The College of New Jersey

NURS 634

Primary Care of Women

Course Description:

• This clinical course focuses on health care in the ambulatory setting for women with gynecological or reproductive health needs over the lifespan.  Emphasis is placed on therapeutic interventions appropriate for management of women experiencing acute episodic or complex chronic illness, as well as strategies for wellness promotion and disease prevention.  Students are assigned to ambulatory care settings, clinics, private offices, and other community settings where nurse practitioners, certified nurse midwives and /or physicians will serve as preceptors. Clinical experience of 150 hours is required.

Objectives:  At the conclusion of this course the student will:

1. Integrate theoretical knowledge of women’s health and healthcare into clinical practice by:

   a.            eliciting an appropriate history

   b.            performing appropriate physical with pelvic exam

   c.            ordering and interpreting appropriate diagnostic studies

   d.            making an appropriate assessment and plan and implementing the plan

   e.            recognizing when consultation and referral are appropriate

   f.            formulating a plan to evaluate your actions

2. Demonstrate competence in theory and clinical skills to perform the comprehensive holistic health assessment of gynecological and reproductive health care of women.

3. Manage acute and chronic health conditions of women in collaboration with a preceptor.

4. Synthesize knowledge from the natural/behavioral sciences and nursing theory and science that provides the foundation for managing the experience of wellness in women.

5. Identify appropriate treatment plans for use in the pharmacologic and non-pharmacologic management of common reproductive health needs of women.

6. Identify strategies for wellness promotion which are appropriate for the primary health care provider.

7. Identify community resources available to assist women in the reproductive years.

8. Identify developmental, cultural, and occupational issues that may impact the health status of women.

9. Identify areas of needed research relating to the primary health care needs of women.

10. Apply principles of collaboration with members of the health care team in the management and referral of women with health needs.

Required Textbooks: 

            Youngkin, E.Q. & Davis, M.S. (1998).  Women’s health:A primary care clinical guide (2^nd Ed.).  Stamford, Connecticut: Appleton & Lange.

            Ross, M., Channon-Little, L., & Simon Rosser, B. (2000).  Sexual health concerns: Interviewing and history taking for health practitioners (2^nd Ed.). Philadelphia:  F.A. Davis.

            Hatcher, R. et al. (1999).  A pocket guide to managing contraception.  Tiger Ga: Bridging the Gap Foundation.

Other Required Readings: Other required readings are on reserve at the college library. 

Teaching Methods: Lecture, discussion, individual and group case study exercises, self-study units.

Student Evaluation:  

Note:  Due dates for assignments are indicated on the syllabus.  Students are expected to hand in assignments by the due date unless prior arrangements have been made well in advance with faculty.

Guidelines for Assignments: Guidelines for Clinical Decision-Making Assignments, SOAP notes and Clinical Case Presentation will be provided.

Academic Honesty: Students are referred to pages 35-41 of the 1999-2000 TCNJ Graduate Bulletin for the statements on academic policies and standards of conduct.  Cheating on exams and plagiarizing are ground for academic jeopardy or dismissal.

Attendance:  Classroom attendance is mandatory and participation is necessary to pass this course. Students must notify faculty prior to absences.  Absence from class does not release the student from didactic or practical assignments. Failure to attend classes will affect your final grade for the course.  Vacations should not be taken during course time.

Promptness:  All students are expected to be present and ready to participate in class and clinical seminar at the time they are scheduled to start. Students who arrive late to class distract their peers and jeopardize their own educational experience and that of their peers. Failure to arrive on time for class will affect your final grade for the course. 

Clinical Experience: Students must pass the clinical component of the course in order to advance to the next course.  Each student will complete a minimum of 150 clinical hours which includes a minimum of 135 hours at one or a combination of clinical site and 15 hours of on-campus clinical seminar. During the clinical experience, the student is expected to assess the chief complaint, gather both subjective and objective data, discuss the data with the preceptor, formulate a management plan, and assist the client in

implementing the plan.  At the end of the semester, the student should be able to meet all of the clinical objectives outlined under the Course Objectives.

Faculty will visit the student at their clinical site to evaluate performance towards meeting the course objectives.  Evaluation during the site visit includes: 

·         Observation of the student with a patient

·         Observation of student interaction with preceptor and other staff

·         Faculty review of student charting

·         Discussion of student performance with preceptor

Students are evaluated on their clinical performance by both TCNJ faculty and their clinical preceptor.  Final clinical grades are awarded by the course faculty.  Students must achieve a passing grade on the preceptor and faculty evaluations and a grade of 75 or higher on clinical assignments (SOAP notes and Clinical Case Presentation) to pass the clinical component of the course.

Each student will maintain daily clinical logs for all clients seen in the clinical setting.  All logs should be dated and marked with the time spent in the clinical site that day.  Format for logs will be provided to the students by faculty.  Logs should be available for review during the faculty clinical site visit. Again, the goal of keeping the clinical logs is to ensure the student is getting suitable experiences at the clinical site. Logs may be handwritten but must be legible. Use as many copies of the log form as needed.

Clinical Site Attire and Behavior: Students are representatives of The College of New Jersey School of Nursing whenever involved in off-campus study. 

·         An ID badge stating your name and identifying you as a Nurse Practitioner Student is required.

·         Dress neatly and professionally with minimal jewelry. Trousers or slacks may be worn but denim jeans or jean type slacks are not permitted.  Closed, low-heeled comfortable shoes are required.  T-shirts are not appropriate. 

·         For client comfort and safety wear fingernails short (not extending beyond the ends of your fingers).  Clear or light colored fingernail polish may be worn. 

·         For client comfort and safety, refrain from wearing perfume/cologne or other strongly scented

    products.

·         A white lab coat may be worn over street clothes as required by the site.

Regarding behavior in clinical settings, students are expected to adhere to the Code for Nurses: American Nurses Association and the School of Nursing Guidelines Concerning Behavior in Clinical Settings.  Students are referred to pp. 33-37 of the 1999-2000 Graduate Student Handbook of the College of New Jersey, School of Nursing, to review these standards

Grading:

                                    A            95-100

                                    A-            90-94

                                    B+            87-89

                                    B            83-86

                                    B-            80-82

                                    C+            78-79

                                    C            75-77

                                    C-            72-74

                                    F            71 and below

Please refer to p. 32 of the 1999-2000 Graduate Student Handbook of the College of New Jersey, School of Nursing, for the Academic Policy Statement on Minimum Grade in FNP Options.

Guidelines for Clinical Decision-Making Exercises (CDEs):

Goals/Purpose:           Assist students to:

• Refine clinical decision-making skills

• Utilize scientific evidence/research in clinical decision-making

• Formulate comprehensive management plans based on scientific evidence

There will be 4 clinical decision-making exercises, each distributed at least one week before it is due.  CDEs will be distributed to students before the lecture content for that topic has been presented.  It is expected that students will use readings and prior experience to complete each CDE.  Each CDE will be followed by several questions relating to advanced practice nursing assessment and decision-making.  The questions will be in a format requiring the student to formulate an answer and provide rationale.  All rationale should be formulated utilizing appropriate scientific references.  References should be cited in the text of the work and in a reference list (APA style).  There may be more than one acceptable answer to each question.

• For each case study the student is required to use at least two references.  References may include required textbooks but at least one additional recent (within the last three years) scholarly publication (i.e. textbooks; evidenced based practice protocols developed by authoritative sources; articles from peer reviewed journals) should be used for each case study.   Manuals are not acceptable as references, nor are published “pocket guides,” “practice manuals” or compilations of practice guidelines marketed for profit. 

• All case studies must be typed, double spaced, with 1” margins on all sides and correct spelling and grammar.

• Each page should have a “running head” containing the student’s name, date and title or number.

• There is no minimum or maximum length, however it is expected that 3-5 pages plus references should suffice.

• APA (4^th edition) format is required for references.

• Independent work is expected of each student.

Guidelines for SOAP notes:

Goals/Purpose:           Assist students to:

                                    *            Refine documentation skills

                                    *            Refine clinical decision-making skills

                                    *            Apply scientific evidence/research to clinical practice

                                    *            Develop differential diagnoses

                                    *            Examine/critique rationale for management plans developed with preceptors

Four SOAP notes will be submitted over the semester (see dates on syllabus).  The note should be taken from a patient you have seen at your clinical site.  Include a copy of the actual chart note with your signature and your preceptor’s co-signature.  Do not expand upon or alter the original SOAP note in any way! Always blacken out any identifying patient information prior to taking this copy out of the clinical site!!  If your clinical site utilizes a checklist, include a copy of the list and rewrite the note in SOAP format.

Choosing Clients for SOAP note papers: Of the four SOAP notes handed in for this course, only one may be a client who you see for “well-woman exam,” where no particular problems are discovered.  Three MUST be on clients who you see for a “problem visit,” or for clients who present for a “well-woman” exam but who is discovered to have a problem at that visit (i.e. a breast mass, evidence of an infection or other problem).

 All original SOAP notes must be legible and should include:

*          Subjective:  HPI and focused subjective history information.  Include medical, family and social history.

*          Objective:   Objective focused physical examination.  Include laboratory and diagnostic test results when appropriate.

*          Assessment:  List the differential diagnoses (3-5) most likely for this patient and a brief explanation (with supporting references) of why you think they should be considered in this situation.  Prioritize the differential diagnoses from most likely to least likely.

*          Plan: List your interventions and include a brief rationale (with supporting references) of why they were chosen in this situation.  All plans MUST include pharmacological/hormonal interventions as applicable; diagnostic tests or procedures as applicable; referrals if applicable; patient (and family, if applicable) education; follow up plans.

In addition to the original SOAP note include the following:

*          Critique your interaction with the client (History and Physical):

*          What other pieces of information should you have gathered? State why you should have gathered this additional data.        

*          Critique your differential diagnosis

*          Are there any other differential diagnoses that you should have included?  Give a rationale for

            your choices.

*          Critique your management plan. 

*          What additional elements should you have included in the plan? Give a rationale for each additional element.

*          Are there any elements in the plan developed at the clinical site that you feel could have been done differently or not done at all? Give a rationale for each suggested change.

*          Scientific Background:  Provide references for all decisions and rationales you have included in the above plan and critique.  In addition, attach one article from your reference list that is clinically relevant to the case that you are submitting.  The reference should be from a peer-reviewed nurse practitioner, medical journal or other related journal and must be no more than 3 years old.  Chapters from textbooks and manuals are not acceptable. You may utilize articles on the supplemental reading list and materials from your textbooks in formulating rationale for the SOAP note papers but make sure that the article you hand in is not on the supplemental reading list for this class.

Format:

*          All copies of original SOAP notes must be clear and legible.

*          For each SOAP note write up the student is required to use at least two references.  References may include required textbooks but at least one additional recent (within the last three years) scholarly publication (i.e. textbooks; evidenced based practice protocols developed by authoritative sources; articles from peer reviewed journals) should be used for each case study.  Manuals are not acceptable as references, nor are published “pocket guides,” “practice manuals” or compilations of practice guidelines marketed for profit.

*          All write-ups must be typed, double spaced, with 1” margins on all sides and correct spelling and grammar.

*          Each page should have a “running head” containing the student’s name, date and title or number.

*          There is no minimum or maximum length, however it is expected that 3-5 pages plus references should suffice.

*          APA (4^th edition) format is required for references.

*          Independent work is expected of each student.

Guidelines for Clinical Case Presentations

Goals/Purpose:           Assist students to:

                                    *            Present cases to other professionals in an organized and succinct manner

                                    *            Refine clinical decision-making skills

                                    *            Apply scientific evidence/research to clinical practice

                                    *            Develop, defend and critique differential diagnoses

*            Examine/defend/critique rationale for management plans developed with preceptors

Each student will prepare one case for oral presentation to faculty and peers.  All faculty and students in the class should be prepared to discuss/critique EACH case after it is presented. 

Preparation for case presentation: One week prior to your presentation distribute to your peers and the course faculty, a copy of your original charting on this client (with all identifiers blacked out).  Also carefully choose an appropriate scientific reference (peer-reviewed journal article or evidence-based clinical practice guideline) and distribute a copy of the reference to faculty and peers.  Your peers and faculty are responsible for reading your chart note and article prior to your presentation. 

Choosing a case for presentation: This must be a client whom you have cared for with your preceptor at your clinical site.  Choose a case that will be interesting and challenging for your peers to learn about.  Do not choose a client who presents for a routine “well-woman” exam unless a problem is discovered during your interaction with the client. 

Presentation:  Each student will have 20 minutes to present their case.  An additional 5-10 minutes will be allowed for class discussion. 

*          Briefly summarize the case for your peers and the faculty

*          State 2-3 diagnoses applicable to this case (conditions, risks, wellness diagnoses)

*          What key elements in the history and physical assessment support each differential diagnosis?

*          What diagnostic workup if any was performed to assist in making the diagnoses and

            what was the rationale for each test?  Were there other or alternative diagnostic tests

            that could or should have been performed?

*          Discuss the management plan and rationales for each element (including but not limited to pharmacological/hormonal/chemical interventions)

After each presentation, the class members will be expected to discuss/critique the case presented.