Effective: 4/1/2016 Baccalaureate
Nursing Competencies- Comprehensive Exam
This exam is to be supervised by a proctor who has been approved by University. Word Count: While there is no required word count for your essays, students who have successfully passed their exams tend to average at least 700-950 words per essay. Format: This exam consists of broad essay questions based on your academic and professional knowledge of nursing. Citations: Your work will be evaluated on your ability to generate, integrate, and express ideas in a concise manner with appropriate citations. In each essay you are required to use appropriate citations and references for the evidence you provide and to substantiate your scholarly comments. Failure to cite your work in any of the three required essays will result in a failing grade on this exam. Rubric: A passing grade on this exam is a 90%. Your exam will be graded by an University faculty member based on the below rubric: Graded Elements Unsatisfactory Satisfactory Good Excellent Organization Thoughts are not organized or presented in a logical sequence. Shows intellectual confusion with lack of organization. Demonstrates necessary knowledge but is not clear or concise. Paper has marginal development of ideas. Well-organized and developed with good use of supporting examples. Scope of the question is presented in a straight forward manner with few contextual errors. Exceptional quality of organization and amount of detail used to support or illustrate all points Scope of the issues to be explored is welldescribed. Essay has logical organization with no errors. Content Content does not address the question. Responses show little understanding of the questions. Responses adequately address the questions. However, thesis is not well-developed and alternatives have not been considered. Responses demonstrate a clear understanding of the questions. Content is focused and straight forward, if uninspired, with few errors. Addresses all points in a clear and articulate manner. Content is error free and presented with clarity and purpose with well-developed detail. Analysis Analysis does not address topic. Failed to present relevant issues or show evidence of critical thinking. Responses fail to develop an analysis of an issue. There is little or no detail. Analysis shows adequate development of critical thinking. Uses enough specific information and examples. Identified some implications but failed to point out gaps or contradictions. Evidence of critical thinking through clear analysis of problems and issues. Implications and contradictions identified but not thoroughly analyzed. Analysis is clear and well-organized. Synthesis of sources and ideas is insightful and indicates a high level of critical thinking. Implications and contradictions discussed in detail. Language Use and Style Numerous spelling, grammatical and punctuation errors. Severe and frequent writing errors. Demonstrates little understanding of the mechanics of writing. No attempt to apply APA style to text or references. Contain few writing errors but little variety or sophistication in language usage. Several spelling, grammatical or punctuation errors which detract from project. Attempted to use APA style in text and references. Good use of the English language. Response has been proofread and has few, if any, errors. Uses language effectively, and contains few writing errors. APA style applied to text and references. Responses demonstrate fluency, language control, and sentence variety. Excellent sentence structure, mechanics, and choice of words. Responses have been proofread. Error-free for spelling, grammar and punctuation. APA style applied to text and references. Please answer all three questions listed below. – Question 1, Professional Issues in a Functional Role The Institute of Medicine report, Health Professions Education: A Bridge to Quality (2003), emphasized the importance of high quality and safe patient care. Five core competencies for all health professionals were identified: Provide patient-centered care, work in interdisciplinary teams, use evidence-based practice, apply quality improvement, and use informatics. For EACH of these five competencies: A. Describe each competency, focusing on how the competency impacts nursing, the patient, and healthcare delivery. B. Explore the obstacles to adopting the competency, as well as strategies to overcome these barriers. C. Identify specific initiatives you can undertake to fulfill these competencies and promote adoption among other colleagues in the health professions. – Question 2, Clinical Issue in a Functional Role Community assessment is a core function of public health nursing and population-centered health care. It is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources. It is the foundation upon which community health interventions are built. Apply the nursing process to promote community health in a select geriatric population. Using the data that have been collected (Attachment #1), analyze it to search for significant themes or trends. This analysis should result in discovery of community health problems (needs for action) and community health strengths (abilities). Use the charts and tables in the document to answer each of the following questions: • What similarities and differences are apparent between the data that were gathered and the data that were generated? • What are the strengths of this community? • In what areas is improvement needed in this community? Consider what you believe to be the priority health concern form this geriatric community. Consider a goal or objective for addressing this problem, and briefly outline some intervention activities to meet the established objective. Lastly, articulate how you would assess the effectiveness of this intervention in resolving the community health concern. – Question 3, Research-Theory-Practice Research is a major force in nursing, and the evidence generated from research is changing practice, education, and health policy. Evidence-based practice is the basis for clinical decision making and nursing interventions that support nursing practice, and demonstrate quality and cost-effective outcomes of nursing care delivery. Baccalaureate-educated nurses’ must have the skills to read, critique, and synthesize research so this evidence can be used to make changes in practice. Critique the following research article, providing a narrative summary of the strengths and weaknesses of the study within each of the broad headings listed below. When labeling an area as a strength or weakness, provide examples from the study and state a rationale. Research problem and purpose: Is the problem significant and relevant to nursing? Was this study feasible to conduct in terms of money commitment; the researchers’ expertise; availability of subjects, facility, and equipment; and ethical considerations? Literature review: Is the literature review organized to demonstrate the progressive development of ideas through previous research? Does the literature review provide a rationale and direction for the study? Study framework: Is the framework presented with clarity? Is the framework linked to the research purpose? Is the framework related to nursing’s body of knowledge? Research objectives, questions, or hypotheses: Are they clearly and concisely expressed? Logically linked to the research purpose? Variables: Do the variables reflect the concepts identified in the framework? Are the variables clearly defined (conceptually and operationally) based on previous research and/or theories? Design: Was the best design selected to direct this study? Does the design provide a means to examine all of the objectives, questions, or hypotheses and the study purpose? What are the threats to design validity? Were these threats identified by the researcher? Have the threats to design validity (internal and external) been minimized? Sample, population, and setting: Is the target population to which the findings will be generalized defined? Is the sampling method adequate to produce a sample that is representative of the study population? What are the potential biases in the sampling method? Is the sample size sufficient to avoid a Type II error? Was the sample size determined by a power analysis? Are the rights of human subjects protected? Are the HIPAA privacy regulations followed in conducting the study? Measurements: Do the instruments adequately measure the study variables? Are the reliability and validity of the instruments adequate for use in the study? Are the instruments clearly described? Are techniques to administer, complete, and score the instruments provided? If the instrument was developed for the study, is the instrument development process described? Data collection: Is the data collection process clearly described? Is the data collection process conducted in a consistent manner? Are the data collection methods ethical? Do the data collected address the research objectives, questions, or hypotheses? Data analyses: Are data analysis procedures clearly described? Are data analysis procedures appropriate to the type of data collected? Are the results presented in an understandable way? Are tables and figures used to synthesize and emphasize certain findings? Are the analyses interpreted appropriately? Interpretation of findings: Are findings discussed in relation to each objective, question, or hypothesis? Are significant and non-significant findings explained? Does the interpretation of findings appear biased? Are the biases in the study identified? Are there uncontrolled extraneous variables that may have influenced the findings? Do the conclusions fit the results from the analyses? Did the researchers identify important study limitations? Are there inconsistencies in the report? ATTACHMENT #1 Community Assessment: Geriatric Population PHASE ONE: DEFINING THE COMMUNITY You are employed as a public health nurse by the Centerville Area Agency on Aging. One of your duties in this position is to provide health services to older persons in this community. Services currently provided by this agency consist of a congregate meal site and a foot clinic. You wonder whether these services are meeting the needs of the target population and if additional services should be offered. Thus, you decide to perform a community assessment on the older population that resides in Centerville. PHASE TWO: ASSESSMENT A. Data Gathering First, you conduct an Internet search to find information about your population. Through your Internet search, you gather the following information: National Data—U.S. Department of Health and Human Services Statistical Profile of Older Americans Aged 65+ • The older population increased by 9.4% from 2000 to 2010. • About 12.4% of the population consists of older Americans. • Older women are more numerous than older men. • Older men were much more likely to be married than older women. • In 2010, the median income among older persons was $21,784 for males and $12,495 for females. • The main source of income for older persons in 2010 was Social Security (89%). • About 10.1% of older persons were below the poverty level in 2005. • In 2009-2010, 38.1% of elderly persons living in the community rated their health as excellent or very good; this is low when it is considered that 66% of persons aged 18-64 rated their health as excellent or very good. • The most frequently reported health conditions in this population in 2009-2010 were hypertension (52%), arthritis (50%), heart disease (32%), cancer (21%), & diabetes (17%). State Data (2010)—Geriatric Population • A total of 14% of the population was older than 65 years. • Median income for an older person was $14,000. • The poverty rate for older persons was 10%, and that for the remaining population was 7.5%. • Leading causes of death among older persons included heart disease (35%), cancer (20%), stroke (8%), and chronic obstructive pulmonary disease (COPD) (6%). Local Data • Centerville population: 6500 • Centerville population (65+): 1500 (25% of the population) • Ethnicity: • White or Caucasian—95% • Black or African American—3% • Latino or Hispanic—2% • Median household income is $29,000 (for all households). • Median household income is $27,000 (age 65+). After collecting data from the Internet, you visit the community center to obtain information about services provided and to review the records of services provided at the Area Agency on Aging. Community Center Data • Bingo: Approximately 40 people attend the weekly bingo game held on Wednesday afternoon. • Exercise program: Approximately 25 people attend the exercise program that is held on Tuesday morning. Congregate Meals One meal site is available within the community; it is located at the community center and serves a mid-day meal Monday through Friday. Approximately 30 older persons attend the meal each day; approximately 100 people attend the meal at least monthly. The number of persons who attend the meals has not significantly changed during the past decade. Most persons who attend congregate meals are retired and live on a fixed income. Foot Clinic A foot clinic is available for older persons in the community. It is located at the main office for the Area Agency on Aging on Main Street. A nurse operates the Foot Clinic from 9 a.m. to 11 a.m. every Thursday. Older persons sign up for a 30-minute appointment by calling the Area Agency on Aging. During this visit, the nurse assesses vital signs, inspects feet, trims toenails if needed, and provides education to older persons. Appointment times always fill up quickly, and sometimes, individuals will wait up to a month to get in to see the nurse. The Area Agency on Aging has been given a state grant to operate the Foot Clinic, so at this time, no fee is charged for services provided. B. Data Generation After you have collected the previous information, you begin to generate your own data about the community. You choose to conduct a focus group at the congregate meal site to gather additional information. To prepare for the focus group discussion, you decide on main topics that you would like to discuss with the group. You prepare a topic list rather than a list of specific questions, because you will allow the group to guide the direction of the discussion. Topic list: • Services currently used • Accessibility of current services • Barriers to use of current services • Recommendations for additional services You contact the director of the community center where the congregate meal is served to help you organize a small group (6-12 people) of older persons for the focus group. You explain that the purpose of the focus group is to discuss services that are currently provided for older persons in the community, as well as ways to improve these services, including a discussion of additional services that may be offered. He states that he will organize the focus group after you let him know the day and time you would like to come to the community center. Focus Group As you conduct the focus group with eight older persons (three males and five females), you jot down notes about what the participants say, and ask the group questions to clarify their thoughts and learn more about their perspectives on services within the community. After you finish the focus group meeting, you look through your notes to identify emerging themes that were discussed. Theme Identification • The group states that current services are available and accessible to them. However, they all state that they are able to drive and have a reliable source of transportation. They express concern for others whom they know in the community who are unable to use the current services because they have no way to get there. • They enjoy the meals that are offered at the community center. They state that the food is good and they enjoy the companionship at meal time. They state that they wish that meals would also be delivered to those who are unable to get to the community center. • They are concerned about the length of time that it takes to be seen at the Foot Clinic. No one is happy about having to wait up to a month to be seen by the nurse. They think that this service should be offered more frequently. Also, they state that the location is not convenient for them. It is often very difficult to find a parking space on Main Street, and all of the parking stalls require parallel parking, which is sometimes difficult to do. Because of this, some of them state that they have had to walk a couple of blocks to get to the office, and this is exhausting. • They wish there was more than one doctor in town. They state that sometimes they need to see the doctor right away but are told that it will be several days before an open appointment time is available. Because of this, many drive to a neighboring town and access the emergency room; they feel they have no other options. • They are concerned about the medical care they receive. They state that they are sometimes unsure about why they are taking their prescribed medications. They state that no one ever takes the time to explain their medications; everyone is always in a rush. When they see the doctor, they feel as though they are always being given another pill, and that no one actually tries to find out what is really wrong with them. They wish someone would take the time to explain things to them. • They wish there was more to do in the community. They stated that they felt fortunate to have a community center, where they can gather on a regular basis. They enjoy the activities that are offered and feel lucky after speaking to residents in other communities who do not have a community center. However, doing the same thing on a weekly basis gets boring, and they would like to have new and different opportunities available to them. • Transportation is a major concern for residents of the community. The town has no public transportation system, so it is difficult to get around if you are unable to drive or do not have a reliable vehicle. They state that some of their friends rarely leave their homes because they have no mode of transportation. C. Data Interpretation After you have collected the data, you analyze the findings. You look through the data to find out whether you have collected adequate information to obtain a complete picture of the community. You review the data you have collected to identify recurrent themes. You identify the strengths and weaknesses of the community so that you can draw some conclusions. Topic Area: Income National /State Data Local Data Interpretation: Conclusion: Topic Area: Health Conditions National /State Data Local Data Interpretation: Conclusion: Topic Area: Congregate Meals Data Gathered Data Generated Interpretation: Conclusion: Topic Area: Foot Clinic Data Gathered Data Generated Interpretation: Conclusion: Topic Area: Additional Services Data Gathered Data Generated Interpretation: Conclusion: On the basis of the community assessment, you are able to draw the following conclusions: Strengths of the Community Areas for Improvement in the Community Recommendations
