Nursing Trainee:___________________________Trainee / Faculty Copy

Complete CHS/UAB Requirements: (complete and give certificates to preceptor)

_____ Information Handbook for Non-COA Nurses

_____ UAB Diversity Training

Provide to Nursing Faculty:

            _____ Semester schedule

                       ______ fall  _____ spring  _____ summer

_____ Nursing Clinical Skills Evaluation Checklist

            _______ Pre-Training  ________ Post-Training

_____ Post-Training Program Relevance Report

_____ Post-training Faculty Effectiveness Evaluation

_____ Semester Record of Clinical and Activity Report

            _____ fall _______ spring _______ summer

Clinical skills:

            ______ Locate and record needed information in patient chart

______ Obtain history (including current and chronic problems, sleep and feeding

               issues, growth and development progress, family and social history)

               from family, chart, or computer sources in a timely fashion

______ Perform physical exam with focus on pulmonary condition

______ Organize and present pertinent history, physical exam, lab/test findings,

              assessment and plan (including follow-up) to physician

______ Consult with other disciplines as needed

______ Prescribe medications (including dosage, teaching, etc.)

______ Provide patient/family education and follow-up plan to family

______ Initiate referrals to community providers

______ Communicate (dictation or phone) with referring physician, school,

               home care as needed.

______ Record in clinical log to reflect a variety of patients’ ages and diagnosis

Identify key issues for PNP care for the following common clinical situations by reading/viewing PNP, pulmonary or pediatric textbook information, family education literature, or 1-2 journal articles (published in the last 5 years);

            ______ Primary care for the child with special health care needs

______ Asthma

______ Bronchopulmonary Dysplaisa (BPD)

______ Cystic Fibrosis (CF)

______ Sleep Problems including sleep hygiene

______ Pulmonary Complications of Neuromuscular Disease

______ Technology Dependent Conditions (home oxygen, apnea monitor, BiPap,

             CPAP, home ventilator, suction, tracheostomy, gastrostomy, cough assist)

______ Growth or Developmental Delays

______ Transition to adult care

            ______ Smoking cessation counseling

            ______ Aerosolized medications

            ______ Metered Dose Inhalers (MDIs) and Dry Powder Inhalers (DPIs)

            ______ Chest PT or other forms of airway clearance (vest, PEEP, etc.)

            ______ GE Reflux precautions

Observe/interact with other disciplines to increase ability to functioning on an interdisciplinary team:

______ Physician

______ Nutritionist

______ Respiratory therapist

______ Social Worker

______ Other _________________________

Observe the following procedures:

______ Pulmonary Function Testing and Spirometry

______ Bronchoscopy

______ Sweat Test

______ Sleep Study

______ Infant PFTs

______ Other _________________________

Complete the following Leadership Projects:

______ Videotaped Interview Skills

______ Family Case Study 

______ System of Care Project,  Agency ______________________________

______ Continuing Education Offering

______ Formal Presentation, Topic __________________________________

______ Review Health People 2020 Document

______ PPC Cultural Competency Modules

______ Health Disparities Poster

Attend Seminars:

______ Research Roundtable (monthly)

______ Interdisciplinary Case Study

______ MCH Network Project Seminars

______ Grand Rounds (Attend a minimum of 3 on topics of interest)

Other clinical experiences/observations :

______ Other CHS Specialty clinics including adolescent clinic

______ Community Outpatient Settings (CRS, ADPH, primary care offices)

______ Inpatient Pulmonary Units