15. Clinical Performance Objectives

Student-Faculty Handbook

University of Detroit Mercy Graduate Program of Nurse Anesthesiology

Reviewed Aug 2001, Feb 2002, Mar 2003, Aug 2003, Jan 2004, Mar 2005, Apr 2006, Aug 2007

Introduction

It is expected that the student will correlate didactic knowledge with clinical practice in the pre/post and intraoperative periods throughout the program. This correlation is an integral part of the objectives for each practicum and performance in this area will be emphasized in the written evaluation. There is no clinical in Fall Term 1. It is expected that students will progress from close supervision in their junior year (Semesters 2 to 4) to general supervision, and finally to the performance of terminal objectives, with minimal guidance (Semester 5 to 7).

Students must maintain current Michigan Registered Nurse licensure, ACLS and PALS certification throughout the program or they may not participate in clinical internships.

Clinical Objectives- Junior Students Winter/Summer (Term 2, 3)

Cognitive Domain

• Performs complete preoperative assessment and chart review prior to surgery with supervision for all elective/emergency cases.
• Formulates Anesthesia Care Plan and discusses with clinical instructor prior to entering O.R.
• Assigns appropriate ASA status to patient.
• Demonstrates basic knowledge of anesthetic agents.
• Identifies potential anesthetic problems and appropriate interventions.
• Assembles checks and maintains the function of all basic anesthetic equipment.
• Describes the pharmacokinetics and provides rationale for use of all drugs administered.
• Demonstrates knowledge of surgical intervention and anesthetic.

Psychomotor Domain

• Performs atraumatic technical skills (venipuncture, insertion of OPA, NPA, esophageal stethoscope)
• Organizes anesthetic equipment, applies basic anesthetic monitors, interprets monitoring data correctly.
• Positions patients using learned principles and explains physiologic effects under anesthesia
• Performs intubation and extubation with dexterity and manages uncomplicated airways.
• Performs induction as discussed with instructor.
• Administers anesthetic agents according to learned principles and instructor discussion.
• Administers and manages regional anesthetic according to learned principles.
• Calculates and administers fluid replacement appropriately.
• Ends anesthetic/extubates according to learned principles under the direct supervision of the instructor.
• Neat and accurate charting and work area.
• Accurate and pertinent report with transfer of responsibility.

Affective Domain

• Communicates effectively with patient, family, and members of the health care team.
• Protects patient privacy and maintains confidentiality consistently.
• Receptive towards learning and accepts constructive criticism.
• Utilizes learning environment and initiates experiences to enhance professional growth.
• Delivers culturally competent care throughout the perianesthetic course.

Clinical Objectives- Junior Students Fall (Term 4)

Cognitive Domain

• Performs complete preoperative assessment prior to surgery with supervision for all elective/emergency cases
• Complete chart review and rapid formulation an ACP discussed with clinical instructor prior to entering O.R.
• Determines the need for additional studies, invasive monitoring, and alternative anesthetic techniques.
• Identifies potential anesthetic problems and appropriate interventions.
• Takes responsibility for resolution of potential anesthetic problems or equipment malfunction.
• Demonstrates independent problem solving skills and uses safe judgment in all cases.

Psychomotor Domain

• Performs basic and complex technical skills atraumatically (intubation, a-line insertion, mask airway management, LMA insertion)
• Performs a variety of induction techniques with competency and dexterity for complicated and uncomplicated airways.
• Calculates and titrates fluid and blood replacement for elective and emergency cases (adult, pediatric and neonatal patients.
• Demonstrates attentiveness to intraoperative events for complex and emergency cases.
• Utilizes invasive monitoring with recognition and correction of abnormalities.
• Performs smooth, timely emergence for all cases with minimal instructor assistance.
• Obtains and completes all pertinent records according to hospital policy (QA, blood slips and death reports)
• Accurate report with transfer of responsibility.

Affective Domain

• Continues to maintain professional conduct and begins to function as a role model and/or resource person for beginning students and other health care personnel.
• Receptive towards learning and accepts constructive criticism.
• Responds to criticism appropriately as a means for self-improvement.
• Identifies clinical experiences which will challenge self and clinical practice.
• Begin participation in state and national professional association to prepare for active involvement.
• Demonstrates self-motivation within the clinical setting.

Terminal Behavior Objectives (Terms 5 to end)

Senior students should display competence in the junior year sets of objectives, in addition to working toward these objectives. Attainment of these final objectives demonstrates that graduates have acquired knowledge, skills and competencies in the areas of patient safety, perianesthetic management, critical thinking, communication, and the professional role.

Patient safety

is demonstrated by the ability of the graduate to:

• Be vigilant in the delivery of patient care
• Protect patients from iatrogenic complications
• Participate in the positioning of patients to prevent injury
• Conduct a comprehensive and appropriate equipment check
• Utilize standard precautions and appropriate infection control measures

Individualized Perianesthetic Management

is demonstrated by the ability of the graduate to:

• Provide care throughout the perianesthetic continuum
• Use a variety of current anesthesia techniques, agents, adjunctive drugs, and equipment while providing anesthesia
• Administer general anesthesia to patients of all ages and physical conditions for a variety of surgical and medically related procedures
• Provide anesthesia services to all patients, including trauma and emergency cases
• Administer and manage a variety of regional anesthetics
• Function as a resource person for airway and ventilatory management of patients
• Possess current advanced cardiac life support (ACLS) recognition
• Possess current pediatric advanced life support (PALS) recognition
• Deliver culturally competent perianesthetic care throughout the anesthesia experience

Critical thinking

is demonstrated by the graduate's ability to:

• Apply theory to practice in decision-making and problem solving,
• Provide nurse anesthesia care based on sound principles and research evidence,
• Perform a preanesthetic assessment and formulate an anesthesia care plan for patients to whom they are assigned to administer anesthesia,
• Identify and take appropriate action when confronted with anesthetic equipment-related malfunctions.
• Interpret and utilize data obtained from noninvasive and invasive monitoring modalities.
• Calculate, initiate, and manage fluid and blood component therapy.
• Recognize and appropriately respond to anesthetic complications that occur during the perianesthetic period
• Pass the Council on Certification of Nurse Anesthetists' (CCNA) certification examination in accordance with CCNA policies and procedures

Communication Skills

are demonstrated by the graduate's ability to:

• Effectively communicate with all individuals influencing patient care
• Utilize appropriate verbal, nonverbal, and written communication in the delivery of perianesthetic care

Professional role

is demonstrated by the graduate's ability to:

• Participate in activities that improve anesthesia care
• Function within appropriate legal requirements as a registered professional nurse accepting responsibility and accountability for his or her practice
• Interact on a professional level with integrity
• Teach others
• Participate in continuing education activities to acquire new knowledge and improve his or her practice

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