INDIAN RIVER STATE COLLEGE

RESPIRATORY CARE PROGRAM

CLINICAL PRECEPTOR HANDBOOK

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Overview
This clinical preceptor handbook is designed to provide guidelines to individuals responsible for the clinical education of respiratory students. The handbooks purpose is to assure program consistency among all of the clinical facilities. It is supplement to the student handbook. Clinical preceptors serve as both teacher and role model. Clinical preceptors therefore should be familiar with the following: 1. Current therapeutic techniques. 2. Proper patient care practices. 3. Use of adequate universal protective methods. 4. Medical record documentation. 5. Professional and Ethical Attributes Clinical preceptors should facilitate the information that the students have learned in their didactic courses and performed in the laboratory setting to the clinical environment in accordance with the clinical plan. Clinical preceptors must supervise the students to insure that they follow the programs policies as well as the policies and procedures of the respective clinical facility. Clinical preceptors are to function as a resource person; instructor and supervisor to the respiratory care student. The ultimate responsibility for the patient lies with the clinical preceptor. Preceptors must be readily available as a resource to students at all times and must supervise all student procedures, review all documentation and maintain two-way communication throughout the assigned shift with the student. Students clinical education activities are a learning experience for the student. The student is not to be substituted for staff members.

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Mission Statements and Goals

A. College Mission Statement Indian River State College (IRSC) is a comprehensive state college serving the diverse and multicultural communities of Indian River, Martin, Okeechobee, and St. Lucie Counties. The college provides students with equal access to a quality learning environment with a wide range of educational opportunities, including global initiatives. IRSC also provides individualized student services and comprehensive instructional programs through traditional and electronic delivery. In partnerships with business, industry, educational institutions, and the community, the College is a leader in economic and workforce development and a center for professional, personal and cultural enrichment. Health Science Division Mission Statement The Health Science Division supports the mission of Indian River State College by preparing students to function effectively as members of the health care team. The division is committed to advancing health care by providing innovative educational programs through excellence in teaching, clinical leadership, and service to the health care community. Respiratory Care Program Goal The goal of the Indian River State College Respiratory Care Program is to prepare students with the entry-level skills necessary to succeed as a competent respiratory therapist in the health care community. Respiratory Care Program Mission Statement The profession of Respiratory Therapy is dedicated to the conservation of life, health, and the prevention of disease. Therefore, Respiratory Therapists are regarded as extremely important professionals in todays society. Their contributions to society offer the satisfaction of pride, service, and rewards in human gratitude. The Indian River State College Respiratory Care Program is dedicated to meeting the educational needs of the students and health care community.

B.

C.

D.

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Program Standards
The fulfillment of the program's mission is assessed by the degree to which the program maintains the following standards: A. Provide an educational environment that promotes student success by: 1. providing appropriate instruction and educational opportunities in the classroom and clinical setting. 2. providing job placement assistance upon graduation. Provide employers with graduates possessing the knowledge, practical skills, and problem solving abilities to: 1. perform procedures of therapeutic quality. 2. provide appropriate patient care. 3. communicate effectively with patients and co-workers. 4. maintain ethical and professional values.

B.

Program Accreditation
The Indian River State College Respiratory Program is accredited by the Committee on Accreditation for Respiratory Care (COARC). The accreditation process has been developed to assure that COARC accredited programs follow education standards and ensure academic excellence. COARC provides peer review of the programs educational content and processes.

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Respiratory Care Program Contacts

A. Faculty Program Director Georgette Rosenfeld grosenfe@irsc.edu Robert Walsh rwalsh@irsc.edu (772) 462-7542

Program Director

Director of Clinical Education

(772) 462-7543

B.

Clinic Department Directors Christina Welch Karen Booth Theresa Ortolani Kelley Sebree Shawn Poland Don Magee (772) 223-5764 (772) 223-5945 ext.3053 (772) 335-4000 ext. 3112 (772) 468-4455 (863) 763-2151 ext. 2757 (772) 567-4311 ext.2122 (321) 434-7104 ext.41403

Martin Memorial South Martin Memorial North St. Lucie Medical Center Lawnwood Medical Center Raulerson Hospital Indian River Medical Center

Holmes Regional Medical Center Vinnie Lorme

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Clinical Preceptor Job Description

Preceptors provide education and supervision for respiratory care students in the clinical setting, consistent with the established standard of medical care in respiratory sciences, policies and procedures of the respective facilities and goals and objectives of the assigned clinical rotation. Specific responsibilities and duties include: 1. Demonstrate knowledge of program goals, clinical objectives, and clinical evaluation systems. 2. Provide students with appropriate and adequate clinical supervision, both direct and indirect in accordance with documented student competencies. Provide students with appropriate and adequate clinical instruction in accordance with the clinic plan. Facilitate proper student rotations in the clinical setting to help achieve course objectives. Perform clinical progress and competency evaluations for students. Exhibit a positive professional attitude toward students and the teaching process. Utilize positive interpersonal communication skills. Participate in continuing education to improve and maintain competence in evaluation and professional skills.

3.

4. 5. 6. 7. 8.

Communicate with program instructors to communicate student progress, strengths and weaknesses. 9. 10. Assist in maintaining effective and well-documented student clinical records in a timely manner. Demonstrate competency in instructional and evaluation methods. Provide a positive role model for students of respiratory science professions. Maintain confidentiality in accordance with program policy. Participate in meetings and serves on committees consistent with the goals of the educational program. Serve as a liaison between the college and the clinical site as necessary. May serve as didactic instructor as assigned by program directors. 5
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11. 12. 13. 14.

15. 16.

General Preceptor Guidelines

1. Develop student assignments in conjunction with the clinic plan that is distributed at the beginning of each clinical rotation. Only allow students to perform those skills which are delineated in the clinical plan. Students are only permitted to perform skills in clinic after they have demonstrated proficiency in the laboratory setting. Students may only perform a specified skill under close supervision after they have observed the preceptor perform the skill. Prior to being checked off for a proficiency, the preceptor must review the patient chart, related documentation and co-sign the patient's chart on all student clinical procedures. The preceptor must remain in close proximity and in communication with the student(s) during performance of all clinical procedures. Preceptors are to check in with students on an hourly basis and be in available via a pager throughout the shift. Students must report to preceptors, in a timely manner (not more than 30 minutes), on any independent action or procedure performed. The clinical preceptor must verify all student assessments and clinical plans. Students may not carry out physician orders without verification by the preceptor as to the appropriateness of therapy and completeness of the order. Students will receive a formal patient report prior to the start of the shift, and must provide a comprehensive report to their clinical supervisor at the end of the shift. ICU report should be given at the bedside. The following procedures must always be directly supervised by a clinical preceptor regardless of student demonstrated competency: Intubation Extubation Arterial Punctures Arterial Line Insertion Securing Artificial Airways (retaping E-T Tubes) 12. Students are assigned to preceptors not to treatments or procedures. The ultimate responsibility for completion of therapy and documentation lies with the preceptor.

2.

3.

4.

5.

6.

7.

8. 9.

10.

11.

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Student Evaluation Process Clinical Grade

Each student will be issued a letter grade for each completed clinical education course. The letter grade is based on the clinical preceptors evaluations, chart reviews, ICU workup sheets, log books, weekly evaluations, case study, instructors evaluation, and completed competencies. Steps in calculating clinical grade: 1. 2. 3. 4. 5. Chart Reviews, ICU Work-up Sheets*, Log Book Preceptor Evaluations Case Study Instructor Midterm Evaluation* Instructor Final Evaluation 10% 10% 20% 20% 40%

* Not applicable in Clinic II summer session. Midterm and Final eval. = 60% of grade

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Chart Reviews
Students are required to perform a comprehensive chart review on at least two medical records daily in Clinic I. The purpose of this exercise is for the student to become proficient in obtaining pertinent information from the patient chart, correlate the diagnosis to the treatment and identify the purpose of medications that are prescribed.

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CHART REVIEW Admission Date:__________ Patient Initials: _____ Hospital Day #_________

Admitting Diagnosis:_____________________________________________________ Admission Orders: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Admission Notes: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ __________________________________ Physician Progress Notes: (New Problems, Plan of Care, Prognosis) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Pulmonary Assessment: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Current Respiratory Orders: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Chest X-Ray Results: ______________________________________________________________________________ ______________________________________________________________________________

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ABG Results: Date/Time/FIO2 Ph/PCO2 PO2/SaO2 HCO3 Interpretation

Lab Results: Identify Abnormals and Explain WBC Hgb/Hct NA+ K+ BUN CPK Troponin INR (PT) Drug Regime: List all Medications, Purpose, and Side Effects Drug Name Dosage Purpose

Side Effects

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Adult ICU Patient Work-up Sheets

Students are to select one patient each day in Clinic III and Clinic IV and complete an ICU workup sheet on that patient. This patient should be on a ventilator and if possible have hemodynamic data available. The purpose of this exercise is to prepare students to evaluate all data related to the patient in the critical care setting. It is essential the students interpret the data and make clinical decisions based on the information obtained in order to be adequately prepared for the clinical simulation exam.

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ADULT ICU PATIENT WORK-UP

Todays Date_____________ Date of Admission_______________ Hospital Day___ Age____ Diagnosis________________________ Sex. M F Hgt. ________Wgt . _____ Patient Vital Signs
HR VITAL SIGNS RR BP ART.BP TEMP CVP PAP PCWP CO CI

IBW_____

Is the Patient Hemodynamically stable?: YES NO

Receiving any Vasopressors? YES NO

Urine output: Color and amount. __________________ EKG Rhythm_______________ Skin Color/appearance_______________________________________________________ Is the Patient sedated/paralyzed(Circle)? Y N Patient assessment: Past Medical History Chest Tube? Y N. IF YES, LEAK? Y N

Past Surgical History

Social History

Pulmonary assessment Breath Sounds Sputum: Color and amount. Culture and Sensitivity Report Respiratory Pattern and rate. May include accessory muscle use,

Head to toe assessment: To include. Head, neck, chest deformities. AP diameter, Peripheral edema and other findings.

Chest X-ray Laboratory Assessment

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HGB OBSERVED NORMAL

HCT

RBC

WBC

NA

CL

PH

PCO2

PO2

HCO3

B.E.

SAT.

FI02

BUN/ Creatinine Nml Clinical Significance

Troponin Nml

INR Nml

Albumin Nml

Lactate Nml

Relate any abnormal lab values, chest x-ray results, hemodynamics, etc. to the patients ventilatory status and assess their ability to be weaned. VENTILATOR SETTINGS
MODE RATE VT FI02 PEEP PS FLOW RATE PRESSURES ALARMS

Current ABGs, with interpretation, on most recent ventilator settings.

PATIENT VENTILATORY PARAMETERS

RATE VT VE NIF/VC COMP. % SHUNT A-a D02 R.R./VT Pa02/PA02

Evaluate the ventilatory support listed above.

What modifications would you make?

Why?

If the above changes were approved and initiated what was the outcome?

Drug Regime - List drugs, dosage, purpose, and side effects.

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Ventilator Flow Sheets

Students are required to maintain a paper copy ventilator flow sheet for every ventilator patient they are assigned. This document must be completed at the time the ventilator check is performed and must be comprehensive and accurate. The concept applied is that anyone reading this document should be able to obtain current and specific information regarding that patient. All ventilator settings, alarm settings, ventilator changes, physician orders, treatments administered, etc must be documented on this flow sheet.

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Indian River State College VENTILATOR FLOW SHEET

Date Time Mode Auto Mode Vt/Exh. Vt Set Rate FiO2 PEEP PS Flow Rate Sensitivity I:E I Time Total RR Spon VT Total VE PIP MAP PIat. Pres. Comp Res Temp/HME SX Neb Given Press Limit Low Press Low VE Low PEEP High RR BP HR ABG PH PCO2 PO2 HCO3 SpO2 ETC02 Initials Vent Type Diagnosis TX Ordered / / / / / / / / / Airway: Oral/Nasal/Tracheostomy Size CM Mark Position Cuff Pressure Date/Time Retaped Patient Care Notes: Num

PH

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Daily Clinical Log

Every student is to maintain a daily log for each clinic day assigned. This log is to include specific data regarding procedures performed, any observations the student experienced that day, any physician contact and an explanation of the most significant learning experience obtained during that clinical day.

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Indian River Sate College DAILYCLINICAL LOG RESPIRATORY CARE PROGRAM

Student: Procedures Performed (Summary: Date: Hospital: Comments:

Observations:

Comments:

Physician Contact: __ Formal Class Described Nature and Estimated Time:

__ Bedside Rounds

Other (Specify): ____________________

TIME: Describe briefly the most significant learning experience (relevant or incidental) occurring during the day; use additional documentation (graphs, drawings, etc.) if necessary so that your experience can be shared with the class.

Instructor/Supervisor Signature

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Attendance Record
Students are required to document the arrival and departure time for clinic on the clinical attendance log. It is the student's responsibility to obtain the signature of the preceptor for verification of time. Preceptors are asked to assure the time documented is correct prior to signing the attendance log.

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IRSC RESPIRATORY CARE CLINICAL ATTENDANCE LOG Student Clinical Rotation

Date

Clinical Site

Time In

Signature

Time Out

Signature

Legend PD = Personal Day X = ABSENT UX = Unexcused Absence SF = School Function MU = Make-up Day

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Physician Evaluation
It is essential that students develop bi-directional communication with physicians for the purpose of relaying and interpreting information. Students are required to have a physician evaluation form completed in Clinic III and Clinic IV. The preceptor is asked to facilitate the students in having the physician complete the evaluation. Some physicians are reluctant to sign the document. In this event, it is acceptable for the preceptor to document the physician's response, identify the physician responding and co-sign the form, in lieu of the actual physician's signature.

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PHYSICIAN EVALUATION Students Name: Please evaluate the student in the following areas: Very Good 4 Needs Improvement 2

Excellent 5 1. Ability to interpret physicians orders Ability to apply theoretical concept to clinical setting Ability to perform procedure with skill Ability to communicate accurately with physicians.

Good 3

Poor 1

2.

3.

4.

Date:

Clinical Preceptor: Physician Signature:

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Daily Clinical Preceptor Student Evaluation During Clinical Rotations, a DAILY clinical preceptor student evaluation will be completed by the preceptor at the end of each clinical day. On this evaluation you will rate the student on strengths, clinical skills, and areas in need of improvement. In addition, the preceptors will provide descriptions of any particularly effective or ineffective behaviors they observe during the shift and will recommend ways for students to improve their performance. The Clinical Preceptor Student Evaluation is part of their final clinical grade.

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Indian River State College Respiratory Care Program Clinical Preceptor Student Evaluation Student: _________________ Preceptor: _______________ Date: ____________________ Facility: __________________

Keeping in mind the students current level of education within the program, please check all of the boxes that apply to the student. 1. Identify any students strengths that you observed. Student demonstrates initiative and a positive attitude while at clinic. Student performs clinical procedures in accordance to AARC guidelines/hospital policy. Student arrives on time and is ready to receive report. Student readily applies theory to bedside practice. Student takes an active role in the care of their patient and gives a comprehensive end of shift report. 2. Comment on areas in need of improvement. Student needs to demonstrate better communication with staff and MD. Student needs to be better prepared and organized. Student needs to maintain a positive attitude. Student needs to demonstrate better understanding of the patients condition and plan of care. Student needs to be more dependable and complete tasks on time. Student needs to document changes thoroughly and promptly. Student needs to maintain appearance in accordance with the student handbook. Student needs to increase efficiency and output. The student needs to review and demonstrate the proper technique for _____________. 3. Does the student demonstrate initiative and desirable work ethics? Yes No. Please explain:

4.

Does the student accept constructive criticism in a positive manner? Yes No. Please explain: 23
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Faculty Midterm and Final Evaluation The IRSC faculty instructor will complete a midterm and final clinical evaluation for each student. This evaluation focuses on the student's ability to perform clinical work within the guidelines of the respiratory program rather than the specific facility (i.e. handwritten documentation, ventilator flow sheets, etc.). The evaluation form consists of twenty categories with five levels of competency for each level. A brief explanation may be added for the chosen competency level. A sample faculty evaluation is attached.

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Reprinted from Respiratory Therapy Competency Evaluation Manual, with permission from Mosby publications. BEHAVIORAL RATING SCALE (LONG FORM) STUDENT ROTATION PARTICIPATING EVALUATORS HOSPITAL/AFFILIATE DATES

OVERALL RATING

REASONING ABILITY

INTERPERSONAL SKILLS

WORK PERFORMANCE

PERSONAL CHARACTERISTICS

COMMENTS AND IMPRESSIONS

RECOMMENDATIONS

STUDENT

EVALUATOR(S)

FACULTY

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OBSERVATIONS DATE CRITICAL INCIDENT DESCRIPTIONS: Include (where applicable) the events leading up to the incident (antecedents), the behavior itself, and any observed consequences of the behavior. Be as specific and objective as possible. APPLICABLE SCALE(S)

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BEHAVIORAL RATING SCALE (LONG FORM)

VERBAL COMMUNICATION Carries on consistently goal-directed communication; is always definite, unambiguous, and clear in meaning and intent. Usually initiates goal-directed communication that is informed, deliberate, and generally unambiguous. Generally initiates adequate communication with infrequent errors of indefiniteness or ambiguity; seldom displays misleading word choices or illformidness. Often has difficulty in communicating meaning or intent; is frequently ambiguous or indefinite; often chooses misleading words or exhibits illformidness. Is consistently ambiguous and indefinite; misleading words or lack of clarity in intent and meaning preclude effective communication. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

ORGANIZATION AND EFFICIENCY Always sets goals and plans and organizes activities so as to achieve optimum and efficient patient care. Organizes and plans assignments well; fails to achieve established goals only when unexpected circumstances intervene. Usually establishes priorities and plans activities efficiently; most goals achieved as intended. Makes some attempt to set goals and organize activities but many priorities are not achieved Exhibits no planning or goal setting; is unaware of priorities and is constantly disorganized. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (Circle Appropriate Statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM) KNOWLEDGE AND COMPREHENSION Demonstrates superior comprehension and knowledge beyond the requirements of the job. Demonstrates above average knowledge and comprehension beyond that essential. Displays adequate knowledge of essential concepts. Has limited understanding of basic concepts; is unsure of essentials. Displays inadequate comprehension of even basic knowledge. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (Circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

GENERAL DEMEANOR Always pleasant, courteous, friendly, and tactful; fosters positive response in others. Generally pleasant and courteous; is poised, accepting, and tactful most of the time. Usually courteous and pleasant; exhibits tactlessness or abruptness only in extenuating circumstances. Abrupt and anxious at times, often detached or unresponsive; must be reminded occasionally to be tactful and courteous. Regularly abrupt, rude, domineering, unaccepting, or condescending; requires constant reminder to display tact, courtesy, or understanding. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (Circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM) THOROUGHNESS AND SAFETY Consistently demonstrates thoroughness, accuracy, attention to detail; performance exceeds safety expectations and is essentially error-free. Usually exhibits thoroughness; work seldom needs to be rechecked; demonstrates due consideration for safety and errors are few. Demonstrates an acceptable level of performance with occasional (though not critical) errors; safety considerations are rarely overlooked. Is frequently careless or negligent, lacking attention to many details; errors occur frequently and safety considerations are often overlooked; requires close supervision. Exhibits overt carelessness and consistently poor quality of performance; makes critical errors of potential danger to patient's well-being; is unsafe and hazardous. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

OBSERVATION, ASSESSMENT, REPORTING OF PATIENT'S STATUS/NEEDS Consistently astute and conscientious in the observation, assessment, and reporting of patient's status or needs to appropriate personnel. Usually alert to most changes, never overlooks or fails to report patient's condition or needs to appropriate personnel. Provides satisfactory observation and assessment of patient's status and needs; generally assures that appropriate personnel are notified. Is often careless in observing and assessing patient's condition or needs; often fails to communicate changes to appropriate personnel. Habitually displays negligence in patient observation and assessment; does not inform appropriate personnel of patient's status or needs. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (Circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM)

DEPENDABILITY AND SELF-DIRECTION Assumes full responsibility for actions and exhibits self-direction in all activities; can independently initiate positive action and rarely requires direct supervision Is generally able to assume responsibility for actions; usually initiates independent action and selfdirection; requires minimal supervision. Is dependable and self-directed in assuming most responsibilities; is aware of limitations and seeks supervision and assistance when necessary. Reluctant to assume self-direction or independently initiate actions; requires close observation and supervision in most activities. Cannot assume responsibility for actions; lacks direction and requires constant observation and direct supervision. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

COOPERATIVENESS AND RECEPTIVENESS Exceptionally cooperative and receptive to suggestions and new ideas. Highly responsive and cooperative; generally receptive to suggestions and new ideas. Usually cooperates, does not resist new ideas. Seldom fails to take suggestions. Unresponsive at times, often failing to cooperate; resists new ideas and seldom carries out suggestions. Is habitually uncooperative and unreceptive; resents or rejects suggestions and new ideas. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM) RECORD KEEPING Always maintains exceptionally complete, accurate, and concise records in full accord with hospital and departmental policy and procedures. Ensures that records kept complete and concise; recognizes and corrects any errors or omissions. Usually maintains records that are satisfactory; occasionally makes minor errors or fails to provide complete description of actions/assessments. Is frequently careless in completing proper records; commits many errors or is often inaccurate and incomplete. Habitually fails to provide documentation of activities. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

PERSONAL APPEARANCE Always presents a clean and well-groomed appearance that exceeds the basic dress code requirements. Consistently neat and well-groomed in accord with basic dress requirements. Usually presents clean and satisfactory appearance, rarely untidy or inappropriate. Often forgetful of standards of appearance or grooming, at times untidy or inappropriately dressed. Habitually negligent of appearance; consistently untidy, unkempt, or unclean. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM)

LEARNING ADAPTABILITY Learns and applies new experiences exceptionally quickly; adjusts rapidly to new conditions or altered situations. Is rather quick to learn from new experiences; readily accommodates changed conditions or situations. Grasps new experiences and adjusts to changes when given a satisfactory time interval. Is rather slow in learning new tasks and has some difficulty accommodating to changing conditions. Seems unable to learn from or apply new experiences and cannot adjust to changes. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

CARE AND USE OF EQUIPMENT AND/OR SUPPLIES Demonstrates exemplary competence and resourcefulness in the utilization and care of equipment and supplies. Efficiently employs available equipment and supplies, giving due care to their use and maintenance. Exhibits satisfactory care and use of equipment in most situations; is never negligent, wasteful, or abusive. Is often inefficient in the use or maintenance of equipment and occasionally provides less than adequate care. Is abusive, negligent, and careless in the use and care of equipment or supplies. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM)

INTEGRITY Consistently exhibits concern for the dignity and welfare of patients and ensures confidence of privileged information; always acknowledges limitations of practice and responsibility/authority granted by the physician; maintains forthright and honest behavior at all times. Generally displays concern for the dignity and welfare of patients and ensures confidence of privileged information; generally recognizes limitations of practice and responsibility/authority granted by the physician; consistently displays forthright behavior. Seldom fails to recognize the importance of the patient's dignity and welfare and responsibility of privileged communication; usually recognizes limitation of practice and responsibility/authority granted by the physician; usually displays forthright and honest behavior. Often disregards patient's dignity or welfare and right to privileged communication; is sometimes negligent in acknowledging limitations of practice and responsibility/authority granted by the physician; fails at times to be forthright and honest. Is negligent or abuse of patient's dignity and consistently fails to maintain confidentiality of privileged communications; fails to recognize limitations to practice and is abusive of responsibility/authority granted by physician; is often dishonest. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

COLLABORATIVENESS Consistently collaborates with supervisors and instructors to maximize learning and implement optimum patient care. Reacts positively towards guidance and applies supervisors' recommendation to improve knowledge, skills, or attitudes. Willingly accepts supervision and guidance; generally applies recommendations and is receptive to constructive criticism. Sometimes reacts negatively towards supervision; often rejects guidance or fails to apply recommendations; has difficulty accepting constructive criticism. Resents supervision and rejects guidance; is defensive or abusive when approached with recommendations; fails to alter behavior when appropriateness criticized. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM)

THEORY INTEGRATION Readily transfers theoretical knowledge to all clinical situations. Applies and relates theory to most clinical activities. Can usually demonstrate how essential aspects of theory relate to specific clinical situations. Exhibits a superficial understanding of the application of theory in most clinical activities. Is unaware of and cannot integrate theoretical concepts with their practical application. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

QUANTITY OF PERFORMANCE Works consistently and with excellent output, utilizes time efficiently. Works consistently with above average output; always completes assigned functions in appropriate time interval. Maintains satisfactory output; is usually able to complete delegated tasks in appropriate time interval. Frequently is unable to complete assigned functions within a satisfactory time limit. Demonstrates unrealistically low output in relation to expectations; is slow and habitually inefficient. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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INITIATIVE Exhibits enthusiasm and initiative in performing assigned tasks; continually seeks out new learning experiences beyond those scheduled or planned. Readily accepts assigned activities and constructively exploits their learning potential; generally seeks out new or additional learning experiences. Keeps pace with regular work assignments and occasionally seeks out new activities. Requires occasional prodding to keep up with delegated tasks, rarely uses time constructively. Must be continuously prodded to meet responsibilities; completes assigned activities only because they are required; does not seek out new learning experiences. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

PATIENT RAPPORT AND CONSIDERATION Communicates readily with patients; always attentive to their emotions, needs, rights, and comfort; is consistently considerate, patient, and accommodating. Maintains good rapport with patients; recognizes their rights and attempts to accommodate their needs; is respectful and courteous. Generally sensitive to patients' needs and rights in planning care; communicates adequately to gain patients' confidence and is usually considerate and respectful. Often ignores or is inattentive to patients' rights and comfort; has difficulty communicating sincerity or consideration; generally fails to achieve rapport with patients. Is incognizant of patients' needs, rights, or necessary comforts; fails to adequately communicate with patient; is insincere or detached. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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BEHAVIORAL RATING SCALE (LONG FORM)

COMPREHENSION AND JUDGMENT Grasps directions quickly and accurately; displays outstanding use of judgment. Readily uses instructions and makes decisions based upon sound judgment. Rarely requires repetition of explanations or referral to instructions; demonstrates good judgment in most situations. Requires needless re-explanations; has difficulty in making rational judgments. Is unable to follow even simple directions; cannot be depended upon to make sound judgments. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusion were drawn)

ATTENDANCE AND PUNCTUALITY Is never absent and always arrives as scheduled (or early) for all rotations and activities. Is absent or late only under extenuating circumstances and with proper notification. Is rarely absent or late for scheduled activities; properly notifies appropriate personnel in advance of difficulties in attendance; seeks to make up lost time. Is frequently absent or tardy and often fails to give notification to appropriate personnel; avoids efforts to reschedule time. Shows disdain for attendance and punctuality requirements; habitually neglects to give notification; rejects efforts to reschedule lost time. At present there is insufficient information available to provide a valid rating; or, this scale is not applicable (circle appropriate statement). Comments (Cite specific incidents from which the above conclusions were drawn).

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Competency Forms (the boxes) Students are evaluated on specific procedures and equipment based on four levels of competency. The levels are to be checked off by the preceptor as the student completes them successfully. The four levels should be checked off as follows: Level 1: Level 2: Level 3: Level 4: The student performs the procedure or uses the equipment properly in the laboratory setting. The student visualizes the procedure or equipment performed properly in the clinic setting. The student performs the procedure or uses the equipment properly under direct supervision of the preceptor. The student is able to perform the procedure or is able to use the equipment independently.

After the student completes level three, he/she is eligible to complete the competency evaluation form for that specific procedure or equipment. Preceptors are asked to initial the cover page, sign their name and credential and identify the facility in which they are employed. Students are not to be signed off on Level 2 in the hospital setting unless they have previously been signed off by a faculty member for Level 1 in the lab setting. It is the student's responsibility to secure signatures for the levels of competency once they have met that objective. Specific proficiencies are delineated for each clinical rotation. This is designed to provide the students with the opportunity to learn the theoretical concepts in the classroom setting and master the skill in the lab setting prior to performing the skill at the bedside. The clinical proficiencies are divided between the four clinical rotations. Each clinic builds on successful completion of the prior rotation. The schedule of clinical proficiencies is attached along with the clinic plan for each clinical rotation. Preceptors are asked to be familiar with the clinic plan in order to assure the student's maximize their learning opportunities in the clinical setting.

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Indian River State College RESPIRATORY CARE PROGRAM Student Name ____________________________________________________________ INSTRUCTIONS As each task is completed, according to the behavioral objectives for that task, the supervising therapist or clinical instructor will initial and date the sheet at the appropriate level of performance.

For the purpose of this record, four (4) levels of performance will be recognized. Level 1 The student has observed the procedure and/or performed the procedure in the lab setting. The student performs the procedure with close, constant supervision, and direction. The student performs the procedure with minimal supervision and direction. The student performs the procedure independently of supervision and direction.

Level 2 Level 3 Level 4 -

Each supervising therapist or clinical instructor's initials will be identified below by their printed name, credential, and hospital.
Initials :Name :Credential :Hospital

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Indian River State College RESPIRATORY CARE PROGRAM

CLEANING And STERILIZATION Level 1 Date Initial Equipment Processing

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Equipment Assembly

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Indian River State College RESPIRATORY CARE PROGRAM

OXYGEN ADMINISTRATION Level 1 Date Initial Nasal Cannula

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Simple Face Mask

Partial/Non- Rebreather Mask

Venturi Mask

Oximizer

Oxygen Analyzers

Blenders

Oxygen Concentrator

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Indian River State College RESPIRATORY CARE PROGRAM

HUMIDITY And AEROSOL THERAPY Level 1 Date Initial Bubble Humidifier

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Heated Humidifier Large Volume Nebulizer (Aerosol Generator) Small Volume Nebulizer

T-Piece/Trach Collar

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Indian River State College RESPIRATORY CARE PROGRAM

IPPB THERAPY Level 1 Date Initial EzPAP

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

BiPap/CPAP

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Indian River State College RESPIRATORY CARE PROGRAM

BRONCHIAL HYGIENE THERAPY Level 1 Date Initial Postural Drainage Percussion and Vibration (Manual/Vest) Coughing and Deep Breathing Instruction

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Incentive Spirometry

Flutter/Acapella

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Indian River State College RESPIRATORY CARE PROGRAM

CARDIOPULMONARY RESUSCITATION & MISCELLANEOUS Level 1 Date Initial Ventilation

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Compression

Chest X-Ray Interpretation

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Indian River State College RESPIRATORY CARE PROGRAM

COMPETENCY LEVEL ARTIFICIAL AIRWAY MAINTENANCE Level 1 Date Initial Nasal-Tracheal Suction Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Artificial Airway Suction

Manual Ventilation

Intubation

Trach Care

Extubation

Securing E-T Tube

Cuff Management

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Indian River State College RESPIRATORY CARE PROGRAM

COMPETENCY LEVEL BLOOD GASES Level 1 Date Initial Arterial Puncture Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

A-Line Sampling

ABG Analysis

Quality Control (Observation) Preventative Maintenance (Observation)

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Indian River State College RESPIRATORY CARE PROGRAM

VENTILATORY MANAGEMENT Level 1 Date Initial Routine Ventilator Check (adult)

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Routine Ventilator Check (neonate)

SIMV/Assist Control

PRVC/VC+

CPAP

Pressure Support

Weaning

Ventilator Circuit Change

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Indian River State College RESPIRATORY CARE PROGRAM

COMPETENCY LEVEL CALCULATIONS Level 1 Date Initial Compliance Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Airway Resistance

A-adO2

a-vdO2

Shunt

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Indian River State College RESPIRATORY CARE PROGRAM

DIAGNOSTIC & ASSESSMENT PROCEDURES Level 1 Date Initial Bedside Ventilatory Assessment

COMPETENCY LEVEL Level 2 Date Initial Level 3 Date Initial Level 4 Date Initial

Flow-Volume Loop

Functional Residual Capacity

Diffusing Capacity

Pulse Oximetry

EKG

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Indian River State College RESPIRATORY CARE PROGRAM Student Name: ____________________________________________________ Clinical Activities Record Document below the date and hospital at which the student observes the following procedures: PROCEDURE Bronchoscopy DATE HOSPITAL INSTRUCTOR

Intubation

Tracheostomy

Stress Test Cardiac Catheterization

Arterial Line Insertion

Thoracentesis

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CLINICAL PROFICIENCY SCHEDULE

Preceptors will evaluate students on procedural competencies once they have demonstrated proficiency in the lab setting and have performed the procedure in the clinical setting to a level three or greater on the clinical skills competency form. The Laboratory Exercises For Competency in Respiratory Care, Butler/Close will be the textbook utilized for the majority of the proficiency skills required for laboratory and clinical evaluations. For evaluations of procedural competency in the lab and clinical settings, students must demonstrate the ability to respond to oral questions without hesitation or prompting and must be able to complete the procedure in the time specified (where applicable).

Time Limitations for Successful Performance of Procedural Competencies

For evaluations of procedural competency in the lab and clinical settings, students must demonstrate the ability to respond to oral questions without hesitation or prompting and must be able to complete the procedure in the time specified (where applicable). Time limits for specific procedures are identified below and must be met in conjunction with specific course objectives. Students are required to comply with these specific time limits for successful completion of course objectives. Any student that can not complete the procedural competency exercise in the lab or clinical setting within the specified time and/or can not respond to the questions related to the procedure without prompting or hesitation, will be withdrawn from the program.

Respiratory Care Clinic I RET 2832 Vital Signs 4 minutes Blood Pressure 3 minutes Patient Interview and History - 4 minutes Physical Assessment of the Chest - 4 minute Auscultation - 4 minutes Medical Records - 5 minutes Chest X-ray Interpretation - 4 minutes Disinfection and Sterilization Isolation Procedures - 3 minutes Cardiopulmonary Resuscitation
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Manual Ventilation Pulse Oximetry - 2 minutes Oxygen Therapy - 4 minutes Oxyhood - 4 minutes Oxygen Analysis - 4 minutes Oxygen Tent - 7 minutes Gas Pressure and Flow Regulation - 4 minutes Aerosol Generators - 4 minutes Humidity Therapy - 2 minutes Aerosol Medication Delivery - 3 minutes

RESPIRATORY CARE CLINIC II RET 2833 Incentive Spirometry 4 minutes Intermittent Positive Pressure Breathing 5 minutes Inspiratory Resistive Muscle Training 4 minutes Directed Cough Techniques 4 minutes Chest Physiotherapy 4 minutes Nasotracheal Suctioning 5 minutes Endotracheal Suctioning 5 minutes EKG 5 minutes Endotracheal Extubation 5 minutes Artificial Airway Insertion 3 minutes Airway Care Cuff Management 3 minutes Trach Care 10 minutes Arterial Blood Gas Puncture 4 minutes Arterial Blood Gas Analyzer Calibration, Maintenance, and QA Arterial Line Sampling 4 minutes Endotracheal Intubation 4 minutes Bedside Pulmonary Mechanics 4 minutes Complete PFT: Spirometry, Diffusion, FRC, Patient History 40 minutes Spirometry Screening Functional Residual Capacity Diffusing Capacity

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RESPIRATORY CARE CLINIC III RET 2834 Routine Ventilator Check (adult) 6 minutes Ventilator Initiation (adult) 6 minutes Ventilator Circuit Change (adult) 6 minutes Ventilator Application (adult) (ventilator management) 4 minutes

RESPIRATORY CARE CLINIC IV RET 2835 Mask BiPAP/CPAP Initiation 4 minutes Routine Ventilator Check (neonate) 4 minutes Ventilator Initiation (neonate) 4 minutes Ventilator Circuit Change (neonate) 6 minutes Ventilator Application (neonate) (ventilator management) 6 minutes Continuous Positive Airway Pressure Therapy (CPAP) Hemodynamic Monitoring Capnography Shunt Studies SPECIAL ROTATIONS Neonatal Intensive Care (Transcutaneous Monitoring, Neonatal Ventilator Care, High Risk Deliveries) Intubation Hyperbaric Oxygen Home Care Pulmonary Rehabilitation Bronchoscopy Cardiac Catheterization Sub-Acute Care Special rotations are designed to increase student knowledge in specialized areas. This time allows for increased physician/student interaction and encourages bidirectional communication. These specialized rotations provide an opportunity
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for the student to discuss and evaluate patients with physicians in an atypical environment. It also gives the physician the ability to assess the student s knowledge of procedures, theoretical concepts and communication skills.

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RESPIRATORY CARE PROGRAM CURRICULUM

Program Curriculum
First Year *BSC 1010 *ENC 1101 General Biology I ......................................................................................... 3 credits Communications I ........................................................................................ 3 credits

FALL SEMESTER *BSC 2093 Anatomy and Physiology I ........................................................................... 3 credits *BSC 2093L Anatomy and Physiology I Lab ..................................................................... 1 credit RET 1024C Introduction to Respiratory Care ................................................................. 3 credits RET 1007 Cardiopulmonary Pharmacology.................................................................. 2 credits RET 1274C Respiratory Care Theory I ............................................................................ 3 credits RET 1485 Cardiopulmonary Anatomy and Physiology ................................................ 3 credits SPRING SEMESTER *BSC 2094 Anatomy and Physiology II .......................................................................... 3 credits *BSC 2094L Anatomy and Physiology II Lab .................................................................... l credit *MAC 1102 Basic College Algebra ................................................................................ 3 credits RET 2275C Respiratory Care Theory II w/Lab .............................................................. 3 credits RET 2503 Cardiopulmonary Diseases ......................................................................... 2 credits RET 2832 Respiratory Care Clinic I ............................................................................. 5 credits SUMMER I SEMESTER RET 2442C Respiratory Care Theory III w/Lab.............................................................. 3 credits RET 2833 Respiratory Care Clinic II ............................................................................ 2 credits SUMMER II SEMESTER *PSY 2012 Introduction to Psychology .......................................................................... 3 credits RET 2414C Pulmonary Function Studies w/Lab ............................................................. 3 credits FALL SEMESTER *PHY 1001 Principles of Physics ................................................................................... 3 credits RET 2264C Mechanical Ventilation w/Lab .................................................................... 3 credits RET 2834 Respiratory Care Clinic III ........................................................................... 3 credits RET 2280 Critical Respiratory Therapy ....................................................................... 3 credits SPRING SEMESTER RET 2835 Respiratory Care Clinic IV.......................................................................... 7 credits RET 2714 Pediatric/Neonatal Respiratory Therapy ..................................................... 3 credits RET 2934 Professional Development in Respiratory Care .......................................... 2 credits RET Introduction to ACLS for Respiratory Therapists credit Note: All core curriculum and natural science courses require a grade of "C" or higher. *May be taken prior to acceptance into the program. If not, student must complete in semester indicated. 56
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CLINIC PLAN CLINIC I RET 2832 CLINIC II RET 2833 CLINIC III RET 2834 CLINIC IV RET 2835

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Clinic Outline CLINIC I PLAN (RET 2832)

OBJECTIVE: Upon completion of RET 2832 (Clinic I) the respiratory student will demonstrate competency in performing the skills associated with the delivery of oxygen and aerosol therapy and the associated proficiencies as presented in RET 1024C and RET 1274C. The clinic will meet twice a week for 8 hours. WEEK 1: Student is oriented to the clinical facility. Tour of the hospital and orientation to department policies and procedures. Orientation continues, department policies are reinforced. Students are to be assigned to follow a floor therapist for the days Complete daily logsheet. Students are expected to review a minimum of two medical records daily and complete chart review worksheets. Students are to be observing oxygen and equipment rounds and should be actively participating in the processing of equipment. Students are expected to begin providing therapy to patients under supervision. Student should be knowledgeable of all aspects of the patients chart and condition. Student should be completing lab proficiencies such as infection control, medical records, etc. Students should be performing routine aerosol/oxygen therapy on at least one patient this week under supervision. Formative weekly ratings and overall clinical progress will be discussed with students this week. Students are expected to be demonstrating competency in medical gas therapy and aerosol therapy as well as getting those proficiencies completed. Students should be performing oxygen therapy and equipment rounds on a routine basis. Students should be becoming proficient at assessment, positioning and obtaining vital signs. Emphasis is placed on auscultating breath sounds. Students should begin completing proficiency evaluations for patient positioning, patient assessment, arterial blood pressure and vital signs. Proficiency evaluations described in week 8 are to be submitted to clinical coordinator this week. Student's clinical progress will be reviewed and midterms will be given out.
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WEEK 2:

WEEK 3:

WEEK 4:

WEEK 5:

WEEK 6:

WEEK 7:

WEEK 8:

WEEK 9:

WEEK 10:

Students are expected to be able to perform routine aerosol/oxygen therapy on two patients beginning this week under supervision. Students should be choosing a candidate for their case study this week. The students are expected to give a comprehensive detailed report for each patient at the end of the shift. Students should be able to increase their workload by taking responsibility for oxygen and/or equipment rounds in addition to their two patients. Students should be able to take up to three patients on oxygen/aerosol therapy. Aerosol therapy proficiency evaluation should be completed by this week. Students are to be given an assignment with approximately 10 12 procedures. Students are expected to refine their organizational skills. All proficiency evaluations are to be completed this week and submitted to the clinical coordinator. Arrangements to make-up any absences should be made and completed prior to the day final exams begin in order for the student to successfully complete this rotation. Case studies are to be completed. Presentation of case studies.

WEEK 11:

WEEK 12:

WEEK 13:

WEEK 14:

WEEK 15:

WEEK 16:

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CLINIC II PLAN (RET 2833)

OBJECTIVE: Upon completion of RET 2833 (Clinic II) the respiratory student will be able to perform IPPB therapy, incentive spirometry, CPT, and airway care (oral airway insertion, nasotracheal suctioning, and extubation). The student will be able to perform ABG's and bedside EKG's. Students will participate in physician bedside rounds. Additionally the student will be able to perform a complete pulmonary function test. WEEK 1: Students are oriented to the clinical facility through observation and close supervision. IPPB and CPT are to be emphasized. Students should also observe blood gas machine maintenance and calibration each clinic day. Students are expected to be performing incentive spirometry, IPPB, and CPT therapy under direct supervision of the clinical preceptor (Limited to 12 procedures per shift). Students should begin completing competency evaluations for I.S., IPPB, and CPT. Students should be introduced to the intensive care unit. Student should be assigned therapy in the ICU on two patients. At least two proficiency evaluations should be turned in this week. Students should be performing airway care. Students are expected to continue performing IPPB and CPT, Students should be working on completing competency evaluations for suctioning and airway care. Students should be able to perform calibration and maintenance on ABG machines.

WEEK 2:

WEEK 3:

WEEK 4:

WEEK 5 & 6: Students should continue performing therapy in the ICU. Students should be completing competency evaluations for ABG punctures. WEEK 7 & 8: Students should continue performing therapy in the ICU with emphasis on IPPB, suctioning and extubation. In addition the students should be attending all cardiac arrest situations when possible. Students should be able to set up and take pulse oximetry measurements. Students should be able to monitor end-tidal CO2 measurements and waveforms where available. Students should also assess, evaluate patients and communicate respiratory care plan to physicians. WEEK 9: Students should be oriented to the pulmonary function laboratory. Students should observe all PFT's. Students should be assigned to the pulmonary function technician, Students should observe all PFT's and perform PFT's on each other and/or on therapists. Students should also pick a candidate for case study focusing mainly on pulmonary function studies.

WEEK 10:

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WEEK 11:

Student should assist on performing PFT's on patients. Students should also be observing cardiac stress testing when possible. Student should turn in all completed proficiency evaluations on pulmonary function studies. Case studies are to be completed and turned in.

WEEK 12:

Note: A clinical preceptor must always directly supervise the following procedures: Intubation Extubation Arterial Puncture Arterial Line Insertion Securing Artificial Airway

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CLINIC III PLAN (RET 2834)

OBJECTIVE: Upon completion of RET 2834 (Clinic III) the respiratory student will be able to draw and interpret ABG's, maintain the blood gas analyzer, prepare and apply adult ventilators to patients, perform ventilator checks, adjust ventilator parameters to stabilize arterial blood gases, apply weaning modalities where appropriate, discontinue ventilators, apply and monitor continuous positive airway pressure, and clean and rebuild ventilator circuits. WEEK 1: Students will meet at the college laboratory and become familiar with the panel controls, alarms and circuits of the Puritan Bennett 7200 and the Servo 900C. Students will be orienting to the hospital and the intensive care unit. Students should, through observation become familiar with the departments respiratory care policies and procedures, and ICU. Bedside assessment, ABG's, cuff maintenance, and treatments in the ICU should be emphasized. Students should flowsheets, and ventilator checks. Students will perform nebulizer therapy, IPPB, IS and CPT in the intensive care setting (on at least two patients). Students should also perform ABG sticks, observe blood gas analysis and perform ventilator checks and bedside ventilator weaning parameters under direct supervision by the clinical preceptor. Students must meet and comply with all specific hospital regulations prior to performing arterial punctures under supervision. Students are expected to complete one "Adult ICU Patient Work-up" sheet each day of clinic and complete a ventilator flowsheet for each ventilator patient they take care of beginning this week. Students are assigned to the ICU with primary responsibilities revolving around the treatment of ICU patients. Routine therapy, airway management, suctioning, taping, cuff management, extubation and ventilator assessment are to be emphasized. (No more than 2 patients). Students are expected to be performing ABG's and observing blood gas analysis. Students are required to disassemble and assemble at least one ventilator this week and complete proficiency evaluation in a non-patient setting. Students may complete proficiency evaluation for ventilator checks and changes in a non-patient setting. Students may be assigned one ventilator patient this week.

WEEK 2:

WEEK 3:

WEEK 4:

WEEK 5 & 6: Students are to be performing arterial punctures and interpretation. Students should continue routine treatments in the ICU, process ventilator equipment and perform ventilator checks and/or changes under supervision. Students should complete two of the following proficiency evaluations this week (bedside assessment, ventilator assembly, ventilator checks) pending proficiency check offs. WEEK 7 & 8: Students are to be assigned up to two mechanically ventilated patients and are to provide comprehensive respiratory care for those patients under preceptor

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supervision. Students should assist therapists with circuit changes and complete ventilator circuit change proficiency. WEEK 9: Students will be oriented to their new clinic site and the ICU this week. They should begin to familiarize themselves with any ventilators not used in the previous clinic site. Students will observe the ICU therapist in performing ventilator care and checks. Students should be familiar with any ventilators not utilized in the previous clinic site. Students must select a patient for a case study this week. Students are to be assigned ICU routine therapy (limit 10-12 procedures) ABG's and ventilator checks. Students are to be assigned to ICU for routine therapy, ABG's, airway management and ventilator checks. Ventilator assembly and check should be mastered this week on ventilators used by this facility. Students are to be assigned one mechanically ventilated patient, and will be responsible for performing all associated respiratory care procedures (under preceptor supervision). Students will continue working with mechanically ventilated patients (up to two). Students will work on completing proficiency evaluations for ventilator checks and circuit changes. Students should be completing proficiency evaluations. All proficiency evaluations are due by the end of the 15th week. Students will continue management of mechanically ventilated patients. All proficiency evaluations and case studies should be done. Students will continue management of ventilators. Up to three vents maximum or two vents with extra ICU procedures or beeper. Complete any unfinished over due proficiency evaluations. Present case studies as scheduled. Submit all clinical logbooks.

WEEK 10:

WEEK 11:

WEEK 12:

WEEK 13:

WEEK 14:

WEEK 15:

WEEK 16:

NOTE: In addition to the activities delineated in the clinic plan, students will also be required to review chest x-rays of ventilator patients and participate in ICU physician rounds on a daily basis. Students are also required to obtain a minimum of 10 physician contact hours for this semester.

A clinical preceptor must always directly supervise the following procedures:

Intubation Extubation Arterial Punctures Arterial Line Insertion Securing Artificial Airway 63
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CLINIC IV PLAN (RET 2835)

OBJECTIVES: Upon completion of RET 2835 (Clinic IV), the respiratory student will be able to provide total respiratory management of adult, pediatric, and neonatal patients. In addition to this the student will be able to establish a respiratory care plan, make assignments and be familiar with technician and therapist criteria evaluations. Emphasis will be placed on critical care of pediatric and neonatal patients, ECG, x-ray and hemodynamic monitoring of all patients and special rotations in hyperbarics, home care, sub-acute care, pulmonary rehabilitation, bronchoscopy and cardiac catherization. The clinic will meet two days per week (2-12 hour shifts, Monday and Wednesday) and additional time will be scheduled for special rotations. WEEK 1: Students will be orienting to the hospital including critical care and nursery units. Students will become familiar with any new equipment including oxyhoods, croup tents, ET tubes and infant ventilators. Students should be familiar with the department's policies and procedures, and with ICU and nursery policies. Students should observe any neonatal, infant, or pediatric emergencies. Students should be observing A-line sampling, pulmonary artery sampling and any hemodynamic profiles. Students will be taking a single ICU ventilator patient and providing comprehensive care for that patient. Students need to complete one "Adult ICU Work-up Sheet" per day. Students should also keep a hard copy ventilator flowsheet for each ventilator patient. Again, students should observe all neonatal, infant, or pediatric emergencies and hemodynamic profiles. Students should also be learning how the workload is established and how daily assignments are delegated. Students should be able to care for up to two ventilator patients as the opportunity arises. Students should draw from A-lines and assist in obtaining hemodynamic parameters and calculating any related values. From this point on the students should participate in any neonate/pediatric and adult emergencies. Students should take two ventilators and start taking call for their assigned area if possible. Students are to include ECG strips and a hemodynamic profile, where possible, with the adult ICU patient work-up sheet. Students should also be responsible for computer work where indicated. Students will be responsible for up to 3 ventilators (under supervision) and be responsible for all therapies, charting and communication with physicians and nurses and charging for therapies where appropriate. Students should be completing all proficiency evaluations.

WEEK 2:

WEEK 3:

WEEK 4:

WEEK 5:

WEEK 6-8:

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WEEK 9-16: Students should be choosing a candidate for their case study at this time (candidates should have a complete hemodynamic profile). Students will continue to manage 2-3 ventilator patients and work in the critical care setting until completion of the semester.

NOTE: In addition to the activities delineated in the critical plan, students will be required to review chest x-rays of ventilator patients and participate in ICU physician bedside rounds. Students are required to maximize bidirectional physician student communication. Students will submit a physician evaluation form this semester. A clinical preceptor must always directly supervise the following procedures: Intubation Extubation Arterial Punctures Arterial Line Insertion Securing Artificial Airway

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Clinical Preceptor Evaluation

Students are responsible for completing an annual clinical preceptor evaluation to confirm preceptors are functioning in conjunction with specific objectives. The following is a sample clinical preceptor evaluation form.

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Name: _________________________________ Clinical Rotation: ________________________ Facility: ________________________________ Semester/Year: __________________________

CLINICAL PRECEPTOR EVALUATION

Clinical Preceptors will be evaluated annually to confirm preceptor is functioning in conjunction with specific objectives. 1 - Poor 2 - Fair 3 - Good 4 - Excellent Score 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Assist student in performance and perfection of clinical skills Assist students to adjust to the hospital setting Acts as a professional role model Provide constructive criticism (positive & negative) Act as a resource person for students during clinical Correlate students assignment with weekly clinical plan and objectives Monitor students progress Evaluate affective behavior weekly Perform proficiency evaluations and oral review Participate in midterm and final clinical evaluations

Evaluator:

__________________________________________

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Clinical Facility Evaluation

Students will be required to complete an evaluation of each clinical facility in an effort to assess the ability of the clinical site and employees to help meet the objectives of the respiratory care program and clinical rotation. The results of this evaluation will be shared with the advisory board annually.

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Indian River State College Department of Respiratory Therapy CLINICAL FACILITY EVALUATION Date: Directions: Indicate the appropriate number of your response in the blank provided. 1. Academic Term 1 Fall 2 Spring 1 RET 2832 3 RET 2834 1 2 3 4 5 6 7 3 Summer I

2.

Course

2 RET 2833 4 RET 2835

3.

Clinical Facility

Martin Memorial Hospital St. Lucie Medical Center Lawnwood Regional Medical Center Raulerson Hospital Indian River Memorial Hospital Martin Memorial South Holmes Regional Medical Center

Directions: Place the number that best describes your assigned clinical facility on the line to the left of each statement 1 Poor 3 Good 2 Fair 4 Excellent 1. 2. 3. 4. 5. 6. 7. 8. 9. Hospital and departmental orientation for students. Accessibility of the departmental procedure manual. Availability of equipment to perform procedures efficiently. Ability to apply lecture/lab objectives to patient situations in the clinic. General attitude of the majority of the RT staff presented towards you. General attitude the hospital staff presented towards you. Availability of the RT staff. Overall opportunity to develop clinical skills. Please use the following space to comment on any additional positive or negative aspects of the rotation. (Continue on back if necessary.)

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Confidentiality of Records
Any form completed concerning a student's progress (i.e. preceptor evaluation, competency form, attendance record, etc.) is considered confidential. All of these records must be kept in a secured location. A student may have access to their records, but not to other student's records.

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