Clinical Practicum I

COURSE DESCRIPTION:

All clinical courses require the student to integrate theory and laboratory training in the patient care setting. The focus of this clinical course is application of basic therapeutic techniques and procedures. Topics include medical records, charting, patient history and physical examinations, infection control, patient positioning, vital signs, breath sounds, chest assessment, oxygen therapy, humidity and aerosol therapy, cough techniques, incentive spirometry, and percussion and postural drainage. 

OBJECTIVES:

• Participate actively and effectively in the development of the respiratory care plan.
• Review existing data, collect additional data, and evaluate all data to determine and defend the appropriateness of the prescribed respiratory care plan.
• Select, assemble, assure cleanliness, check for proper function, and correct malfunctions of equipment used in providing respiratory care.
• Initiate, conduct, and modify prescribed therapeutic procedures.
• Maintain patient records and communicate relevant information to other members of the healthcare team in a professional manner.

Clinical Portfolio complete     20%

Case study                               20%

Task analysis                           20%

Performance evaluation         40%

MANDATORY ITEMS:

Each student will compile a clinical portfolio documenting the learning activities for the semester.

The clinical portfolio is to be organized as follows:

In a 3 ring binder create divisions (using tab sheets) for the following in the exact order listed.

1. Cover sheet
2. Course syllabus
3. Clinical schedule
4. Sign in sheet
5. Competency list
6. Daily log form
7. Daily performance evaluations
8. End of rotation (Affective) performance evaluation
9. Clinical site evaluations

General requirements

1. Daily logs-Daily logs are used to document the practice of clinical skills of the student.It is vital that these logs are completed every day the student attends clinic. It is the student’s responsibility to ensure that these logs are completed daily – before you leave the clinic. Activities performed during the day may be listed on the log from the list of competencies contained in the clinical portfolio.
2. Sign in sheets-the student must be signed in and out for each day in clinic – no exceptions! 
3. Daily performance- evaluations-the student will have a daily performance evaluation completed and signed by the clinical preceptor every day when the student is in clinic-no exceptions!  Any category noted as NI will be addressed by the clinical chair.
4. Affective evaluations-You must download from DataArc and place in your clinical portfolio a completed Affective Evaluation from the site where you have spent your clinical time. Due at final check-off
5. Site evaluations-You must download from DataArc and place in your clinical portfolio a site evaluation for every site you attend.  The site evaluation must be completed on DataArc, before printing out and placing in the clinical portfolio. Due at final check-off
6. Clinical portfolios will be presented to the Clinical Chair at the completion of each two week clinical block for evaluation.  If the clinical portfolio is not complete when turned in for final review, the highest letter grade possible for clinic will drop by one!

GENERAL GUIDELINES ON Competencies

1. Required competencies are listed in each course syllabus.
2. Prior to being checked-off the student must practice the skills several times.
3. A hospital staff member that has worked with you can fill out competencies. It is your responsibility to make sure the competencies are completed properly.
4. Student will be responsible for performing any procedure at any time once they have passed the competency for that procedure.
5. It is the student’s responsibility to demonstrate weekly progress in clinical check-offs to their Clinical Coordinator.
6. It is the student’s responsibility to contact the Clinical Coordinator if they are having problems with the competencies.
7. A student must complete the competencies specified in the course syllabus. Failure to complete the required competency may result in an unsuccessful grade in clinicals and prevent completion of the program.

competencies:

Once a clinical skill has been mastered, it is the responsibility of the student to have their preceptor verify these skills by completing the documentation in the clinical notebook.

A competencymust be completed for the following skills:

1. Basic Life Support (completed in lab on campus)

2. Handwashing

3. Isolation Procedures

4. Charge documentation

5. Vital Signs

6. Patient Assessment

7. Chest Assessment

8. X-ray Interpretation

9. Oxygen Therapy (Use of at least one oxygen delivery device)

10. Pulse Oximetry

11. Transport with Oxygen

12. Aerosol and Humidity Therapy (Use of at least one device)

13. Aerosol Drug Administration (metered dose inhalers, dry powder 

   inhalers and small volume nebulizer)

14. Incentive Spirometry

15. Intermittent Positive Pressure Breathing*

16. Chest Physiotherapy

17. Positive Expiratory Pressure Mask Therapy*

18. Flutter valve therapy*

(*Competency can be used as a “floater”. If the opportunity is not available in this rotation, it can be “floated” to a subsequent rotation.)

CASE STUDY:

Following the format outlined here, each student will turn in a typed or word processed case study. All attempts will be made to let you work on your case study during clinical time, however, it may be necessary for you to remain at the clinical site for some additional time to complete the case study. Case studies will be graded on their neatness, completeness and student’s ability to interpret and analyze data.

Case study Format:

The following outline should be followed exactly for the case studies. Include all titles and subject headings. Typed copies of the case studies are to be turned in on or before Dec. 3rd.^.

Patient Data

1. Name: initials only
2. Age
3. Sex

Admitting data

1. admitting chief complaint
2. pertinent history-medical, family, social/occupational
3. current differential or working diagnosis

Present chest examination (a and b to be done by student)

1. observations of setting and general appearance
2. inspection, auscultation, percussion and palpitation
3. radiologic

Vitals signs (one set to be done by the student) Get at least three sets of vital signs;

Present, admitting, and one set of intermediate values. Comment specifically on any measures that are not normal.

1. heart rate/rhythm
2. ventilatory status
3. blood pressure
4. temperature

Any lines or tubes (Art. Line, chest tube, etc.)

Clinical laboratory data. Where possible get at least three sets of clinical laboratory data; present, admitting, and one set of intermediate values. Comment specifically on any measures that are not normal.

1. red blood cells
2. hemoglobin/hematocrit
3. white blood cells
4. blood gases (including 02 content Fi02 and ventilatory data and interpretation of acid-base status and oxygenation for each blood gas)
5. platelets
6. clotting studies (clotting time, PT, PTT)
7. Serum electrolytes (relate abnormals to ABG’s)
8. Sputum cluture and sensitivity
9. Blood urea nitrogen (BUN)
10. Creatinine
11. Glucose
12. Urinalysis

Pertinent medications-include for each; synopsis of PDR (or other drug book) sections for 1. Description, 2. Indications and usage (specific to this case), 3. Precautions, 4. Adverse reactions, 5. dosage and administration.

1. respiratory
2. cardiovascular
3. antibiotic
4. other-analgesics,antacids, anticoagulants, antihistamines, decongestants, anti-inflammatory, antipyretics, diuretics, narcotics

Evaluation of major organ systems other than drugs

1. heart
2. neurological
3. liver
4. kidneys
5. GI

Major diagnostic procedures and results (listed by date)

Rationale for initial treatment

Major complications since admission

Rationale for current treatment (applied to present illness)

Rationale for current respiratory care

Reasonable short term plan for the patient

At the end of the clinical rotation, the students will present their case study. Your presentation should be no longer than 10 minutes on Nov. 29^th and Dec. 1^st .

  For your presentation, you will present the following information in narrative form (in your own words):

  1. Patient data (Age, gender)

  2. Admitting data, chief complaint

  3. Pertinent History-medical, family, social/Occupational

  4. Working Diagnosis (give description of disease)

  5. Any pertinent issues with labs or x-rays

  6. Any pertinent treatment and outcomes (medications, medical interventions such as CPR, ventilator, etc)

  7. Length of Stay, summary of outcomes and prognosis, plan of care

  You will also turn in the written draft of your case study as outlined in the syllabus.

Presentations will be graded on content, professionalism, and ability to answer questions about In a narrative form summarize the important aspects of the patients illness.

Task Analysis:

Each student must complete and submit 3 task analysis papers. The task analysis may be done on any of the commonly ordered modalities assigned for completion during the Fall clinical rotations. The completed papers must be turned in by October 29th.

Task Analysis Format:

Patient info: Age, patient diagnosis, area

Therapy type (i.e., oxygen therapy (cannula), aerosol treatment (small volume nebulizer), Bronchial hygiene therapy (PEP, incentive spirometer, IPPB)

Indications:

Contraindications:

Hazards:

Outcomes:

Monitoring:

Performance steps:

Clinical Evaluation:

Each student will be evaluated on their performance during their clinical rotation. 

The evaluation includes:

1. professional appearance
2. attendance
3. arrive on time and prepared
4. dependability
   1. can function as part of the healthcare team
   2. friendly and helpful within the department
   3. accepts supervision, seeks feedback
   4. appropriate and courteous with patients 
   5. conducts self in a professional/ethical manner
   6. communicates effectively, use appropriate language
   7. can prioritize and use effective time management
   8. self-directed and manages work responsibly
   9. self confident, uses good judgment
   10. participates in educational activities that enhance clinical performance

ATTENDANCE POLICY

Attendance at clinical sites is an essential component of the student’s

clinical education. The student must be in their assigned area of

rotation and prepared for instruction at the scheduled time for that    

rotation.

Signing in and out:

Each student is required to document their clinical hours on the sign-in sheet in the clinical portfolio. The sign in/out for each clinical day will be signed by the therapist with whom the student has worked on that clinical day. Each student will complete 18, 12 hours shifts for a total of 216 hours of clinical time. Every student is required to make up any missed time.

MISSED CLINIC DAYS

If a student is unable to present at the clinical site, it is his/her responsibility to report the intended absence to the clinical site and Director of Clinical Education prior to the time for the Practicum. When reporting an absence to the Director of Clinical Education, please call 940-397-4652 (department secretary) and leave the message.

 When reporting the absence to the clinical site, have the hospital operator page the charge therapist on night shift. Leave the message with the charge therapist.

The calls to report an absence must be made at least one hour prior to the scheduled time for the Practicum. An absence not reported by this procedure will be recorded on the Clinical Incident Form. The Director of Clinical Education will take extenuating circumstances into account. An adverse decision may be appealed to the Program Director. A make up day may be arranged.  All missed clinic days will be made up in double time.

LATE POLICY

It is equally important that a student be punctual to the clinical site. In order for the student to obtain maximum benefit from the clinical Practicum, they must be present for the report given at the change of shift. Late is defined as arriving at the clinical site

fifteen minutes past the scheduled time for the Practicum.However, if a student arrives later than thirty minutes past the scheduled time for the Practicum, he/she may not be allowed to stay for that clinical day. If a student must be late for clinical it is their responsibility to contact the site prior to the scheduled time for Practicum.

After contacting appropriate person within the specified time, the student must be present within one hour of scheduled time for the Practicum. Depending on the area of rotation and the circumstances, an alternative assignment may be made. If a student is habitually late the instructor and/or the Clinical Director will counsel them.

If the student does not report tardiness to the appropriate person, an absence will be recorded. The Director of Clinical Education will take extenuating circumstances into account. Every two days a student is late, an unexcused absence will be recorded.

It is equally important that all students remain at their clinical site for the entire designated time. If the student must leave early for any reason, the student must call the Clinical Director. Students will be required to make up any missed hours.

Leaving the clinical site for any reason and not communicating with the preceptor and the Clinical Director is grounds for dismissal from the program.

It is also required that all students communicate with their assigned preceptor any time they leave their area for any reason (lunch, break, work on case studies, etc.)

INCLEMENT WEATHER:

In cases of bad weather or severe weather conditions, the student must use their own judgment when deciding whether or not to attend clinical. The student will inform the clinical instructor as soon as possible. If schools in your clinical area are canceled, your absence will be excused.