THE UNIVERSITY OF TEXAS MEDICAL BRANCH

SCHOOL OF NURSING

N4532 NURSING: THE CHILD AND FAMILY

CLINICAL OBJECTIVES
Clinical experiences in this course will provide the student opportunities to interact and
provide nursing interventions to the pediatric population. This is achieved by:

1. Demonstrating knowledge of normal and altered growth and development

patterns.

2. Appling the nursing process and critical thinking skills to achieve their health care
goals in various settings.

3. Utilizing psychomotor, affective, cognitive and communication skills in delivering

care in various settings.

4. Instructing parents/care providers on the anticipatory guidance to address the

safety needs during the various developmental stages.

5. Collaborating with the interdisciplinary team managing care.

6. Apply principles of evidence based practice in providing nursing interventions.

7. Incorporating age appropriate and therapeutic play activities in nursing plans of

care.

8. Delivering nursing care within the scope of the nursing practice act and the
guidelines of institutional policies.

9. Demonstrating sensitivity to the philosophies, moral codes, cultural and ethnic

characteristics and lifestyles of the pediatric patients and the families in assisting
them to achieve their health care goals.

10. Recognizing the impact of the professional nursing role and professional
boundaries in providing care to the pediatric patient and their families.
 THE UNIVERSITY OF TEXAS MEDICAL BRANCH
SCHOOL OF NURSING

N4532 NURSING: THE CHILD AND FAMILY

CLINICAL PRACTICUM GUIDELINES

1. There are clinical or lab days every week in this course. Clinical times vary.

2. Dress for inpatient data collection: Lab coats over street clothes, name tag and
I.D. badge should be worn at all times. UMTB nursing uniforms and shoes are to be
worn for hospital and ambulatory pediatric care clinical experiences. The UTMB
School of Nursing patch is to be worn on the left shoulder of scrubs and lab coat
while in clinicals. Appearance must be consistent with safe practices, i.e., hair off the
collar, fingernails short with no polish. Overall neat, clean, and well-groomed
appearance is expected. Jewelry worn must be consistent with safe health practices
and professional appearance, i.e., no dangling earrings, necklaces or large rings.
Dress for community experiences: Street clothes, professional appearance and
name tag. Students must follow student hand book policy and their clinical site’s
dress code policy. Uniform may vary depending on clinical site requirements.

3. Students will care for one client and may progress to a two client assignment,
depending on the census.

4. Assignments may be made with the clinical instructor the first week. Each of the
following weeks, students are to self select a patient and post the information on the
patient care unit the day prior to clinical unless otherwise specified, using student
clinical assignment sheets. These will be made available by the clinical instructor or
a designated student.

5. Each student is to complete a student/client kardex and place the completed

kardex in an envelope posted on the inpatient unit by the clinical instructor for his/her
pick –up before the start of the shift preferably the day the client is selected. Clinical
faculty may vary this procedure depending on site and preference.

6. Each student is expected to come to the clinical area prepared to provide direct
hands on care for his/her patient(s). Preparation includes:
a. preclinical reading in required text and/or other sources on all
significant patient problems.
b. ability to describe the patient's health problems and nursing care
needs.
c. ability to verbally present the nursing care plan developed for each
patient.
d. completion of student/pt. kardex and able to discuss the patients’
medications including indications, side effects, safe dosage and mode of action.
e. In addition to the care plan, the student is expected to have information
on the patient's past health history, present hospital course, nursing and medical
diagnoses, specific procedures and diagnostic tests. Students are expected to
 complete readings and practice the psychomotor skills, if appropriate, prior to
beginning any new procedures. (The clinical instructor may ask an
unprepared student to leave the clinical area.)

7. Students are to attend scheduled conferences each week. Some conference

topics are structured and others are unstructured to allow discussion of selected
patient problems students have identified.

8. If a student is ill and unable to attend the clinical practicum, the clinical unit and
the instructor should be notified at least 60 minutes prior to the start of the clinical
shift for the day.

9. When leaving the unit for breaks, lunch, or end of the day, the student will report
off to the appropriate staff nurse.

10. Students are to be in the clinical area only during designated times.

11. Clinical evaluation conferences will be scheduled by the clinical instructor.

12. Grading of clinical performance will be based upon successful achievement of

the clinical performance criteria and is graded as pass/fail at the end of the
semester. In order to pass the clinical component of N4532, the student must
have a passing score by the last week of clinical on behaviors identified by an
asterisk on the clinical evaluation form. Each graded plan of care grade must
be passing.
 THE UNIVERSITY OF TEXAS MEDICAL BRANCH
SCHOOL OF NURSING

N4532 NURSING: THE CHILD AND FAMILY

TOPIC: GUIDELINES FOR CLINICAL IN THE INPATIENT UNITS

Suggested items to include when developing your schedule:

1. Listen to report
2. Determine whether equipment is functioning properly with alarms set as
appropriate
3. Assess child including status of IV and I and O record
4. Report to appropriate personnel any discrepancies in physician orders,
medication availability, patient status, etc.
5. Check chart for new orders
6. Assess vital signs and weigh as ordered
7. Give medications at scheduled times
8. Complete preoperative preparations as soon as possible
9. Feed child
10. Bathe and provide oral hygiene
11. Complete treatments
12. Include other activities - play, O.T., P.T., school, patient/family teaching
13. Report off at end of shift, charting completed

Vital signs: - Chart within first hour of shift

1. Respirations
a. Count 1 full minute in an infant.
b. Observe before taking temperature and counting pulse rate to
determine regularity, retractions, nasal flaring.

2. Pulse
a. Count apical heart rate in infant for 1 full minute.
b. Take pulse before temperature, crying increases heart rate.
3. Temperature
a. Children under 5 years of age to have axillary or rectal temps. q4h
unless contraindicated. Check institutional policies/guidelines regarding rectal
temps
b. Children over 5 years may have oral temps.
c. Don't leave child alone when taking temperature.

4. Blood Pressure
a. As ordered q2, 4h, etc.
b. Routine blood pressure means q shift.
 c. Use a blood pressure monitor on small child.

Intake and Output:

1. Maintain record of intake and output on bedside chart.

2. IV intake is to be assessed and charted hourly.
3. List IV fluids separately, including fluid name, additives, and rate of flow.
Separate columns are to be used for blood, IV medications, etc.
4. Record anything pertinent to intake and output. (i.e., IV positional, infiltrated or
discontinued, drip rates; type of diet, type of formula, how formula or diet tolerated;
Clinitest, specific gravity, color of urine, foley discontinued; stools, amount, color,
guaiac, consistency, changes; drainage from dressing).
5. Children on fluid restrictions require close observation and accurate
documentation.

Weights:

1. All infants are to have daily weights, unless contraindicated, and are to be
weighed without clothes or diaper.
2. Scales should be balanced and disinfected before and after use.
3. Older children are weighed according to doctor’s orders or unit protocol.
4. Weights should be done as one of the first things in AM, before breakfast or
according to policy of individual unit.

Feeding:

1. Infants are fed q3-4h. Check flow sheet to determine schedule and time of last
feeding.
2. Discard unused formula and food after each feeding.
3. Do not prop bottles in infant's mouth.
4. Place infant on right side after feeding and careful burping.
5. Record exactly what child eats at each meal.

Charting:

Entries on the flow sheet and nursing notes must be written on scratch paper and
approved by the instructor before they are recorded in the chart or computer unless
otherwise instructed. This is variable per faculty and clinical sites. Some sites will
provide electronic chart access and/or charting.

Sign off the following each shift:

1. Medication sheet
2. Flow sheets
3. Nursing notes
4. Patient education sheet
 5. Electronic charting

When patient goes to OR, sign:

1. Pre-op sheet
2. Pre-op med sheet
3. Transfer note on nursing notes including pre-op med and its effects.

When patient is discharged, complete:

1. Discharge summary form

2. Discharge note on the nursing notes including the current physical and emotional
status, topics of patient education taught, as well as the patient/family’s
understanding of the information.

When there is a stat medication:

1. Chart that medication was given on the medication sheet.

2. Make entry on nursing notes indicating why the drug was given and its effects.

Medications:

1. Location of an injection is to be listed on the medication sheet.

2. When PRN medications are administered, the evaluation of effectiveness of the
medication should be indicated in the nursing notes. The instructor or patient’s
nurse will countersign for narcotics.
3. Medications are to be administered within 30 minutes of the prescribed time.
4. Determine if medication orders are in effect. It is the student's responsibility to
ensure that these orders are current and correct prior to the first day of patient
care. Antibiotics and narcotics must be renewed on a regular schedule. Do not
administer medication if the order has expired.
5. Students must obtain an order stating the flow rate for all continuous IV fluids.
6. No IV push meds, chemotherapy or blood products are to be administered
by students.
7. Students are not to give medications without their nurse or faculty present.

When there is a charting error, draw one line through entry. Write initials above the
entry. Follow protocol for computerized charting.

Students may not take verbal or phone orders.

Safety:

1. Know location of child at all times.

2. Since infants cannot call for help, their needs must be anticipated.
3. Never walk away from an isolette or incubator leaving port holes open or top up.
4. Always remember to put side rails up.
 5. Never leave small objects in bed with infants or within their reach.
6. When restraints must be used, they should be applied in a manner which
maintains proper body alignment and circulation as well as ensuring comfort.
7. Restraints should be used only when necessary and never as a substitute for
careful observation. Loosen one extremity at a time q1h to prevent occlusion of
circulation and loss of muscle strength.
8. When a child is placed in a high chair or wheelchair, be sure that the child is
properly secured, i.e., strapped at waist.
9. Remove unused equipment and supplies from the room.
10. Wash hands thoroughly between patients.
11. Know location of emergency care unit evacuation plan.
12. Protect the child by ensuring that proper identification of visitors and staff is
visible.

Hygiene:

1. All children should have a toothbrush, toothpaste, slippers, and a comb or brush
at the bedside.
2. A schedule for routine hair shampooing should be established for each child.
3. Assist the child and/or the family in providing bath and mouth care.
 THE UNIVERSITY OF TEXAS MEDICAL BRANCH
SCHOOL OF NURSING
N4532 NURSING: THE CHILD AND FAMILY
SUMMER 2014

TOPIC: GUIDELINES FOR CRITICAL CARE EXPERIENCE

OVERVIEW:

The purpose for this experience is to provide the student a beginning experience in the
care of children (and their families) who are hospitalized for a life-threatening health
problem. Primarily a 1 day experience, the student will work closely with a registered
nurse (RN) in providing care to a child in the Pediatric Intensive Care Unit (PICU).
During this experience, the student should focus on the following aspects of the
experience of the child client in the PICU:
1. Multisystem response to a life-threatening physiologic dysfunction:
a. Response to alteration in comfort/pain.
b. Hemodynamic response.
c. Response to alteration in sleep rhythms/sensory inputs.
d. Psychologic response.
2. Actual and potential effects of the PICU experience on child’s growth and
development.
3. Family response to the PICU experience.
Guidelines for the Experience:
1. The student will assist the RN in providing care to
the assigned child. The student may perform caregiving activities/procedures that
he/she has successfully performed prior to this rotation, under the supervision of
the RN. The student will confer with the RN on which procedure/caregiving
activities the student may perform. Under no condition should the student
perform any of these activities independently without the joint decision-making
with the RN.
2. The student may not administer any medications
to a child in the PICU unless with the RN. No IV pushes, chemotherapy, or blood
products are to be administered by students. Students will be required by their
clinical faculty to have knowledge of the medications ordered.
 THE UNIVERSITY OF TEXAS MEDICAL BRANCH
SCHOOL OF NURSING

N4532 NURSING: THE CHILD AND FAMILY

SUMMER 2014

TOPIC: GUIDELINES FOR EXPERIENCES IN THE CLINICS

OVERVIEW:

The purpose of the outpatient experience is to provide students the opportunity to

interact with children and families in the most common setting in which children receive
health care. Students may be assigned to an outpatient experience for a day or more of
clinical.

During this experience students should focus on the following activities.

1. Take vital signs, measure children (length, circumference), weights, and chart
and graph results.

2. Follow a clinic nurse as she prepares children and performs care.

3. Collect specimens and perform phlebotomy with the assistance of the nurse if
he/she is willing to supervise the student.

4. Give immunizations under the supervision of a nurse.

5. Provide patient and family education, for example, informed consent for
immunizations.
 THE UNIVERSITY OF TEXAS MEDICAL BRANCH
SCHOOL OF NURSING

N4532 NURSING: THE CHILD AND FAMILY

SUMMER 2014

TOPIC: GUIDELINES FOR THE DAY CARE EXPERIENCE

PURPOSE:

The purpose of this experience is to provide the students with the opportunity to
observe developmental behaviors of young normal children in a natural setting.

During this experience students should focus on:

1. playing games and interacting with the children at their developmental level.

2. participate in providing snacks and lunch for the children.

3. provide simple hygiene education.

4. participate in post conference to discuss observations and interactions with the

clinical instructor.
 THE UNIVERSITY OF TEXAS MEDICAL BRANCH
SCHOOL OF NURSING

N4532 NURSING: THE CHILD AND FAMILY

SUMMER 2014

TOPIC: GUIDELINES FOR PROVIDING HEALTH CARE IN SCHOOLS

PURPOSE:

The purpose of this experience is to provide the students with the opportunity to interact
with and provide health care to children at school. Students will participate in school
wide screenings and in some settings, provide health education to children at a variety
of developmental levels.

During this clinical experience students will be focusing on the following activities.

1. Provide required screenings of children in the school setting.

Those screenings include; hearing, vision, scoliosis and acanthosis nigricans.

2. Organize and conduct the screenings.

3. Work as a team to accomplish the screenings, keep the children

entertained, document and report the information to the school nurse.

4. Interact with the children on their developmental level.

Provide simple health education to school children at their level of understanding