professional nursing program faculty, a BSN prepared individual who is not enrolled in a masters or higher degree in nursing or related field program is limited to a maximum of three calendar years.

For professional nursing faculty, a BSN prepared individual who is enrolled in a masters in nursing or related field program shall be approved annually on an individual basis and is limited to a maximum of five calendar years.

The number of faculty variances shall not exceed 20 percent of the number of full time nurse faculty employed (not FTE) by the program.

(c) Nursing Faculty Responsibilities:

Developing, implementing, evaluating, and updating the purpose, philosophy, objectives/outcomes, and organizational framework of the nursing program.

Developing, implementing and evaluating the curriculum.

Developing, evaluating, and revising student admission, progression, retention, and graduation policies within the policies of the institution.

Participating in academic advising and guidance of students.

Providing theoretical instruction and clinical or practicum experiences.

Monitoring instruction provided by preceptors.

Evaluating student achievement of curricular objectives/outcomes related to nursing knowledge and practice.

Providing for evaluation of teaching effectiveness in accordance with parent institution policy.

Participating in activities which facilitate maintaining the faculty member’s own nursing competence and professional expertise in the area of teaching responsibility and maintaining clinical competence through clinical experience, workshops, and/or continuing education.

Participating in a faculty organization, which meets regularly at scheduled and recorded meetings, and provides for faculty involvement in the operation of the program.

(d) Faculty policies and procedures shall be available in writing and shall include qualifications, rights, and responsibilities of faculty members, the criteria for evaluation of performance, and promotion and retention policies.

(e) Clinical preceptors may be used to enhance clinical learning experiences.

Clinical preceptors shall be Florida licensed nurses (which may include practice under the terms of Rule 64B9‑3.009, F.A.C.).

There shall be written guidelines for the use of clinical preceptors that include the following:

Criteria for selecting preceptors.

The functions and responsibilities of the clinical preceptor shall be clearly delineated in a written agreement between the clinical agency, the preceptor and the nursing education program.

The preceptor shall have clinical expertise and competence in the area where serving as a preceptor.

The preceptor is approved by the program faculty and the facility/agency.

The preceptor shall be physically present and available to the student at all times while the student is performing in a nursing capacity with patients or clients.

The faculty member shall retain responsibility for the student’s learning experiences and meet periodically with the clinical preceptor and student for the purposes of monitoring and evaluating learning experiences.

Written clinical objectives are specified and given to the preceptor prior to the preceptorship experience.

(5) Students.

(a) A nursing student shall practice nursing as a student within the meaning of Chapter 464, F.S., only within the courses of an approved program in which the student is enrolled and under the supervision of program faculty.

(b) The nursing program shall admit students to the program based upon the number of faculty, available educational facilities and resources, and the availability of clinical learning experiences for the student.

(c) The program shall provide written policies for admission, readmission, transfer, advanced placement, promotion, graduation, withdrawal, or dismissal to the student shall be consistent with those for students in the parent institution and acceptable educational standards.

(d) The program or parent institution shall provide accurate records of scholastic achievement to each student.

(6) Curriculum for a Professional Nursing Education Program: To ensure the preparation of nurses capable of competent practice, the curriculum for a professional nursing education program shall be implemented by the program director and faculty as written and shall include at least the following, regardless of educational delivery method:

(a) A philosophy or list of assumptions, organizing frame‑work, program objectives/outcomes, course objectives/outcomes, teaching strategies, and evaluation methods which are:

Developed and written by the faculty;

Consistent with the law regulating the practice of nursing as a registered nurse;

Internally consistent;

Implemented as written; and

Distributed to each nursing student.

(b) A curriculum plan showing the sequence of courses, skills lab, and clinical experiences, and the units of credit or number of clock hours allotted to theory, skills laboratory, and clinical experiences to ensure sufficient preparation for the safe and effective practice of nursing as a registered nurse.

(c) A curriculum content that:

Includes courses or content in three major areas;

Physical, biological, technological sciences, and mathematics,

Social and behavioral sciences, which shall include concepts that assist a student in the development of a foundation for:

(i) Understanding and communicating with individuals or groups across the life span, and their interactions in society;

(ii) Understanding the effect of economic, political, religious, cultural, and growth and developmental experiences upon human behavior;

(iii) Understanding of content for any required continuing education courses in Chapter 64B9-5, F.A.C.

Nursing science related to nursing practice in a variety of settings where health care can occur and which shall include the following content:

(i) The nursing process, critical thinking, problem solving, and decision‑making related to meeting the nursing care needs of individuals or groups across the life span;

(ii) Physiological and psychosocial nursing needs of individuals or groups across the life span with commonly occurring acute and chronic physical and mental health problems, illnesses, and adaptations;

(iii) Promotion, maintenance, and restoration of health across the life span including methods of dealing with end of life issues;

(iv) Theoretical and clinical instruction must clearly reflect content in medical surgical, obstetric/maternal‑child, pediatric, geriatric, and psychiatric/mental health nursing;

(v) Management, delegation, coordination, and evaluation of safe, effective nursing care;

(vi) The role of the registered nurse in the health care system, including health teaching and counseling, legal aspects, and ethics;

(vii) Nursing history and nursing trends;

(viii) The law regulating the practice of nursing as set forth in Chapters 456 and 464, F.S. and Chapter 64B9, F.A.C.

(d) Curriculum specific to Baccalaureate degree nursing programs shall additionally include:

Preparation as change agent;

Research and statistical methods;

Theoretical and clinical instruction in community/public health nursing.

(e) Program shall provide information for credits and hours of instruction such that:

The ratio of credit hours to clock hours of theory, skills laboratory and clinical experience shall be specified for each nursing course. These ratios shall be consistent for all nursing courses and conform to parent institutional requirements.

The total hours for graduation from the nursing program shall be at least consistent with those required for graduation from other programs of the parent institution.

(7) Curriculum for a Practical Nursing Education Program: To ensure the preparation of nurses capable of competent practice the curriculum for a practical nursing education program shall be implemented by the program director and faculty as written and shall include the following, regardless of educational delivery method:

(a) A philosophy or list of assumptions, organizing framework or theme, program objectives/outcomes, course objectives/ outcomes, teaching strategies, and evaluation methods which are:

Developed and written by the faculty;

Consistent with the law regulating the practice of nursing, as a licensed practical nurse;

Internally consistent;

Implemented as written; and

Distributed to nursing students.

(b) A curriculum plan showing the sequence of courses, skills lab, and clinical experiences and the units of credit or number of clock hours allotted to theory, skills laboratory, and clinical experiences to ensure sufficient preparation for the safe and effective practice of nursing as a licensed practical nurse.

(c) A curriculum content that:

Spans a minimum length of one academic or calendar year of full‑time study. If the program is offered as part of a high school curriculum, the program shall be implemented no earlier than the beginning of the student’s junior year.

Includes courses or content in three major areas, which may be integrated, combined, or presented as separate courses and shall include:

Basic biological, physical, technological sciences and mathematics which shall include an understanding and application of wellness and disease concepts, safety and security procedures, emergency response, infection control, computer skills medical terminology, blood borne diseases including mandatory instruction on HIV/AIDS under Section 456.033, F.S., mandatory instruction on domestic violence under Section 456.031, F.S., nutrition, and body structure and function.

Basic social and behavioral sciences that shall include concepts that assist a student in the development of a foundation for:

(i) Understanding and communicating with individuals or groups across the life span.

(ii) Understanding the effect of economic, political, religious, cultural, and growth and developmental experiences upon human behavior.

(iii) Understanding legal and ethical responsibilities in the role of the licensed practical nurse.

Basic nursing science related to nursing practice in a variety of structured settings where health care can occur and which shall include the following content:

(i) The nursing process as appropriate to the role of the practical nurse in meeting the basic nursing care needs of individuals or groups across the life span in the promotion of health.

(ii) Basic physiological and psychosocial nursing needs of individuals with commonly occurring acute and chronic physical and mental health problems, illnesses, and adaptations with predictable outcomes.

(iii) Promotion, maintenance, and restoration of health across the life span including methods of dealing with end of life issues.

(iv) Theoretical and clinical instruction must clearly reflect content in medical, surgical, obstetric/maternal-child, pediatric and geriatric nursing.

(v) Provision of safe, effective nursing care.

(vi) Pharmacology and medication administration to include calculation of medication dosages.

(vii) Nursing history and nursing trends.

(viii) The law regulating the practice of nursing as set forth in Chapters 455 and 464, F.S., and Chapter 64B9, F.A.C.

(d) Program shall provide information for credits and hours of instruction.

The ratio of credit hours to clock hours of theory, skills laboratory and clinical experience shall be specified for each nursing course. These ratios shall be consistent for all nursing courses and conform to institutional requirements.

Clinical experiences shall make up at least 50% of the total program.

(8) Clinical Experiences. All clinical experiences shall:

(a) Be an integral part of the total curriculum plan and show a relationship to concurrently taught theory.

(b) Require that faculty plan for the student’s learning experiences in cooperation with agency personnel.

(c) Have Board approval secured prior to the time a facility/agency or community‑based site is utilized for student clinical experience by submitting a request on Board approved forms.

(d) Have contractual agreements between the program and the facility/agency or community‑based site in writing, state rights and responsibilities of each party, include a termination clause and be reviewed annually.

(e) Provide written notification to the Board by the program director when a clinical facility/agency being used for students’ clinical practice loses accreditation or approval status.

(f) Meet established course objectives/outcomes.

(g) Provide the student with the opportunity to practice cognitive, psychomotor and affective skills in the performance of a variety of nursing functions with individuals or groups across the life span.

(h) Occur appropriately in a variety of settings to include healthcare facilities/agencies and community‑based sites.

(i) Simulated clinical experiences using the Human Patient Simulator © or its substantial equivalent may be substituted for no more than 25% of direct care experiences provided that:

Specific clinical objective‑based scenarios are presented, providing the student with appropriate cognitive, affective, and psychomotor development.

Faculty is physically present to guide the simulation experience.

Permission is requested and received from the Board to substitute simulated clinical experiences for direct care experiences.

(j) Include a minimum of 675 hours supervised by appropriate faculty or preceptor for practical nursing programs and a minimum of 600 hours supervised by appropriate faculty or preceptor for professional nursing programs.

(k) Be provided within the state by board approved nursing programs only. Out-of-state programs that are fully approved by another state board of nursing may apply to the board per subsection 64B9-2.011(7), F.A.C. The board may add requirements for maintaining such approval.

(9) Healthcare Facility/Agency Experiences:

(a) Healthcare facilities and agencies used for clinical experiences shall be currently licensed/certified by the State of Florida.

(b) All healthcare facilities and agencies shall provide proof of accreditation or approval by a recognized accrediting or approving agency.

(c) Facilities/Agencies shall have:

A registered nurse licensed under Chapter 464, F.S., who is administratively responsible for nursing services.

A sufficient number of patients/clients to provide learning experiences to meet the objectives of the course.

An environment in which the student is recognized as a learner.

A sufficient number of nursing personnel, currently licensed under Chapter 464, F.S., and appropriately qualified, to ensure that patients receive safe, effective care at all times, and to serve as role models.

Established standards for nursing care congruent with the Board’s legal standards for nursing care.

Written job competencies for all categories of nursing personnel and criteria for making patient assignments.

Appropriate references and current practice/procedure manuals available to students.

A means of communication between faculty and facility/agency administrative personnel and between faculties of all nursing education programs that use the agency.

Evidence that the agency’s personnel understand their relationship to faculty and students and that the responsibility for coordination is specifically identified.

Designated conference areas on, or in close proximity to clinical learning sites.

(d) Clinical experiences based on program objectives shall be planned so that the student is able to gain clinical experience within the operational hours of the healthcare facility/agency or community based site.

(e) When clinical experiences are supplemented by observational experiences, those hours of observational experience shall constitute 20% or less of total clinical hours for that specific clinical course into which the observational experience has been incorporated.

(f) Faculty shall be responsible for supervising students on no more than two units of a healthcare facility during one clinical instruction period.

(g) Faculty‑student ratio shall be at a maximum ratio of 1:12 in healthcare facilities/agencies.

(h) Faculty shall be physically present within the healthcare facility/agency while students are providing direct care to patients/ clients.

(10) Community-Based, Learning Experiences.

(a) The community-based learning experience shall be developed with clearly defined outcomes specific to concurrently taught theory.

(b) Community-based learning experiences may not comprise the majority of clinical experience hours of the total curriculum.

(c) Faculty-student ratio shall be at a maximum ratio of 1:12 in community‑based learning experience setting.

(d) Faculty shall be accessible by two‑way communication, able to respond to an inquiry when made, and readily available for consultation to students in a community-based setting.

(e) Faculty will retain the responsibility for the selection and guidance of the student community‑based learning experiences and for the evaluation of the student performance.

(f) The community-based learning experience is only appropriate for the Professional Nursing program preceptorships.

(11) Preceptorship Experiences.

(a) The student shall be enrolled in the course of the program in which the preceptor experience is a part and shall not be reimbursed for nursing services from the agency in which the experience occurs.

(b) Each designated preceptor may have one alternate preceptor who meets the requirements of paragraph 64B9‑2.015(4)(e), F.A.C. When the designated preceptor is unable to supervise the student due to unforeseen circumstances, this alternate preceptor will supervise the student.

Practical Nursing Preceptorships.

A Practical Nursing preceptorship can occur in any course of the nursing curriculum, which includes concurrent theory.

Faculty shall supervise up to twelve students in any one facility and be readily available on site during the student preceptorship.

The preceptor shall be assigned no more than two (2) students for any preceptor experience.

Professional Nursing Preceptorships.

The supervising faculty member must be available to the student and the preceptor by telephone or beeper.

With faculty approval, the preceptor or the designed alternate may have students accompany them to multiple practice sites for student clinical experience.

The preceptor may have a maximum of two (2) students assigned for preceptorship.

The Professional Nursing preceptorship can occur in any course of the nursing curriculum, which includes concurrent theory, and is beyond the fundamental, introductory nursing clinical course and has a maximum ratio of instructor to students of 1:12.

The Professional Nursing preceptorship may also occur as a culminating experience at the end of the program when the student has completed all nursing theory and clinical experiences in the program and has a maximum ratio of instructor to students of 1:18.

(12) Program Evaluation.

(a) The minimal acceptable level of performance as required by the Board on the National Council of State Boards of Nursing licensing examination for graduates of a nursing education program during the fiscal year of the Department shall be 10% below the national or state average, whichever is lowest, as published by the contract testing service of the National Council of State Boards of Nursing.

(b) The nursing program shall have a written plan for the systematic evaluation of the total program and its outcomes for the purpose of determining competency, adequacy and effectiveness. The plan shall include the methodology, frequency of evaluation, assignment of responsibility, and evaluative criteria. The following areas shall be evaluated:

Organization and administration of the program;

Philosophy, conceptual framework, and objectives/outcomes;

Curriculum;

Educational facilities, resources, and services;

Clinical resources;

Students theoretical and clinical performance;

Graduates’ performance on the licensing examination;

Graduates’ nursing competence;

Performance of the faculty;

Protection of patient safety;

The methods and instruments used for evaluation purposes.

(c) There shall be evidence that the evaluation plan is being implemented and that faculty review evaluative data and take corrective action as needed.

Specific Authority 464.006, 464.019(2) FS. Law Implemented 464.019 FS. History–New 1-28-02, Amended 10-19-06.

Notice of Proposed Rule

 

DEPARTMENT OF HEALTH

Board of Nursing

RULE NO.:           RULE TITLE:

64B9-2.022
          Clinical Training

PURPOSE AND EFFECT:
The rule is being created to establish the uses and limitations of simulation technology in nursing programs.

SUMMARY: Establish the uses and limitations of simulation technology.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

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The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: During discussion of the economic impact of this rule at its Board meeting, the Board, based upon the expertise and experience of its members and the substance of the rule, determined that a Statement of Estimated Regulatory Costs (SERC) was not necessary because the rule does not impose additional rights, obligations, or duties on any persons or businesses, and that the rule will not require ratification by the Legislature. No person or interested party submitted additional information regarding the economic impact at that time.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY:
464.006, 464.019 FS
.

LAW IMPLEMENTED:
464.019 FS
.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Joe R. Baker, Jr., Executive Director, Board of Nursing, 4052 Bald Cypress Way, Bin #C02, Tallahassee, Florida 32399; Joe.Baker@flhealth.gov.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64B9-2.022 Clinical Training.

(l) Clinical learning experiences shall be an integral part of the total curriculum plan and show relationship to concurrent theory.

(2) Clinical training must be in the United States, the District of Columbia, or a possession or territory of the United States.

(3) Clinical training must include experience in:

(a) Acute Care:  where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery.

(b) Long Term Care: a continuum of medical and social services designed to support the needs of people living with chronic health problems that affect their ability to perform everyday activities.

(c) Community-based Care:  Where health care is provided to the community as a whole, providing nursing care to individuals, families, and groups, to promote wellness, maintain health and prevent illness.

(4) Supervision:

(a) A clinical instructor is a faculty or staff member responsible for an assigned cohort of students in a clinical environment.   

(b) A clinical preceptor is a registered nurse supervising a student in the clinical setting.   The preceptor provides oversight of the student’s patients and gives feedback to the student and the clinical instructor.  The clinical preceptor may be a licensed practical nurse if supervising students for a practical nursing education program.

(c) The clinical instructor must directly supervise no more than 12 students, unless, by written agreement the clinical training site allows more, not to exceed 18 students.

(d) Direct supervision means the clinical supervisor is within the health care facility while the students are providing care to the patients.

(e) Indirect supervision is allowed in a hospital setting if:

There is no more than 18 students.

There is direct supervision by an assigned clinical preceptor.

The clinical instructor is available by telephone.

The arrangement is approved in writing by the clinical training site.

(f) Indirect supervision is allowed for community-based clinic experiences when the clinical instructor is available by telephone, unless the clinical experience is an invasive or complex nursing activity.  Supervision for invasive or complex nursing activities must be approved by the community-based clinical site.

(5) Up to 50% of each clinical training category: acute care, long-term care, and community-based care may be simulated when accompanied by traditional clinical experience. 

(a) Traditional clinical experience consists of activities that include observation, hands-on experience with patients, and interaction with an interdisciplinary team.

(b) Simulation consists of activities or events replicating clinical practice using scenarios, high-fidelity manikins, medium-fidelity manikins, standardized patients, role playing, skills stations, and computer-based critical thinking situations. 

High-fidelity simulation is experience using full scale computerized patient simulators, virtual reality or standardized patients that are extremely realistic and provide a high level of interactivity and realism for the learner.

Medium-fidelity simulation is experience using two-dimensional focused experiences to problem solve, perform a skill and make decisions, or the use of mannequins more realistic than static low fidelity ones having breath sounds, heart sounds, and/or pulses.

(c) Debriefing is a part of the simulation that follows the experience.  Participants’ reflective thinking is encouraged, and feedback is provided regarding the participant’s performance in the simulation experience.   The purpose of debriefing is to move toward assimilation and accommodation in order to transfer learning to future situations.

Specific Authority 464.006, 464.019 FS Law Implemented 464.019 FS History—New__________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Board of Nursing

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Nursing

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 8, 2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: December 26, 2017

64B9-2.022 Clinical Training.

(l) Clinical learning experiences shall be an integral part of the total curriculum plan and show relationship to concurrent theory.

(2) Clinical training must be in the United States, the District of Columbia, or a possession or territory of the United States.

(3) Clinical training must include experience in:

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(a) Acute Care: Care for patients who are acutely ill with a wide variety of medical issues or are recovering from surgery. Care may be provided in hospital units, subacute care facilities, home care agencies, ambulatory care clinics, outpatient services, residential facilities, skilled nursing facilities, private practice, adult day care agencies, primary care and specialty practices, schools, insurance companies and private companies.

(b) Long Term Care: A continuum of medical and social services designed to support the needs of people living with chronic health problems that affect their ability to perform everyday activities.

(c) Community-based Care: Where health care is provided to the community as a whole, providing nursing care to individuals, families, and groups, to promote wellness, maintain health and prevent illness.

(4) Supervision:

(a) A clinical instructor is a faculty or staff member responsible for an assigned cohort of students in a clinical environment.

(b) A clinical preceptor is a registered nurse supervising a student in the clinical setting. The preceptor provides oversight of the student’s patients and gives feedback to the student and the clinical instructor. The clinical preceptor may be a licensed practical nurse if supervising students for a practical nursing education program.

(c) The clinical instructor must directly supervise no more than 12 students, unless, by written agreement the clinical training site allows more, not to exceed 18 students.

(d) Direct supervision means the clinical supervisor is within the health care facility while the students are providing care to the patients.

(e) Indirect supervision is allowed in a hospital setting if:

There is no more than 18 students.

There is direct supervision by an assigned clinical preceptor.

The clinical instructor is available by telephone.

The arrangement is approved in writing by the clinical training site.

(f) Indirect supervision is allowed for community-based clinic experiences when the clinical instructor is available by telephone, unless the clinical experience is an invasive or complex nursing activity. Supervision for invasive or complex nursing activities must be approved by the community-based clinical site.

(5) Up to 50% of each clinical training category: acute care, long-term care, and community-based care may be simulated when accompanied by traditional clinical experience.

(a) Traditional clinical experience consists of activities that include observation, hands-on experience with patients, and interaction with an interdisciplinary team.

(b) Simulation consists of activities or events replicating clinical practice using scenarios, high-fidelity manikins, medium-fidelity manikins, standardized patients, role playing, skills stations, and computer-based critical thinking situations.

High-fidelity simulation is experience using full scale computerized patient simulators, virtual reality or standardized patients that are extremely realistic and provide a high level of interactivity and realism for the learner.

Medium-fidelity simulation is experience using two-dimensional focused experiences to problem solve, perform a skill and make decisions, or the use of mannequins more realistic than static low fidelity ones having breath sounds, heart sounds, and/or pulses.

(c) Debriefing is a part of the simulation that follows the experience. Participants’ reflective thinking is encouraged, and feedback is provided regarding the participant’s performance in the simulation experience. The purpose of debriefing is to move toward assimilation and accommodation in order to transfer learning to future situations.

Rulemaking Authority 464.006, 464.019 FS. Law Implemented 464.019 FS. History–New 3-20-18, Amended 4-14-19.

Discussion 3

 

Review the
rules and regulations of the Florida Board of Nursing related to clinical training (Links to an external site.)
. Assess the academic organization where you are performing your practicum experience in relation to how they fulfill these requirements.

Review the
Family Education Rights and Privacy Act (FERPA) of 2002 legislation (Links to an external site.)
as it relates to students’ rights. What rights are afforded to students based on this legislation? What does this mean for faculty and Schools of Nursing?

What are your thoughts about carrying professional liability insurance as a nursing faculty member?

Bioethical standards that relate to nursing practice include autonomy, beneficence, non-maleficence, justice (fairness), veracity, fidelity, confidentiality, and respect for human dignity. Nurse educators must also consider these standards as they relate to the conduct of educational experiences for students. Consider each one of these standards and discuss how it might relate to a teacher/student clinical learning experience, student/patient experience, student/student interaction. How do the above standards relate to academic dishonesty, especially in clinical experiences?

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https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html -àFamily Educational Rights and Privacy Act (FERPA).

Advanced practice nurses often treat patients with vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT). While the symptoms of both disorders are noticeable, these symptoms are sometimes mistaken for signs of other conditions, making the disorders difficult to diagnose. Nurses must examine all symptoms and rule out other potential disorders before diagnosing and prescribing treatment for patients. In this Assignment, you explore the epidemiology, pathophysiology, and clinical presentation of CVI and DVT.

To Prepare

Review the section “Diseases of the Veins” (pp. 598-599) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders.

Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis.

To Complete

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Write a 2- to 3-page paper that addresses the following:

Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.

Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.

Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper

Discussion is for business law 1

Designer Baby (Scalisi vs. NY Univ. Medical Center, p. 429)

Why was the basis of the parent’s argument that they were not bound by the written contract in the Scalisi et al. v. New York University Medical Center case? How did the court rule and what was the reasoning for that decision. Do you agree or disagree. Why or why not? Have you ever entered into an oral contract? Discuss.

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Rubic

For your initial post (1), you must do the following:

 Compose a post of one to two paragraphs.

 In Module One, complete the initial post by Thursday at 11:59 p.m.

Eastern Time.

 In Modules Two through Eight, complete the initial post by Thursday at

11:59 p.m. of your local time zone.

 Take into consideration material such as course content and other

discussion boards from the current module and previous modules, when

appropriate (make sure you are using proper citation methods for your

discipline when referencing scholarly or popular resources).

NUR 643 Topic 2: Problem Focus Exams: Head, Eyes, Ears, Nose, and Throat (HEENT)

Topic 2: Problem Focus Exams: Head, Eyes, Ears, Nose, and Throat (HEENT)

Read the “Procedures for Advanced Health Assessment Check-Offs” and submit your response below in this forum within the allotted timeframe for completion: Procedures for Advanced Health Assessment Check-Offs Acknowledgement I, (INSERT NAME), verify that I have read, understand, and will comply with the requirements set forth in the “Procedures for Advanced Health Assessment Check-Offs” document.

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Objectives:

Review the appropriate anatomy and physiology related to the HEENT systems: head, eyes, nose, ears, and throat.

Explore basic physical examination techniques for conducting a HEENT examination for the applicable regions.

Compile focused subjective and objective health history for the specified HEENT regions while communicating effectively with the patient.

Prepare a competent SBAR (situation, background, assessment, and recommendations) documentation note.

SBAR Template

Choose an experience from your nursing practice. Using the “SBAR” template, explain the situation in detail, followed with background information. Then explain your immediate assessment and recommendations you have for the provider.

Include the following in the “SBAR” template:

Be sure to include three or four evidence‐based references, not older than 5 years.

When giving your recommendation discuss how you would educate the client using evidence‐based research and guidelines. How would you deliver your recommendation in various learning environments?

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Health Assessment Topic Reflection 2

Complete a 250‐word reflection of what you have learned during this topic. Include the following in your reflection:

Think about an experience you’ve encountered when viewing or completing the particular assessment.

Discuss difficulties that could potentially arise or specific questions related to completing this type of assessment.

Include illustrative examples of potential strategies used to overcome the difficulties encountered when completing (the particular) assessment.
            

Describe how the Christian worldview and compassion for all plays a role in this type of assessment.

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Course Code Class Code Assignment Title Total Points

NUR-643E NUR-643E-O500 Health Assessment Topic Reflection 2 10.0

Criteria Percentage 1: Unsatisfactory (0.00%) 2: Less Than Satisfactory (80.00%) 3: Satisfactory (88.00%) 4: Good (92.00%) 5: Excellent (100.00%) Comments Points Earned

Content 85.0%

Topic 2 DQ 1

As an instructor, you are working with a nursing student in the second year of a 4-year nursing program. The student does not perform an ear exam correctly. How would you explain the appropriate technique to examine the ears?

Topic 2 DQ 2

You are working the triage desk of the ED. A client presents with sudden loss of vision of the right eye after a head collision during a volleyball game. What would your assessment include? What could be initial problems and would they warrant emergent intervention?