TEACHING PLAN
LEARNER READINESS: This is an assessment of the patients learning needs. Include a description of the patient, his or her clinical situation, personal history or any significant data related to lifestyle that may impact learning, such as cultural and social issues. Include the patient’s knowledge, skills and attitudes about his or her situation, any previous experience related to health problems, areas of strength that are related to his or her learning, the impact of family or other supportive persons, and the patient’s motivation for learning about his or her situation.
GOAL: Goals are statements that describe, in broad terms, what is to be accomplished by the learner. Educational goal statements are written to communicate the expected or intended achievements of the teaching plan.
OBJECTIVES: Objectives are not written as a restatement of the goal. Instead, objectives are precise statements that specify the behavior changes needed to achieve the goal. Each learning objective must state the skill or activity the patient must do in order to objectively measure what he or she has learned. (Review Potter and Perry p. 323, Guidelines for writing goals and expected outcomes). Use action verbs to write educational objectives. Examples are: choose, define, describe, differentiate, identify, list, demonstrate, explain, discuss (See Bloom’s taxonomy handout for a complete list). Remember to include a time frame for each objective.
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Note: Use the number of objectives necessary to meet your stated goal.
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Must use a minimum of 3 objectives.
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CONTENT/INFORMATION
1. For each of the objectives listed above, the teaching information or content is included in this section as presented to the patient. This section should be concise and worded at the learner’s level. If you are using demonstration or handouts, include a copy of the handout(s) also.
Evidence-Based Rationale:
This is the statements of supportive scientific evidence at the foundational level to support the basis for the content information taught to the learner. (cite reference in APA format)
2. Again, this content should be specifically related to objective #2 as stated above and worded at the learner’s level.
Evidence-Based Rationale:
This is the rationale for content #2.
(cite reference)
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TEACHING STRATEGIES/MATERIALS USED
State the teaching strategies and materials used. (Writing the content and teaching actions in side-by-side columns enables the teacher to compare content with teaching methods and reflect on whether the objectives can be met by the methods indicated). Examples of teaching methods may be demonstration, discussion, as well as teaching tools used to supplement instruction. See Lewis, Heitkemper, Dirksen, O’Brien, & Bucher, 2007, pp. 60-63.
Evidence-Based Rationale:
This should be statements of supporting data for why you the above listed strategies and materials were the most effective way to present the teaching plan. (cite reference)
Pt. Specific Rationale:
These are statements why chosen strategy is appropriate for this specific patient in this particular setting.
Include teaching strategies and materials used for content #2.
Evidence-Based Rationale:
Include the rationale for your selection of teaching methods and materials used above. (cite reference)
Pt. Specific Rationale:
Include why appropriate for this specific patient.
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CONTENT/INFORMATION
3. Again, this content should be specifically related to objective #3 as stated above and worded at the learner’s level.
Evidence-Based Rationale:
This is the rationale for content #3.
(cite reference)
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TEACHING STRATEGIES/MATERIALS USED
Include teaching strategies and materials used for content #3.
Evidence-Based Rationale:
Include the rationale for your selection of teaching methods and materials used above. (cite reference)
Pt. Specific Rationale:
Include why appropriate for this specific patient.
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EVALUATION: Evaluation assesses what the patient learned and indicated areas that need additional or repeat teaching. If your objectives were measurable to begin with, evaluation is possible. Learning is evaluated in terms of changed behaviors. Use the same terminology that was used in goal/objectives when stating whether or not goal was met. There are a number of reasons why learning may not have occurred. Some common reasons are that the patient was not ready to learn or had other problems like pain, stress, coping issues or fatigue. The patient may have had inaccurate background knowledge or experience. Your assessment of their learning needs may have been inaccurate. Your objectives may have been ambiguous or incomplete, or your teaching methods may not have been inappropriate for the content or objectives stated.
OBJECTIVE 1. State your evaluation of objective #1 using the same terminology used when stating the objective. Be specific and include data assessment to validate that objectives were met.
OBJECTIVE 2. State your evaluation of objective #2. Again, include specific data to validate objectives were met.
OBJECTIVE 3. State your evaluation of objective #3. Include specific data as noted above.
REVISION: In the future, how would you have changed this teaching plan for this patient to improve his or her learning?
Note: Remember to include an additional reference page that follows APA format for this teaching plan.
NURR 201
Patient/Client Teaching Plan
Special Instructions: Student must verify patient with clinical instructor for this assignment. .
Name: _________________________________________ Date: _________________
Objectives:
Upon completion of this assignment the student will be able to:
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Assess the individual learner’s educational needs.
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Apply the nursing process in the formulation of goals, objectives, evaluations and revisions to patient and family teaching.
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Utilize various teaching strategies in the clinical setting with an assigned patient.
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Support information with references
Criteria: Possible Earned
Points Points
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Learner Readiness 7
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Goal 2
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Objectives 6
(Minimum of 3 required)
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Content/Implementation 7
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Evidence-Based Rationale for content 9
(Cite reference)
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Teaching action 2
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Evidence-Based Rationale & Rationales 3
for teaching action (Cite reference)
8. Patient specific rationale __4___ ______
9. Evaluation 3
10. How would you revise for the next time? 2
11. References in APA 5th edition format, 5
and considering criteria as outlined in the
student handbook.
Total 50
NURR 201 Teaching Plan Grading Rubric
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Excellent
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Satisfactory
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Unsatisfactory
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Points Awarded:
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6-7
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3-5
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0 – 2
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Criteria #1:
Learner Readiness
(7 points)
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A complete description of the patient’s and/or family/significant other’s learner readiness is provided. Attention is paid to the physical, psychological, sociocultural, and educational aspects of the individual. At least six to eight different, specific aspects are considered and discussed. The patient’s preferred learning style is addressed, as well as his/her motivation to learn, and whether or not he/she has ever had experience with the information presented.
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A vague description of the patient’s and/or family/significant other’s learner readiness is provided. Limited attention is paid to the physical, psychological, sociocultural, and educational aspects of the individual. Only three to five different, specific aspects may have been considered and discussed. The patient’s preferred learning style may have been omitted. There was little attention given to the patient’s motivation to learn this material, or his/her previous exposure to the information.
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An incomplete description of the patient’s and/or family’s/significant other’s learner readiness is provided. Little attention is given to the physical, psychological, sociocultural, and educational aspects of the individual. Two or less different, specific aspects are considered.
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Points Awarded:
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2
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0
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Criteria #2:
Goal
(2 points possible)
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A goal is clearly stated. It is not a restatement of the objectives, but describes, in broad terms, what is the main identifiable focus of the teaching session. The goal is focused on the learner.
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The goal is incomprehensible or does not correlate with the objectives in any manner. It is either way too broad or too specific and is not focused on the learner. The goal is vague and shares remarkable similarities to the objectives. It is not quite broad enough or may not be learner specific.
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Points Awarded:
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5-6
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2-4
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0-1
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Criteria #3:
Objectives
(Minimum of 3 required)
(6 points possible)
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Three objectives are presented and each objective is learner-centered and describes in specific detail what is to be achieved by the learner. The objectives are realistically measurable; answering the questions: ‘who will do what, how well, under what circumstances, by when’. A timeframe states when the objective will be achieved.
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Three objectives are presented, however they are not learner-centered, or they fail to describe in specific detail what is to be achieved by the learner. Or the objectives are not entirely realistic and/or measurable. A timeframe may not be given.
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Less than three objectives are presented, or they fail to describe realistic, measurable, learner centered activities, with a timeframe.
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NURR 201 Teaching Plan
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Points Awarded:
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5-7
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3-4
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0 – 2
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Criteria #4:
Content/Implementation
(7 points possible)
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Content is clearly described and worded at the learner’s level. The content is clearly thought out and thorough in depth and breadth.
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Content is described, but is not worded at the learner’s level. The content is vague or the information is not thoroughly presented.
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Content is vague or even incorrect. Little effort seemed to have been made to word it at the learner’s level.
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Points Awarded:
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7-9
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3-6
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0 – 2
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Criteria #5:
Evidence-based rationale for content (cite reference appropriately)
( 9 points possible)
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Supportive scientific references are directly quoted to fully support the basis for the information provided to the patient. The information validates the content presented at the foundational level defining the purpose behind the content. Information is appropriately referenced.
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Supportive scientific references are quoted, but are generalized and do not fully support the basis for the information provided to the patient. The rationale may not be provided at the foundational level to support the purpose behind the content. Information may not be appropriately referenced.
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Supportive scientific references are vaguely provided. Little support is provided for the information offered to the patient. Information is not appropriately referenced or student does not give credit to the author(s) by using quotation marks when exact words are used from reference(s).
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Points Awarded:
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2
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1
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0
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Criteria #6:
Teaching Strategy or Action
(2 points possible)
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A text book teaching strategy is listed that correlates closely with the content provided. The teaching action is appropriately chosen and defined.
(Potential teaching actions: lecture, lecture-discussion, discussion, group teaching, demonstration/return demonstration, role play, audiovisual materials, printed materials, internet) Each content area must have a different rationale and/or a different reference supporting it.
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Teaching rationale may have been appropriately chosen and defined but each content area may have used the same rationale or the same reference.
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The teaching strategy chosen may not have been standard or did not fit with patient scenario and content in any way. No teaching action may have been provided. A teaching strategy may have been chosen however it vaguely correlated with the content provided. Another teaching action would have been more appropriate for the specific situation.
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Points Awarded:
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3
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2
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0 – 1
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Criteria #7:
Evidence-based rationales and rationales for teaching strategy or action (cite reference)
(3 points possible)
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Supportive scientific references are directly quoted to fully support the information provided to the patient. Information is appropriately referenced.
A reasonable rationale for why the designated teaching action was chosen for the SPECIFIC patient is provided.
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Supportive scientific references are quoted, but are generalized and do not fully support the information provided to the patient. A rationale for why the designated teaching action was chosen is provided, however it does not correlate with the SPECIFIC patient.
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Supportive scientific references are vaguely provided. Little support provided for the info offered to the patient. Information may not be appropriately referenced.
No rationale why the designated teaching action was chosen for this specific patient… or perhaps it does not reasonably correlate with the patient.
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Points Awarded:
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4
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2-3
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0 – 1
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Criteria #8
Patient specific rationale
(4 points possible)
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Rationale is provided clearly stating why the chosen teaching strategy or action was appropriate for presenting this material to this particular patient in this setting.
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Rationale provided may not have clearly stated the reason for choosing the teaching strategy. It may have lacked patient specificity.
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Patient specific rationale was missing or vague.
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Points Awarded:
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3
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2
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0 – 1
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Criteria #9:
Evaluation
(3 points possible)
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An evaluation of the teaching experience in totality is provided. Reflective analysis is displayed, spelling out how the patient responded to the teaching. Evaluation of each objective is provided, with description of whether or not the objective was met and to what degree.
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An evaluation of the teaching experience is provided but it does not display reflective thought and analysis.
An evaluation of each objective is provided but it may be vague or may not accurately describe what was achieved by the learner.
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The evaluation is not reflective and does not display thoughtful analysis. An evaluation of each objective is either not completed, or inaccurate. Reflective thought may not have been displayed.
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Points Awarded:
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2
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1
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0
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Criteria #10:
How would you revise for the next time?
(2 points possible)
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Reflective thought is provided to the revision of the teaching session. Influence of the learner’s readiness, realistic nature of the goals and objectives, and thoroughness and presentation of content is considered.
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Revision does not display appropriate reflective consideration for the teaching session. Reflective thought may not be fully displayed or little attention may be paid to learner readiness.
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No revision is provided, or no attention may be paid to the learner’s readiness, realistic nature of the goals and objectives, and thoroughness and presentation of content.
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Points Awarded:
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5
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2-4
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0 – 1
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Criteria #11:
References in APA 5th ed. format, and considering criteria as outlined in the student handbook.
(5 points possible)
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APA format is nearly perfect. No spelling or grammatical errors, etc. Paper is appropriate length with consideration given to number of references. All references listed on reference page were cited in the body of the paper. Pt confidentiality is maintained.
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Few APA format errors. Occasional spelling and/or grammatical errors, however they do not obscure the meaning. Paper is appropriate length and consideration is given to number of references. Pt confidentiality is maintained.
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Major APA formatting errors. Frequent spelling and/or grammatical errors that obscure the meaning of the paper. Paper is inappropriate length or no consideration given to number of references. Pt confidentiality may be broken.
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Reference Information
All written work (excluding case studies) must utilize APA format. Please refer to instructional presentation under “Assignment” button in Blackboard for a summary explaining how to formulate title page, reference citations, reference page, and other expectations.
PORTFOLIO
PURPOSE:
The portfolio:
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Is used to detail information about the students personal and professional progress related to academic and professional career development throughout the ADN program.
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Will also serve as a critical thinking outcome.
DEFINITION OF CRITICAL THINKING
A cognitive approach to inquiry that uses intellectual curiosity in a holistic manner for the purpose of making goal-directed decisions and solving problems with respect to the process of nursing. This holistic approach draws upon clarity, relevance, and logic as well as emotion, belief structure, and culture. The process can be carried out autonomously or cooperatively with a goal of reaching a conclusion which can be evaluated through validation.
In compiling the portfolio, student will include:
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All graded original work.
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Completed journal submissions, including instructor comments
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Updated professional development plan. Document on professional development plan all ISNA activities, which must include (minimally) membership, attendance at one meeting, participation in one activity and one fundraiser.
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Updated philosophy of nursing
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Updated record of assignments
PORTFOLIO WILL BE COLLECTED MINIMALLYAT THE BEGINNING OF EACH CLINICAL ROTATION BY THE CLINICAL INSTRUCTOR AND AT THE TIME OF EVALUATIONS
Professional Development Form Name: ___________________________________
College of Southern Idaho
Associate Degree Nursing Program
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This form is to be maintained throughout the course of your nursing education. Please update accordingly and bring to ALL clinical evaluations. It should be kept in your portfolio.
Identify activities contributing to professional development and the date they occurred:
Example of activities: healthcare related in-services, research of a special topic, services projects related to healthcare, ISNA meetings or activities, special presentations as part of post-conference or class, journal articles, recertification (CPR, etc.), college classes outside of program requirements, work in healthcare field, etc.
Activities Contributing to Professional Development
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Date Completed
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Record of Assignments:
Present this to your clinical instructor during clinical evaluation. This section is to be updated at the end of each rotation/semester by your clinical instructor.
Course
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Semester
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Teaching Plan Topic
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Care Plan Topic
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Instructor Initials/Date
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Personal Philosophy of Nursing:
This is a statement of the principles that guide your practice as a nurse. This philosophy should evolve over time as you gain more experience and insight into your PERSONAL nursing practice.
My personal philosophy of nursing at the beginning of my education:
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
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________________________________________________________________________________________________________________________________________________________________________________________________________________________
My personal philosophy of nursing at this point of nursing school:
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________
SECTION D
CLINICAL
GUIDELINES FOR CLINICAL ACTIVITIES
Invasive nursing procedures initially performed by students must be approved by the clinical instructors prior to performing them. The instructor will observe the student or delegate it to the primary RN. After a procedure has been observed to be successful, the student may be given permission to perform subsequent similar procedures with the primary RN*.
* A primary RN is an RN who has been previously approached and has agreed to assume responsibility for accurate performance by the student whom she/he is assisting or observing during a procedure.
List of Applicable Procedures
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Preparation of calculated dosages.
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All medication administration including:
Narcotic procurement, IV medications, adding meds into any IV solution, and blood products. Preparation of insulin injections, heparin, lovenox, IV or po digitalis, blood products, TPN, chemotherapy, adenosine, IV dihydroergotamine, IV hydralizine, IV labetolol, IVvasopressin, IV vitamin K, verapamil, interelin, IV methergine, phentolamine, IV narcotic infusions and PCA/Epidural pump medications. Students will follow the hospital policy regarding the administration of IV medications.
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Central line care and blood draws/ venipuncture.
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All dressing changes.
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Airway care (tracheostomy tubes, endotracheal tubes, changing of tracheotomy tubes, suctioning, etc.).
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Initial postoperative position changes of patients with total joint replacements.
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Management of patients with major vertebral trauma or surgery.
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Nasogastric intubations.
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Urethral catheter insertions.
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Initial post - TUR prostatectomy catheter irrigations.
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Initial postoperative and/or postnatal assessment in the recovery room and/or delivery room. Students will not administer medications in recovery rooms.
Student's entries on patient's medical records that document care, other than activities for which an instructor or primary RN must be present, need not be cosigned.
OBJECTIVES FOR CLINICAL SPINOUTS:
Objectives for NURR 201 Home Health Spinout
A. At the end of this experience, the student will be able to:
1. Describe the role of the home health/hospice nurse as related to:
a. Building trust and rapport with patient/client and recognizing their value system.
b. Elements of the initial visit.
c. Nursing process - assessment, diagnosis, planning, implementation, evaluation.
d. Prioritizing nursing care.
e. Setting limits with patients/clients.
2. Identify parameters of home visits with regard to Medicare, Medicaid and third-party documentation guidelines for reimbursement. Include quality control and specific documentation forms.
3. Describe patient/client care delivery system with emphasis on:
a. Caseload management
b. Patient/client education
c. Cultural diversity
d. Multi-disciplinary services
e. Family assessment
4. Determine modifications in infection control in a home environment.
5. Identify adaptations in procedures, equipment, or treatment regimes for delivery of nursing care in the home environment.
The student will:
1. Participate with Nurse Designate for two full clinical days in:
a. Delivery of home care
b. Team meetings
c. Documentation
2. Maintain online journaling.
ADDITIONAL EXPECTATIONS:
1. Each student must be able to arrange transportation to and from home health experience. CSI students are covered by the college insurance policy as long as the driver and automobile have private insurance coverage.
2. Attendance is necessary for both clinical spin-out days. Students are expected to contact their clinical instructor and agency if unable to attend. Make-up experience will be planned with CSI home health coordinator. Plan for your day to be 0800-1700. The exact seven hours of clinical time will be scheduled by the nurse.
3. Call your assigned Home Health Agency on the afternoon prior to your first scheduled spinout day to establish time and place for meeting with your assigned RN. This may also be an opportunity to learn about the patients you will be visiting. Call again during your spinout week if instructed to do so by your RN designate.
4. Wear professional street clothes (jewelry according to dress code). No Levis.
5. A stethoscope will be necessary for home health visits.
6. Procedures and assessments are to be performed under the direction of RN designate.
7. The student is expected to attend case conferences scheduled during the experience day.
8. Include home health experience in your journaling. This self-reflection may include your feelings, questions and observations about the home health nursing role. Reflect on relationships between client and caregiver.
Objectives for NURR 201 Pediatric Spinout
At the end of this experience, the student will be able to:
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Understand disease process affecting the pediatric patient.
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Identify adaptations in procedures, equipment, or treatment regimes for delivery of nursing care in the pediatric setting
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Complete an age appropriate assessment on a pediatric patient.
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Recognize variations from norms regarding assessment findings.
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Accurately document assessment findings.
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Interpret vital sign changes in pediatric patients and correlate to nursing priorities for care.
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Observe and/or demonstrate administration of medications and immunizations within the pediatric population.
Objectives for NURR 201 Hemodialysis Spinout
At the end of this experience, the student will be able to:
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Observe the pre-dialysis care performed. Assist with obtaining baseline vital signs and review pre-dialysis labs (BUN, serum creatinine, sodium, potassium, Hct.).
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Describe the fistula/graft (site and type) and how it was accessed for dialysis.
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Summarize the dialysis procedure; i.e., what is monitored, medications given, and
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possible complications.
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Identify patient teaching, (before, during, and after dialysis). Review patient teaching
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literature.
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Identify dietary modifications required for patients with recurring hemodialysis.
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Answer all the above objectives in your journaling.
Objectives for NURR 201 Respiratory Therapy Spinout:
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Describe the relationship between ventilation and perfusion.
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Identify the processes involved in gas exchange.
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Identify the different types of respiratory equipment used in oxygen administration
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Identify assessment findings commonly seen with individuals experiencing:
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Hyperventilation
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Hypoventilation
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Hypoxemia
Objectives for NURR 201 Cardiac Cath Lab Spinout:
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Identify the American Heart Association current treatment recommendations for patients experiencing Acute Coronary Syndrome.
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Describe the purpose for, the procedure and possible complications related to the following coronary interventions:
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percutaneous coronary intervention (PCI)
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stent placement
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atherectomy
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laser angioplasty
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Observe pre, intra, and post procedure nursing interventions.
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Assist with pre and post procedure assessment, VS, and pt. education (if appropriate and with supervision).
Objectives for NURR 201 GI lab Spinout:
1. Observe preparation of patient for endoscopic procedures
2. Participate in preparation of patients under the direction of a licensed professional nurse
3. Observe endoscopic procedures
4. Observe and/or participate in the post-procedure care of patients
5. Describe some common complications encountered during endoscopic procedures and nursing interventions associated with each
Objectives for NURR 201 Wound/Ostomy Spinout:
1. Review skin protocol at St. Luke’s Magic Valley Regional Medical Center
2. Demonstrate a proper skin assessment
3. Determine patient risk for skin breakdown using the Braden Score
4. Choose appropriate interventions for the nursing care plan (for specific skin issues)
5. Describe situations that would warrant a referral to the wound specialist
6. Perform dressing changes under the direct supervision of the wound ostomy certified RN (WOCN)
Objectives for NURR 201 Diagnostic Imaging Spinout:
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The student will identify the role of the Diagnostic Imaging (DI) nurse and participate and function as part of the DI team.
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The student will perform and increase psychomotor nursing skills in the DI setting.
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Student will observe the initiation of conscious sedation, and may participate in patient assessment and related documentation. This includes preparation for potential complications.
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Student will identify connection between disease process and its presentation through radiologic imaging.
Objectives for NURR 201 Preoperative and Postanesthesia Care Unit (PACU) Spinout:
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The Registered Nurse will help students to learn through the following behaviors:
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Role modeling and demonstration.
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Direct teaching.
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Discuss organization, prioritization, delegation, self assessment and communication.
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Expected student clinical behavior:
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Describe purpose and components of pre-op assessment.
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Discuss informed consent, pre-op teaching, and pre-op medications.
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Assess patients systematically under the direction of the RN (PACU)
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Define components of the initial post-anesthesia assessment.
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Verbal report by the anesthesia care provider
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ABC evaluation
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Oxygen therapy
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ECG monitoring
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Neurological and urinary system assessment
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Identify standards of care in the PACU.
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Discuss the PACU experience from the patient’s and family perspective.
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Discuss nurses’ ethical obligations to patients in the PACU.
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Identify non-pharmacological and pharmacological strategies to promote comfort and decrease anxiety.
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Identify normal heart rhythm, basic dysrhythmias and paced rhythms.
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Discuss invasive and noninvasive hemodynamic assessment.
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Explain etiology and nursing assessment and management of nausea and
vomiting, pain, hypothermia, hypoxemia, and altered LOC.
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Discuss malignant hyperthermia protocol.
http://www.medstudents.com.br/anest/anest1.htm
Objectives for NURR 201 Cancer Center Spinout:
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Review history for two cancer center patients and identify goals for cancer therapy.
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Outline modalities for the cancer treatment of one cancer patient.
A. Surgery
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diagnostic
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staging
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curative, palliative, reconstructive, preventative
B. Chemotherapy
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vascular access
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side effects of chemotherapeutic agents
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procedure for extravasation
C. Radiation
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external beam
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implant therapy (brachytherapy, closed therapy, sealed)
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Identify essential elements of radiation and chemotherapy safety precautions.
CRITERIA FOR CLINICAL JOURNAL TEMPLATE
Name Date Clinical day
Please submit a journal entry after each clinical day. Entries for students in Mon./Wed clinicals are due at 1800 on the day following each clinical day. Students who are in Fri./Sat. clinicals have journal entries due for both clinical days by 1800 on Monday. Attached to each assignment is a journal template which you will complete after each clinical day, save, and then send electronically through Blackboard to your instructor. You will notice an exclamation point in the grade book after submitting your assignment. Once your clinical instructor responds to your entry you will see a “0” in the grade book. Click on the “0” to view your instructor comments. Please print a copy of your entry and your instructor’s comments and include in a notebook for review at your final evaluation. _______________________________________________________________________
1. Describe your feelings about:
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Strengths and areas for growth in your clinical performance.
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Clinical decisions made, nursing judgments, and possible alternate responses and interventions. What would you do differently?
c. Critical thinking: Identify what could go wrong; what complications may occur? What assessments are made to determine if those complications are occurring? What nursing interventions will prevent the complication(s)?
d. Submit at least one unanswered question related to your clinical experience this day, i.e., “I would like to know -------“
2. Reflect on your utilization of learning experiences that day, including patient
teaching completed.
3. Evaluation of your clinical goals each clinical day.
4. Identify three (3) goals for your next clinical day.
a. Skill:
b. Professional Development:
c. Theoretical Application:
Clinical Tally Sheet
Patient Codes Name _____________________________________
M – Medical Course____________________________________
S – Surgical Rotation___________________________________
P – Pediatric Agency____________________________________
G - Geriatric Instructor Signature ________________________
DATE
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PT.
CODE
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M/F
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AGE
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MEDICAL DIAGNOSES
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STUDENT ACTIVITIES
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MEDICATIONS GIVEN, ROUTES
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PATIENT TEACHING
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Name _________________________________
DATE
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PT.
CODE
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M/F
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AGE
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MEDICAL DIAGNOSES
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STUDENT ACTIVITIES
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MEDICATIONS GIVEN, ROUTES
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PATIENT TEACHING
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Name _________________________________
DATE
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PT.
CODE
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M/F
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AGE
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MEDICAL DIAGNOSES
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STUDENT ACTIVITIES
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MEDICATIONS GIVEN, ROUTES
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PATIENT TEACHING
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Checklist for signature forms to be turned in at the beginning of the semester
Bring this checklist with the signed forms to your first day
________ Student handbook validation
________ Health insurance
________ Vehicle insurance
________ Clinical confidentiality form
________ Davita Dialysis confidentiality form
________ Drug/alcohol form
COLLEGE OF SOUTHERN IDAHO
ASSOCIATE DEGREE NURSING PROGRAM
NURR 201
HANDBOOK VALIDATION
THIS FORM MUST BE RETURNED TO THE CLINICAL INSTRUCTOR BY MONDAY, AUGUST 25, 2008
I have read the course requirements for NURR 201 and I understand the expectations. I understand that failure to meet course requirements will result in failure in the course and dismissal from the nursing program.
____________________________________________
Signature
___________________________________________
Date
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I have reviewed the Student’s ADN Handbook, 2007-2008, and have also read the updated Policies in the current Student ADN Handbook, 2007 -2008.
_____________________________________________
Signature
__________________________________________
Date
___________________________________________________________________
Health Sciences and Human Services
COLLEGE OF SOUTHERN IDAHO
HEALTH SCIENCES AND HUMAN SERVICES
HEALTH INSURANCE FORM
I hereby show, by my signature, that I have health insurance in place at this time and that I will continue to keep this coverage in effect throughout this semester and until the completion of the Health Sciences and Human Services program in which I am currently enrolled
____________________________________________
Program of Study
___________________________ ___________________
Signature of the Insured Student Date
VEHICLE LIABILITY INSURANCE FORM
I hereby show, by my signature, that passengers, automobile and I (driver) are covered by liability insurance in an amount at least equal to that required by the laws of the State of Idaho. My signature also indicates that I have a valid driver’s license from the state of which I am a legal resident or of the State of Idaho.
Student Signature______________________________________
Date ________________________________________________
___________________________________________________________________
Health Sciences and Human Services
CLINICAL CONFIDENTIALITY CONTRACT
In order to uphold nursing’s legal and ethical responsibility to the confidential nature of the data contained in all patient records, electronic, paper, or otherwise and to prevent unauthorized access to hospital supplies, medications or information:
I, _______________________________________(print name), will not divulge information about clients and/or their families that I am exposed to as a result of my position as a student. This would include, but is not limited to, information presented in classroom discussions, post-conferences, clinical practice, and agency visits. I may only divulge such information to fellow health care professionals as is necessary and useful to enhance delivery of care and education. I will omit client/agency identification data in all written work. In addition, as a condition to receiving a computer sign-on code and allowed access to a system in any agency, I agree to comply with the following terms and conditions.
1. My sign-on code is equivalent to my LEGAL SIGNATURE and I will not disclose this code to anyone or allow anyone to access the system using my sign-on code.
2. I am responsible and accountable for all entries made and all retrievals accessed under my sign-on code, even if such action was made by me or by another due to my intentional or negligent act or omission. Any data available to me will be treated as confidential information.
3. I will not attempt to learn or use another’s sign-on code. I will not use my sign-on code from CSI’s clinical education experience in my personal employment and vice versa.
4. If I have reason to believe that the confidentiality of my sign-on code from my CSI clinical education experience has been compromised, I will immediately inform my clinical instructor.
5. I will not leave a secured computer access application unattended while signed on.
Any breach of confidentiality or unauthorized access is considered unsatisfactory clinical behavior and will result in a meeting with the clinical instructor, Course Coordinator and the ADN Chairperson and may result in dismissal from the program.
Signature_______________________________________ Date_____________________
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