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MANILA TYTANA COLLEGES

Manila Doctors College of Nursing


CLINICAL FOCUS
Description:
Objective:

This course deals with the application of concepts, principles and theories, and methods of developing the essential knowledge, skills,
and attitude in the care and management of sick clients across the lifespan with emphasis on the adult and older persons with
alterations/problems in nutrition, metabolic and endocrine functions.
Provide opportunities to demonstrate procedures needed and for actual experience to ensure competencies in caring for clients with
alterations/problems in oxygenation are developed

Area of Exposure:
Duration:

Manila Doctors Hospital, 3c ward

24 hours/week 8 hours/day

Focus:

Metabolism

Equipments:

Weighing scale, tape measure, special diet lists, nasogastric or gastrostomy tube, colostomy, ileostomy, hot sitz bath, TPN set, blood
glucose monitoring set, insulin injection.
Entry Competencies:
Completed RLE 103 skills laboratory return demonstration
Knowledge in Fundamentals of Nursing, Anatomy and Physiology
Skills in the nursing process
Decision making skills and critical thinking skills
Orientation of clinical instructors regarding the policies and guidelines of the institution which must have been completed prior to student
exposure and in coordination with affiliating institutions training officer for a week or depending on the institutions policy.
Orientation of activities for students which is usually done before actual exposure or on the first day of clinical experience.
Orientation on the following:

Intermediate
Competencies

Clinical Activities
Faculty

Method of Evaluation
Student

I.

Safe
and
Quality Nursing
Practice
o
Help the student identify health
a. Identifies
the needs of patients based on patient
health needs of classification system. Emphasis is to
the patient
give care to patients with the following
conditions:
a)
Alteration in nutrition less than
body requirement.
b)
Alteration in nutrition more than
body requirement
c)
Alteration
in
oral
mucous
membrane integrity
d)
Alteration in comfort; epigastric or
abdominal pain
e)
Fluid volume deficit
f)
Activity intolerance

b. Provides
sound
decision making
in
care
of
individual/groups
considering their

o
o

a.
b.
c.
d.
e.
f.
g.

o
Assists
students
in
problem
identification, gathering of data
related to the problem, and selection
of appropriate action.
o

Determine the health needs of the


client based from proper assessment
and data gathering
Determine results and implications of
diagnostic / laboratory examinations of
clients:
A. Non-Invasive
Ultrasound of abdomen
stool culture
radioiodine assay
thyroid scan
basal metabolic rate
oral glucose tolerance test
urinalysis
B. Invasive
a. Barium swallow
b. Esophagoscopy
c. Biopsy
d. cytology examination
e. gastric secretion analysis
f. endoscopy, rectal examination
g.
percutaneous
transhepatic
cholangiogram
h. liver function test
i. fasting blood sugar test
j. glycosylated hemoglobin
k. two hours post prandial blood
glucose
l. endocrine assay
Gather relevant data that is related to
problems identified using different
techniques like ward rounds, chart
audits, interview & etc.
Enumerate appropriate actions that
are based on problems identified.

o Observation
o Quiz
o Case presentation
o Concept mapping
o One on one conference
o Client feedback
o Performance evaluation checklist

beliefs, values.

c. Promotes patient
safety
and
comfort.

d. Priority setting in
nursing
care
based
on
patients need.
e. Administers
medications and
other
health
therapeutics.

f.

Utilizes
nursing
process
as
framework
for

Supervises and motivates students


in performing age-specific safety
measures and comfort measure in all
aspects of patient care.

o
o

Ensure safety and comfort of patient


by following institutional guidelines
and policies.
Always ensure that side rails are up,
strap patients if necessary (if allowed
by agency)

Help the students in identification o


and analysis of priority needs.

Prioritize the problems identified

Ensure and supervise the students in o


conforming with the ten golden rules
in medication administration and o
health therapeutics:
a. Gastrointestinal,
hepatobillary
and
pancreatic
function:
Anitiemetics,
anticoagulant,
hematinic
agents, laxatives and stool
softeners,
antipruritus,
vitamin
supplement,
antacids,
antihyperlipidemics,
antispasmodics, antidiarrheal
b. Endocrine
function:
corticosteroids,
alphaadrenergic blocking agents,
beta-adrenergic
blocking
agents, tyrosine inhibitors,
dopamine
receptor
antagonists, glucocorticoids,
parathyroid hormone agents,
thyroid
hormone
agents,
insulin, oral hypoglycemic
agents

Discuss the drug study about the


medication to be administered.
Follow and apply the ten rules in
medication administration.

nursing. Performs
comprehensive,
systematic
nursing
assessment.

a. Determination
and
management of cause
b. Hydration
c. Drug therapy
d. Tube feeding
e. Dietary management
f. Total
parenteral
nutrition
o
administration
g. CBG monitoring
h. Insulin administration
i. Oral care
o
o

g. Formulates care
plan
in
collaboration with
patients,
other
health
team
members.

Supervise students in performing


bedside nursing procedures to the
patient:

Emphasize
obtaining
procedures.

the
importance
of
consent
during
o

Ensure completeness of appropriate


assessment forms.
o

Supervise students in performing


effective assessment techniques and
in obtaining comprehensive client
information.

o
Emphasize
the
importance
of
maintaining
privacy
and
confidentiality of patient.
o

Assists in developing comprehensive


patient care plan.
Nursing Diagnoses taxonomy:
a. Impaired gas exchange
b. Inability to sustain spontaneous
ventilation

Recognize in the importance of


obtaining consent prior to procedures,
including its legal implications.
Checks presence of signed consent if
the
patient
will
undergo
any
therapeutic procedures.
Fill up appropriate assessment forms
based on institutions policy.
Perform
effective
and
correct
assessment techniques and utilize
necessary forms and records to ensure
complete
and
comprehensive
information.
Maintains privacy and confidentiality
of patients.
Able to identify appropriate nursing
diagnosis and institute appropriate
nursing interventions.

h. Implements NCP
to
achieve
identified
outcomes.
i.

Responds
urgency
patients
condition.

to
of
o

II.

c. Dysfunctional ventilatory weaning


response
d. Decreased cardiac output (CO)
e. Altered tissue perfusion systemic
f. Alterations in nutrition less than
body requirement
g. Chest pain
h. Activity intolerance
i. Anxiety
j. Activity Intolerance
k. Fluid volume deficit
Supervises in revising care plan in
which the objectives and goals have
not been met.
Supervise
the
student
in
implementing interventions that are
immediate, appropriate, and with
urgency.

States expected outcomes in nursing


interventions.

Accomplishes
discharge plan.

Monitors effectiveness of nursing


interventions and reformulates care
plan for attainment of goals.

Identify sudden changes in health


condition and act to the situation with
urgency.

Communication
a. Establishes rapport
with patients,
significant others
and members of
the health team.

b. Identifies verbal
and non-verbal
cues.

c. Responds to
needs of
individuals,
family, group and
community.
d. Uses appropriate
information
technology to
facilitate

Helps in creating good working o


relationship
among
patient,
significant others, and members of o
the health team.
o
Helps students in interpreting clients
body language and expression.
o

Discusses
the
importance
responding properly.

of o
o

Assists the student in choosing o


appropriate
method
of
communication.
o
o

patient

centered

o
Creates an atmosphere of trust and o
confidence.
o
Listens attentively to patients queries o
and requests.
Spends time with patients to facilitate
conversation and allows expression of
concerns.
Discern,
interpret,
and
validate
patients body language and facial
expression.
Provides
reassurance
through
therapeutic,
touch,
warmth
and
comforting words of encouragement.
Readily smiles.
Utilizes telephone, mobile phone, email
and internet, and informatics.
Identifies a significant other so that
follow up care can be obtained.
Provides holding or emergency

Observation
One on one conference
Client feedback
Performance evaluation checklist

communication.
e. Utilizes formal
and informal
channels.
III.
Health
Education
a. Assesses the
learning needs of
the patient and
the family.
b. Develops Health
Education plan
based on
assessed and
anticipated
needs.
c. Develops learning
material for
health education.

numbers of services.

o
o

o
d. Implements the
Health Education
Plan.

Assists students in obtaining correct o


and
complete
assessment
information.
o

Emphasizes the importance of o


having
consideration
with
the o
learners social, cultural, political,
economic, educational, and religious
beliefs and practices.
o
Assists the students in formulation of
a comprehensive health educational o
plan with the following components,
objectives,
content
and
time
o
allotment.
Provides for feedback to finalize
plan.
o

Supervises
students
in
the
implementation
of
the
health o
education plan using the appropriate
o
strategies and techniques.
o

e. Evaluates the
outcome of health
Education

o
o

Assists students in using correct


evaluation parameters and in proper o

Obtains learning information through


interview, observation, and validation
Differentiates relevant from irrelevant
data or information.
Fills-up assessment records completely
and correctly.
Role play in post conference
Allow students to give health teachings
with supervision
Respects the social, cultural, political,
economic, educational, and religious
beliefs and practices of the patients.
Involves the patient, family and significant
others and other resources during health
education.
Formulates
a
comprehensive
health
educational plan.

Provides
a
conducive
learning
environment for the patient and the
significant others.
Considers the patient and familys
preparedness.
Uses
the
appropriate
teaching
strategies suited to the needs of the
patient and family.
Provides reassuring presence through
active listening, touch and facial
expressions
and
gestures,
and
therapeutic communication.
Monitors
patient
and
familys
responses to health education.
Uses correct evaluation parameters.

o
o

Observation
Performance evaluation checklist

documentation of outcome.
IV.

Legal
Responsibility
a. Adheres to
practices in
accordance with
the nursing law
and other
relevant
legislation
including contract
and informed
consent.

Discusses the legal requirements in


nursing practice such as having
updated professional license, and
consent forms and other waivers.

o
o
o
o

b. Adheres to
organizational
policies and
procedures, local
and national.

o
o

c. Document care
rendered to
patients.

V.

Discusses the mission and vision and


the established norms and conducts
by the institution.

Ethico-moral
Responsibility
a. Respects the
rights of
individual/ groups

b. Accepts
responsibility &
accountability for
own decisions

Supervises students in proper


documentation and checks the
completeness and correctness of
documents. Utilizes appropriate
patient care records and reports

o
o

Revises plan for attainment of goals


and objectives as necessary.
Recognize the importance of a
professional license and other
qualifying requirements in nursing
practice
Observes staff nurses when confirming
information given by the doctor about
informed consent.
Observes staff nurses in securing
waiver of responsibility for refusal to
undergo treatment or procedure.
Recognize the importance of having a
complete and correct informed
consent and other legal forms or
documents.
Acts according to the norms and
conduct of the institution.
Comply with the mission and vision of
the institution

Emphasizes the responsibility and


accountability that entails his/her job
description.

.
o

Observation
Checking of documentation

Observation

Utilizes appropriate patient care


records and reports.
Accomplishes accurate documentation
in all matters concerning patient care
in accordance with the standard
nursing practice.

Discusses the patients bill of rights.


o

o
o

Renders patient care while being


guided with the patients bill of rights.
Protects the positive image of the
profession by being well groomed,
hygienic, well-mannered, and act

and actions.
c. Adheres to the
national and
international code
of ethics for
nurses
VI.

Personal and
professional
Development
a. Identifies own
learning needs.
b. Pursues
continuing
education.

c. Gets involved in
professional
organizations and
civic activities.

d. Projects a
professional
image of nurse.

e. Possesses
positive attitude
towards change
and criticism.
f.

Performs function

professionally and ethically.


o

Aware of the code of ethics for nurses.

Helps and motivates the students in


identifying their professional and
personal aspirations, and in
examining their strength and
weaknesses.
Discusses the need to participate in
formal and non formal education.

Verbalizes personal and professional


aspirations and goals.
The strengths and weaknesses as an
individual and as a nurse.
Recognize the importance of attaining
information or continuing education in
the improvement of care.

Emphasizes the importance of being


involved in professional organizations
and civic activities.
Discusses the need to maintain
membership to professional
organizations like PNA, CCNPI,
ANSAP, etc.

Ensure that the students project the


professional image of the nurse and
follows the policies set by the
institution and college.

Discusses the code of ethics for


nurses.

o
o

o
o

o
o

o
o
o

Provides criticisms and suggestions.

o
o
o

The importance of actively


participating in professional, social,
civic and religious activities.
Support activities related to nursing.
Aware of the professional
organizations.
Demonstrate good manners and right
conduct at all times.
Dresses appropriately.
Demonstrate congruence of words and
actions.
Behaves appropriately at all times.
Listens and accepts suggestions and
recommendations.
Tries new strategies and approaches.
Adapts to changes willingly.

o
o
o

Observation
One on one conference
Attitude evaluation checklist

according to
professional
standards.

Explains the functions of a nurse


based on professional standards.

o
o

g. Application of
learned
information

Management of
Resources and
Environment
a. Organizes
workload to
facilitate patient
care.

o
o

Allow students to effectively and


correctly apply learned information
about patient care and management
with supervision and guidance.

Aware of nursing function based on


professional standard.
Sets attainable goals to enhance
nursing knowledge and skills.
The importance of current nursing
practices.

Applies learned information correctly


and effectively for the improvement of
care

Identifies task or activities that need o


to be accomplished.
o
Plans the performance of task or
activities based on prioritization.
Finishes work assignment on time.

VII.

b. Utilizes resources
to support patient
care
c. Ensures the
functioning of
resources.
d. Maintains safe
Environment

o
o
o

o
o

Records
Management
a. Maintains

Emphasizes
the
importance
of
organizing
workload
and
time
management.
Assign patients to students based on
their capabilities.
Helps
in
determining
enough
resources needed to deliver patient
care.
Reminds
students
about
importance of proper use
maintenance of equipment.

the
and

Ensure
adherence
to
policies,
procedures
and
protocols
on
prevention and control of infection.
Show to the students the emergency
exit to be used in cases of fire or
earthquake

o
o
o
o
o
o
o

Observation
One on one conference

Prepares and control equipments and


materials needed for implementation
of nursing care.
Routinely checks proper functioning of
the equipments.
Refers malfunctioning equipment to
right authority.
Observes proper disposal of waste,
segregating the waste according to its
classification
Know where the emergency exits to
be used in case of need.

VIII.

Ensures that documentation of

Completes updated documentation of o

Checks accurate charting and other

accurate
and
patient care is completely updated.
updated
o
documentation of
patient care and
outcome.
o Discusses the legal implications of
b. Observes
legal
keeping records.
o
imperatives
in
recording
o
keeping.
IX.
Quality
Improvement
o Supervise students in identifying o
a. Gathers data for
variations
in
nursing
care
or
quality
standards by different methods such
improvement.
as ward rounds, audits, patient o
b. Participates
in
feedback form, etc.
nursing
audits
and rounds.
o
o
o
c. Identifies and
reports variances.

Assists the students in identifying


and reporting variances.
o
o

d. Recommends
solutions to
identified
problems.

o
Supervises and assists students in
making recommendations about
solution for identified problems.
o
o

X.

Research
a. Gathers
data
using
different
methodologies

Assists the students in identifying


possible researchable problems and

patient care.
Utilizes appropriate record system o
based on the institutions policies and
guidelines.

documentation.
Allow students to chart in the nurses
notes

Observes confidentially and privacy of


patients records.
Does not fabricate data
Demonstrate knowledge of method o
appropriate for the clinical problems o
identified.
Detects variation in nursing care or
standard by doing audits, ward rounds,
etc.
Enumerate necessary elements at
bedside for improvement of patient
care.
Solicits feedback from patient.
Contributes relevant information about
patient condition as well as unit
condition to other members of the
health team.

Observation
One on one conference

Identifies
actual
and
potential
variances to patient care.
Makes
proper
documentation
of
variances observed.
Reports
variances
identified
to
appropriate group.
Enumerate appropriate suggestions
about
corrective
and
preventive
measures for problems identified.
Communicates
and
discusses
suggestions with appropriate groups.
Enumerate
problems.

possible

researchable o
o

Journal sharing
Observation

in data gathering.
b. Recommends
actions
for
implementation.
c. Applies research
findings
in
nursing practice.

o
o

Supervises the students in making


recommendations.
Emphasize
the
importance
of
applying research findings into
nursing practice.

o
o

o
o

Defining Qualities

Empowering Qualities
Enabling Qualities
Enhancing Qualities

Prepared by:

Kenneth E. Librea, RN, MAN


Clinical Instructor

Identify
appropriate
methods
of
research based on the problem
identified.
Analyzes data gathered
Make
recommendations
about
practical
solutions
to
identified
problems.
Recognize the importance of applying
research findings and solutions for the
improvement of nursing care.
Update self to recently conducted
research studies

Safe and quality care


Communication
Collaboration
Health Education
Legal Responsibility
Ethico-moral Responsibility
Personal and Professional Development
Management of Environment and Resources
Record Management
Quality Improvement
Research

Checked by:

Approved by:

Lualhati Floranda, RN, MAN

Katherine Vera Santos Lucas, RN, MAN


Dean, College of Nursing

RLE, Coordinator

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