UNIVERSITY OF LA SALETTE COLLEGE OF NURSING SANTIAGO CITY

CLINICAL FOCUS LEVEL IV (BSN 4-B) ST 1 SEMESTER SY 2012-2013

MUNICIPAL HEALTH OFFICE RAMON, ISABELA

PREPARED BY: JOSETTE CUMARAT-LIWANAG, RN, MSN CLINICAL INSTRUCTOR

UNIVERSITY OF LA SALETTE COLLEGE OF NURSING SANTIAGO CITY

I. HOSPITAL PROFILE Municipal Health Office of Ramon is located at Bugallon Norte, Ramon, Isabela and is a primary level of Health Care Delivery System implementing the different DOH program and services. It caters services to the families of the 19 barangays of the said municipality.

II. DESCRIPTION OF LEARNERS The learners are Level IV students currently enrolled in NCM 106 Care of Clients with Problems in Cellular Aberrations, Acute Biologic Crisis including Emergency and Disaster Nursing with ages 19-32 years old. They were previously exposed to the different hospitals and have undergone community activities. They have handled patients with different disease entity in various hospitals the college is affiliated with. Students have satisfactorily completed the requirements of NCM 100, 101, 102, 103, 104 and 105. They have backgrounds on Anatomy and Physiology, Theories of Nursing, Health Assessment, Nutrition and Diet Therapy, Biochemistry, Health Education, Pathophysiology and Pharmacology.

III. CLINICAL HOURS/EXPERIENCE The students are expected to complete 96 hours of related learning experience in the area. They will report in the hospital 8 hours for 3 days every Thursday, Friday and Saturday for 4 weeks at 7am to 3pm shift.

IV. FOCUS FOR CLINICAL EXPERIENCE Perception and Coordination Disturbance in Cellular Functioning The Client in Acute Biologic Crisis The Client in Emergency and Disaster Situation

V. COURSE OBJECTIVES At the end of rotation the student should be able to: 1. Utilize the nursing process in the care of individuals and families in the community setting. 2. Ensure a well-organized and accurate documentation system. 3. Relate with client/s and their family and the health team appropriately. 4. Observe bioethical concepts/principles, core values and nursing standards in the care of clients/families. 5. Promote personal and professional growth of self and others.

VI. ORIENTATION 1. Explain the objectives of the community exposure, requirements and activities to the students. 2. Familiarize with the different programs/services and set-up of the MHO.

3. Explain the method of evaluation. Performance Evaluation Case Study/Presentation Quizzes Evaluation Exam Requirements TOTAL VII. REQUIREMENTS

- 60% -15% - 5% - 10% - 10% = 100%

1. Make nursing care analysis of one patient/family of either type and discuss it with the clinical instructor either individually or group. 2. Passed quizzes during the rotation period. 3. Passed the evaluation examination at the end of the rotation. 4. Participates in an informal conference and discussion as scheduled. 5. The students will perform nursing care to assigned patients/families and will include: Monitoring and recording vital signs. Performing health assessment. Providing safe and conducive environment for the patient/family. Providing health education. Preparing and administering medications/vaccines. Performing nursing procedures. Carrying out doctors orders. 6. The students are required to participate and contribute their effort in the accomplishment of the group case study and presentation. 7. All requirements must be done with quality and must be submitted on or before the deadline. VIII. EVALUATION 1. Sharing of learning experiences by the students and giving of observations, suggestions regarding the activities done. 2. Case study 3. Family/community nursing care plan 4. Written examination 5. Evaluation of self, group, community area and instruction at the end of the clinical rotation. IX. SCHEDULE OF DAILY ACTIVITIES Every 1st day of duty in a four week rotation (Thursday) TIME 6:45 07:30 7:30 08:30 8:30 12:00 12:00 01:00 1:00 01:30 1:30 02:30 2:30- 4:00 ACTIVITIES Assembly and travel time Checking of attendance, uniforms and paraphernalias Orientation and review of the DOH programs with MHO staff LUNCH BREAK Briefing and physical orientation at the MHO set-up Briefing and designation of area (admitting, dental, laboratory and treatment) Planning and coordinating of activities with the Rural Health Midwife of the Barangay

Friday (First Week) 6:45- 8:00 8:00- 12:00

Assembly/Travel time Admitting Area: Admit patient, collection of data and vital Signs taking Dental: Collection of data and vital signs taking, assisting tooth Extraction Laboratory: Assist the staff in the collection of specimen Treatment Area: Assist/Apply basic nursing skills (nebulization; Removal of sutures; I and D; wound dressing; drug administration- oral, ID, IM, and SC); documentation 12:00- 1:00 Lunchbreak 1:00- 2:00 Resume of activities 2:00- 4:00 Discussion and quiz on scheduled topics

Saturday (First Week) 6:45- 8:00 8:00- 9:00 9:00- 10:00 10:00- 12:00 12:00- 1:00 1:00- 2:00 2:00- 4:00

Assembly time/ Travel time Courtesy Call Home visit/ ocular inspection Planning of activities with the family Lunchbreak Collating of data collected/ FNCP/CNCP making Discussion/ Lecture/ Post- conference

Thursday and Friday ( Second and third Week) 6:45- 8:00 Assembly/ Travel time 8;00- 12:00 Resume activities ( Admit patient, collection of data and taking Vital signs, apply basic nursing skills); health teachings 12:00- 1:00 Lunchbreak 1:00- 2:00 Resume activities 2:00- 4:00 Discussions/ lectures/ quizzes

Saturday ( Second and Third Week) 6:45- 8:00 Assembly/ Travel time 8:00- 12:00 Integration at the selected Barangay and family ( Mothers class, small group discussions), Implementing FNCP 12:00- 1:00 Lunchbreak 1:00- 4:00 Resume activities ( Discussions/ lectures/ quizzes), post-conference

Thursday and Friday (Fourth Week) 6:45- 8:00 Assembly/ Travel time 8:00- 12:00 Resume of daily activities 12:00- 1:00 Lunchbreak 1:00- 4:00 Preparation for case presentation (editing of output and dry run), socialization

Saturday (Fourth Week) 7:00- 3:00 Case presentation and Evaluation Exam

X. TEACHING PLAN NO. OF HOURS

WEEK 1

SPECIFIC OBJECTIVES At the end of first week the students will be able to: a. Familiarize with the policies, regulations, vision-mission and setup of the MHO, Ramon.

ACTIVITIES

1. General orientation 4 hours of students and clinical instructors with the MHO staff. 2. Lecture/discussion about assessment of patients with cellular aberrations. Ref: Medical-Surgical Nursing by Brunner & Suddarth Textbook on Medical Surgical Nursing by Boyer

b. Review and identify the appropriate nursing assessments to clients with cellular aberrations.

3 hours

After 3 days, the students will be able to: a. Demonstrate ability in applying appropriate principles and techniques of physical examination in newborn, children and adults deviation from normal.

1. Students actual performance of assessment of clients condition/health status through interview and physical examination. 2. Perform effective nurse-patient interaction through the use of effective therapeutic communication. 3. Maintain good interpersonal relationship with clients, colleagues and other members of the health team.

1.5 hours

b. Show positive and approachable relations towards client and significant others, other members of the health team and the clinical instructor.

1.5 hours

1 hour 3 At the end of the 3rd week, the students will be able to: a. Assess client/s condition through interpretation of laboratory findings/results and implications. 1. Chart reading and interpretation of the clients laboratory findings. 1 hour 2. Students sharing/reporting

individual clients laboratory findings and implications. 1 hour 3. Students observation of the diagnostic /laboratory examinations in the laboratory area.

1.5 hours 4 At the end of the 4 week, the students will be able to: a. Observe/practice bioethical concepts/principles, core values and nursing standards in the care of clients.
th

1. Lecture /discussion about the clients/patients rights. Ref: Fundamentals of Nursing by Kozier 1 hour 2. NPI to selected clients/families by utilizing effective therapeutic communication. 30 mins 3. Evaluation of self, by peer and by the clinical instructor and sharing of clinical experiences.

b. Promote personal and professional growth of self and others.

3 hours 5 After 3 days the students will be able to: a. Identify and apply principles of management for altered cellular aberrations and its causes. 1. Lecture /discussion of the Journal Reading on the principles of management of altered cellular aberrations.

2 hours 6 After 2 weeks, the students will be able to: a. Determine and apply the management of causes of cellular aberrations. 1. Journal reading/sharing/ reporting about the management of causes of cellular aberrations.

1 hour

2. Observing and assisting clients

undergoing management.

2 hours 7 At the end of the week, the students will be able to: a. Apply standard assessment of the critically ill or clients with acute biologic crisis which focused on history takings. 1. Students assessing/observing critically ill clients in the community. 2. Sharing of outputs of assessment with the group. 1 hour

1 hour 8 At the end of 4th week, the students will be able to: a. Identify and be familiarize with the different laboratory examinations of clients in acute biologic crisis or with multi-organ problem. 1. Journal reading/reporting on the different laboratory examinations of clients in acute biologic crisis. 2 hours 2. Observing and assisting in the different laboratory examinations of clients in acute biologic crisis/multi-organ problem.

At the end of 1st week, the students will be able to: a. Identify appropriate nursing diagnosis pertinent to problems/alterations in cellular aberrations and acute biologic crisis.

1.5 hours 1. Require students to bring their own NANDA and formulate appropriate nursing diagnosis to clients in cellular aberrations and acute biologic crisis. Ref: NANDA 2. Sharing of outputs with the members of the group and clinical instructor.

1.5 hours

1.5 hours

10

At the end of the week, the students will be able to: a. Determine/identify how to manage the causes of acute biologic crisis/multi-organ failure and identify the different life-saving interventions needed.

1. Journal reading/ reporting on the management of causes of acute biologic crisis/multi-organ failure and lifesaving interventions. 2. Lecture/discussion with the students about the management of the causes of acute biologic crisis and the different lifeinterventions needed.

1.5 hours

1.5 hours

11

After 3 weeks, the students will be able to: a. Apply the different management of the causes of acute biologic crisis including psychosocial and behavioral interventions.

1. Actual psychosocial and behavioral interventions of 1.5 hours students to clients through NPI.

1. Require students to bring their own drug handbook.

12

At the end of rotation, the students will be : a. Able to identify and be familiar with the different pharmacologic interventions/management of clients with cellular aberrations and in acute biologic crisis.

2. Assign students drugs/medications for drug study. 3. Sharing of outputs with the group.

1 hour

2 hours

1. Lecture/discussion on the different nursing responsibilities for clients undergoing surgical and special

3 hours

procedures. Ref: Medical Surgical Nursing by Brunner &Suddarth Textbook of Medical Surgical Nursing by Boyer

13

After 3 days the students will be able to: a. Identify and apply the nursing responsibilities for clients with cellular aberrations undergoing minor surgical and special procedures.

1. NPI with clients who will undergo surgical and special procedures. 2. Observation of cases/special procedures.

1 hour

2 hours

1.5 hours

14

At the end of the week, the students will be able to: a. Apply the different principles and concepts of bioethics in the care of clients.

1. Journal reading/sharing with the group about the concepts of bioethics in the care of clients. 2. Observing students doing their NPI and conferences.

1.5 hours

1 hour 15 After 3 weeks, the students will be able to: a. Acknowledge /identify the different types of emergency. 1. Students will observe and assist in the management of emergency cases in the admission and observe the nurses role in emergency.

1 hour

b. Apply appropriate nursing interventions to clients who are in emergency situation.

16

At the end of rotation, the students will be able to:

1. Research/review/ discussion about

a. Identify the nurses role in disaster and emergency.

fluids and electrolytes. Ref: Medical Surgical Nursing by Brunner & Suddarth Medical Surgical Nursing By Boyer 2. Return Demonstration on insertion of IV catheter and administration of IVF.

1 hour

b. Familiarize with the different fluid and electrolyte therapy.

c. Demonstrate ability and develop self-confidence in the care of clients who are undergoing IVF therapy.

Prepared By:

JOSETTE CUMARAT-LIWANAG, RN, MSN Clinical Instructor