SAMPLE SYLLABUS

Long Term Care Clinical Scholars Program (LTC-CSP) Summer Nursing Internship A collaboration between UW-Madison School of Nursing and Edgewood College School of Nursing Description of the program The Long Term Care Clinical Scholars Program is designed to provide a twelve week summer internship experience for baccalaureate nursing students in a nursing home setting. The program consists of supervised clinical experiences, classroom workshops and independent study for classroom preparation. Faculty: Dr. Barbara Bowers UW-Madison School of Nursing Phone: 263-5185 E-mail: bjbowers@wisc.edu

Dr. Colleen Gullickson Edgewood College SoN Phone: 574-5380 E-mail: cgullickson@edgewood.edu

Additional Instructors and Staff: Kim Nolet, MS, Program Coordinator, UW-Madison School of Nursing Brenda Ryther MS, RN, Researcher, UW-Madison Ctr for Health Systems Research & Analysis Tonya Roberts MS, RN, UW-Madison Doctoral student Andrea Gillmore MS, RN, UW-Madison Doctoral student Rachel Roiland MS, RN, UW-Madison Doctoral student Program Goals 1. Increase the appeal of long term care for new baccalaureate prepared nurses and baccalaureate nursing students by creating positive experiences showing nursing homes as welcoming, interesting, and innovative places to work where RN nursing skills are used and valued. 2. Increase feelings of preparedness in caring for older adults in nursing homes for nursing students entering the workforce. 3. Increase complex nursing skills in care of older adults for baccalaureate nursing students. 4. Increase the leadership abilities in care of older adults for baccalaureate nursing students.

SAMPLE SYLLABUS
Learning Expectations: This intern experience is based on the following assumptions*: Learning is a collaborative process characterized by active engagement. All clinical scholars share the responsibility for making the internship a meaningful and productive experience. We are here to learn with, from, and about one another. Preparation prior to workshops, attendance, and participation will make for the most fruitful interaction. All of us together will likely be more knowledgeable than anyone of us alone. Learning is enhanced by sharing diverse ideas. Clinical scholars are encouraged to critique others thinking, and to remember that ideas, rather than individuals, are open to challenge. Questions represent opportunities for learning and are indicative of engagement with the subject matter. One individuals questions often lead to clearer understanding for all. Enthusiastic involvement in all learning opportunities is a desired goal. Clinical scholars are encouraged to give the class facilitator and one another feedback, especially as regards ways of improving the learning environment. Only if you are willing to honestly, fairly and constructively address internship concerns do you retain the right to complain about them. *adapted from EC NRS 340 Professional Nursing; Long-term Health Issues course syllabus Program Structure The Clinical Scholars Program is a twelve week guided internship experience consisting of both clinical work and workshop learning opportunities. Workshops: Workshops will be held every Wednesday from 2:30 to 4:30 p.m. (see schedule). Some classes are group workshops designed for you and interested staff members from the participating homes. Other classes are for the clinical scholars only. Workshop format: Open discussion and dialogue are vital components of all workshops. Instructors will limit their presentation of content to approximately 15 minutes. The remaining class time will be spent in active dialogue and activities designed to maximize application of classroom content to your clinical experiences. As such, preparing for workshops by completing readings and other activities is vital. Without this, your class contributions will be very limited. You will be assigned some brief activities to complete at your worksite during the course of the internship and these will be discussed at workshops. See the weekly schedule of this syllabus for details. You will need to read each weeks pre-workshop activities well in advance to assure you have time to complete the activity. 2

SAMPLE SYLLABUS
Clinical work experiences: The clinical component consists of at least three shifts working as a nurse tech in your matched nursing home each week. Your exact schedule will be determined by your worksite. You may need to spend additional time on-site to complete required program experiences (see pre-workshop clinical activities for each weekly workshop). This is similar to clinical prep time in your undergraduate program. You will not be paid for this additional on-site time. Clinical work format: You will use a Tracking Worksheet to guide your learning experiences. Weekly entries on this document are required to focus and direct your clinical development. Self-evaluation is an important component of professional growth and will be an important vehicle by which you and your preceptor determine your clinical experiences and progression. Work expectations: Professional behavior and courtesy are expected at all times. Unprofessional behavior can be interpreted as lack of interest and reflects poorly on the Clinical Scholars Program. You are an employee of the nursing home and are expected to follow all work rules and guidelines provided to you by the home. When you are not on paid time, but are on-site to complete other activities, you are also expected to be on your best professional behavior and adhere to employee guidelines. Remember, no chewing gum, texting, or phone calls on work time!

SAMPLE SYLLABUS
Absences Clinical work absences: You are an employee of the long term care facility and therefore are required to follow the workplace policies regarding absences from your scheduled clinical work. You must contact the appropriate person at your worksite to inform them of your absence. If you will miss a meeting with your preceptor or someone else at the home, you must also notify that person of your absence. If you do not follow workplace policies, you be subject to their normal disciplinary policies. Workshop absences: Clinical Scholars have been selected as part of a competitive application process. Therefore, it is important each clinical scholar fully participate in the internship program to which you applied. It is expected you attend each weekly workshop. If it is necessary to miss a workshop, you must notify Kim Nolet, Program Coordinator at 262-8146 or kanolet@wisc.edu. You must also contact the workshop instructor/s as soon as possible to arrange to make up content you will be missing. Successful Program Completion The Clinical Scholar Program is not a course, therefore a grade is not assigned. Successful completion will entitle you to a Clinical Scholar Program certificate of completion that details the program offerings. This is anticipated to give clinical scholars a competitive edge when applying for nursing jobs. Successful completion entails: Attending all Clinical Scholar Program weekly workshops (and completing special assignments to a satisfactory level if absent for any workshops). Completing assigned workshop readings. Completing assigned clinical work experiences related to the workshops. Working your assigned shifts at your matched nursing home and complying with workplace rules and guidelines. Completion of the CSP Tracking Worksheet in collaboration with your preceptor.

SAMPLE SYLLABUS
Workshop Schedule and Details Week 1: June 8 Interns Only, 2:30-4:30 p.m. Topics 1) Time Management 2) Polypharmacy Instructors Andrea Gilmore, MS, RN & Barbara Bowers, PhD, RN Objectives Objectives: 1. Demonstrate ability to prioritize care and effectively manage time in complex situations. 2. Demonstrate an understanding of age-related changes that contribute to pharmacologic complications in the elderly population. 3. Identify common adverse drug reactions in the elderly. 4. Demonstrate an understanding of strategies to examine possible adverse reactions in clinical practice including addition and withdrawal of medications. Required 1. Up To Date Drug Prescription for Older Adults: Readings http://www.uptodate.com/contents/drug-prescribing-for-older-adults 2. Beers Criteria: https://www.dcri.org/trial-participation/the-beers-list Suggested 1. If you are not familiar with age-related physiological changes, please visit Readings http://consultgerirn.org/topics/normal_aging_changes/want_to_know_ more and familiarize yourself with this information. Required Pre-Workshop Activities: Clinical 1. Consider the following questions that will be discussed during the Activities Preworkshop: Workshop a. What should you use as a guide to make decisions about care prioritization? b. What is important when considering how you prioritize care? c. What do you think about when you consider ways to effectively manage your time? d. What does time management involve? e. What is necessary to have effective time management? f. How can you anticipate the consequences of the decisions that you make?
th

Week 2: June 15th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only Topic Resident Quality of Life Instructors Tonya Roberts, MS, RN and Barbara Bowers, PhD, RN Objectives 1. Discuss the importance of addressing quality of life for ltc residents. 2. Distinguish the relevance of quality of life for different populations. 3. Discuss the intersection of quality of care and quality of life. Required Readings 1. Cohen-Mansfield, J. & Taylor, J. W. (2004). Hearing aid use in nursing homes part 1: Prevalence rates of hearing impairment and hearing aid use. Journal of the American Medical Directors Association, 5, 283-288. 5

SAMPLE SYLLABUS
2. Kane, R., Kling, K., Bershadsky, B., Kane, R., Giles, K., Degenholtz, H., et al. (2003). Quality of life measures for nursing home residents. The Journals of Gerontology: Series A, 58(3), M240. 3. Kracker, J., Kearns, K., Kier, F. J., & Christensen, K. A. (2011). Activities preferences and satisfaction among older adult in a veterans administration long-term care facility. Clinical Gerontologist, 34(2), 103-116. Check intern website for any suggested readings.

Suggested Resources & Readings Required Clinical Activities PreWorkshop

Find out if your facility has a resident council and when they meet. If there will not be a meeting prior to this workshop, find out who coordinates the meetings and ask if they have notes from previous meetings you could review. Think about the nurse's role in the issues that residents discuss. or Review a long term residents plan of care. Think about how the plan addresses the residents quality of life. Now think about a family member, maybe a grant parent, and ask yourself whether you would be happy with such a plan of care in terms of overall quality of life.

Week 3: June 22nd Interns Only, 2:30-4:30 p.m. Topic Communicating with Team Members & Families Instructors Melanie Krause, PhD, RN, Andrea Gilmore, MS, RN and Barbara Bowers, PhD, RN Objectives 1. Decide when to initiate communication with physicians/NPs and demonstrate ability to gather and prepare relevant information. 2. Demonstrate ability to effectively and concisely communicate gathered information with physicians/NPs. 3. Demonstrate ability to effectively provide feedback to coworkers and engage in conversations with unlicensed staff in a supervisory capacity. 4. Understand family dynamics and coping and demonstrate ability to communicate with residents and family members in ways that foster shared decision making. Required Readings 1. Colorado 5 Million Lives Campaign, Sample SBAR (SituationBackground-Assessment-Recommendation) Communication Tool [electronic]: http://www.colorado5millionlives.org/repository/Pdfs/INTERVE NTION/SBAR/GenericReportToPhysician.pdf 2. University of Pittsburgh (2003). Principles of Effective Feedback [electronic]: 6

SAMPLE SYLLABUS
http://www.pacwcbt.pitt.edu/Curriculum/533%20Preparatory%2 0and%20Beginning%20Phases%20of%20CW%20Supervision/ Handouts/HO18%20%20Principles%20of%20Effective%20Fee dback.pdf 3. Gladstone, J. & Wexler, E. (2002). Exploring the relationships between families and staff caring for residents in long-term care facilities: family members perspectives. Canadian Journal on Aging., 21(2), 39-46. Check intern website for any suggested readings.

Suggested Resources & Readings Required Clinical Activities PreWorkshop

Before you contact a physician yourself, observe a nurse information exchange with a physician (your preceptor can help you identify this learning opportunity). What kinds of questions did the physician have? Was the nurse prepared to answer those questions? How did the nurse communicate information from the physician back to staff and/or family? This activity will prepare you for workshop discussions and to interact independently with physicians.

Week 4: June 29th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only Topic Achieving and Maintaining Resident Function Instructors Barb King, PhD, RN and Barbara Bowers, PhD, RN Objectives 1. Understand the factors contributing to unnecessary functional decline in nursing home residents 2. Identify practices in their environments that contribute to resident functional decline 3. Analyze how the system they work in could be altered to prevent functional decline where possible Required Readings 1. Fitzsimmons, S. (2010). Physical functioning: Maintaining, improving, and preventing decline. Activities Directors Quarterly for Alzheimers & Other Dementia Patients, 11(1):1521. 2. Bell, A. (August, 2002). Restored function, renewed hope. Provider. 57-60. 3. Connelly, D (2000). Resisted exercise training of institutionalized older adults for improved strength and functional mobility: A review. Geriatric Rehabilitation,15(3): 628. Suggested Check intern website for any suggested readings. Resources & Readings Required Clinical 1. Contact an admission nurse to see if you can work with him/her when a new resident is admitted. What information is provided Activities Preon the admitting notes regarding ambulatory status? Does the Workshop 7

SAMPLE SYLLABUS
plan of care reflect a thorough understanding of the residents potential? How will the plan of care maximize this potential? OR 2. Look at the PT or OT plan for a resident. This could be a resident currently receiving PT or OP services or one whose formal PT/OT plan has ended. What is the plan for improving ambulation? How was potential assessed? Is the staff following through on improving ambulation? If not, what are the barriers? If yes, what is being done? Is walking ability important to the resident? How do you know? Is the nursing staff continuing the plan effectively for those whose OT/PT has expired? Week 5: July 6th Interns Only, 2:30-4:30 p.m. Topic Diabetes, Swallowing and Nutrition Instructors Colleen Gullickson, PhD, APNP, RN Objectives 1. Demonstrate sound decision-making skills in a variety of resident situations addressing diabetes management. 2. Recognize diabetic emergencies and appropriate interventions to resolve them. 3. Demonstrate appropriate assessment skills in the early recognition of nutritional problems including swallowing. 4. Implement evidence based strategies in optimizing nutritional care for older Required Readings 1. Review diabetes care from your med/surg and pharmacology texts. 2. Amella, E., Lawrence, J., (2007). Eating and feeding issues in older adults with dementia: Part II interventions. Try This: Best practices in nursing care to older adults. Issue D11.2. Hartford Institute for Geriatric Nursing, NY. 3. Metheny, N. (2007). Preventing aspiration in older adults with dysphagia. Try This: Best practices in nursing care to older adults. Issue 20, Hartford Institute for Geriatric Nursing, NY. 4. Mentes, J. (2006). Oral hydration in older adults. AJN, 106(6), 40-48. Suggested Check intern website for any suggested readings. Resources & Readings Required Clinical 1. Review your facilities hypoglycemic protocol. Is it evidence Activities Prebased? What suggestions would you make to improve this Workshop protocol? How is intake recorded & reported? 2. Review your facilities most recent survey results related to nutrition. What corrective action(s) have been implemented since the survey? 8

SAMPLE SYLLABUS
3. How is the interdisciplinary team utilized once a resident has been identified as having a swallowing problem? Week 6: July 13th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only Topic Assessing and Managing Changes in Cognition Instructors Colleen Gullickson, PhD, APNP, RN Objectives 1. Identify evidence based assessment tools that can be utilized to guide resident care. 2. Explore multidisciplinary management strategies for individuals with cognitive impairments. 3. Develop a cadre of interventions to assist in caring for individuals with dementia. Required Readings 1. Smith, M. & Buckwalter, K. (2005). Behaviors associated with dementia. AJN, 105(7), 40-52. 2. Perry, J., Galloway, S., Bottorff, J., & Nixon, S., (2005). Nursepatient communication in dementia. Journal of Gerontological Nursing, April, 43-52. Suggested 1. Rader, J, Barrick, A., Hoeffer, B., Sloane, P., McKenzie, D., Resources & Talerico, K., & Glover, J. (2006). The bathing of older adults Readings with dementia. AJN, 106(4), 40-48. 2. Amella, E. (2007). Eating and feeding issues in older adults with dementia: Part 1: Assessment & Part II: Interventions. Try this: Best practices in nursing care to older adults with dementia, Hartford Institute for Geriatric Nursing, NY. Required Clinical 1. Review your facilities policy/protocol for when a residents Activities PreMMSE decreases below 15. Workshop How is the HCPOA activated? What is the procedure for obtaining consent for care? 2. Review your facilities psychotropic protocols related to mandated washout periods. Week 7: July 20th Interns Only, 2:30-4:30 p.m. Topic Change in Condition: Assessment and Care Planning Instructors Brenda Ryther, MS, RN & Tonya Roberts, MS, RN Objectives 1. Discuss change of condition and how it can be recognized by nursing home staff. 2. Understand the importance of communicating and responding to change of condition. 3. 3. Identify care planning strategies to address change of condition. Required Readings 1. Boockvar, K.S. & Lachs, M.A. (2003). Predictive value of nonspecific symptoms for acute illness in nursing home residents. JAGS, 51: 1111-1115. 2. Taunton, R.L., Swagerty, D.L., Smith, B., Lasseter, J.A., & Lee, R.H. (2004). Care planning for nursing home residents: incorporating the Minimum Data Set requirements into practice. 9

SAMPLE SYLLABUS
Suggested Resources & Readings Journal of Gerontological Nursing, 30(12): 40-49. 1. Boockvar, K., Brodie, H.D. & Lachs, M. (2000). Nursing assistants detect behavior changes in nursing home residents that precede acute illness: development and validation of an illness warning instrument. JAGS, 48(9). 2. Amella, E.J. (2004). Presentation of illness in older adults. AJN, 104(10): 40-51. 1. Attend a care conference to observe care team discussion, including resident change of condition. Note which disciplines attended the care conference. Follow-up with the care team to learn how the information and plans discussed are translated and communicated into daily practice.

Required Clinical Activities PreWorkshop

Week 8: July 27th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only Topic End of Life Care Instructors Colleen Gullickson, PhD, APNP, RN & Rachel Roiland, MS, RN Objectives 1. Utilize therapeutic presence and professional communication skills in providing end of life care. 2. Advocate for resident and family requests in providing end of life care. 3. Demonstrate an understanding of the nurses role in providing spiritual care. 4. Apply basic pathophysiologic principles related to pain management and nutrition at end of life. Required Readings 1. ANA position statement: Pain management and control of distressing symptoms in dying patients. 2. Liao, S., & Ackermann, R., (2008). Interdisciplinary end-of-lifecare in nursing homes. Clinical Gerontologist, 31(4). 83-96. 3. Sheehan, D.K., & Schirm, V. (2003) End- of-life care of older adult. AJN, 103(11), 48-59. 4. Kruse, B.G., Ruder, S., & Martin. L. (2007). Spirituality and coping at the end-of-life. Journal of Hospice and Palliative Nursing, 9(6). 296-304. Suggested Check intern website for any suggested readings. Resources & Readings Required Activities 1. Review your facilitys protocols end of life pain management, nutrition management, and/or comfort cares. Pre-Workshop 2. Review your facilitys protocol for the activities that should be completed after an individual has passed away. What activities will be expected of you and other staff? 3. Check to see if your facility has any resources that provide information about end-of-life cultural practices. Review them if they are available. 4. On a piece of paper or note card, write two questions you would like answered during class. (Bring them with you.)

10

SAMPLE SYLLABUS
Week 9: August 3rd Interns Only, 2:30-4:30 p.m. Topic Resident Comfort and Pain Management Instructors Andrea Gilmore, MS, RN & Tonya Roberts, MS, RN Objectives 1. Demonstrate an understanding of age-related changes that contribute to increased prevalence of chronic pain in the elderly population, generational considerations, and common acute syndromes that contribute to pain in the elderly population. 2. Demonstrate an understanding of pain and the nurses role in its identification, assessment, and treatment. a) Identify a variety of non-pharmacological, evidence based strategies to promote resident comfort. b) Utilize the multidisciplinary team to optimize resident comfort. 3. Demonstrate the ability to make clinical judgment about pain management and resident comfort in persons with limited communicative ability and dementias. Required Readings 1. Gran, et al. (2009). Alone with my pain it cant be explained, it has to be experienced. A Norwegian in-depth interview study of pain in nursing home residents. International Journal of Older People Nursing, 5(1), 25-33. 2. Strategies for Success: Pharmacologic management of persistent pain in the older adult. Clinical Advisor ,October 2010. 3. GeriatricPain.org: Analgesic Trial (1 page, skim over) 4. GeriatricPain.org: Recommendations Pain Assessment with Cognitive Impairment (2 pages, skim over) Suggested 1. If you are not familiar with age-related physiological changes, Resources & please visit Readings http://consultgerirn.org/topics/normal_aging_changes/want_to_ know_more and familiarize yourself with this information. 2. Cultural Aspects of Pain management: http://www.eperc.mcw.edu/fastFact/ff_78.htm 3. Pseudoaddiction: http://www.eperc.mcw.edu/fastFact/ff_69.htm 4. Pain scales in multiple languages: http://www.britishpainsociety.org/pub_pain_scales.htm Herr, K., Bursch, H., Ersek, M., Miller, L. L., Swafford, K. 1. Geriatricpain.org 2. ConsultGeriRN.org 3. City of Hope Pain Resource Center: http://prc.coh.org/ Required Activities 1. Prior to attending this workshop, examine your facilities pain Pre-Workshop management practices and protocols. Does your facility have a specific protocol? What is the process for acquiring and distributing controlled substances? How do these practices influence resident care and pain management? 2. Talk to nurses and nursing assistants about the pain management practices in the facility. Do they have ideas about 11

SAMPLE SYLLABUS
how it could be improved? Are there general guidelines that are followed? Week 10: August 10th Group, 2:30-3:30 p.m. workshop + 30 minutes for interns only Topic Nursing Leadership and Management Instructors Barbara Bowers, PhD, RN Objectives 1. Understand the staff nurses role and expectations as a leader in nursing homes 2. Describe the impact of staff nurse leadership on nursing home quality 3. List desirable leadership qualities for long term care nurses 4. Develop strategies to improve staff nurse to CNA delegation, communication and coaching and mentoring 5. Select leadership strategies and skills to practice and improve upon in the workplace Required Readings 1. Boockvar, K. S., Gruber-Baldini, A. L., Burton, L., Zimmerman, S., May, C., & Magaziner, J. (2005). Outcomes of infection in nursing home residents with and without early hospital transfer. Journal of American Geriatric Society, 53(4), 590-596. 2. McGillis-Hall, L., McGilton, K. S., Krejci, J., & Pringle, D. (2005). Enhancing the quality of supportive supervisory behavior in long-term care facilities. The Journal of Nursing Administration, 35(4), 181-187. 3. Maxwell, J. C. (1993). The quickest way to gain leadership: Problem solving. In Developing the Leader Within You (pp. 7595). Nashville: Thomas Nelson. Suggested Check intern website for any suggested readings. Resources & Readings Required Clinical 1. Review the most recent Survey findings for your facility. Select one citation from the survey, or another quality issue your Activities Prefacility has recently tried to improve. Read the Plan of Workshop Correction (if a Survey citation) or QI plan (if another quality issue). 2. Briefly interview a charge nurse (that was employed at the home at the time of the last survey) about the issue. Do they know about the issue from the survey or other quality initiative you are discussing? How do they view their role? Have they tried to change CNA practices around this issue? How? Have their strategies worked? Have they encountered any challenges? 3. Bring your notes to the workshop for our 30 minute postworkshop debrief. Week 11: August 17th Interns Only, 2:30-4:30 p.m. 12

SAMPLE SYLLABUS
Topic Instructors Objectives Required Readings RN Decision Making in LTC and Practice Change Colleen Gullickson, PhD, APNP, RN, Guests 1. Describe some current innovations in LTC. 2. Discuss how to select and implement practice change. 1. Koren, M. J. (2010). Person-centered care for nursing home residents: the culture-change movement. Health Affairs, 29(2), 312-317. 2. Tobin, S. S. (2003). The historical context of humanistic culture change in long-term care. In A. S. Weiner & J. L. Ronch (Eds). Culture Change in Long-Term Care: Haworth Social Work Practice Press, New York. Check intern website for any suggested readings.

Suggested Resources & Readings Required Clinical Activities PreWorkshop

1. Be prepared to discuss situations youve encountered during the internship which could benefit from change

Week 12: August 24th Group, 2:30-3:30 p.m. workshop; 3:30-4:30 Internship Celebration! Topic Creating a Safety Culture Instructors Andrea Gilmore, MS, RN and Brenda Ryther, MS, RN Objectives 1. Understand the factors that contribute to a culture of safety 2. Analyze the relationship between adverse events and the culture of a specific work setting 3. Understand the specific challenges for patient safety encountered in long term care settings 4. Understand the basic components of a safety culture. Required Readings 1. Scott-Cawiezell, J. et al. (2006). Moving from a culture of blame to a culture of safety in the nursing home setting. Nursing Forum, 41(3) 133-140. 2. Pearson, A (2005). Minimizing errors in health care: Focusing on the 'root cause' rather than on the individual. International Journal of Nursing Practice, 1:141. Suggested 1. AHRQ Patient Safety Survey Tool: Resources & http://www.ahrq.gov/qual/nhsurvey08/nhsurvey.htm Readings Required Activities 1. Consider the following questions: Pre-Workshop What are the organizational factors that promote a culture of safety? How do nursing homes differ from other environments in terms of the factors contributing to a safety culture?

13