San Jose State University

School of Nursing
NURS 147B-Practicum IV-3 Units
Section: 10 _ Clinical Day (s): Thursday _____ Meeting Time: 9-4:30
Class Location: Cambrian Center 2360 Samaritan Place San Jose 95124
Professor's Name: Dr. Lisa Rauch RN, APHN-BC, DNP
Office (Number/Location): HB404
Office Telephone: 408-924-1347 / Cell# 408-391-1809
Email Address: Lisa.Rauch@sjsu.edu / Lisa@rauchcc.com
Office Hours & Days: Fridays by appointment only

COURSE DESCRIPTION
Applies nursing process to care of clients from diverse populations in the community in
a variety of settings. A systems approach to caring for individuals and groups across the
life span with community health care needs.
PREREQUISITES
Completion of Semester 4 or Bridge Semester.
COREQUISITES
NURS 127B and NURS 137.
REQUIRED
NURS 147B core course reader and section course reader.
NURS 1l7B required references.
Other materials/supplies/equipment as required by faculty members.
COURSE OBJECTIVES
Upon completion of this course, the student will:
1. provide nursing care according to the guidelines of the Nurse Practice Act, the ANA

Standards of Community Health Nursing, and the agency;

2. provide nursing care in a safe, age and culturally-sensitive manner;

3. demonstrate effective oral and written communication skills;
4. manage a caseload with complex needs in a community setting;
5. use the research process and information technology to gather information and to

implement and document nursing care for clients;

6. independently assume responsibility to formulate and implement personal learning

objectives which demonstrate an understanding of professional behavior;

7. conduct a (n) assessment (s);
8. analyze data from assessment (s);
9. based on priority nursing diagnosis and in collaboration with clients, families, groups,

community and other health team members, formulate/revise plan of care;

10. evaluate client outcomes; and
11. critically analyze complex community health nursing situations.

COURSE REOUIREMENTS
The following requirements have been designed to help the student meet the above
objectives:
1. written and evaluated personal objectives;
2. participation in designated activities such as assessments, teaching, community
surveys, leadership/professional activities, and community service (see course
calendar);
3. manage a case load with complex needs;
4. provide written and oral documentation and do presentations;
5. complete the Program Achievement Tool; and
6. complete midterm and final course and personal self-evaluations.

TEACHING STRATEGIES
Guidance of clinical learning experiences. Individual and group conferences and
presentations.
EVALUATION AND GRADING
The student is required to meet all course objectives satisfactorily and safely as
specified on this greensheet and the practicum evaluation tool in order to receive a
grade of credit (CR). Guidelines for safe student practice are regulated by the LAWS

relating to Nursing Education, Licensure-Practice, California State Nurse Practice Act,

agency policies, and the current Handbook for Student Nurses. Satisfactory completion
of (a) specified written assignments, (b) written midterm and final evaluations of clinical
performance, and (c) all learning activities are required for a grade of credit. Failure of a
practicum course halts progression until the course is successfully repeated for credit.
In addition, unsafe nursing behaviors, documented by the faculty member, will be
sufficient cause for a grade of no credit (NC).
Poor attendance, chronic tardiness, or late papers/charting/logs will contribute to the
assignment for a no credit grade.
If a student is to be absent from the practicum area, it is the student's responsibility to
notify the appropriate persons prior to the assignment time, and such absence may
result in an inability to meet course objectives (thus, unsatisfactory progress in the
course). An alternate course of action for absenteeism will be negotiated between the
faculty and the student based upon agency policies, safe practice, and the student's
ability to meet the objectives. The purpose is one of mutual decision making with the
faculty having the final approval of any course of action and progression in the course.
ACADEMIC INTEGRITY
Academic integrity statement (from Office of Judicial Affairs): Your own commitment to
learning as evidenced by your enrollment at San Jos State University, and the
University's Academic Integrity Policy required you to he honest in all your academic
course work. Faculty is required to report all infractions to the Office of Judicial Affairs.
All SJSU policies in the Catalog, Schedule of Classes and Academic Senate apply to
this course.
(See http://info.sjsu.edu/static/catalog/policies.html)
Please note the Academic Integrity policies, SO2-4 and SO3-7, can be found at
(http://sa.sjsu.edu/download/judicial/AcademicDishonestyPolicy.pdf
Plagiarism policy can be found at (http://www2.sjsu.edu/leap/plagiar.htm) Please refer to
this policy when completing assignments for this course.
COURSE ACCOMODATIONS
Campus policy in compliance with the Americans with Disabilities Act: If you need
course adaptations or accommodations because of a disability or if you need special
arrangements in case the building must be evacuated, please make an appointment
with me as soon as possible, or see me during office hours, Presidential Directive 97-03
requires that students with disabilities register with DRC to establish a record of their
disability.

The university is committed to providing reasonable academic accommodations to

students with disabilities. The DRC is located at One Washington Square, San Jose, CA
95192-0168. Voice mail: 408-924-6000, TTY: 408-924-5990, FAX: 408-924-5999.
POLICY STATEMENT ON PRE-CLINICAL DOCUMENTATION
All students must submit copies of documentation required by the School of Nursing to
the faculty before participating in any clinical experiences.
DISRUPTIVE CLASS BEHAVIOR
In the classroom environment, you must respect the rights of others seeking to learn,
the professionalism of the faculty, and the differences of viewpoints. Student conduct
that disrupts the learning process shall not he tolerated and may lead to disciplinary
action and/or removal from class.
STUDENT ENROLLMENT STATUS
Individual students are responsible to ensure that they are properly enrolled in class by
the census date for the semester. Students are not able to add courses after the census
date.
COURSE READER SUBJECT TO CHANGE
The course reader is subject to change in the event of extenuating circumstances.
Students absent from class are responsible for obtaining information presented in class.
NURS147B/Greensheet Rev 08/01/06

Standardization of Nursing Students Apparel and Related Issues including 12

Standards
Standard 1 Grooming:
Impeccable (i.e., daily bathing, clean hair, clean uniforms, clean shoes,
etc.)

Standard 2 Jewelry:
Rings - 1 simple
Earrings - 2 pairs per ear (maximum) only; small studs only
Necklaces - none visible
Bracelets - none
Watch - with second hand or digital
Standard 3 Hair:
Conservative style and color, no bright colors (e.g., purple, green); midlength:
pinned or pulled back behind ears; long hair: back and off collar, hair
accessories to match hair color; men: short mustaches and short, cropped
beards permitted
Standard 4
Make-Up: Conservative
Standard 5
Body Piercing/Tattoos:
Nothing visible (remove and/or cover with band aids and/or clothing) Standard 6
Artificial Nails: Not permitted
Standard 7
Nail Polish:
Nails: clean, short, and filed
Polish: clear and/or neutral colors permitted, unless agency requests no
polish

SAN JOSE STATE UNIVERSITY

SCHOOL OF NURSING
NURSING 147B
PRACTICUM IV
COMMUNITY HEALTH NURSING
STUDENT INFORMATION SURVEY
Name: _______________________________________________
PREVIOUS EXPERIENCES RELATED TO COMMUNITY HEALTH NURSING
(home visiting, contact with community groups, agencies, etc.)
EXPECTATIONS OF COMMUNITY NURSING PRACTICUM
1. What are your concerns, apprehensions, fears?

2. In what areas of Community Health Nursing are you most interested? (Specific age

groups, health problems, etc.)

SELF ASSESSMENT &: LEARNING STYLES

1. What do you do to help yourself learn?
2. What are your professional strengths?
3. What teacher behaviors facilitate your learning?
4. What teacher behaviors inhibit your learning?

OTHER COMMITMENTS DURING THE SEMESTER

(Employment, family. commute, other activities. and anticipated events or problems)

OTHER INFORMATION - COMMENTS Is there anything else that you think I need to
know or that you would like to tell me in relation to your participation in this practicum?

Semester 7
Outcome Objectives
HURS 147B COMMUNITY HEALTH NURSING EXPERIENCE
By the end of the experience in the community health settings, the students will be able
to:
Week 1 and 2
1. Identify resources tor health care information and education.
2. Complete their self-assessment and formulate their personal learning objectives.
3 Familiarize themselves with the goals and organizational structure of the clinical
settings.
4 Discuss the types of clients serviced by the clinical setting.
5 Discuss the goals and organization of the community health clinical rotation.
6 Develop an activity plan for the semester. .
7. Identify effective strategies for entering a client's home.
8. Explore personal attitudes, values, and beliefs related to the community health setting.
9. Conduct a cursory survey of the community.
10.
Recognize committee health practices as a' means of meeting needs of
individuals, families, groups and the community.
Week 3 and 4
1. Identify strategies for personal and client safety.
2. Conduct home visits.
3. Complete documentation for visits.
4. Conduct a safety evaluation of the client's home and neighborhood.
5. Collect pertinent health data using appropriate assessment techniques and tests.
6. Identify community resources for their clients.
7. Analyze client's assessment data and determine the potential or actual health problems.
8. Identify the multidimensional facets of client's problems and possible solutions.
Week 5
1. Formulate a care plan based on systems framework appropriate to their assigned
clients.
2. Utilize the ANA standards of community health nursing.

3. Implement the care plan in collaboration with a health care team and community
resource personnel.
4. Evaluate the care plan and case management strategies and revise as necessary.
5. Identify appropriate case management strategies.
6. Utilize a cultural assessment model to obtain data.
Week 6
1. Initiate referrals.
2. Identify appropriate health teaching resources.
3. Develop a teaching plan for individuals and/or groups.
4. Identity measurable outcome criteria.
5. Assume a leadership role in health promotion.
6. Recognize need for change or improvement in learning behavior.
Week 7
1. Complete mid-term self-evaluation and meet with instructor.
2. Participate in agency activities and conferences.
3. Continue client visits, assessments, and referrals.
4. Present community survey data. The actual week of the presentation may vary
according to rotation schedule.
5. Identify specific needs, problems and resources for target populations.
6. Continue community assessment locating community resources for clients.
7. Evaluate a community resource's appropriateness for a client referral.
Week 8-13
1. Explore alternative ways of implementing interventions to achieve stated goals.
2. Collaborate with client and other team members to establish mutual, realistic, short and
long-term goals.
3. Evaluate the client's progress toward attainment of outcomes.
4. Manage a caseload of clients and/or families with complex needs.
5. Adapt their care plan and case management strategies to reflect clients perceptions
and beliefs.
Week 13-14
1. Prepare self, clients, families and staff for termination.

2. Evaluate the effectiveness of their case management strategies and plan of care.
3. Reflect how their own beliefs have impacted their nursing practice.
4. Evaluate the status of their client and make appropriate referrals.
5. Document a final or summative evaluation of the client's status.
6. Independently seeks to broaden own knowledge base in the implementation of
community health nursing skills.
Week 15
1. Complete final self-evaluation and meet with instructor.
2. Evaluate achievement of own learning goals.

SAN JOSE STATE UNIVERSITY

SCHOOL OF NURSING
NURSING 147 B
PRACTICUM IV
COMMUNITY HEALTH NURSING
BEHAVIORAL EXPECTATIONS
BEHAVIORS THAT THE INSTRUCTOR CAN EXPECT FROM THE STUDENTS:
The student will:

Arrive on time to the clinical seminars and practicum

Complete assignments on time
Seek advice and consultation from the instructor when unclear about clinical practicum
or assignments
Act independently in arranging clinical time with preceptor
Act in professional manner at all times
Put personal safety above any clinical requirements
BEHAVIORS THAT THE STUDENTS CAN EXPECT FROM THE INSTRUCTOR:
The Instructor will:

Be available for consultation and advisement during clinical seminars and clinical
practicum time, and if unavailable provide students with name and location of a back up
instructor
Provide structured and unstructured situations for learning
Provide continued feedback on course requirements
Return written assignments within a reasonable time
Monitor the students activity by discussions/communications to assess the students
progress
Arrange for clinical settings.
Act as a liaison between the student and the clinical agency and/or agency contact as
needed
Provide for a midterm evaluation
Provide site and client visit for monitoring purposes.
Provide for a formal evaluation at final conference time during finals week

10

Blooms Taxonomy
Knowledge
List
Name
Identify
Show
Define
Recognize
Recall
State
Visualize

Comprehension
Summarize
Explain
Interpret
Describe
Compare
Paraphrase
Differentiate
Demonstrate
Classify

Application
Solve
Illustrate
Calculate
Use
Interpret
Relate
Manipulate
Apply
Modify

Analysis
Analyze
Organize
Deduce
Contrast
Compare
Distinguish
Discuss
Plan
Devise

Synthesis
Design
Hypothesize
Support
Schematize
Write
Report
Justify

Evaluation
Evaluate
Choose
Estimate
Judge
Defend
Criticize

This table provides appropriate verbs to use in writing student behavioral objectives for
the clinical setting. Students need to focus on the Application through Evaluation levels
when developing personal learning objectives for the semester. Kemp (1977) cites
additional verbs applicable to the various levels of the cognitive domain:
1. Knowledge: arrange, duplicate, label, memorize, order, relate, repeat, reproduce
2. Comprehension: discuss, express, identify, indicate, locate, recognize, report, restate,
review, select, tell, translate
3. Application: choose, demonstrate, dramatize, employ, operate, practice, schedule,
sketch, use
4. Analysis: appraise, categorize, critique, diagram, differentiate, discriminate, examine,
experiment, inventory, question, test
5. Synthesis: arrange, assemble, collect, compose, construct, create, formulate, manage,
organize, plan, prepare, propose
6. Evaluation: appraise, argue, assess, compare, defend, predict, rate, score, select
support, value
Objectives can also be addressed in the Affective Domain (emphasizing feelings and
emotions) and the Psychomotor Domain (focus on motor skills).
An example of a measurable objective in the Affective Domain is: The student will
verbally EXPRESS feelings of increased comfort when providing care to clients in the
home setting. (Expression of feelings of increased comfort is measurable)
An example of the Psychomotor Domain is: The student will auscultate at least 3 blood
pressures with 100% accuracy.
SAN JOSE STATE UNIVERSITY
SCHOOL OF NURSING
NURSING147B

PRACTICUM IV
COMMUNITY HEALTH NURSING
WINDSHlELD OR WALK1NG COMMUNITY ASSESSMENT SURVEY
(View videotape #244 in the NLRC prior to beginning this activity)
OBJECTIVES:
1. Conduct a windshield or walking community assessment survey
2. Identify possible community needs for health promotion and/or health care services.
3. Identify possible target populations
4. Identify health hazards in the community
5. Prioritize the health care needs
6. Develop possible strategies for meeting health care needs
OBSERVATIONS:
PHYSICAL ENVIRONMENT (dwellings, undeveloped areas, open spaces, commercial
spaces, industry):

NEIGHBORHOODS (describe what you observe-how would you describe the

neighborhood and the population):

RESOURCES (do non-health and/or health care resources exist in the area? Are they
accessible to the residents of the area?Includes churches, schools, etc.):

Possible health services to provide:

Refer to Stanhope & Lancaster (2004), page 357 for a detailed guide in completing this
activity.

12

SAN JOSE STATE UNIVERSITY

SCHOOL OF NURSING
NURSING 147B PRACTICUM
IV
AMERICAN NURSES ASSOCIATION SCOPE AND STANDARDS
FOR PUBLIC HEALTH NURSING
Standards of Care
Standard I. Assessment: The public health nurse assesses the health status of
populations using data, community resources identification, input from the
population, and professional judgment.
Standard II. Diagnosis: The public health nurse analyzes collected assessment data and
partners with the people to attach meaning to the data and determine
opportunities and needs.
Standard III. Outcome Identification: The public health nurse participates with other
community partners to identify expected outcomes in the populations and their
health status.
Standard IV. Planning: The public health nurse promotes and supports the development
of programs, policies, and services that provide interventions that improve the
health status of populations.
Standard V. Assurance: Action Component of the Nursing Process for Public Health
Nursing: The public health nurse assures access and availability of programs,
policies, resources, and services to the population.
Standard VI. Evaluation: The public health nurse evaluates the health status of the
population.

ANA SCOPE AND STANDARDS FOR PUBLIC HEALTH NURSING (cont.)

Standards of Professional Performance
Standard I. Quality of Care: The public health nurse systematically evaluates the
availability, accessibility, acceptability, quality, and effectiveness of nursing
practice for the population.
Standard II. Performance Appraisal: The public health nurse evaluates his or her own
nursing practice in relation to professional practice standards and relevant
statutes and regulations.
Standard I. Education: The public health nurse acquires and maintains current
knowledge and competency in public health nursing practice.
Standard IV. Collegiality: The public health nurse establishes collegial partnerships while
interacting with health care practitioners and others and contributes to the
professional development of peers, colleagues, and others.
Standard V. Ethics: The public health nurse applies ethical standards in advocating for
health and social policy and delivery of public health programs to promote and
preserve the health of the population.
Standard VI. Collaboration: The public health nurse collaborates with the
representatives of the population and other health and human service
professionals and organizations in providing for and promoting the health of the
population.
Standard VII. Research: The public health nurse uses research findings in practice.
Standard VIII. Resource Utilization: The public health nurse considers safety,
effectiveness, and cost in the planning and delivery of public health services
when using available resources to ensure the maximum possible health benefit to
the population.
San Jose State University
The Valley Foundation School of Nursing
N147B Community Health Nursing
Clinical Evaluation
Instructor: _______________
Student: ______________
Semester Level: ___________
Clinical Site:
___________

14

School Program Outcome#1: Demonstrate critical thinking competencies, including

the use of the nursing process, the research process, ethical decisionmaking and an
attitude of inquiry.

Behaviors
Provides nursing care according to the
guidelines of the Nurse Practice Act, the
ANA Standards of Community Health
Nursing, QSEN, and the agency.
1.1 Reviews and familiarizes self with

Midterm
PE
NFE U

Final
S

a. Nurse Practice Act

b. ANA Standards of Community Health
Nursing
c. QSEN
d. Policies and procedures of agency
1.2 Demonstrates application through:
a. Documentation
b. Presentations
c. Practice
Comments

Comments

PE: Progressing as Expected

NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

School Program Outcome#2: Provide therapeutic nursing interventions for Clients.

Midterm
Behaviors

PE

NFE

Final
S

2. Provides nursing care in a safe, age and

culturally sensitive manner when interacting
with clients and other health professionals,
while in the clinical setting and when
documenting the nursing process
2.1 Provides care that is:
a. Therapeutic (beneficial, appropriate,
ethical)
b. Promotes beneficence
c. Culturally Sensitive
d.Exhibits beginning competencies of
diverse, age and culturally specific needs
and practices
Ccomments

Comments

PE: Progressing as Expected

NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

Student Program Outcome#3: Utilizes interpersonal relationship skills to develop

interactive and dynamic relationships with clients, families/caregivers, and
multidisciplinary health care team members.
Midterm
Behaviors

PE

16

NF
E

Final
S

3. Demonstrates effective oral and written

communication skills that include personal
objectives, charting, presentations,
journals, summaries and interactions with
other.
a. Clear:
b. Concise
c. Correct
d. Therapeutic
e. Appropriate
f. Timely
CComment
s

PE: Progressing as Expected

Comments

NFE: Needs Further Evaluation

U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

Student Program Outcome#4: Demonstrate Communityfocused competencies for

well and atrisk clients through health promotion and disease prevention activities.
Midterm
Behaviors
4. Manages a caseload of clients with
complex needs in a community setting,
including

a. Case management activities

PE

NFE

Final
S

b. Collaboration with other professionals

(case conferences, interdisciplinary
meetings, providing/obtaining
information, referrals.)
Comments

PE: Progressing as Expected

NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

18

Comments

Student Program Outcomes #5: Promote interdisciplinary care through

participation in community partnerships, collaborative relationships, and use
of appropriate resources.
Midterm
Behaviors

PE

NFE

Final
S

5. Uses the research process and

information technology to gather
information and to implement and document
nursing care for clients.
a. Attends workshops, conferences, or
professional meetings.
b. Participates in and/or attends health fairs.
Comments

PE: Progressing as Expected

NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

Comments

Student Program Outcome # 6: Implement holistic clientdriven primary

care which emphasizes empowerment, health education, and health
promotion.
Midterm
Behaviors

PE

NFE

Final
S

6. Independently assumes responsibility to

formulate, implement, and evaluate
personal learning objectives that
demonstrate an understanding of
professional nursing behavior.
6.1 Evaluates self on role specific behaviors
as:
a. Community Educator
b. Direct care provider
c. Researcher
d. Advocate
e. Communicator, Consultant, Case Manager
6.2 Writes personal learning objectives
a. Timely
b. Demonstrate growth over course semester
Comments
PE: Progressing as Expected
NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

20

Comments

Student Program Outcome # 7:Demonstrate flexible therapeutic nursing practice in a

rapidlychanging, multicultural health care environment.
Midterm
Behaviors

PE

NFE

Final
S

7. Conducts assessment appropriately.

a. Completes client, family, group,

and/or community assessment
appropriate to agency/problem.
b. Chooses/uses appropriate tools
c. Completes assignments in a timely
manner
d. Organizes data in a meaningful
manner.
Comments

Comments

PE: Progressing as Expected

NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

Student Program Outcome # 8: Demonstrate care management and leadership

competencies; including case management, resource management, advocacy, and
outcome evaluation.
Midterm
Behaviors

PE

NFE

Final
S

8. Analyzes data from needs assessment.

8.1 Uses critical thinking to establish
priorities.
8.2 Formulates appropriate nursing
diagnoses.
8.3 Critically analyze complex community
health nursing situations as demonstrated in
clinical conference and case presentations.
PE: Progressing as Expected
NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

Comments

Comments

Student Program Outcome # 9: Employ nursing informatics at the basic practice level to
improve healthcare delivery and outcome evaluation.

Behaviors

Midter
m
PE
NFE U

Fnal
i
S

9. Based on priority nursing diagnosis and

in collaboration with clients, families,
groups, community and other health team
members, formulates/revises plan(s) of
care that include:
9.1 Therapeutic rapport

a. Health promotion

b. Health education

c. Accident/disease prevention.
9.2 Utilize teaching, advocacy, cost
effectiveness, leadership, collaboration,
referral, case management activities, and
consultation as appropriate.
Comments

PE: Progressing as Expected

NFE: Needs Further Evaluation
U: Unsatisfactory
S: Satisfactory
Unsatisfactory Learning Objectives:

Comments

School Program Outcome #10: Demonstrate professional role competency incorporating

professional responsibilities and standards, accountability, ethical guidelines, legal
mandates, and activity within the profession.
Midterm
Final
Behaviors

PE

NF
E

10. Evaluate client outcomes based on

specifically defined criteria.

a. Physiological
b. Psychosocial
c. Functional
d. Socioeconomic
e. Spiritual
f. Safety
PE: Progressing as Expected

Comments

Comments

NFE: Needs Further Evaluation

U: Unsatisfactory
S: Satisfactory

Midterm evaluation date: __________

Final evaluation date: _____________

Faculty Signature: ________________

Faculty Signature: ________________

Student Signature: ________________

Student Signature: _______________

Additional Comments:

SAN JOS STATE UNIVERSITY

School of Nursing

N147B Section 1 -Community Health Nursing

COMMUNITY HEALTH FINAL SELF EVALUATION
Directions: Bring to the final conference all items requested by your Professor:
1. Final Community Health Self Evaluation
2. A word-processed discussion (at least 2 pages) evaluating your first half semesters goals and second
half semesters goals (hardcopy).
3. Describe how you viewed your role in this agency reflecting the parameters of the Nurse Practice Act
and how this experience expanded your concept of nursing practice.
4. Discuss briefly content that was useful from other semesters and content that would have been useful
in these semesters.
5. Discuss any information that would have been useful prior to this semester regarding the expectations
of Semester 7.
6. After the final evaluation and completion of all paperwork, you have one final tasktake the
Community Health Achievement exam during finals week. All students (Basic and RNs are to take
this exam) for the semesters requirement to be completed.

Assessment of Home Safety

When assessing the home environment, remember that assessment involves both its safety for the
client and its potential information about the persons past and present lifestyle.
Outside of Home
A) Traffic - Is there heavy traffic that can be dangerous for the children and or elderly?
B) Safety of neighborhood High crime area? May need to do home visit with a partner.
C) Clutter -Is there a lot of objects on the property?
D) Walkways -sidewalks and stairs
1. Are there raised or uneven places in the sidewalks?
2. Are the stairs in good repair?
3. Are the top and bottom stairs painted white or bright contrasting color to improve visibility?
4. Are there hand rails? Are they securely fastened?
E) Are screens on-the doors and windows in good repair?
F) Is there an alternate exit for the house?
G) Note if there are pets - esp. dogs and if they are secured.
Inside the House
A) Overall impression -cluttered (enough room for mobility), possible fire hazard, messy vs neat, dirty
vs clean.
B) Also note if there are a lot of insects - insect infestation.
C) Are scattered rugs firmly anchored with rubber backing -May need to remove loose rugs.
D) Are electrical cords in good repair? Are there loose cords that may be hazardous? Look at heating pad
cord.
E) If children are present, are safety plugs placed in sockets?
F) Light, heat and ventilation
1.
2.
3.
4.
5.

Adequate lighting
Stairway lighting
Temperature at comfortable range? - too hot or cold
Heater vented properly? obstructed or flowing easily
Cross ventilation
G) Note condition of furniture - sturdy enough to support weight

Assessment of Home Safety (continued)

1.

H) Kitchen
Stove, refrigerator and sink
a. Assess for portable cooking appliance (hot plates)
b. Stove -free of grease or flammable objects, baking soda available in case of fire
c. Are matches used or is pilot light on in gas stoves?
d. Refrigerator working? Food stored properly?
e. Sink draining well? Garbage disposal working?
f. Trash - taken out daily?
g. Height of cupboards - is there a sturdy stool available
h. Are there skid proof mats on the floor?
I) Bathroom

1.
2.
3.

Are there handrails beside the tub, shower and or toilet? esp. for elderly
Skid proof mats on floor, in the bathtub and/or shower?
Electrical outlets and appliances safely away from tub?
1. If client is compromised -is there a shower chair or portable commode or raised toilet seat
appliance? safety aids may be required to prevent falls.
J) Bedroom

1.

Can client get in and out of bed safely?

K) Emergency situations

1.
2.
3.

Is telephone coded with emergency numbers? easy access

Does patient have family, friends or neighbors who visit?
Remote control safety devices - rent monthly
Resources
Meals on Wheels
Friendly visitors
Home Health Aids / housekeepers - Home Health Agencies
Senior centers or organizations
Medicare A/B or private insurance - obtain safety devices with MD orders.
Social Workers
American Cancer Society, Red Cross, Muscular Dystrophy Assoc. - may loan or rent equipment St.
Vincent de Paul Society may be able to assist
Public Health Nurses
Emergency Food Bank

SAN JOS STATE UNIVERSITY

School of Nursing

FAMILY ASSESSMENT GUIDELINES

Semester 7 Faculty
Revised December 2003

TABLE OF CONTENTS

Page
Purpose .............................................................................................................................................1
Objectives ........................................................................................................................................1
Directions .........................................................................................................................................1
I.

Identification of Family ...............................................................................................2

II.

Individual and Family Data .........................................................................................2

III.

Assessment and Inferences ..........................................................................................5 IV. Plans of

Action ............................................................................................................5

V.

Evaluation Plan ............................................................................................................6

VI.

Results and Final Evaluation .......................................................................................6

PURPOSE:
The purpose of a Family Assessment and Planning Guide is to assist the nursing student in the
community to develop and implement a plan of care for a family. The six sections included in this
Family Assessment and Planning Guide are designed to assist the nursing student in assessing the
strengths and weaknesses of the family while determining an appropriate course of action.
OBJECTIVE:
1. Systematically describe the characteristics of a selected family within the context of the community.
2. Utilize the nursing process to assess and plan nursing care of selected family (ies).
a. Collect data.
b. Develop inferences about actual and potential health problems.
c. Develop a plan of intervention and a plan by evaluation of adequacy of intervention. d. Evaluate
results.
DIRECTIONS:
1. There are six sections included in the Family Assessment and Planning Guide. In order for the
assessment to be complete, each of the six sections must be addressed.
2. Use the Guidelines on pages 2-7 in collecting and analyzing information, and for planning your
nursing interventions.
3. Review references especially as you develop inferences about your family arid the familys health
status.

GUIDELINES FOR COMPLETING TIIE FAMILY ASSESSMENT

I.

Identification of the Family

The composition of all the family members (and their ages) who are presently living in the
household should include both kinship and non-kinship relationships. No real names should be used.
In the social history highlight the social background of each family member in order to assess
their knowledge base, financial support, and occupation. Describe the following:
A. Education
B. Income
C. Occupation

D. Marital Status
E. Ethnicity
F. Cultural Background
An assessment of the community and neighborhood will help you consider the environmental
factors that affect the selected family. It will also assist you in identifying the resources that are (or
are not) at the disposal of the client.
II.

Individual and Family Data

This section will assist you in identifying the problem areas of the family.

A family health history should be taken to assess the actions that the family has taken in the past
when one of their members was ill. This may serve as a useful barometer in determining their present
and future health care actions. Describe also the familys reasons for referral.
Assessment of the family dynamics assists the nurse in many ways. Dysfunction in Family
Dynamics is often reflected in the health status of the family as a whole or in the individual members.
Also, an understanding of family values and beliefs guides the nurse in establishing health goals and
priorities with the family. Finally, how family members relate, their roles and communication patterns
form a base and guide the planning of nursing interventions. For example, if a husband with
hypertension relates in a dominant role vis-a-vis wife and children, a need for diet change requires
that the nurse plan how the husband can direct and control this change, at least a short term strategy.
A longer-term strategy might be to assist the family to develop new roles ...
Techniques to use in assessing individual and family dynamics include interviewing,
observation, use of an interactive exercise, and making a graph of main life events from birth to now.
In describing family dynamics, include the following
A. Communication patterns
B. Leadership
C. Roles and relationships
D. Values .E. Beliefs regarding health and illness
F. Priorities
In order for the student to use the selected family as a resource for solving their own problems,
it is necessary to identify the present and potential strengths of members. Following is a useful guide
for recognizing the familys capabilities. Choose and discuss the strengths most relevant to your
family:
A. The ability to provide for the familys physical, emotional, spiritual, and cultural needs.

1. Physical -includes space management, nutritionally balanced meals, familys general health status.
2. Emotional-includes helping family member to recognize and develop their capacity for sensitivity to
each others needs.
3. Spiritual - includes sharing of basic beliefs and spiritual or religious values.
4. Cultural - includes sharing of basic beliefs and cultural values.
B. Child rearing practices and discipline.
1. The capability of both parents to respect each others views and decisions on childrearing practices.
2. If a single parent, the capacity of the parent to be consistent and effective in raising the child/children.
C. Communication
1. The ability to communicate and express a wide range of emotions and feelings both verbally and nonverbally.
D. Support, security, and encouragement.
1. The capacity of the family to provide its members with feelings of security and encouragement.
2. Balance in the pattern of family activities.
E. Growth-producing relationships.
1. The familys ability to maintain and build friendship and relationships in their neighborhood.
F. Responsible community relationships.
1. The capacity of the family members to assume responsibility through participation in social, cultural
or community activities.
G. Growing with and through children.
1. The capacity of parents to recognize that children may be a force for growth in their own lives.
H. Self-help and accepting help. .
1. The familys ability to seek and accept help when they feel they need it.
I. Flexibility of family functions and roles.
1. The ability of the family members to fill-in for one another during the times of illness or when
needed.

J. Crisis as a means of growth.

1. A familys ability to unite and become supportive during a crisis or traumatic experience.
K. Family unity, loyalty, and intrafamily cooperation
1. The ability of the family to recognize and use family traditions and rituals that retain their unity and
pride.
III. Assessment and Inferences
Following the data gathering phase and description of the family, the student makes an
assessment and formulates inferences about the familys needs and/or problems. The nurse bases the
assessment on initial reason for referral as well as assessment of Family Dynamics.
The assessment reflects the familys perception of their needs as well as the students
perception of the familys needs. Note it is the familys perception rather than anyone individual
within the family. Thus, it is the family as a group of its members that shares its perception as a
group.
To make an inference means to draw a conclusion or make a deduction based on facts or
indications. From the data collected and the assessment of a family, the nurse makes inferences. For
instance, data could be as follows: a middle aged truck driver, father of three children; wife - a clerk,
combined income of $60,000; live in Milpitas three blocks from wifes work, 10 blocks from local
hospital, 5 blocks from childrens elementary school never been sick a day in his life, wears the
pants in the family, is main decision-maker, dominant role; wife referred to as little miss; saving
money for a recreational vehicle; husband had heart attack three weeks ago been sitting at home,
drinking, very apathetic. Wife is managing the home and finances well, but is upset over husbands
atypical drinking and his bad heart. You might infer that there is a role change within this family
that necessitates planned intervention.
Inferences also allow the student to explore his or her own value judgments about the family
that may enhance or impede nursing interventions.
Inferences need to be validated. To validate something means to give evidence that will support
the conclusion you have drawn as an inference. A review of the literature, an analysis of norms, and
discussion with other persons involved in the family (relatives, service agencies) are means of
validating inferences.
IV. Plan of Action

Following the gathering of data and a well-developed assessment the nursing-student can plan
for the most appropriate intervention. The student recognizes his or her role (referrer, direct care
provider) and identifies the type of intervention (e.g., diagnostic, treatment, teaching). The student
analyzes whether action is on a primary, secondary, or tertiary level of prevention.
Once the student identifies family needs and problems, consideration must be given to the
resources available to the family, both internal and community resources. How appropriate are these
resources in meeting the familys needs/problems? Will the family be willing and able to utilize the
resources? Consider the acceptability, accessibility, and available of community resources.
V. Evaluation Plan
The nurse must construct a method for evaluating the effectiveness of the action-plan. What
will the family be able to do when their need/problem is effectively solved? The nurse needs to
consider the family here, as its member can best describe how it would be without the
need/problem. For instance, the husband/wife described in the heart attack scenario anticipates
resolution to mean no drinking, the husband returns to gainful employment in a month, and
planning a family vacation in 6 months.
It is the outcomes against which both direct interventions and/or referrals to outside resources
are measured. For instance, if as part of the intervention the student refers the husband/wife to
counseling at the Family Services of D.S.S., the effectiveness of that agency can be evaluated. This
is accomplished if the husband and wife communicate to the nurse a sense of understanding of the
impact of the illness on their roles and exhibit comfort in temporary role change.
Also, the nurse evaluates the flexibility and efficiency of the resources in meeting the needs of
the family. For instance, the agencys hours must be convenient, the agencys approach and
language must suit the ethnic and cultural characteristics of the family.
VI. Results and Final Evaluation
After the plan of action is implemented, the student compares the actual results with those
anticipated. Effectiveness then of the plan can be evaluated. If the plan called for direct
intervention, were the anticipated results achieved or, did the family utilize recommended
resources? If not, why not? If they did - how effective were these resources.
The evaluation will assist the nurse to plan future actions with the family and to build up his or her
information base about community resources that might be needed or used in the future.

Fall 2006
San Jose State
University School of
Nursing
Nurse Managed
Centers
Overview
The School of Nursing (SON) at San Jose State University (SJSU) began
developing Nurse Managed Centers (NMCs) over 15 years ago, in a
community partnership with the University and local community agencies
serving individuals in high risk populations or with special health needs.
There are currently 10 local NMCs serving individuals across the lifespan.
The focus of the NMCs is twofold. First, it provides accessible, affordable non
invasive nursing services to individuals in the community. Secondly it
provides an academic environment for clinical students in the nursing
program. This combination of service and learning which is identified as a
partnership, allows for an optimal community health nursing experience for
the students and quality health care for the clients receiving service. The
services provided include: Home visits to frail older adults, referral and
resource information, one on one health teaching, blood pressure screenings
and health promotional group activities for the community at large.
The overall goal of the Health Place is to help older adults stay in their own
homes for as long as safely possible. We offer continual support and
monitoring of existing health problems, medication and activities of daily
living, as well as conduct health assessments to identify any new health
problems that may be occurring.
NMCs are used as a community based learning experience for undergraduate
and graduate nursing students at SJSU. In addition to this effective
community service; an ongoing research study identifying patient outcomes
of community based care is conducted by the faculty at the individual sites.
SJSU NMCs provide an essential service to the underserved populations we
target. With the help of the students, faculty and a generous CDBG grant
from the Town of Los Gatos, we are able to provide continuity of care during
non academic time to all of our clients.

Home Visit Procedure

1.

Contact client by phone to set up a time before each visit.

2.

Preparation for visit:

Read clients chart to obtain a history of the clients condition/needs/nursing diagnosis.
Be prepared to do an appropriate assessment
Complete assessment and diagnosis forms
Check BP, Pulse, Resp, Lungs
Provide direct client care (Intervention)

a.
b.
c.
d.
e.
3.

In the beginning, chart after each visit (using SOAPIE format for all changes in conditions or
new nursing diagnosis on a separate sheet of paper and place it in the student box on the
top of the file cabinet. After the note has been checked, copy it into the chart.

4.

Update client Kardex and Nursing Care Plan weekly if needed. Be sure to check for correct
address and phone numbers of MD and other health resources. You are responsible for
keeping the medications and problem list up to date.

5.

Complete a weekly report on EACH client even if you dont contact then. Use the form
provided.

6.

Complete a Client Contact Form after each home visit or agency visit.
(Blue forms)

Medication Log
Medication
Dose/Route
(WNL)

Purpose /
Action

CHN
Assessment/Client
Teaching

Nursing
Evaluation

San Jose State University

School of Nursing
Resource File Development
Included in the role of the Community Health Nurse, is providing referrals to your
clients regarding local / state community resources. To develop this expertise we
will be making a mock resource file for our agency. Each student, during the
semester is required to complete two agency visit /evaluation. Fill out the
following form to add to the resource binder and use this form for your discussion
in clinical conference. Include (1) paragraph typed summary of relevance to the
older population.
Agency Name:
Address
Telephone #:
E-mail / Web site:
Contact Person:
Population Served:

Services Provided:

Fee Structure:

Date of visit: ____________

Fall 2006

San Jose State University

School of Nursing
Community Health
Student Learning Goals and Objectives
Clinical Log N147B.3
Student:

_________________________________________________

Each week you will be required to write 1 or 2 objectives for your learning. These
objectives should reflect what actions you will be trying to accomplish in the next
week. They should be focused on your learning. Starting February 3, 2008
you
will email me your goals and objectives by 5pm Sunday Night to
Lisa@rauchcc.com.
Please include the following:
Write one (1) Overall goals for the first half of this semester. (Goals are long
term and general statements that you would like to accomplish. (Ex: I want to
climb Mt Everest)

Learning Objectives: Please provide 2 or 3 learning objectives for each overall

goal (a learning objective includes an action, criteria, time frame and sometimes
condition.
(Ex. To compare and contrast (action verb) nursing roles in a community setting
(condition) surrounding agencies that work with children ages 5-12 yrs old
(criteria), by mid term (time frame).

Please include a short paragraph critically analyzing your progress towards

meeting your goals and objectives. Please explain whether you met your
behavioral objectives and goals. If not, what you might do differently to achieve
these tasks.

San Jose State University

School of Nursing

Agency Assessment
N147B
Name of Agency:
Contacts:
Population Served:
Services offered: (Detailed)

Cost for Services:

Access to Services:
Assessment of Aggregate:

Teaching and Learning Opportunities:

Health Promotion Plan:

Student(s) at Agency:
Days/ Times:
Primary Role:

Health Promotion Presentation Guidelines

San Jose State University
School of Nursing
N147B
The health promotion in agency assignment is to take place in your assigned agency. You
will need to identify and assess the population at risk at your agency. The following information
should be submitted to the instructor two weeks prior to scheduled date of program/ project. The
information should be no more than 2-pages in length and a combination of outline and
paragraph APA format. (Cite references)
PART A TO BE TURNED IN TWO WEEKS BEFORE PROJECT
1. Assessment of at risk population:
Describe your population
Include why your project is important for this population.
Describe learning style of population.
Identify which level of prevention you are working in (primary, secondary, tertiary)

2. Develop a goal and 2-4 objectives for your teaching / project:

Include which domain of learning you are working in.
3. Outline program:
Include set up your teaching environment
Materials / equipment used
Pamphlets or visuals
Type of interactive teaching strategy you will use
Content of program, diagrams, pamphlets, handouts
Describe how you plan to evaluate your program/ project
4. Implement project / program:
Arrange with agency coordinators teaching dates
Assess environment prior to teaching Conduct project / program

Health promotion activity cont.

PART B TO BE TURNED IN THE WEEK AFTER THE PROJECT

5. Summary/ Reflection: Prepare a one-page paper with the following criteria for your
classmates on the day of your presentation.
Selection of project and purpose for this aggregate
Describe project, goal and objectives
Describe barriers to implementing your project/ program
Were your goals and objectives appropriate for the population you served?
What were your planned outcomes and how did you evaluate them? Describe what you
learned from participating in this project/program What would you do differently next time?
Describe what you learned from this assignment?
This assignment should be typed in APA format and include a title page with the name of your
program / project and 3 references. Use your community health text, and or other nursing texts,
Internet and appropriate articles for resources.
This assignment has two parts: a) the outline of program /project No. 1-4 should be turned in
two weeks prior to arranged program date for review by the instructor. Outline will be returned
to you for editing if necessary and b) provide a 1-page post evaluation No. 5 one week after
conducting project/ program in agency.
Health promotion projects include strategies or activities to promote well-being in the client.
They help clients practice healthy behaviors and change unhealthy behaviors (Stanhope
&Lancaster, 2004).
Primary Prevention: Directed towards well clients. Promotes health and provides specific
protection from disease. Education
Secondary Prevention: Early diagnose or treatment of illness in the presence of disease.
Screenings
Tertiary Prevention: Addresses rehabilitation and treatment care to prevent further progression
of the disease.

San Jose State University

School of Nursing
The Health Place
Client Priority Summary

Semester:

Fall: _____ Spring _____

Student Name: ______________________________________

Client Name:_________________________________________ Date ______________ Age:
________
Priority: High

Med

Low

Address:
____________________________________________________________________________
Directions to home/ Apt:
_______________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Phone Number: _____________________________
Emergency Contact Person:
_____________________________________________________________
Phone number: __________________________________
Physician: _______________________________________ Phone:
______________________________
Nursing Dx:
1.
2.
3.
4.
Medical Dx:
1.
2.
3.
4.
Medications List:
1.
2.
3
4.
5.

(Medication Form Attached Yes

No)

Nursing Plan of Care:

Summary of Nursing Interventions:

Justification of Priority

Other information/notes:

CCF Information
Insurance:

Yrs in US:

Referred by:
Ethnicity:

Community Service Hours

Guidelines:
15 hours to be done outside of the clinical setting as a volunteer. Students can go in
groups to events but are encouraged to attend individually. Hours can be broken down
by preparation for the event, participation in the event, debriefing / conference sharing
of the event.

The following events (attached) are suggestions for you to consider but are not limited
to for CSHs.

All CSHs must be completed before the 13 week of clinical.

The health education/fair worksheet in your course reader needs to be turned in by

week 14 of clinical.

All CSHs must be approved by your clinical instructor prior to your participation in the
event if you would like credit for attendance at that event.

Your role as a community volunteer is not limited to physical assessment of clients. You
may also participate in the planning and evaluation of events and educational events.

While participating in any volunteer event all SJSU guidelines for nursing students are
enforced. Proper dress, name tags, professional behavior, etc are expected of all
students.