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University of Pennsylvania
School of Nursing
Course Syllabus
Summer 2014

TITLE:  N 793 Clinical Fieldwork in Nurse Anesthesia Practice III
			
COURSE UNITS: 2 cu			

CATALOG DESCRIPTION:
This course provides the opportunity for students to integrate theoretical knowledge and research finding into practice within the clinical setting.  Student’s progress by providing anesthesia care for patients with more complex health problems.  Techniques for managing pain of clients are emphasized.  Anesthetic requirements as dictated by patient assessment including the surgical procedure are studied in greater depth.  The student now possesses the ability to combine theories and skills in selected clinical situations.  The guidance of CRNA faculty preceptors contributes to the development of the student’s critical thinking.  
 
PLACEMENT:  Summer/Year II

FACULTY:   Dawn Bent, DNP, CRNA

PRE-REQUISITES:	N 681, N 682, N 683,  N 580, N 581, N 617, N 6198,  N 791, N 792-Clinical Fieldwork in Nurse Anesthesia Practice II

CO-REQUISITES:	 None

COURSE OVERVIEW:
This course is designed to provide experience in caring for patients with complex, multisystem problems. Anesthesia experience for selected surgical specialties, introduce the student to the particular requirements for these specialties.  Strategies for managing the acute pain of patient are emphasized. The student grows in the ability to individualize a plan of care specific to the patients’ needs and surgical requirements.  Seminars further discuss role development of the beginning nurse anesthetist as well as the role of the nurse anesthetist in the interdisciplinary health care team.

COURSE OBJECTIVES:
1.	Demonstrate advanced clinical decision-making and develop clinical competency as a beginning nurse anesthetist.
1.	Develop and implement plans of care in collaboration with nurse anesthetists, anesthesiologists, nurses, physicians and other members of the interdisciplinary health care team.
1.	Analyze and implement ethical and cultural sensitive care of the patient undergoing anesthesia.
1.	Demonstrate advanced verbal and written communication skills.
1.	Integrate a systems approach to the assessment and plan of care development for the patient undergoing anesthesia services.
1.	Analyze the importance of quality improvement and utilize evidence-based guidelines in the management of the patient undergoing anesthesia services.
1.	Describe and discuss models of care available to the nurse anesthetist.
1.	Increase proficiency in clinical database management in the delivery of patient care.
1.	Develop and demonstrate critical thinking skills with the use of simulation.
1.	Demonstrate with the use of simulation advanced cardiac life support (including the pediatric patient) in a crisis situation.
1.	Demonstrate appropriate intubation skills (inclusive of alternate airway devices) with the use of sim man.   
1.	Discuss neurophysiology as it related to pain pathways and discuss unique models of care for  the patient presenting with a pain syndrome.
1.	Identify correct procedure in assembling hemodynamic equipment and maintaining sterility.
1.	Demonstrate proper technique for the insertion of central lines and swan ganz catheter.
1.	Review and update your knowledge about the cardiac cycle as it relates to basic pulmonary artery pressure measurements.

TEACHING METHODS:
Supervised clinical practice, faculty conducted clinical rounds, clinical conferences, lecture, and seminar discussion, discussion board and case presentations.

EVALUATION METHODS:
EVALUATION METHODS:
The clinical fieldwork of this course is dependent upon successful completion of the clinical objectives at a competent level that is necessary to pass the course.  Students who do not successfully complete the clinical fieldwork component of this course will fail the entire course and may not progress in the program.

Clinical Progression 
	Verbal warning for clinical probation-Final grade decreases to B
	Written warning for clinical probation-Final grade decreases to B-
	Clinical Probation for 30d-Final grade decreases to C+
IE: Final Grade for 100% (as listed below)of your grade = A, your final grade will decrease to B if you have been given a verbal warning for clinical probation, a B- if you were given a written warning for clinical probation, and a C+ if you were placed on clinical probation.
Note: Verbal warning, written warning for clinical probation and clinical probation are described in the MSN Nurse Anesthesia Handbook Addendum
Failure to successfully come off probation or recurrence of probation may result in failure of the course and necessitates review from the Progressions Committee.

Discussion Board-55%
Manuscript-25%
Comprehensive Exam-20%

DRUG FREE WORKPLACE:

The abuse of alcohol and other substances among healthcare workers is an unfortunate, but real health problem. Professional nurses who abuse alcohol and/or other drugs endanger their own well-being as well as the health and safety of the consumer. 
The ANA Code for Nurses requires the professional nurse to safeguard the client from harm; to assume responsibility and accountability for all of her/his actions; to maintain competency and to participate in the profession’s efforts to establish and maintain conditions of employment conducive to the delivery of high quality nursing care. You are held to the standards of this Code for Nurses as a student nurse anesthetist.

Your clinical affiliate site(s) abide by the Drug Free Awareness Act of 1988 that mandates them to have a “drug free workplace”. They are committed to maintaining a safe workplace free from influence of drugs or any other controlled substances. 
Therefore, your clinical sites endorse a drug-free work place. Please be advised that drug testing for reasonable suspicion may require that a nurse anesthesia student (NAS) to undergo an immediate hair, blood and/or urine drug screen and possibly a physical body examination under any of the following circumstances (but not limited to):

1.  When there is reasonable suspicion that the NAS is under the influence of intoxicants, non-prescribed narcotics, hallucinogens, marijuana or other non-prescribed controlled substances.

2.  After the occurrence of a work-related injury, illness, or accident while on school/hospital property.

3.  Observation of poor judgment or careless acts, which caused or had the potential to cause a threat to patient safety, jeopardized the safety of others, or resulted in damage to equipment.

4:  If investigation of missing controlled substances points to the particular student as having a high likelihood of being involved.

5. NAS’s must report all psychoactive drugs that they are taking by prescription and an evaluation by their prescribing health care provider documenting their assessment that these medications will not impair the psychomotor performance required for safe anesthesia delivery. NAS's who are taking over-the-counter or prescribed medication are responsible for being aware of the effect the medication may have on their academic performance or personal behavior and should report to their program faculty the use of any medication that may impair their performance.

Student Accountabilities and School of Nursing Potential Actions:
1.	NAS's who refuse to undergo an immediate drug and alcohol screen will be subject to immediate disciplinary actions, up to and including dismissal from the program.
2.	 NAS's are held accountable for controlled substances per department policy for controlled substances at all clinical sites.  Failure to comply may result in a failure in the coursework and/or dismissal from the program.

DUE DATES FOR EVALUATIONS/CAREPLANS/TYPHON SUMMARY:

June 3, 2014
July 1, 2014
August 5, 2014
September 9, 2014

***An evaluation form for EVERY day in clinical is REQUIRED.

When you submit your monthly packet, you must also submit a copy of the 3 month schedule that reflects the days you were in clinical. If an evaluation is missing from a CRNA/MDA preceptor, please submit who you were with on that day and the reason for not having the evaluation.

The evaluation process provides critical feedback. It is a meaningful process that leads to growth and development of the integration of your didactic knowledge into the clinical area. 

In accordance to the existing policies and procedures of the Council on Accreditation, the evaluation process as defined by the academic institution must be adhered to by all parties involved. Therefore, it is critical that the program faculty be made aware if the clinical affiliate site is not returning the evaluation tool to the SRNA in a timely manner and/or if the SRNA is not turning in the evaluation tool into the University of Pennsylvania.

REGISTRATION FOR NEXT SEMESTER:

You must register for your summer semester nurse anesthesia classes by last day of the spring semester. Reason being, you are not covered under UPENN’s malpractice insurance for clinical unless you are registered for N 794.

Failure to register on time will result in removal from clinical. The day(s) missed as a result of late registration will be made up on the student(s) personal time and/or in the form of an independent student in summer of 2014.

N 793 COURSE REQUIREMENTS:

Immunizations/PPD/RN Licenses/ACLS/BLS/PALS Certification:

Students who are noncompliant with renewal will:

Have their N 793 final grade dropped by one letter grade.
Be removed from clinical on the date of expiration.
The student will not be permitted to return to clinical assignments until proof of renewal or record of immunization is submitted.
The clinical time missed will be required to be made up during the semester missed. 
In the event the student does not make up the missed time, the student will be given an incomplete in the N 793 course and required to take an independent study.

You are required to adhere to the policies and procedures of your clinical affiliate site. Failure to do may result in a failure in this course and/or dismissal from the program.

ROTATION EXPECTATIONS:

Students who are rotating to clinical affiliate site outside of their primary clinical site:

Must schedule a pre and post rotation meeting with the Program Director and/or Associate Program Director. 

This meeting must take place a no later than 2 weeks prior to rotating out and no later than 2 weeks post rotation. 

A post rotation evaluation form must be submitted on TYPHON post rotation.

MANUSCRIPT GUIDELINES:

Grading of the Manuscript

Components to be included in this paper are listed in the “Guide for Authors” link on Black Board under “Course Documents/Class 1”.  

Grades will be weighted according to the following criteria:

I.	I.	Introductory Paragraph/Case Report                                       30%
Introduction word count-less than 100. This should be brief and focus the reader’s attention to the reason for writing the paper. It is written in present tense.
The student is able to discuss the case performed in past tense. Report the case as it unfolded-do not gives reasons for your actions or behaviors.

II.	Discussion					                                   30%
The student is able to describe the anesthesia implications of the problem citing current literature. Describe the rationale for your actions and risk/benefits of any options you had.  This section is not merely a pathophysiology review that can be found in textbooks. You must relate your case to noting how and why your case was the same or different.  This position should be supported with current literature.

III.	Structural Format							               30%
The student develops a manuscript described in American Medical Association Manual of Style (AMA).
Title: Make the title brief and specific to the subject. No more than 56 letters or spaces.
Author: First name, middle initial, last name, current academic degree(s), anticipated date of graduation and e-mail address.
Keep word count between 1200-1400. The reference page does not count against word count.
Type:  Use Microsoft word, 12 font, single-spaced, one-inch margin. Place one space after the last punctuation of sentences. Do not indent; separate paragraphs with double space. End the sentence with a period before placing the superscript number for the reference.
Keywords:  Provide 5 keywords that can be used to identify this article on a web based search

IV. 	Checklist								               10%

EXTENSION POLICY:
Students may be granted only one 7 day extension for the manuscript.  Prior approval by course director must be obtained for an extension 72 hours prior to the due date.  Students requesting an extension will have their grade for the late paper reduced by 10pts.  Papers without extensions will not be accepted after the due date and a zero will be assigned to that percentage of the grade.   Papers with an extension will not be accepted after the 7 day extension period has expired and a zero will be assigned to that percentage of the grade. 

DISCUSSION BOARD GUIDELINES: 

The discussion board is a forum to share clinical pearls, exemplars and explore pharmacologic, physiologic, pathophysiologic concepts that underpin an evidence based practice of anesthesiology. This site to exchange information relative to your clinical experiences related to the subject matter, discuss concepts that are puzzling and/or remarkable.
 You may also post articles of related interest from peer reviewed journals here to share with your colleagues.  5 Page typed evidenced-based paper is due as specified on syllabus. APA format. References are required. The student must log on to discussion board and engage in scholarly dialogue weekly as discussed.
Late or failure to post comments and/or hand in related paper (without prior approval) will result in 10 point reduction of final grade for N 793 per offense. 

Topics/related required readings are posted under "Course Documents" on Blackboard.

GRADING POLICY: 
A+ 97-100   	A  93-96    A- 90-92
B+ 87-89 	B 83-86      B- 80-82
C+ 77-79     C 73-76      C- 70-72
Below 70 = F
Grades will be rounded as follows:
	0.1-0.4 will be rounded down to the next whole number and 0.5-0.9 will be rounded up to the next whole number.
Should a student be found responsible for cheating in this course, their grade for the course will be a failure.
The University Code of Academic integrity will be followed in this course.  It is available on Blackboard and the student handbook.

Code of Academic Integrity
Since the University is an academic community, its fundamental purpose is the pursuit of knowledge. Essential to the success of this educational mission is a commitment to the principles of academic integrity. Every member of the University community is responsible for upholding the highest standards of honesty at all times. Students, as members of the community, are also responsible for adhering to the principles and spirit of the following Code of Academic Integrity. 
Academic Dishonesty Definitions
Activities that have the effect or intention of interfering with education, pursuit of knowledge, or fair evaluation of a student’s performance are prohibited. Examples of such activities include but are not limited to the following definitions: 
A. Cheating: using or attempting to use unauthorized assistance, material, or study aids in examinations or other academic work or preventing, or attempting to prevent, another from using authorized assistance, material, or study aids. Example: using a cheat sheet in a quiz or exam, altering a graded exam and resubmitting it for a better grade, etc. 
B. Plagiarism: using the ideas, data, or language of another without specific or proper acknowledgment. Example: copying another person’s paper, article, or computer work and submitting it for an assignment, cloning someone else’s ideas without attribution, failing to use quotation marks where appropriate, etc. 
C. Fabrication: submitting contrived or altered information in any academic exercise. Example: making up data for an experiment, fudging data, citing nonexistent articles, contriving sources, etc. 
D. Multiple submission: submitting, without prior permission, any work submitted to fulfill another academic requirement. 
E. Misrepresentation of academic records: misrepresenting or tampering with or attempting to tamper with any portion of a student’s transcripts or academic record, either before or after coming to the University of Pennsylvania. Example: forging a change of grade slip, tampering with computer records, falsifying academic information on one’s resume, etc. 
F. Facilitating academic dishonesty: knowingly helping or attempting to help another violate any provision of the Code. Example: working together on a take-home exam, etc. 
G. Unfair advantage: attempting to gain unauthorized advantage over fellow students in an academic exercise. Example: gaining or providing unauthorized access to examination materials, obstructing or interfering with another student’s efforts in an academic exercise, lying about a need for an extension for an exam or paper, continuing to write even when time is up during an exam, destroying or keeping library materials for one’s own use., etc. 
* If a student is unsure whether his action(s) constitute a violation of the Code of Academic Integrity, then it is that student’s responsibility to consult with the instructor to clarify any ambiguities. 
(Source: Office of Provost, 1996)

REQUIRED TEXTS:

Barash, P.G., Cullen, B.F. & Stoelting, R.K. Eds. (2000). Clinical Anesthesia 4^th Edition. Phila., PA:  Lippincott, Williams & Wilkins

Stoelting, R. & Miller, R. (2000). Basics of Anesthesia 4^th Ed. New York: Churchill Livingstone

RECOMMENDED TEXTS:

WEEKLY TOPICAL OUTLINE:
DATE | TOPIC | OBJECTIVE | Discussion Board
Week 1 | | |

5-20-14

Introduction to Course
Discussion Board
Spring Semester Evaluations

Week 2
5-27-14

Discussion Board

1-9,15

Topic: OLV and Thoracic Surgery
MODULE 1

Week 3
6-03-14

Discussion Board

1-9,12

Topic: Operating Room Fires
MODULE 2
“Fires in the Operating Room and ICU: Awareness is Key To Prevention”

Week 4
6-10-14

Discussion Board

1-12

Topic: Visual Loss
MODULE 3
“Practice Advisory for Visual Loss With Spine Surgery”

Week 5
6-17-14

Work on Manuscripts

1-12

N/A

Week 6
6-24-14

Discussion Board

Manuscript DRAFT due and Discussion Board

1-9,12

Topic: Medication Safety
MODULE 4

Week 7
7-01-14

Discussion Board

1-12

Topic: Cardiac Stents in the Perioperative Period
MODULE 5

Week 8
7-08-14

Discussion Board

1-9

Topic: Minimally Invasive Surgery
MODULE 6

Week 9
7-15-14

Discussion Board

1-9

Topic: Student lead discussion

Week 10
Marjorie Cessaire
7-22-14
9-12pm

In class lecture

1-9, 13-15

Pain Management in Trauma Patients

Week 11
7-29-14
Dawn Bent

Comprehensive Exam
Final Manuscript DUE

1-9

N/A

Week 12
8-05-14
Dawn Bent

TOTAL NUMBER OF THEORY HOURS:	 45
TOTAL NUMBER OF CLINICAL HOURS:     420