| Course Number: | NR511 |
|---|---|
| Course Title: | Differential Diagnosis and Primary Care |
| Course Credits: | 3 credits (Theory 0.5; Clinical 2.5) |
| Prerequisite: | NR508, NR509 |
Syllabus
Overview
Course Description
This course will provide students with content regarding formulating differential diagnoses of individuals within the primary care setting, along with an introduction to critical diagnostic skills to cultivate evidence-based behaviors. An emphasis will be placed on processing client information in a logical, progressive manner and formulating differential diagnoses for individuals across the lifespan. The course will include 125 hours of supervised clinical practicum in primary care.
Textbooks and Resources
Required Textbooks
The following books are required for this course:
Author, A. A., & Author, B. B. (year of publication). Title of textbook in italics (X ed.). City, ST: Publisher.
Information regarding supplementary material, software, etc.
American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
Optional Textbooks
The following books are required for this course:
Book Title
Information regarding supplementary material, software, etc.
Physical Books and Supplies
To obtain all your books and supplies, visit the online Chamberlain bookstore at https://bookstore.chamberlain.edu/.
Textbooks and Resources
Required Textbooks
The following books are required for this course:
Access E-Book
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
Access E-Book
Ferri, F. F. (2016). Ferri’s clinical advisor 2017: 5 books in 1. Elsevier - Health Services
Access E-Book
Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Retrieved from http://online.vitalsource.com
The following book is required across all FNP courses:
American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
The following book is recommended across all FNP courses:
Goroll, A. H., & Mulley, A. G. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). Retrieved from http://online.vitalsource.com
Physical Books and Supplies
To obtain all your books and supplies, visit the online Chamberlain bookstore at https://bookstore.chamberlain.edu/.
eBook Details
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Access your eBook by clicking on the book cover or title in the syllabus page. Bookshelf Online will open.
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Program Outcomes
Program Outcomes of Chamberlain nursing programs can be found in the Program Descriptions section of your College Catalog. You can access your College Catalog at http://www.chamberlain.edu/msncatalog.
The MSN program outcomes are aligned with the American Association of Colleges of Nursing publication, The Essentials of Master's Education in Nursing (2011). Upon completion of the MSN degree program, the graduate will be able to:
1
Practice safe, high-quality advanced nursing care based on concepts and knowledge from nursing and related disciplines.
2
Construct processes for leading and promoting quality improvement and safety in advanced nursing practice and healthcare delivery.
3
Use contemporary communication modalities effectively in advanced nursing roles.
4
Evaluate the design, implementation and outcomes of strategies developed to meet healthcare needs.
5
Develop a plan for lifelong personal and professional growth that integrates professional values regarding scholarship, service and global engagement.
6
Apply legal, ethical and human-caring principles to situations in advanced nursing practice.
7
Design patient-centered care models and delivery systems using the best available scientific evidence.
8
Manage human, fiscal and physical resources to achieve and support individual and organizational goals.
9
Compose a plan for systematic inquiry and dissemination of findings to support advanced nursing practice, patient-care innovation, and the nursing profession.
10
Collaborate interprofessionally in research, education, practice, health policy and leadership to improve population health outcomes.
11
Apply principles of informatics to manage data and information in order to support effective decision making.
Course Outcomes
Chamberlain College of Nursing courses are built to align course content with specific Course Outcomes (COs). The COs define the learning objectives that the student will be required to comprehend and demonstrate by course completion. The COs that will be covered in detail each week can be found in the Overview page in that particular week. Whenever possible, a reference will be made from a particular assignment or discussion back to the CO that it emphasizes.
Upon completion of this course, the student will be able to do the following.
1
Demonstrate diagnostic reasoning that will assist in health promotion and illness management of common health problems in primary care through case study presentation. (PO 1)
2
Plan for healthcare delivery in an evidence-based manner to support high-quality and cost-effective care and decision-making. (PO 1, 9, 11)
3
Formulate differential diagnoses based on the subjective and objective patient data obtained from the case study. (PO 1, 3)
4
Create weekly S-O-A-P documentation on a clinical patient, demonstrating increased mastery each week. (PO 1, 3)
5
Create a plan of care which integrates pharmacological, complementary, and non-pharmacological therapies for management of common health problems. (PO 1)
6
Utilize established standards and guidelines for management of common pediatric, gynecology, internal medicine, and behavioral conditions in primary care. (1, 11)
7
Engage in sequential application of selected advanced skills/procedures. (PO 1)
8
Demonstrate advanced skills/procedures for quality outcomes pertinent to patient care. (PO 1, 2)
9
Perform selected advanced skills/procedures appropriate to student competence and provider scope of practice. (1)
10
Conduct a systematic and accurate assessment of a client's total health status, utilizing appropriate interviewing and data collection techniques. (PO 1, 2, 5, 11)
11
Reflect on personal and professional growth toward achieving competence as a family nurse practitioner. (PO 5, 7)
Course Schedule
| Week, CO, and Topics | Readings | Assignments |
|---|---|---|
| Week 1 CO 3, 6, 8 Primary Care in the 21st Century, Caring and the Art of Diagnosis and Treatment | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
| Attestation Statement Completion (required to begin course) Clinical Encounter Log in eLogs with SOAP note APEA myQBank Weekly Practice Questions (required but not graded) |
| Week 2 CO 4, 6, 9, 10, Evidence-Based Practice, Neurological Problems, and Eyes, Ears, Nose, and Throat Problems | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.).Retrieved from http://online.vitalsource.com
| Clinical Encounter Log in eLogs with SOAP note APEA myQBank Weekly Practice Questions (required but not graded) |
| Week 3 CO 4, 5, 7, 8, 9 Health Promotion, Skin Problems, and Respiratory Problems | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
| Clinical Encounter Log in eLogs with SOAP note APEA myQBank Weekly Practice Questions (required but not graded) Case Study Discussions |
| Week 4 CO 2, 5, 7, 8, 9 Diagnostic Testing, Cardiovascular Problems, Abdominal Problems, Renal Problems | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
| Clinical Encounter Log in eLogs with SOAP note APEA myQBank Weekly Practice Questions (required but not graded) Midterm Clinical Performance Evaluation in eLogs (required) Case Study Discussion |
| Week 5 CO 3, 5, 6, 7, 8, 9 Men’s Health Problems, Women’s Health Problems, Musculoskeletal Problems | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
| Clinical Encounter Log in eLogs APEA myQBank Weekly Practice Questions (required but not graded) Case Study Discussions |
| Week 6 CO 2, 5, 7, 8, 9 Complex Diagnosis, Endocrine and Metabolic Problems, Hematologic and Immune Problems, and Emergency Problems | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
| Clinical Encounter Log in eLogs (required but not graded) APEA myQBank Weekly Practice Questions (required but not graded) Case Study Discussions |
| Week 7 CO 1, 3, 5, 7, 8, 9 Laboratory tests, Psychological Problems, Palliative Care and Practical Psychotherapy | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
| Clinical Encounter Log in eLogs (required but not graded) APEA myQBank Weekly Practice Questions (required but not graded) Case Study Discussions |
| Week 8 CO 11 Ethical and Legal Issues, the Business of Advanced Practice, Putting Caring into Practice: Caring for Self | Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Retrieved from http://online.vitalsource.com
| Clinical Encounter Log in eLogs (graded) Clinical Performance Evaluation (graded) Reflection (graded) |
Late Assignment Policy
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.
In the event of an emergency that prevents timely submission of an assignment, students may petition their instructor for a waiver of the late submission grade reduction. The instructor will review the student’s rationale for the request and make a determination based on the merits of the student’s appeal. Consideration of the student’s total course performance to date will be a contributing factor in the determination. Students should continue to attend class, actively participate, and complete other assignments while the appeal is pending.
This Policy applies to assignments that contribute to the numerical calculation of the course letter grade.
Evaluation Methods
The maximum score in this class is 1,000 points. The categories, which contribute to your final grade, are weighted as follows.
| Graded Item | Points | Weighting |
|---|---|---|
Clinical Course Attestation (due before Week 1 content will be available) | N/A | N/A |
APEA myQBank Weekly Practice Questions (required but not graded- Weeks 1-7) | N/A | N/A |
| Case Study Discussions (100 points, Weeks 1–7) | 700 | 70% |
Clinical Hours/Patient Encounter Validation (Due Week 4- required to progress to Week 5) | N/A | N/A |
Reflection | 50 | 5% |
Clinical Encounter Log (due Weeks 1–8) SOAP notes in eLogs (due Weeks 1-4) Clinical Performance Evaluation (Week 8) Final clinical performance evaluation pass, documentation of 125 hours*, and completed SOAP notes = 250 points Fail or unsatisfactory on clinical performance evaluation, less than 125 hours documented*, and/or SOAP notes not submitted=0 points. *A maximum of fifteen (15) alternative hours is allowed in each FNP clinical course. The alternative hours can only be documented in the three (3) approved categories (1. Lab review 2. Telephone management 3. Prescription refills). | 250 | 25% |
| Total | 1,000 | 100% |
A passing grade, or S, must be achieved on the clinical performance evaluation. If this is achieved and the 125 clinical hours are documented, the 250 points will be added to the remainder of the course points to calculate the final course grade. If the student does not achieve a passing grade (fail) for the clinical performance evaluation, then the final course grade assigned will be F.
No extra credit assignments are permitted for any reason.
All of your course requirements are graded using points. At the end of the course, the points are converted to a letter grade using the scale in the table below. Percentages of 0.5% or higher are not raised to the next whole number. A final grade of 76% (letter grade C) is required to pass the course.
| Letter Grade | Points | Percentage |
|---|---|---|
| A | 940–1,000 | 94% to 100% |
| A- | 920–939 | 92% to 93% |
| B+ | 890–919 | 89% to 91% |
| B | 860–889 | 86% to 88% |
| B- | 840–859 | 84% to 85% |
| C+ | 810–839 | 81% to 83% |
| C | 760–809 | 76% to 80% |
| F | 759 and below | 75% and below |
NOTE:To receive credit for a week's discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week's assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.
Students agree that, by taking this course, all required papers may be subject to submission for textual similarity review to Turnitin.com for the detection of plagiarism. All submitted papers will be included as source documents in the Turnitin.com reference database solely for the purpose of detecting plagiarism of such papers. Use of the Turnitin.com service is subject to the Terms and Conditions of Use posted on the Turnitin.com site.
Participation for MSN
Threaded Discussion Guiding Principles
The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD's ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.
Participation Guidelines
Each weekly threaded discussion is worth up to 25 points. Students must post a minimum of two times in each graded thread. The two posts in each individual thread must be on separate days. The student must provide an answer to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded thread topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion thread in which late entry occurs (up to a 10-point deduction for that week). Subsequent posts, including essential responses to peers, must occur by the Sunday deadline, 11:59 p.m. MT of each week.
Direct Quotes
Good writing calls for the limited use of direct quotes. Direct quotes in Threaded Discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the Grammar, Syntax, APA category.
Grading Rubric Guidelines
NOTE: To receive credit for a week's discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week's assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.
Participation for MSN
Participation Guidelines
The weekly case study discussion is worth up to 100 points. Students are expected to participate a minimum of four times (once in Part One by Tuesday, 11:59 p.m. MT, once in Part Two by Thursday, 11:59 p.m. MT, provide a written summary in SOAP format to the Dropbox by Sunday, 11:59 p.m. MT, and one post to a student peer as required in the interactive dialogue criterion). The student must provide answers to the graded case study questions from Part One, post a treatment plan for Part Two and provide a written summation of their case in SOAP format to the Dropbox for Part Three. The written summation must be submitted in a Word document and the following file naming convention be used: Last name.week#.SOAP For example: if your last name is Smith then your Week 1 SOAP note would be saved as Smith.Week1.SOAP
Grading Rubric
| Criteria | Exceptional Outstanding or highest level of performance | Exceeds Very good or high level of performance | Meets Satisfactory level of performance | Needs Improvements Poor or failing level of performance | Developing Unsatisfactory level of performance |
|---|---|---|---|---|---|
| Total Points Possible= 100 | |||||
| 30 Points | 26 Points | 24 Points | 11 Points | 0 Points | |
| Application of Course Knowledge | Post contributes unique perspectives/insights applicable to the results from the physical exam and diagnosis (es). Part One: Initial post includes at least three (3) appropriate differential diagnoses with rationale and answers all questions presented in the case. Demonstrates course knowledge/assigned readings by: linking questions and tests/interventions to diagnoses,linking diseases by identifying symptoms and patient information. Parts Two and Three: Primary and secondary diagnoses and treatment plan supported with rationale from the literature. Differential diagnoses are eliminated. All five (5) parts of the treatment plan are thorough, specific and evidence-based. | Post contributes unique perspectives or insights, but may lack some applicability to presented case study patients. Part One: Initial post includes at least two (2) appropriate differential diagnoses with rationale and answers most of the questions presented in the case. One to two (1-2) elements of specificity identified in course expectations not met Parts Two and Three: Confirmed diagnosis (es) and treatment plan partially applicable and evidence-based for each case study patient. | Post has limited perspective, insights and/or applicability to presented case study patients. Part One: Initial post does not address each patient or does not include at least two (2) differential diagnoses for each patient. Some evidence-based rationale may be missing. Does not answer questions presented in the case. Two (2) or more elements of specificity from course expectations not met. Parts Two and Three: Confirmed diagnosis and treatment plan are not applicable to specific case study or some sections may not be evidence-based. | Post perspectives are not consistent with current practice. Three (3) or more elements from course expectations missing from parts two and/or three, differential diagnoses not eliminated from Part Two and/or Three. | Post offers no insight or application to the case study presentation. |
| 30 Points | 26 Points | 24 Points | 11 Points | 0 Points | |
| Support from Evidence-Based Practice (EBP) | Initial discussion posts in Parts One, Two and SOAP note are supported by evidence from appropriate sources published within the last 5 years. In-text citations and full references are provided. | Initial discussion posts for Parts One, Two, and SOAP note are partially supported by evidence from appropriate sources published within the last 5 years. In-text citations and full references are provided. Evidence-based reference( s) used but may not fully support the treatment plan. | Initial discussion posts for Parts One, Two, and SOAP note are partially supported by evidence. Sources may not be scholarly in nature or may be older than 5 years. In-text citations and/or full references may be incomplete or missing. | Citations to non-scholarly websites given as rationale to support differential diagnoses and/or treatment plan. | Discussion posts contain no evidence-based practice reference or citation. *Students should note that factitious sources, sources that are clearly not read by the student and used, or sources that have incorrect dates will result in an automatic zero (0) for this section for the week. |
| 10 Points | 9 Points | 8 Points | 4 Points | 0 Points | |
| Organization | Discussion posts and SOAP notes presents case study findings in a logical, meaningful, and understandable sequence. Each problem-based learning case study patient is presented individually in all discussion posts and SOAP notes. Part One: Discussion questions addressed individually for each patient. | Discussion posts and SOAP notes are relevant to the topic but may be unclear or difficult to follow in places. Part One: Discussion questions may not be addressed individually for each patient. Part Two or SOAP note contains all elements but may not be written following SOAP note format. | Discussion posts and SOAP notes not fully relevant to the topic. May be unclear or difficult to follow in places. Part Two and SOAP note do not contain all components and/or may be missing data. | Discussion post presents case findings and plan or intervention that are sometimes unclear to follow and may not always be relevant to topic. | Discussion post is not relevant to case study. |
26 Points | 23 Points | 21 Points | 10 Points | 0 Points | |
| Interactive Dialogue | Presents case study findings and responds substantively to at least one topic-related post of a peer including evidence from appropriate sources, and all direct faculty questions posted in Parts One and Two. | Presents case study findings and responds substantively to at least one topic-related post of a peer. Does include evidence from appropriate sources. | Responds to a student peer and faculty questions but the posts adds limited content or insights to the discussion. Does include evidence from appropriate sources. | Responds to a student peer and/or faculty, but the nature of the response is not substantive. | Does not respond to a topic-related peer post and/or does not respond to faculty questions posted by Sunday. |
4 Points | 3 Points | 2 Points | 1 Points | 0 Points | |
Grammar, Syntax, APA | APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one errors. | Two to four errors in APA format, grammar, spelling, and syntax noted. | Five to seven errors in APA format, grammar, spelling, and syntax noted. | Eight to nine errors in APA format, grammar, spelling, and syntax noted. | Post contains greater than ten errors in APA format, grammar, spelling, and/or punctuation or repeatedly makes the same errors after faculty feedback. |
| 0 Points Deducted |
| Points Deducted for Late or Missing Posts | |||
Participation Enters first post to part one by 11:59 p.m. MT on Tuesday; First post to part two by 11:59 p.m. MT on Thursday; and submits written summation by Sunday 11:59 p.m. MT. Written submission (SOAP notes) will NOT be accepted after Sunday 11:59 p.m. MT. | Enters first post to Part One by 11:59 p.m. MT on Tuesday; first post to Part Two by 11:59 p.m. MT on Thursday; and enters peer response/faculty responses and written summation (SOAP) by Sunday 11:59 p.m. MT. |
|
| Ten percent (10%) per day for each late discussion post. *See Calculating Late Posting Penalty Document Written submissions including SOAPs will not be accepted after Sunday 11:59 p.m. MT of the week they are due. 33 points deducted per part if Part One, Part Two or SOAP note is/are not submitted by Sunday by 11:59 p.m. MT of the week they are due. |
Webliography Disclaimer
The purpose of the Webliography is to provide students with annotated bibliographies of world wide websites relevant to their courses. These websites are not meant to be all inclusive of what is available for each course's subjects and have not been sanctioned as academically rigorous or scholarly by Chamberlain College of Nursing. Please exercise caution when using these websites for course assignments and references.
Professional Portfolio
Select assignments from courses across the FNP program will be compiled as artifacts within a Professional Portfolio to demonstrate your professional growth and expertise. Your final portfolio, which will be submitted in the final course NR661, will be assessed against the learning outcomes of the program. The Professional Portfolio will include the following:
- Reflections from Week 8 for all FNP courses
- Five exemplar case studies (student selects top five)
- eLogs portfolio
- Curriculum vitae
- Professional development plan paper from NR510