Semester design PEDIATRIC NURSING

Plus program for Nursing Indonesia

Involved universities: Faculty of Nursing, University of Indonesia Nursing program faculty of Medicine University of Diponegoro Semarang Nursing program, faculty of Medicine, University of Airlangga, Surabaya Nursing program, faculty of Medicine, University of Brawijaya, Malang Nursing program, faculty of Medicine, University of Udayana, Denpasar Nursing program, faculty of Medicine, University Hasanudin, Makasar Nursing program, faculty of Medicine, University Andalas, Padang Nursing program, faculty of Medicine, University Syah Kuala,Banda Aceh Indonesia Version 0.1, November 20072, December 2008

CONTENTS
Introduction.................................................................................................................................3 Core task and level......................................................................................................................4 1.Blueprint of the semester ......................................................................................................13 2.Core Assignments..................................................................................................................15 ..................................................................................................................................................15 Knowledge................................................................................................................................24 Assessment................................................................................................................................27 Planning....................................................................................................................................30

Introduction
The curriculum for the plus program for Paediatric Nursing for several universities in Indonesia was set up in a series of workshops in November 2007. The setup of the program is part of the project Development of Nursing Specialization, which was funded by Nuffic-NESO. This document is one of the results of this series of workshops, which was attended by participants of all universities in Indonesia as mentioned. During the workshop series six plus programs have been developed: Critical Care, Paediatrics, Maternity, Gerontology, Adult Nursing and Mental Health. This document describes the design of the semester of Paediatric Nursing. The results preceding Semester Design are the gathered in the Curriculum Profile. The design of the plus program is based upon guidelines, as mentioned in the Curriculum Profile. In the Professional Profile (part of the Curriculum Profile) the tasks a professional should be able to perform in practice are described and the core task is defined for the Paediatric Nursing professional. In the Curriculum Profile the core task of the curriculum are detailed. For each core task level was defined. One plus program contains one semester. The Curriculum Profile provides information on the core task that is central to this semester. This Core task is: To provide direct nursing care using nursing process approach for hospitalized children with chronic, acute, and life threatening illnesses. To be able to design the core assignments of the semester more information is needed, so a task analysis was done. Then the final core assignment was designed and assessment of the final assignment and therefore of the semester was considered. The next steps were designing the complete series of core assignments in the semester, drafting the assessment plan and adding the knowledge and skills to the design. After the core assignments were detailed, an assessment plan was made, and knowledge subjects and routine skills were defined. Finally a draft planning was made. The next chapter contains the core task and the description of the level (chapter 2). A complete overview of the semester is given in (chapter 3): semester design, which includes the task hierarchy that is applicable to this semester. Chapter 4 describes all core assignments of the semester. Knowledge (chapter 5) and Routine skills (chapter 6) clarify the supportive information and skills to be acquired. Chapter 7 describes how students will be assessed. A draft planning completes the semester design (chapter 8).

Core task and level

The next, core task will be the focus of learning: The main task is: to provide direct nursing care using nursing process approach for hospitalized children with chronic, acute, and life threatening illnesses Since, there is only one main task that the students will be trained for three different type of illnesses, we divide the core task into three parts based on the types of diseases or illnesses. Therefore, there will be three core tasks which derived from one main task for three different terms which should be completed by the students of paediatric program. In the following part, the core tasks are described in terms of knowledge Core task A : To provide direct nursing care using nursing process approach focused on Special Treatment for hospitalized children with chronic illnesses, such as: a. Patient with heredity diseases (thalassemia, hemophilia) b. Patient with congenital diseases c. Patient with malnutrition problems Related professional task action/process (verb) and result/product - to assess the patient health status - to formulate nursing diagnosis based on the assessment data - to develop nursing care plan for the patient - to implement the nursing care plan - to evaluate the nursing care plan - to document and to report the patients nursing care delivery

result/product: - the document of: 1) nursing assessment, 2) nursing care plan, 3) the nursing progress report - the fulfilment of patients needs as stated by the patients and family - the patients health problems are solved based on patient and family evaluation - the satisfaction of the patient and family according to the nursing care services as stated by the patient and family Assessment criteria (how can Complex skills one know if one performs the - Skill full core task properly?) - accurate - gentle - respond quickly based on patient needs - based on SOP (standard operation procedures) - involve the patient and family if needed Attitude - caring - empathy - independent - able to work in team or group - able to work under pressure - self confident - problem solver, not problem maker Character - helpful - active and diligent - smart - creative and full of initiative

less anxiety or panic curious self directed person

Knowledge items (which Knowledge related to knowledge items are related - the chronic diseases suffered by the children (patho physiology to this core task? What does of the diseases): someone need to know in a. heredity diseases order to perform the core b. congenital diseases task?) (use nursing curricula c. malnutrition problems items) d. pain management the analytical thinking of paediatric nursing care for patient with chronic diseases - the specific interventions and procedures in handling the paediatric patients who are suffered from the chronic diseases - the nursing process approach for paediatric nursing care, specifically the phase of assessment, diagnosing, and planning Skills (which routine skills are - Assessment skills: necessary to perform the core how to interview or communicate with baby and toddler (hetero task?) (use nursing curricula anamnesis) items) how to conduct physical exams for baby and toddler how to conduct Denver test on baby to pre school age diagnostic test: 1) how to draw blood intravenously from baby; 2) how to assist LP/BMP procedure How to make interpretation and analysis for all the finding above How to manage pain in children - Specific Skills: Maintaining IV therapy for children Fluid balance for baby to school age Phototherapy Blood transfusion for children with haemophilia Inserting IV-line for baby Inserting IV-line for toddler Administering injection (IM, SC, IV) for babies and toddler Complex wound care and stoma care - Nursing interventions for specific illnesses/ diseases: patient with congenital disease ( heart, GI, urinary) patient with chronic heredity illnesses, such as thalasemia, and hemofilia patient with malnutrition problems

Core task B: To provide direct nursing care using nursing process approach focused on Special Treatment for hospitalized children with acute illnesses, such as: - Patient with Fever with seizure - Patient with Pneumonia - Patient with Meningitis/encephalitis - Patient with dehydration - Patient with Sepsis - Patient with tetany Related professional task action/process (verb) and result/product - to assess the patient health status - to formulate nursing diagnosis based on the assessment data - to develop nursing care plan for the patient - to implement the nursing care plan - to evaluate the nursing care plan - to document and to report the patients nursing care delivery result/product: - the document of: 1) nursing assessment, 2) nursing care plan, 3) the nursing progress report - the fulfilment of patients needs as stated by the patients and family - the patients health problems are solved based on patient and family evaluation - the satisfaction of the patient and family according to the nursing care services as stated by the patient and family Assessment criteria (how can Complex skills one know if one performs the - skilful core task properly?) - accurate - gentle - respond quickly based on patient needs - based on SOP (standard operation procedures) - involve the patient and family if needed Attitude - caring - empathy - independent - able to work in team or group - able to work under pressure - self confident - problem solver, not problem maker Character - helpful - active and diligent - smart - creative and full of initiative - less anxiety or panic - curious - self directed person

Knowledge items (which Knowledge related to knowledge items are related Patophysiology of the diseases (acute illnesses) such as to this core task? What does - Pneumonia someone need to know in - Meningitis/encephalitis order to perform the core - Dehydration task?) (use nursing curricula - Sepsis items) - Tetany

the analytical thinking of paediatric nursing care for patient with

acute diseases and patient safety the specific interventions and procedures in handling the paediatric patients who are suffered from the acute diseases the nursing process approach for paediatric nursing care, specifically the phase of assessment, diagnosing, and planning

Skills (which routine skills are - Assessment skills: necessary to perform the core how to identify the signs and symptoms of respiratory distress task?) (use nursing curricula how to recognize the seizure and shock symptoms items) how to analyse the abnormal vital signs how to perform first aid for the emergency situation how to interpret the blood gasses analysis and electrolyte findings how to determine the level of dehydration - Specific Skills: Measuring the fluid demands Measuring and correcting the acid-base balance Performing inhalation and suction Monitoring the intraoseus fluid procedure Providing appropriate position for patient with respiratory problems Performing patient safety to prevent injury - Nursing interventions for specific illnesses/ diseases: patient with alteration in acute respiratory system (pneumonia) patient with alteration in fluid electrolyte balance, patient with dehydration patient with seizure with fever patient with sepsis patient with tetany

Core task C: To provide direct nursing care using the nursing process approach focused on special treatment for hospitalized children with life threatening illnesses, such as a. Cancer b. HIV/AIDS Related professional task action/process (verb) and result/product - to assess the patient health status - to formulate nursing diagnosis based on the assessment data - to develop nursing care plan for the patient - to implement the nursing care plan - to evaluate the nursing care plan - to document and to report the patients nursing care delivery result/product: - the nursing document of: 1) nursing assessment, 2) nursing care plan, 3) the nursing progress report - the fulfilment of patients needs as stated by the patients and family - the patients health problems are solved based on patient and family evaluation - the satisfaction of the patient and family according to the nursing care services as stated by the patient and family Assessment criteria (how can Complex skills one know if one performs the - skilful core task properly?) - accurate - gentle - respond quickly based on patient needs - based on SOP (standard operation procedures) - involve the patient and family if needed Attitude - caring - empathy - independent - able to work in team or group - able to work under pressure - self confident - problem solver, not problem maker Character - helpful - active and diligent - smart - creative and full of initiative - less anxiety or panic - curious - self directed person

Knowledge items (which Knowledge related to knowledge items are related - patophysiology of the diseases: to this core task? What does Cancer someone need to know in HIV/AIDS order to perform the core task?) (use nursing curricula - the analytical thinking of paediatric nursing care for patient life items) threatening illnesses - the concepts of universal precaution and palliative care - the specific interventions and procedures in handling the paediatric patients who are suffered from life threatening illnesses (universal precaution) - the nursing process approach for paediatric nursing care, specifically the phase of assessment, diagnosing, and planning Skills (which routine skills are - Assessment skills: necessary to perform the core - performing anthropometrics assessment task?) (use nursing curricula - assessing pain level items) - Performing health assessment (physical and laboratory) for patient with cancer and HIV/AIDS - Assessing sign and symptoms of opportunistic infection - Assessing the obedience level of patient - Specific Skills: Isolation techniques Monitoring side effect Chemotherapy Maintaining TPN (total parenteral nutrition) Performing playing therapy Performing standard procedure for HIV/AIDS - Nursing interventions for specific illnesses/ diseases: patient with cancer, patient with HIV/AIDS

The core task at above described level results in the following Task Hierarchy (Figure 1): Figure: Task Hierarchy

Task Hierarchy, part 1

Task Hierarchy, part 2

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2.1. Different levels of the core task complicating factors The core task can be divided into different levels. Firstly complicating factors are stated. Each complicating factor can be divided into easy, moderate and difficult level. As a choice for this program, the end level is shown in bold. These are the specifications of the level that is applicable to the Core Task: Complicating factor Age of the children: - Communications with patients - How to handle the patients Severity of illness Number of patient being cared for a working time (shift) Number of health problems for each patient Type of ward The nature of illness Skills for nursing action Type of documentation mild 1 Moderate 2-4 Severe More than 5 Easy/Beginner School age/ teenage Moderate/Intermediate Pre school age Difficult/Expert Baby /toddler

1-2

3-5

Many

policlinic No complications Communication and physical assessment skills Self reflection report

Regular With complication Analytical thinking. invasive Case analysis report

High Care With complications Communication, assessment, analytical thinking and Invasive Portfolio

1.

Blueprint of the semester

The next table will show an overview of all subjects in the plus program: Item Short description Chapter A. Term 1 Core task: To provide direct nursing care using Core task 4 nursing process approach for hospitalized children with and core chronic diseases assignments related t B. Term 2 Core task: to provide direct nursing care using
nursing process approach for hospitalized children with acute illnesses C. Term 3 Core task: to provide nursing care for hospitalized children with life threatening illness Core assignments consist of: 1. Overview about how to provide nursing care for hospitalized children using nursing process approach (from assessment to evaluation) 2. Completion task: conduct an assessment to children with chronic illnesses 3. Completion task: develop nursing care plan for children with acute illnesses 4. Completion task: specific nursing intervention and evaluation for children with life threatening illnesses 5. Provide comprehensive nursing care for hospitalized children

Knowledge (non routine)

A. 1. The concepts of communication and pediatric nursing concepts of atraumatic care concepts of nursing process 4. Concepts physical assessment in pediatric patient and interpration data Critical Reasoning in nursing care B. 1. Specific intervention and procedure in handling pedatric patient with chronic, acute and life threatening illnesses 2. Decision making and evaluation the effectiveness of therapy

Routine skills

Term 1 1. Assessment skills: how to interview or communicate with baby and toddler (hetero anamnesis) how to conduct physical exams for baby and toddler how to conduct Denver test on baby to pre school age diagnostic test: how to draw blood intravenously from toddler patient 2. Specific Skills:

Maintaining IV therapy for children Fluid balance for baby to school age Inserting IV-line for toddler Blood transfusion for children with haemophilia Administering injection (IM, SC, IV) for babies and toddler Complex wound care and stoma care Isolation technique for chronic heredity diseases Phototherapy Inserting IV-line for baby Prevention of injury from seizures Isolation technique for acute illnesses Inhalation therapy Chemotherapy Assist patient undergoing radiotherapy Maintaining TPN Tracheostomy care Complex wound care Resuscitation Heart and Lung for paediatric patient

Term 2 3. Nursing interventions for specific illnesses/ diseases: patient with congenital disease ( heart, GI, urinary) patient with chronic heredity diseases, such as thalasemia, haemophilia patient with malnutrition problems patient with alteration in acute respiratory system (pneumonia, diphtheria) patient with alteration in fluid electrolyte balance, patient with alteration of GI (diarrhoea, poisons) patient with seizure with fever patient with DHF (Dengue Hemorrhagic Fever) patient with Fever with seizure patient with Meningitis/encephalitis high risk newborn: Hyper billirubinemia, BBLR, respiratory distress patient with sepsis Term 3 4. Mastering in comprehensive care plans for the hospitalised children with chronic, acute and life threatening illnesses

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2.

Core Assignments

In the next Tables, the core assignments will be described. There is one Table for each Core Assignment. Before starting the program, the student should complete the personal assignment. Personal assignment : to develop a profile for the PDP (Personal Development Program) To do Action/ Result Situation: By the end of the meeting, the students will be able to develop their personal profile based on their competencies and experiences in clinical practices in order to adjust their individual learning process during pursuing the certification program in paediatric nursing Students comprehend about the profile Compose a personal profile based on the specific format: o What Knowledge, Skills, Attitudes that students already have (competencies) o What experiences that students already have ( include inside and outside class/ school activities) o What should the students focus on to achieve during the plus program based on their competencies and experience (students personal goals) - This assignment must be completed by the students before the program begin - They should submit their personal profile at the first meeting or classroom activities Assessment criteria: - Product : Document of personal profile - The document should consist of: o Competencies already owned by students o Experiences o Personal plan or personal learning goals for their personal study during their certification program in paediatric nursing (the responsibility to achieve this plan is under the students themselves)

Conditions

Assessment criteria Product: Process:

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Core Assignments The following are description of the core assignment during the plus program. Core Assignments consist of: 1. Description of Core Assignment 1: Overview about how to provide nursing care for hospitalized children using nursing process approach (expert example from nurses whom successes in caring patient) 2. Description of Core Assignment 2: Completion task: conduct a comprehensive assessment to hospitalized children with chronic illnesses 3. Description of Core Assignment 3: Completion task: develop nursing care plan for hospitalized children with acute illnesses 4. Description of Core Assignment 4: Completion task: specific nursing intervention and evaluation for hospitalised children with life threatening illnesses 5. Description of Core Assignment 5: provide comprehensive nursing care for hospitalized children and complete documentation

Core Assignment 1: Overview of nursing care for hospitalized children using nursing process approach To do After the exploration, the Students will understand about: action/result - steps of nursing process approach - the tasks of the paediatric nurse - the nursing interventions specific to the diseases Result: Students has an overview about nursing care for hospitalized children Students discussion within groups of students which facilitated by a teacher who also act as an expert in paediatric nursing for 2 hours Situation: Students explore their knowledge about nursing care for hospitalized children with their colleagues in the classroom Methods of delivery(choose one of these methods) 1. Teacher act as an expert in providing nursing care and direct open discussion with students 2. Students sharing experience during their bachelor study about how to deliver nursing care 3. Using PBL approach Conditions Pre conditions of students: Before the interaction with the teacher, the students already have experience working in paediatric clinical setting during their bachelor study; assessment of the students competency based on their personal profile Conditions to perform task: discussion within groups of students facilitated by a teacher who also act as an expert in paediatric nursing for 2 hours - Number of students in a group: 5 students - Students Presentation about the result of group discussion (20 minutes) - The first week of program (in school) Assessment criteria Product: Process: Assessment criteria: Product : Written/computer typed group report in 2500-3000 words, will be submitted by next week

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The criteria for product are: a) completeness of nursing process approach being used b) consider the psychosocial aspect of the children c) includes the concept of play and non traumatic approach in nursing care Process Active involvement for every students in group discussion

Core Assignment 2: Completion task: conduct comprehensive assessment to a number of patient with chronic illnesses

To do action / result:

The student will be able to interview or communicate with baby and toddler (hetero anamnesis) conduct physical exams for baby and toddler conduct Denver test on baby to pre school age diagnostic test: 1) how to draw blood intravenously from baby; 2) how to assist LP/BMP procedure make interpretation and analysis for all the finding above manage pain in children 1. Skills lab - trains physical assessment with simulated patient in couples - trains children development test using DDST format with simulated patient in couples 2. Clinical practice - assess the patient with heredity disease (school age children) - assess the patient with congenital disease (baby-toddler) - assess the patient with malnutrition (pre school school age children) Skills lab: - simulated patient is a voluntary patient - conduct complete physical assessment in 20 minutes per patient (simulated) for 3 patients - conduct DDST test for 30 minutes per patient (simulated) for 3 patients Clinical practice: - assess the patient with heredity disease (school age children): 3 patients - assess the patient with congenital disease (baby-toddler): 3 patients - assess the patient with malnutrition (pre school school age children): 3 patients Complete the assignments: at the week seven

Situation

Conditions

Assessment criteria Product: Process:

Assessment Criteria: Product: 1. Document of nursing assessment using assessment format attached with the patient record. These documents will be assessed by the clinical instructor 2. Presentations slides: summary about the experience in assessing the patients for students presentations sessions at school Criteria of the document: 1. The assessment report should be SMART (specific, measurable,

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2.

achievable, reasonable/realistic, time bound) based on the patient conditions Documents are ready to evaluate or assess by the clinical instructor every day

Criteria for Process Assessment: 1. Selection of the patient being cared based on the type of illness (heredity,
congenital and malnutrition)

2. During assessment, students will demonstrate the following aspects: 1)

utilize appropriate communications technique with the patients; 2) consider the psychosocial aspect of the children (holistic approach); 3) utilize the concept of play, and non traumatic approach in assessing the patient. (observation sheets needed) Every students may be assess by the clinical instructor according to their personal pace, however by the end of second week program they should accomplish the learning objectives

3.

3. Core Assignment 3: Completion task: the students should develop nursing care plan for the patient with acute diseases

To do action / result:

After completion the task, the student will be able to develop nursing care plan for patient with : 1. DHF 2. Fever with seizure 3. Pneumonia 4. Meningitis/encephalitis 5. GI problems: diarrhoea, poisons, 6. Sepsis Action/nursing activity : 1. Interpreting patient assessment data 2. Formulate nursing diagnosis based on data 3. Prioritise nursing diagnosis 4. Set patient objective of care based on diagnosis 5. Define the outcomes for each diagnosis. 6. Determine nursing intervention needed to overcome the problem.

Situation

Setting: Clinical practice Knowledge needed : A. Concepts related 1. Nursing care of paediatric patient with DHF 2. Nursing care of paediatric patient with seizures 3. Nursing care of paediatric patient with pneumonia 4. Nursing care of paediatric patient with GI problems 5. Nursing care of paediatric patient with sepsis B. Specific intervention 1. Identify nursing intervention for patient with DHF 2. Identify nursing intervention for patient with seizures 3. Identify nursing intervention for patient pneumonia 4. Identify nursing intervention for patient with GI problems 5. Identify nursing intervention for patient with meningitis 6. Identify nursing intervention for patient with sepsis

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Conditions

Clinical setting Based on the assessment data of the patient, the student develop nursing care plan for the patient using the steps of formulating the diagnosis and developing nursing care plan listed above. The minimum of two nursing care plan for each type of illnesses should be developed The assignment must be completed on week ten

Assessment criteria Product: Process:

Assessment criteria: Product : Document of nursing care plans using provided format Criteria of the document: 1. The nursing care plan document should be SMART (specific, measurable, achievable, reasonable/realistic, time bound) based on the patient conditions and needs 2. The patient care plan should consider the patient as unique individual and holistic person 3. Documents are ready to evaluate or assess by the clinical instructor every day

1.

Description of Core Assignment 4: Completion task: conduct specific nursing intervention and evaluation for hospitalized paediatric patients with life threatening illnesses

To do action / result:

After completion the task, the students will be able to perform /conduct specific intervention to overcome the health problems for patient with: 1. HIV/AIDS, 2. Cancer Action to do: 1. communicate with patients and family 2. perform independent nursing action 3. perform dependent nursing action 4. perform collaborative action 5. refer the patient to other appropriate health provider if needed 6. counsel the family 7. educate patient and family Setting: 1. Skills lab for train specific interventions with models or simulated patient 2. Clinical practice for train specific interventions with real patients 3. School (classroom) for presenting the experiences Knowledge needed : A. Concepts related 1. Nursing care of paediatric patient with HIV/AIDS 2. Nursing care of paediatric patient with Cancer B. Specific intervention 1. Nursing interventions for specific illnesses/ diseases: patient with cancer patient with HIV/AIDS 2. Specific Skills needed: Isolation techniques for patient with low immune status (high risk)

Situation

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 Conditions

Chemotherapy Assist patient undergoing radiotherapy Maintaining TPN Tracheostomy care Complex wound care

Skills lab: 1. Each student may train their skill related to skills needed for implementing nursing care for patient using models or simulated patient.(see list of skills above ) 2. The skills of the student will be asses by laboratory instructor/teacher.( need list of nursing procedures/SOP) Clinical setting 1. Each day of clinical work the students must provide nursing care for a group of patient (3-5 patients) 2. The students may select the patients according to their needs 3. Based on nursing care plan of each patient, the student conduct nursing interventions (including dependent, independent, collaborative nursing interventions, counselling, referring, or educating the patient and family) for patient with a. HIV/AIDS, b. Cancer 4. Each day activities (progress report of the patients) should be written down in the log book using SOAPIE/DAR formats 5. The accuracy and time needed for performing every procedures (based on SOP) are observed by clinical instructor using observation sheets School setting: 1. The students must report (present) their summary activities in the class based on their log book 2. Student presentation is 30 minutes each

Assessment criteria Product: Process:

Assessment criteria: Product : 1. Document of nursing progress report according to the patients being cared for using provided format (SOAPIE/DAR format) are available in the clinical fields. These document will be assessed by clinical instructor; 2. The nursing progress report document should be SMART (specific, measurable, achievable, reasonable/realistic, time bound) based on the patient conditions and needs; 3. Summary of progress report for classroom presentations. The observation sheet during presentations will be provided for peer assessment Process 1. Selection of the patient based on the type of illness ( HIV/AIDS, Cancer ) 2. Each day of clinical work the students must provide nursing care for a group of patient (3-5 patients) 3. Students attitude (quick respond , caring and empathy, utilize appropriate communications technique with the patients , utilize holistic approach, utilize the concept of play, utilize non traumatic approach) during clinical practice also evaluate by clinical instructor using observation sheets . 4. Every students may be assess according to their personal pace, however by the end of second week program they should accomplish the learning objectives 5. the students may be assessed based on their competency profile, the students who are achieving the targets would design their own assessment

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schedule

6. Patients and family satisfaction of student interventions/performance on 7.

conducting specific intervention for the patient (instrument for assessing Patients and family satisfaction needed) Students performance scores (observations made by the clinical instructors) includes: 1) for independent action and dependent action: clinical instructor will observe student performance during performing the procedures; 2) for collaborative action: case conference report (attended by the health member),

5. Description of Core Assignment 5: to provide comprehensive nursing care for hospitalized children and complete the written documentation for the nursing care being provided

To do action / result:

After completion the task, the students will be able to provide comprehensive nursing care for patient with: chronic, acute, life threatening illnesses Action to do: 1. perform assessment 2. develop nursing care plan 3. implement and evaluate the plan 4. make documentation 5. communicate with patients and family 6. refer the patient to other appropriate health provider if needed 7. provide counselling to the family 8. educate patient and family Real life situation: clinical setting The students should provide the comprehensive nursing care for a group of patients with each type of life threatening illnesses. The nursing care of these patients is provided by the students since patient admitted to the hospital until they discharge from the hospital. The criteria of the patients are the patients who have several health problems with minimum of moderate severity conditions Clinical Practice setting : 1. The students could select patients 2. By the end of the clinical practice, the student should provide comprehensive nursing care for patient with: chronic, acute and life threatening illnesses 3. By the end of the clinical practice (seventh week), the students must complete the nursing care documentation for each patient 4. During their clinical practice period the students should perform a minimum of one case conference with the attendance of other health team members 5. During their clinical practice period the students should perform a minimum of one referral for the patient to other health team member based on patients need. 6. Final assignment is conducted at the end of term period: the eight week of first term. During the final assignment, the student will have one randomly selected patient to be taken care of for the whole week and prepare the comprehensive nursing documentation of the patient In a determine time during the final week, the student will be observed by the clinical instructor and teacher when performing selected procedures. After the observation finished, there will be an oral examination between the students and clinical instructor & teacher

Situation:

Conditions

21

School setting: 1. Each student must present their summary of nursing care of the patients in the class for 30 minutes during the classroom activities. Different cases and/or diseases will be presented each week by different students. The students has an opportunity to present at least one case during the first term 2. By the end of the first term, the student must submit the complete documentation of the selected nursing care as final assignments Assessment criteria Product: Process: This assignment must be completed on week 18 Assessment criteria: Product: 1. One documents of comprehensive nursing care for patient with 2. Three documents of comprehensive nursing care for patient with 3. One document of health education program for a group of patients with 4. One document of case conference report with other health team members 5. One document of referral report to the appropriate health team member The product criteria: 1. The document of comprehensive nursing care should be SMART (specific, measurable, achievable, reasonable/realistic, time bound) based on patient conditions which includes: a. Literature review related to patient disease b. Complete patient assessment c. nursing care plan d. progress report 3. the health education program consist of : a. the objectives of patient education b. the content or summary of teaching materials c. the method of patient education d. the teaching and learning activities e. the media and resources used 4. the case conference report: a. summary of patient data b. nursing diagnosis c. nursing care plan d. nursing care progress and evaluation e. summary of inputs or suggestions from participants during conference 5. the referral report a. patient data b. nursing action which has been done c. reason for referral Process criteria 3. Students attitude (quick respond, caring and empathy, utilize appropriate communications technique with the patients, utilize holistic approach, utilize the concept of play, utilize non traumatic approach) during final clinical performance evaluation will be evaluated by clinical instructor and the teacher using observation sheets . 4. An oral examination about the patient case will be conducted after the completion of implementation of the procedures. A list of questions will be used by the evaluator which consist of: a. Patophysiology of the disease b. patient assessment c. nursing diagnosis d. nursing care plan for selected nursing diagnosis e. evaluation of patients condition 3. Observation during case conference will be conducted by the clinical

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instructor using the observation format includes: a. clarity of presentation b. the accuracy of time management c. the clarity and accuracy in answering questions raised d. the appropriate media and resources being used

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Knowledge
In this chapter the knowledge to be acquired by the students is described. Knowledge item (Non Routine) What knowledge? Short description

A. 1. The concepts of communication and pediatric nursing concepts of atraumatic care concepts of nursing process Concepts physical assessment in pediatric patient and interpration data Critical Reasoning in nursing care B. 1. Specific intervention and procedure in handling pedatric patient with chronic, acute and life threatening illnesses 2. Decision making and evaluation the effectiveness of therapy

How will the student acquire the knowledge?

Since the students already learn the knowledge during their bachelor study, in the plus program, the students only learn the knowledge in depth. Therefore, the students will explore their knowledge about nursing care for hospitalized children with chronic, acute and life threatening illnesses according to term, through internet searching or study literature in the library and discuss it with their colleagues. Methods of delivery 1. Teacher act as a coach in facilitating student in identify the action plan for student that the student want to achieve 2. Students sharing experience during their bachelor study about how to deliver nursing care with children 3. Using PBL approach: the students will divided into small group, and each group should prepare literature study about each type of diseases. 4. Each group has to present their paper during the classroom activity. This activity will be assess by peer group and the teacher

How much time will it take the student approximate ly? When will the student acquire the knowledge?

Per term, classroom activities= 16 hours/term. The length of each term is 6 weeks. Every week there will be one day activities in the school. Therefore every week there will be an approximately 160 minutes for learning theory or acquire the knowledge and coaching group or individual coaching if needed (3 hours interactions).

Every week there will be one day classroom activities at school for a period of 160 minutes. During this activity the students will be directed to acquire the knowledge listed in planning table.

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6. Routine Skills In this chapter the routine skills to be acquired are described.
Routine skill aspect
What routine skill?

Short description
Term 1 1. Assessment skills: how to interview or communicate with baby and toddler (hetero anamnesis) how to conduct physical exams for baby and toddler how to conduct Denver test on baby to pre school age diagnostic test: how to draw blood intravenously from toddler patient 2. Specific Skills: Maintaining IV therapy for children Fluid balance for baby to school age Inserting IV-line for toddler Blood transfusion for children with haemophilia Administering injection (IM, SC, IV) for babies and toddler Complex wound care and stoma care Isolation technique for chronic heredity diseases Phototherapy Inserting IV-line for baby Prevention of injury from seizures Isolation technique for acute illnesses Inhalation therapy Chemotherapy Assist patient undergoing radiotherapy Maintaining TPN Tracheostomy care Complex wound care Resuscitation Heart and Lung for paediatric patient Term 2 3. Nursing interventions for specific illnesses/ diseases: patient with congenital disease ( heart, GI, urinary) patient with chronic heredity diseases, such as thalasemia, haemophilia patient with malnutrition problems patient with alteration in acute respiratory system (pneumonia, diphtheria) patient with alteration in fluid electrolyte balance, patient with alteration of GI (diarrhoea, poisons) patient with seizure with fever patient with DHF (Dengue Hemorrhagic Fever) patient with Fever with seizure patient with Meningitis/encephalitis high risk newborn: Hyper billirubinemia, BBLR, respiratory distress patient with sepsis Term 3 4. Mastering in comprehensive care plans for the hospitalised children with chronic, acute and life threatening illnesses

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How will the student train the routine skill?

For each term, In the Skills laboratory practice: discuss with laboratory instructor about POA identify and prepare equipment for procedures train specific skills with models or simulated patients learn the standard operation procedures (SOP) coached during exercises by laboratory instructor skills lab examination For each term, In Clinical practice discuss with clinical instructor/ teacher coached during clinical practice by clinical instructor provide direct nursing care activity for patients write report and nursing documentation case conference with other health team member manage patient care (team work collaboration, utilize referral system) other clinical activity clinical examination by the clinical instructor and the university teacher (only once in the end of term 3) 1. Skills Laboratory practice Total credits for skills lab = 1 credit/term = 32 hours/term The length of each term is 6 weeks. Every week there will be one day activities in the school for theory and practicum. Therefore every week there will be an approximately 320 minutes for learning skills in the skills laboratory (5 hours, 20 minutes of lab interactions) 2. Clinical Practice Total credits for clinical practice = 3 credit/term = 192 hours/term The length of each term is 6 weeks. Every week there will be four day activities in clinical practice. Therefore every week there will be an approximately 32 hours of clinical working. Each term (6 weeks period). 1) At school: one day per week 5 hours + 20 minutes: skills lab practice and classroom activity 2) Clinical practice: four days a week (8 hours per day) working in hospitals (paediatric ward) including the coaching group

How much time will it take the student approximately?

When will the student train the routine skill?

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Assessment
In this chapter the assessment of this semester is described.
The assessment plan is given as follows:

CA1: Overview of Nursing Process Method of Assessment - Groups reports of 1500 words - Feed back from teacher CA2: Conduct Comprehensive assessment for chronic illnesses Method of Assessment: - case report of nursing assessment - Peer group review CA3: Develop nursing care plan for acute illnesses Method of assessment: - Nursing care plan report - Self reflection - Presentation CA4: Provide specific nursing intervention and evaluation for hospitalised children with life threatening illnesses
Method of assessment: - Case report - Feed back - Peer review CA5: provide comprehensive nursing care for hospitalized children and complete

documentation Method of Assessment: - Portofolio - Feed back - Self reflection

Project: Clinical Examination

Coaching Project (after week 13): Each student should plan a coaching program for bachelor student. The student should design a brief plan about coaching implementation. The teacher and clinical instructor will observe the student performance in implementing the coaching. Feedback will be given by teacher, CI and bachelor student whom get coached.

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Written Exam: Written Exam would be consists of 100 Multiple choice questions. The materials for written exam: communication, critical reasoning, health assessment and concepts of atraumatic care. Big evaluation: Big evaluation consist of clinical examination, self reflection and evaluation for the quality of competency their portfolio and the log book. For the clinical practice each student should make an action plan about the competency they want to achieve. The action plan written in the log book, every feed back also will written in the log book signed by teacher or CI. Assessment: Attendance Presentation
-

: 10 % :5%
Content clarity (35 %) Media (20 %) Performance (20 %) Argumentation (25 %)

Project :5% CA (Completeness) : 10 % GRADING: Written Exam Clinical Exam/Big Evaluation

: 30 % : 40 %

A. Nursing Care Plan: 55 % 1. Nursing Documentation: 25 % Assessment (5 %) nursing care plan (5 %) progress report (5 %) referral report (5 %) case conference report (5 %) 2. Final report on nursing care (10%) 3. Participation and attendance (15 %) B. Knowledge: Concepts & theory related to 15 % 1. case study (10%) 2. Presentation: peer assessment (5 %) C. Skills: Nursing intervention and procedure for acute illnesses = 30 % 1. Clinical observations 2. Assessment 3. execute specific nursing procedures

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For each assessment, the following criteria are stated: Assessment Factors: 1. Oral presentation (10 %),
consist of: a. presentation: peer assessment during classroom activity (5%) b. during final examination: oral clinical examination (5%)

Assessment Criteria per Assessment Factor: 1. clarity of speech (10) 2. body language (10) 3. readiness (10) 4. use of media and references 5.
6. 7. (10) time management (10) deliver presentation systematically (10) ability to utilize or apply concepts or theory related in answering questions and justify the statements: analytical ability (40) grammar and spelling (5) structure of document (5) clarity of the document (5) specific according to the assignment (10) accuracy of description of content (20) proper references to be used (10) analytical intensity of report (25) originality of the report (20)

Scoring Rules/Grading
Likert scale: 1 = not available/worst 2 = less 3 = sufficient 4 = good 5= excellent - Total Score= (value x score per item):5 - Maximum score =100, minimum score = 20 - Minimum score to pass is in line with the university or faculty rules and regulations - Grading system is according to university rules and regulations

2.Report writing: (45%) - Group academic paper (10%) - Patient Assessment report (5%) - Nursing Care plan (5%) - Progress report (5%) - Referral report (5%) - Case conference report (5%) - Final report (10%) 3.Skill observations/ performance (25%) consist of : During clinical practice (15%) c. Assessment skills d. Procedure skills e. f. During final exams (10%) Assessment skills Procedure skills

1. 2. 3. 4. 5. 6.
7. 8.

1. precision of action (25) 2. appropriate time being used (15) 3. procedure is done in order or neatly based on SOP (25) 4. efficient in handling materials (10) 5. body language used during procedures (15) 6. self confidence (10) 1. precision of action (25) 2. appropriate time being used (15) 3. procedure is done in order or neatly based on SOP (25) 4. efficient in handling materials (10) 5. body language used during procedures (15) 6. self confidence (1 presence and active involvement in each assignments

5. Skills lab: OSPE (10%)

6.Participation and Attendance (10%) includes activities in Classroom Skill lab

- the student must attend the clinical practice and skills lab activity for 100 %, where as for a classroom activity a minimum of 85 %

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Clinical practice

Planning
In this chapter firstly, an assessment planning of the semester is given. Then a more accurate planning will be given. Week CA Method Teacher Activity Student Assessment Activity 1 CA 1 Overview Term 1 Groups reports Provide Expert example Give feedback Listening Asking question Writing group reports Conduct assessment Write case report

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CA2 Conduct comprehensive assessment for chronic illnesses CA 3 Develop nursing care plan for acute illnesses

Term 2 Case Reports Peer Review

Provide case Give Feedback Marking case report

NCP report Self Reflection Presentation

Give feedback on Doing NCP and student comprehensive performance assessment, Analysing data and interpreting Formulating diagnosis and identify nursing intervention Observe Give feedback Conduct nursing process Write case report Start Coaching Project Conduct clinical exam Submit portfolio Doing self reflection

14

CA4 Provide specific nursing intervention and evaluation for life threatening

Term 3 Case report Peer review

18

CA 5 Provide comprehensive nursing care for hospitalized children and complete documentation

Clinical Exam Portfolio Self reflection

Mark the performance Feedback

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PLANNING 18 WEEKS FOR PEDIATRIC PLUS PROGRAM

Week s Integral Line Knowledge (Theory) Term I Skills Remarks

CA1: Overview Communication In Communication Expert example Pediatric Nursing

Concepts Patient Safety atraumatic and nursing process Health Assessment Physical Assessment

Critical and making

reasoning Data interpreting decision and defining diagnosing Specific intervention for chronic disease Specific intervention for chronic disease

Chronic Illnesses

Written Exam

T : 1 day SL: 1 day CP: 4 days practice incl. CG T : 1 day SL: 1 day CP: 4 days practice incl. CG T : 1 day SL: 1 day CP: 4 days practice incl. CG T : 1 day SL: 1 day CP: 4 days practice incl. CG T : 1 day SL: 1 day CP: 4 days practice incl. CG T : 1 day SL: 1 day CP: 4 days practice incl. CG

Term II CA2: Assessment Acute Illnesses for chronic illnesses

Specific intervention acute disease Specific intervention acute disease Specific intervention

Discussion

Discussion

T : 1 day for SL: 1 day CP: 4 days practice incl. CG T : 1 day for SL: 1 day CP: 4 days practice incl. CG T : 1 day for SL: 1 day

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10

CA3: Develop NCP for Acute illnesses

11

12

13

14

CA4: Intervention and evaluation for Life threatening illnesses

15

16

17

18

CA5: Clinical Exam: Comprehensive Care Plan

CP: 4 days practice incl. CG Presentation Specific T : 1 day intervention for SL: 1 day acute disease CP: 4 days practice incl. CG Life threatening Specific T : 1 day Illnesses intervention for life SL: 1 day threatening CP: 4 days disease practice incl. CG Discussion Specific T : 1 day intervention for life SL: 1 day threatening CP: 4 days disease practice incl. CG Term III Coaching Coaching T : 1 day SL: 1 day CP: 4 days practice incl. CG Discussion Performance T : 1 day Nursing care for SL: 1 day pediatric and CP: 4 days coaching practice *coaching project incl. CG Discussion Performance T : 1 day Nursing care for SL: 1 day pediatric and CP: 4 days coaching practice *coaching project incl. CG Discussion Performance T : 1 day Nursing care for SL: 1 day pediatric and CP: 4 days coaching practice *coaching project incl. CG Discussion Performance T : 1 day Nursing care for SL: 1 day pediatric and CP: 4 days coaching practice *coaching project incl. CG Big Evaluation

acute disease

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