Clinical Skills Self-Assessment Everyone ought to have specific attributes, including their strengths and weaknesses. My experience as a nurse has equipped me with several skills that will come in handy when I start working as a psychiatrist. Recognizing the signs and symptoms of mental illness is one of my strengths, thanks to the knowledge and abilities I have gained over the years. On the other side, I must have a lot of weaknesses. The options for professional development that I need to investigate during my career to increase my skills in making use of the results of psychological tests. This paper will discuss three strengths and weaknesses and three clinical skills that a nursing student would like to become a professional before graduating from a nursing program. These strengths and weaknesses will be compared to three clinical skills that a nursing student would like to have. PRAC 6665/6675 Clinical Skills  Self-Assessment Form Desired Clinical Skills for Students to Achieve Confident (Can complete independently) Mostly confident (Can complete with supervision) Beginning (Have performed with supervision or needs supervision to feel confident) New (Have never performed or does not apply) Comprehensive psychiatric evaluation skills in:  Recognizing clinical signs and symptoms of psychiatric illness across the lifespan Differentiating between pathophysiological and psychopathological conditions  Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)  Performing and interpreting a mental status examination  Performing and interpreting a psychosocial assessment and family psychiatric history  Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational). Diagnostic reasoning skill in: Developing and prioritizing a differential diagnoses list Formulating diagnoses according to DSM 5-TR based on assessment data  Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes Pharmacotherapeutic skills in: Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)  Evaluating patient response and modify plan as necessary  Documenting (e.g., adverse reaction, the patient response, changes to the plan of care) Psychotherapeutic Treatment Planning: Recognizes concepts of therapeutic modalities across the lifespan Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)  Applies age-appropriate psychotherapeutic counseling techniques with ...

1. Clinical Skills Self-Assessment
Everyone ought to have specific attributes, including their
strengths and weaknesses. My experience as a nurse has
equipped me with several skills that will come in handy when I
start working as a psychiatrist. Recognizing the signs and
symptoms of mental illness is one of my strengths, thanks to the
knowledge and abilities I have gained over the years. On the
other side, I must have a lot of weaknesses. The options for
professional development that I need to investigate during my
career to increase my skills in making use of the results of
psychological tests. This paper will discuss three strengths and
weaknesses and three clinical skills that a nursing student would
like to become a professional before graduati ng from a nursing
program. These strengths and weaknesses will be compared to
three clinical skills that a nursing student would like to have.
PRAC 6665/6675 Clinical Skills
Self-Assessment Form
Desired Clinical Skills for Students to Achieve
Confident (Can complete independently)
Mostly confident (Can complete with supervision)
Beginning (Have performed with supervision or needs
supervision to feel confident)
New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric
illness across the lifespan
Differentiating between pathophysiological and
psychopathological conditions

2. Performing and interpreting a comprehensive and/or interval
history and physical examination (including laboratory and
diagnostic studies)
Performing and interpreting a mental status examination
Performing and interpreting a psychosocial assessment and
family psychiatric history
Performing and interpreting a functional assessment (activities
of daily living, occupational, social, leisure, educational).
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
Formulating diagnoses according to DSM 5-TR based on

3. assessment data
Differentiating between normal/abnormal age-related
physiological and psychological symptoms/changes
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice
guidelines for medication plan (e.g., risk/benefit, patient
preference, developmental considerations, financial, the process
of informed consent, symptom management)
Evaluating patient response and modify plan as necessary
Documenting (e.g., adverse reaction, the patient response,
changes to the plan of care)
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the
lifespan

4. Selecting appropriate evidence based clinical practice
guidelines for psychotherapeutic plan (e.g., risk/benefit, patient
preference, developmental considerations, financial, the process
of informed consent, symptom management, modality
appropriate for situation)
Applies age-appropriate psychotherapeutic counseling
techniques with individuals and/or any caregivers
Develop an age-appropriate individualized plan of care
Provide psychoeducation to individuals and/or any caregivers
Promote health and disease prevention techniques
Self-assessment skill:
Develop SMART goals for practicum experiences

5. Evaluating outcomes of practicum goals and modify plan as
necessary
Documenting and reflecting on learning experiences
Professional skills:
Maintains professional boundaries and therapeutic relationship
with clients and staff
Collaborate with multi-disciplinary teams to improve clinical
practice in mental health settings
Identifies ethical and legal dilemmas with possible resolutions
Demonstrates non-judgmental practice approach and empathy

6. Practices within scope of practice
Selecting and implementing appropriate screening
instrument(s), interpreting results, and making
recommendations and referrals:
Demonstrates selecting the correct screening instrument
appropriate for the clinical situation
Implements the screening instrument efficiently and effectively
with the clients
Interprets results for screening instruments accurately
Develops an appropriate plan of care based upon screening
instruments response
Identifies the need to refer to another specialty provider when
applicable

7. Accurately documents recommendations for psychiatric
consultations when applicable
Summary of strengths:
As a nurse, I have several strengths that keeps me strong to
work as a mental nurse.
My expertise and ability to spot the signs and symptoms of
mental illness is one of my strengths as a mental health
professional. After spending some time working in a psychiatric
hospital, I can differentiate between psychiatric symptoms and
medical symptoms with complete accuracy.
My second strength is the ability to effectively interact with
other healthcare practitioners to offer appropriate care for
patients. According to Delaney and Vanderhoef (2019), the
collaboration between specialists is an essential strategy for
improving the treatment outcomes of mental patients. My third
strength is that I can authorize to administer and analyze results
of mental status
examinations.
My fourth strength I can choose appropriate screening
procedures for psychiatric patients. I am also able to analyze the
results of the screening to design the treatment plan that is
intended for the patient. My last strength is that I have the
capacity to preserve professional boundaries while also
fostering therapeutic relationships. According to Smythe et al.
(2018), nurses have a responsibility to maintain a high level of
professionalism in their work. Therefore, to accomplish the

8. necessary capabilities throughout my internship experience, I
will make use of the strengths that have been discussed
previously.
Opportunities for growth:
During the internship, one of the areas for improvement that
needs to be investigated is the development of abilities to
implement the results of screening tests in psychiatric practice.
Although I have experience with a variety of screens for
psychiatric patients, I have observed that the outcomes of these
screenings are not always effectively implemented. To
guarantee that I come out of my internship experience with the
skills and knowledge necessary for this field of work, I will
need to collaborate closely with members of my academic
faculty as well as other healthcare professionals. The
application of psychotherapy methods that are suitable for the
patient's age is yet another area of development that I need to
investigate during my internship experience. According to
Zeeck et al. (2018), there is a wide variety of psychotherapy
that can be utilized with individuals suffering from mental
illness. The age of the patient is also a factor that must be
addressed when providing treatment. I do not have the
knowledge or the abilities necessary to be able to apply various
forms of psychotherapy to patients of varying ages who seek
treatment in psychiatric practice. Because of this, I need to gain
the necessary abilities in the application of psychotherapy to be
able to give psychiatric patients with care that is high-quality,
risk-free, and effective. Assessing the efficacy of care provided

9. to psychiatric patients is another area of development that needs
to be investigated throughout the internship.
Notify you of any adjustments to ensure the highest possible
level of care for your patients. When it comes to evaluating
psychiatric care, I don't feel as though I have the necessary
knowledge or skills. As a result, one of my goals for the
internship is to enhance the talents I already possess in this
area.
Now, write three to four (3–4) possible goals and objectives for
this practicum experience. Ensure that they follow the SMART
Strategy, as described in the Learning Resources.
1. Goal: To equip participants with the skills necessary to
conduct mental illness screenings by the time the internship
ends
a. Objective:To perform the interpretation of the results of at
least ten psychiatric screenings every week while I am doing my
internship
b. Objective:To construct at least ten treatment plans for

10. psychotic patients based on the screening data gathered from
those individuals while participating in the internship
c. Objective:To collaborate with the instructors and other
healthcare professionals at the internship site to interpret and
put into action treatment programs for psychotic patients while
they are enrolled in the internship program
2. Goal: To achieve the level of competence required to provide
a variety of psychotherapy therapies to psychotic patients of
varying ages
a. Objective: To acquire knowledge regarding the several
psychotherapy modalities that are utilized by the psychotic
patients.
b. Objective: To put into practice the utilization of a variety of
psychotherapy modalities to provide care for patients of varying
ages
c. Objective: To collaborate with my professors and other
healthcare professionals in the management of a variety of
mental illnesses.
3. Goal: To have developed abilities in the evaluation of
psychiatric treatment
a. Objective: To assess the treatment plans of at least 10
patients on a weekly basis
b. Objective: To provide interventions that are supported by
evidence to conduct psychiatric treatment evaluations.
c. Objective: To participate in an evaluation of mental therapy
alongside my instructor
Signature:
Date: June 5, 2022
Course/Section: NRNP PRAC 6675/33

11. References
Delaney, K. R., & Vanderhoef, D. (2019). The psychiatric
mental health advanced practice registered nurse workforce:
Charting the future. Journal of the American Psychiatric Nurses
Association, 25(1), 11-18.
Fletcher, T. L., Hogan, J. B., Keegan, F., Davis, M. L., Wassef,
M., Day, S., & Lindsay, J. A. (2018). Recent advances in
delivering mental health treatment via video to the home.
Current psychiatry reports, 20(8), 1-9.
Lee, W. J., Liao, Y. C., Wang, Y. F., Lin, I., Wang, S. J., &
Fuh, J. L. (2018). Plasma MCP-1 and cognitive decline in
patients with Alzheimer’s disease and mild cognitive
impairment: a two-year follow-up study. Scientific
reports, 8(1), 1-8.
Smythe, E., Hennessy, J., Abbott, M., & Hughes, F. (2018). Do
professional boundaries limit trust?. International journal of
mental health nursing, 27(1), 287-295.
Zeeck, A., Herpertz-Dahlmann, B., Friederich, H. C.,
Brockmeyer, T., Resmark, G., Hagenah, U., ... & Hartmann, A.
(2018). Psychotherapeutic treatment for anorexia nervosa: a
systematic review and network meta-analysis. Frontiers in
psychiatry, 9, 158.
When to Disconnect? Bioethical Distinction between
Assisting or Substituting Vital Organs

12. Rev. Alfred Cioffi, SThD, PhD
Institute for Bioethics
St. Thomas University
Miami Gardens, Florida
Introduction
Without a doubt, in the United States, life expectancy has been
steadily increasing over
the past half century: in 1950, the average life span for
Americans was about 68.2 years;
in 2015, it was 79.1.i As more people tend to live into old age,
we are experiencing a
larger number of patients on life support systems toward the end
of their life. For
example, a Frontline report of the Public Broadcast System
recently stated that nearly
70% of all Americans die in a hospital, nursing home or long-
term care facility.ii
Often, persons who have a terminal illness or are approaching
the end of their life, and

13. their loved ones, do not know how much treatment is too much,
and they struggle as to
when to finally stop treatment and allow the patient to die in
peace.iii Conversely,
healthcare professionals during such times may tend to slide
into “extraordinary means”
of life support –bioethically speaking– perhaps simply due to
legal/fiscal concerns
regarding potential lawsuits, or due to the patients’ family
requesting futile care.iv A
general bioethical principle that is very useful in these
situations is the fact that there is
no moral obligation to substitute vital organs. Substituting a
vital organ, in this context,
means totally replacing the vital function of the dying organ,
with either a transplant or
with medical machinery.v This article seeks to explain how this
rule may be applied in
deciding when to stop treatment, and thus allow a patient to die
in peace.
Vital Organs
By definition, a functioning vital organ is essential for

14. maintaining life. Examples of vital
organs in the human body are: brain, brain stem, heart, both
lungs, liver, whole stomach,
whole intestines, pancreas, both kidneys. It is well known that,
once the death process has
begun, each one of these vital organs has an expected lifespan,
in terms of minutes or
hours, even after the brain and stem have stopped functioning
irreversibly. For example,
without oxygen, within the range of minutes, the lifespan of a
human brain may be less
than four to six minutesvi; for the heart, within twenty
minutes.vii In the range of hours
could be the stomach, intestines, liver and kidneys.viii It is also
well known that each vital
organ of the human body functioning by itself is not sufficient
to maintain life; rather,
each one of these organs must function within its proper organ
system, and all systems
must be integrated –by the nervous system– so as to maintain
human life.

15. The Death Process
Regardless of how long each vital organ may last after anoxia
(lack of oxygen), when a
vital organ begins to fail irreversibly, one can say that the death
process has begun. One
may never kill an innocent being, but one may allow a person to
die.ix When a moral
dictate is not clear to some, it helps to pose the statement in the
reverse. For example,
imagine if we could not allow people to die; that is an untenable
situation! Therefore,
morally, one may allow people to die. One may have to provide
the means possible for
the dying person to die in peace, but one may certainly allow a
dying person to die.
Hence, whenever a vital organ begins to fail irreversibly, we
can say that the dying
process has begun for that person. Family and friends, and the
healthcare professionals
attending the dying person, in conscience, may allow that
person to die in peace.
Clinically, this may include disconnecting vital support
systems, save those that are

16. merely assisting the patient (i.e., a respirator, a Foley, or
analgesics).
Assisting versus Substituting
Morally speaking, it is essential to distinguish between assisting
or substituting vital
organs. In other words, assisting vital organs may be considered
standard medical
practice, or the standard of care, including the normal use of
clinical procedures, devices
and/or medications. Bioethically, these are ordinary means of
life support because they
are considered vital or necessary for maintaining life.x
However, when it comes to substituting one or more vital
organs, this typically involves
more elaborate clinical equipment and procedures, including
such sophistications as
general anesthesia and surgery. Typically this becomes
extraordinary means of life
support and, by definition, does not oblige morally.xi
Essentially, the reason why
extraordinary means are not obligatory is because all vital

17. organs fail naturally sooner or
later; experience inexorably demonstrates that to be so.xii When
this is so, there is no
moral obligation to substitute the dying organ(s) with a healthy
one, or equivalent devices
or machinery.
General Moral Obligation
There is a bioethical obligation to assist vital organs when
possible, but there is no moral
obligation to substitute vital organs when failing irreversibly.
Again, when a moral
dictate is not clear, it helps to pose the statement i n the reverse.
For example, imagine if
there was a moral obligation to substitute all vital organs when
failing irreversibly; that
too is untenable! Therefore, there is no moral obligation to
substitute vital organs when
failing irreversibly. One may try to substitute them (i.e.,
transplants), xiii but there is
no moral obligation to do so.

18. Exception
A possible exception to this bioethical principle is when certain
vital organs are failing in
an otherwise healthy person, and a temporary substitution
presents a positive prognosis.
For example, the otherwise healthy person with pneumonia who,
as a patient, becomes
intubated. One could argue that the ventilator is indeed
substituting the lungs, at least at
first, but the hope is that this intubation be temporary. Another
example could be dialysis,
at least until a matching kidney is found. So, for certain vital
organs and under certain
conditions, one can understand that a temporary substitution of
a failing vital organ may
obligate morally.
Even so, it is also important to further distinguish between short
term and long term
protocols. For example, the intubation of a pneumonia or COPD

19. patient may be
considered short term (typically, one to two weeksxiv), whereas
dialysis in a patient with
renal failure –considering the current extended waiting lists for
renal transplants– may be
indeed long term (typically, in the range of yearsxv). In such
long term protocols, an
argument could me made that there may come a time when these
procedures no longer
obligate, bioethically speaking. This is also an area where one
finds a possible
discrepancy between standard clinical practice (i.e., dialysis)
and morally extraordinary
means (i.e., substitution of failed kidneys). In such cases,
prudence calls for a patient-by-
patient assessment, including such factors as age, blood type,
genetic makeup, and even
the patient’s own subjective estimation of how burdensome the
procedure is becoming. xvi
Conclusion
Sometimes, patients in healthcare facilities or at home, and their
loved ones, just do not

20. know when to stop burdensome treatments. If the patient is
terminal but the death process
is not obvious, one can ask the attending physician; “doctor, has
his/her vital organs
begun to shut down irreversibly?” If the answer is, “yes,” then
treatments may be stopped
morally. Bioethically, comfort care always obligates, and this
patient can then be allowed
to die in peace.
i http://www.data360.org/dsg.aspx?Data_Set_Group_Id=195,
accessed 5 June 2016
ii http://www.pbs.org/wgbh/pages/frontline/facing-death/facts-
and-figures/, accessed 5

21. June 2016
iii Rodriguez KL, Young AJ. Patients' and healthcare providers'
understandings of life-
sustaining treatment: are perceptions of goals shared or
divergent? Soc Sci Med. 2006
Jan;62(1):125-33
ivWillmott L1, et al., Reasons doctors provide futile treatment
at the end of life: a
qualitative study.Med Ethics. 2016 May 17. doi:
10.1136/medethics-2016-103370. [Epub
ahead of print]
v Please note that, for bioethical purposes, the emphasis is on
the function of the vital organ, rather than on
its structure. Thus, a dialysis machine substitutes the kidneys
functionally; conversely, one can say that a
transplanted heart that has been rejected by the patient’s body,
has failed so substitute the dying heart
functionally, even though the structural substitution was
successful.
vi
http://www.nlm.nih.gov/medlineplus/ency/article/000013.htm,
accessed 5 June 2016
vii
http://www.pathology.washington.edu/research/labs/murry/inde
x.php?a=research&p=inf

22. o, accessed 5 June 2016
viii http://www.dcids.org/facts-about-donation/frequently-
asked-questions/, accessed 5
June 2016
ix Declaration on Euthanasia, Congregation for the Doctrine of
the Faith (1980), Section
IV
x Ethical and Religious Directives for Catholic Health Care
Services (Fifth Ed.), US
Conference of Catholic Bishops (2009), No. 56
xi ERD, 57
xii It is not the scope of this article to delve into why, if all
living cells posses an inherent
reparatory mechanism, do all vital organs end up failing sooner
or later. For inquiry into
this topic, the reader may look up: telomeres and cellular aging.
xiii ERD, 63
xiv http://www.nhlbi.nih.gov/health/health-
topics/topics/vent/whoneeds, accessed 5 June
2016
xv http://www.kidneylink.org/TheWaitingList.aspx, accessed 5
June 2016
xvi ERD, 27
http://www.data360.org/dsg.aspx?Data_Set_Group_Id=195
http://www.pbs.org/wgbh/pages/frontline/facing-death/facts-
and-figures/
http://www.ncbi.nlm.nih.gov/pubmed/?term=Rodriguez%20KL
%5BAuthor%5D&cauthor=true&cauthor_uid=15993530
http://www.ncbi.nlm.nih.gov/pubmed/?term=Young%20AJ%5B

23. Author%5D&cauthor=true&cauthor_uid=15993530
http://www.ncbi.nlm.nih.gov/pubmed/15993530
http://www.ncbi.nlm.nih.gov/pubmed/?term=Willmott%20L%5B
Author%5D&cauthor=true&cauthor_uid=27188227
http://www.ncbi.nlm.nih.gov/pubmed/27188227
http://www.nlm.nih.gov/medlineplus/ency/article/000013.ht m
http://www.pathology.washington.edu/research/labs/murry/inde
x.php?a=research&p=info
http://www.pathology.washington.edu/research/labs/murry/inde
x.php?a=research&p=info
http://www.dcids.org/facts-about-donation/frequently-asked-
questions/
http://www.nhlbi.nih.gov/health/health-
topics/topics/vent/whoneeds
http://www.kidneylink.org/TheWaitingList.aspx
The Unconscious States
Awareness of self and the environment: internal / external
(difficulties)
(lack of response to painful stimulus)
clinical definitions of:
• coma (Glasgow Coma Scale) (induced coma)
• persistent vegetative state (PVS)
• traumatic head injury
• brain hypoxia
• epileptic seizure

24. • syncope
• other unconscious states (ex. Locked-in syndrome)
CONSCIOUSNESS:
Awareness of self and the environment: internal / external
(difficulties; how to measure?)
UNCONSCIOUSNESS:
Lack of response to painful stimulus
Coma (Glasgow Coma Scale) (induced coma)
persistent (permanent) vegetative state (PVS)
VS MCS
MAGNETIC RESONANCE IMAGING (MRI)
Traumatic Brain Injury (TBI)
• complex injury
• broad spectrum of symptoms
• and disabilities

25. Mayo Clinic: TraumaticBrainInjury.com
TBI
mild
severe
~ 30 min.
Brain Hypoxia (anoxia)
3 PAIRS OF ARTERIES TO THE HEAD:
• 1 PAIR VERTEBRAL
• 2 PAIRS CAROTID
Epileptic Seizure (epileptic fit)
Neuronal activity:
• Abnormal
• Excessive
• Generalized
• Synchronous
Electro-EncephaloGram (EEG)

26. Syncope (fainting):
• Temporary loss of consciousness
• Sudden drop in blood pressure
Other unconscious states:
• Non-epileptic seizure
• Locked-in syndrome
• Etc.
LOCKED-IN SYNDROME:
• Aware
• cannot move or communicate verbally
• complete paralysis of nearly all voluntary muscles
• Except for vertical eye movements and blinking
Damage to specific portions of the lower brain
and brainstem, with no damage to the upper
brain (cerebral cortex).

27. MAGNETIC RESONANCE IMAGING (MRI)
POSITRON EMISSION TOMOGRAPHY (PET)
COMPUTED TOMOGRAPHY (CT)
VEGETATIVE
STATE
MINIMALLY
CONSCIOUS
STATE
LOCKED-IN
SYNDROME
(MRI)
DIAGNOSIS -> PROGNOSIS
MANAGEMENT, RELIEF: PAIN / SUFFERING
BIOETHICAL ANALYSIS: BENEFIT / BURDEN
BIOETHICAL MEANS OF LIFE SUPPORT:
• ORDINARY (PROPORTIONATE) / EXTRAORDINARY
(DISPROPORTIONATE)
CLINICAL MEANS OF LIFE SUPPORT:
• STANDARD MEDICAL PRACTICE / EXPERIMENTAL

28. TREATMENT
ETHICAL OBLIGATION RE. VITAL ORGANS: ASSIST /
SUBSTITUTE
WHEN TO WITHHOLD OR WITHDRAW LIFE SAVING
TREATMENT?
ERD
32. While every person is obliged to use
ordinary means to preserve his or her health,
no
person should be obliged to submit to a health
care procedure that the person has judged,
with a free and informed conscience, not to
provide a reasonable hope of benefit without
imposing excessive risks and burdens on the
patient or excessive expense to family or
community.
33. The well-being of the whole person must
be taken into account in deciding about any
therapeutic intervention or use of technology.
Therapeutic procedures that are likely to
cause harm or undesirable side-effects can be
justified only by a proportionate benefit to
the patient
56. A person has a moral obligation to use

29. ordinary or proportionate means of preserving
his or her life. Proportionate means are those
that in the judgment of the patient offer a
reasonable hope of benefit and do not entail
an excessive burden or impose excessive
expense on the family or the community.
57. A person may forgo extraordinary or
disproportionate means of preserving life.
Disproportionate means are those that in the
patient’s judgment do not offer a reasonable
hope of benefit or entail an excessive burden,
or impose excessive expense on the family
or the community.
Slide Number 1Slide Number 2Slide Number 3Slide Number
4Slide Number 5Slide Number 6Slide Number 7Slide Number
8Slide Number 9Slide Number 10Slide Number 11Slide Number
12Slide Number 13Slide Number 14Slide Number 15Slide
Number 16Slide Number 17
BIOETHICAL ISSUES TOWARD THE END OF HUMAN LIFE
• TRILLIONS OF CELLS
• VITAL ORGANS
• MAJOR CAUSES OF DEATH
• DISTINCTION BETWEEN ASSISTING OR SUBSTITUTING
VITAL ORGANS

30. REVIEW:
BIOLOGICAL UNIT OF LIFE = CELL
LEVELS OF BIOLOGICAL ORGANIZATION (HIERARCHY
OF LIFE):
CELLS -> TISSUES -> ORGANS -> SYSTEMS (ORGAN
SYSTEMS) -> ORGANISM
(INDIVIDUAL)
• VITAL ORGANS
VITAL ORGANS:
• BRAIN
• BRAIN STEM
• BOTH LUNGS
• HEART
• LIVER
• PANCREAS
• STOMACH
• SMALL INTESTINE

31. • LARGE INTESTINE
• BOTH KIDNEYS
• MAJOR CAUSES OF DEATH
% Primary Organ
1. Diseases of the heart 28.5 HEART
2. Malignant tumors 22.8 ANY VITAL ORGAN
3. Cerebrovascular diseases 6.7 BRAIN
4. Chronic lower respiratory diseases 5.1 LUNGS
5. Accidents (unintentional injuries) 4.4 ANY VITAL ORGAN
6. Diabetes mellitus (Type II Diabetes) 3 PANCREAS
7. Influenza and pneumonia 2.7 LUNGS
8. Alzheimer’s disease 2.4 BRAIN
9. Nephritis, nephrotic syndrome and nephrosis 1.7 KIDNEYS
10. Septicemia (blood poisoning) 1.4 BLOOD
11. Suicide 1.3 ANY VITAL ORGAN
12. Chronic liver disease and cirrhosis 1.1 LIVER

32. 13. Primary hypertension and hypertensive renal disease 0.8
ANY VITAL ORGAN
14. Parkinson’s disease (tied) 0.7 BRAIN
15. Homicide (tied) 0.7 ANY VITAL ORGAN
All others 16.7 ANY VITAL ORGAN
100
(Source: CDC/NHS National Vital Statistics System)
15 Major Causes of Death (USA)
• DISTINCTION BETWEEN ASSISTING OR SUBSTITUTING
VITAL ORGANS
DIALYSIS: SUBSTITUTES KIDNEYS
RESPIRATOR; ASSISTS IN PROVIDING OXYGEN
VENTILATOR; DEPENDS ON THE SETTINGS: ASSIST OR
SUBSTITUTE BREATHING
RESPIRATORS: ASSIST BREATHING
(NOT VENTILATOR)

33. VENTILATOR: PERFUSION
WEANING PROCESS
VENT ~ 2-3 WEEKS BEFORE TRACHEOTOMY
EXTUBATION
TRACHEOTOMY
(TRACHEOSTOMY)
CARDIOPULMONARY RESUSCITATION (CPR):
• ASSISTS / SUBSTITUTES HEART
Defibrillation
Automated External Defibrillator (AED)
Implantable Cardioverter Defibrillator (ICD)
Wearable Cardioverter Defibrillator (WCD)
• treatment for cardiac dysrhythmias
• Ex. ventricular fibrillation (VF) and ventricular tachycardia
(VT)

34. • delivers a dose of electric current to the heart
• VITAL ORGANS
• DISTINCTION BETWEEN ASSISTING OR SUBSTITUTING
VITAL ORGANS
• ASSISTING VITAL ORGANS GENERALLY OBLIGATES
BIOETHICALLY
• SUBSTITUTING VITAL ORGANS GENERALLY DOES NOT
OBLIGATE
Slide Number 1Slide Number 2Slide Number 3Slide Number
4Slide Number 5Slide Number 6Slide Number 7Slide Number
8Slide Number 9Slide Number 10Slide Number 11Slide Number
12Slide Number 13Slide Number 14Slide Number 15Slide
Number 16
Master of Science in Nursing
Practicum Experience Plan
Overview:
Your Practicum experience includes working in a clinical
setting that will help you gain the knowledge and skills needed
as an advanced practice nurse. In your practicum experience,
you will develop a practicum plan that sets forth objectives to
frame and guide your practicum experience.
As part of your Practicum Experience Plan, you will not only

35. plan for your learning in your practicum experience but also
work through various patient visits with focused notes as well
as one (1) journal entry.
Complete each section below.
Part 1: Quarter/Term/Year and Contact Information
Section A
Quarter/Term/Year:
StudentContact Information
Name:
Street Address:
City, State, Zip:
Home Phone:
Work Phone:
Cell Phone:
Fax:
E-mail:
PreceptorContact Information
Name:
Organization:
Street Address:
City, State, Zip:
Work Phone:
Cell Phone:
Fax:
Professional/Work E-mail:

36. Part 2: Individualized Practicum Learning Objectives
Refer to the instructions in Week 2 to create individualized
practicum learning objectives that meet the requirements for
this course. These objectives should be aligned specifically to
your Practicum experience. Your objectives should address your
self-assessment of the skills found in the “PMHNP Clinical
Skills Self-Assessment Form” you completed in Week 1.
As you develop your individualized practicum learning
objective, be sure to write them using the SMART format. Use
the resources found in Week 2 to guide your development. Once
you review your resources, continue and complete the
following. Note: Please make sure each of your objectives are
connected to your self-assessment. Also, consider that you will
need to demonstrate how you are advancing your knowledge in
the clinical specialty.
** YOU MUST HAVE 3 NEW OBJECTIVES EACH
QUARTER. You may include previous practicum objectives;
however, you still must have 3 new objectives for your current
course.
Objective 1: <write your objective here> (Note: this objective
should relate to a specific skill you would like to improve from
your self-assessment)
Planned Activities:
Mode of Assessment: (Note: Verification will be documented in
Meditrek)
PRAC Course Outcome(s) Addressed:
· (for example) Develop professional plans in advanced nursing
practice for the practicum experience

37. · (for example) Assess advanced practice nursing skills for
strengths and opportunities
Objective 2: <write your objective here> (Note: this objective
should relate to a specific skill you would like to improve from
your self-assessment)
Planned Activities:
Mode of Assessment: (Note: Verification will be documented in
Meditrek)
PRAC Course Outcome(s) Addressed:
·
Objective 3: <write your objective here> (Note: this objective
should relate to a specific skill you would like to improve from
your self-assessment)
Planned Activities:
Mode of Assessment: (Note: Verification will be documented in
Meditrek)
PRAC Course Outcome(s) Addressed:
·
Part 3: Projected Timeline/Schedule
Estimate how many hours you expect to work on your Practicum
each week. *Note: All of your hours and activities must be
supervised by your Preceptor and completed onsite. Your
Preceptor will approve all hours, but your activities will be

38. approved by both your Preceptor and Instructor. Any changes to
this plan must be approved.
This timeline is intended as a planning tool; your actual
schedule may differ from the projections you are making now.
I intend to complete the 144 or 160 Practicum hours (as
applicable) according to the following timeline/schedule. I also
understand that I must see at least 80 patients during my
practicum experience. I understand that I may not complete my
practicum hours sooner than 8 weeks. I understand I may not be
in the practicum setting longer than 8 hours per day unless pre-
approved by my faculty.
Number of Clinical Hours Projected for Week (hours you are in
Practicum Setting at your Field Site)
Number of Weekly Hours for Professional Development (these
are not practicum hour)
Number of Weekly Hours for Practicum Coursework (these are
not practicum hours)
Week 1
Week 2
Week 3
Week 4

39. Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Total Hours (must meet the following requirements)
144 or 160 Hours

40. Part 4 - Signatures
Student Signature (electronic): Date:
Practicum Faculty Signature (electronic)**:
Date:
** Faculty signature signifies approval of Practicum Experience
Plan (PEP)
Submit your Practicum Experience Plan on or before Day 7 of
Week 2 for faculty review and approval.
Once approved, you will receive a copy of the PEP for your
records. You must share an approved copy with your Preceptor.
The Preceptor is not required to sign this form.
© 2020 Walden University 3
Rubric Detail
Select Grid View or List View to change the rubric's layout.
Content
Name: PRAC_6675_Week2_Assignment2_Rubric
Grid ViewList View
Excellent

41. Good
Fair
Poor
Record the required information in each area of the Practicum
Experience Plan (PEP):
Part 1: Quarter/Term/Year and Contact Information:
ᵒ Identify Quarter/Term/Year
ᵒ Identify Student Contact Information:
Name, Street Address, City, State, Zip, Home Phone, Work
Phone, Cell Phone, Fax, and Walden University Email
ᵒ Identify Preceptor Contact Information:
Name, Organization, Street Address, City, State, Zip, Work
Phone, Cell Phone, Fax, and Professional/Work Email
Points:
Points Range:
5 (5%) - 5 (5%)

42. The response accurately and clearly identifies the
Quarter/Term/Year, all Student Contact Information, and all
Preceptor Contact Information.
Feedback:
Points:
Points Range:
4 (4%) - 4 (4%)

43. The response identifies the Quarter/Term/Year, and at least
90% of Student Contact Information and Preceptor Contact
Information.
Feedback:
Points:
Points Range:
3.5 (3.5%) - 3.5 (3.5%)

44. The response identifies the Quarter/Term/Year, and at least
80% of Student Contact Information and Preceptor Contact
Information.
Feedback:
Points:
Points Range:
0 (0%) - 3 (3%)

45. The response is inaccurate, incomplete, or is missing
identification of the Quarter/Term/Year and/or identifies less
than 80% of Student Contact Information and Preceptor Contact
Information.
Feedback:
Part 2: Individualized Practicum Learning Objectives:
Explain 3 Individualized Practicum Learning Objectives that
address your self-assessment of the skills found in the Clinical
Skills Self-Assessment, are SMART (i.e., Specific, Measurable,
Attainable, Results-Focused, Time-Focused), and meet the
requirements for this course.
Each Practicum Learning Objective must describe planned
activities, mode of assessment, and PRAC course outcome(s)
addressed for the skills you would like to improve from your
self-assessment.

46. Points:
Points Range:
69 (69%) - 75 (75%)
The response clearly, accurately, and thoroughly explains 3
Individualized Practicum Learning Objectives that address the
self-assessment of the skills found in the Clinical Skills Self-
Assessment. They are SMART (i.e., Specific, Measurable,
Attainable, Results-Focused, Time-Focused) and meet the
requirements for this course.
For each Learning Objective, the response clearly, accurately,
and thoroughly describes planned activities, mode of
assessment, and PRAC course outcome(s) addressed for the
skills to be improved from the self-assessment.
Feedback:

47. Points:
Points Range:
60 (60%) - 68 (68%)
The response accurately explains 3 Individualized Practicum
Learning Objectives that address the self-assessment of the
skills found in the Clinical Skills Self-Assessment, are SMART
(i.e., Specific, Measurable, Attainable, Results-Focused, Time-
Focused), and meet the requirements for this course.
For each Learning Objective, the response accurately describes
planned activities, mode of assessment, and PRAC course

48. outcome(s) addressed for the skills to be improved from the
self-assessment.
Feedback:
Points:
Points Range:
53 (53%) - 59 (59%)
The response somewhat vaguely explains 3 Individualized

49. Practicum Learning Objectives that address the self-assessment
of the skills found in the Clinical Skills Self-Assessment. They
may not all be SMART (i.e., Specific, Measurable, Attainable,
Results-Focused, Time-Focused), or fully meet the requirements
for this course.
For each Learning Objective, the response somewhat vaguely
describes planned activities, mode of assessment, and PRAC
course outcome(s) addressed for the skills to be improved from
the self-assessment.
Feedback:
Points:
Points Range:

50. 0 (0%) - 52 (52%)
The response inaccurately or incompletely explains 3
Individualized Practicum Learning Objectives that address the
self-assessment of the skills found in the Clinical Skills Self-
Assessment. Some or all are not SMART (i.e., Specific,
Measurable, Attainable, Results-Focused, Time-Focused),
and/or do not meet the requirements for this course.
For each Learning Objective, the response has a vague,
inaccurate, and/or incomplete or missing description of planned
activities, mode of assessment, and PRAC course outcome(s)
addressed for the skills to be improved from the self-
assessment.
Feedback:
Part 3: Projected Timeline/Schedule:

51. Describe your practicum timeline/schedule:
ᵒ Number of weekly hours projected to work on your practicum
ᵒ Number of weekly hours for professional development
Points:
Points Range:
14 (14%) - 15 (15%)
The response includes a clear, accurate, and thorough
description of the practicum timeline/schedule, including
number of weekly hours projected to work on the practicum and
number of weekly hours for professional development.
Feedback:

52. Points:
Points Range:
12 (12%) - 13 (13%)
The response includes an accurate description of the practicum
timeline/schedule, including number of weekly hours projected
to work on the practicum and number of weekly hours for
professional development.
Feedback:

53. Points:
Points Range:
11 (11%) - 11 (11%)
The response includes a somewhat vague description of the
practicum timeline/schedule, and may be missing details about
the number of weekly hours projected to work on the practicum
or number of weekly hours for professional development.

54. Feedback:
Points:
Points Range:
0 (0%) - 10 (10%)
The response includes a vague, incomplete, and/or inaccurate
or missing description of the practicum timeline/schedule,
including number of weekly hours projected to work on the
practicum or number of weekly hours for professional
development.

55. Feedback:
Written Expression and Formatting—English Writing
Standards: Assignment follows correct grammar, mechanics,
and proper punctuation.
Points:
Points Range:
5 (5%) - 5 (5%)

56. Uses correct grammar, spelling, and punctuation with no
errors.
Feedback:
Points:
Points Range:
4 (4%) - 4 (4%)
Contains 1-2 grammar, spelling, and punctuation errors.

57. Feedback:
Points:
Points Range:
3.5 (3.5%) - 3.5 (3.5%)
Contains 3-4 grammar, spelling, and punctuation errors.

58. Feedback:
Points:
Points Range:
0 (0%) - 3 (3%)
Contains ≥ 5 grammar, spelling, and punctuation errors that
interfere with the reader’s understanding.

59. Feedback:
Show Descriptions
Show Feedback
Record the required information in each area of the Practicum
Experience Plan (PEP):
Part 1: Quarter/Term/Year and Contact Information:
ᵒ Identify Quarter/Term/Year
ᵒ Identify Student Contact Information:
Name, Street Address, City, State, Zip, Home Phone, Work
Phone, Cell Phone, Fax, and Walden University Email
ᵒ Identify Preceptor Contact Information:
Name, Organization, Street Address, City, State, Zip, Work
Phone, Cell Phone, Fax, and Professional/Work Email
--
Levels of Achievement:

60. Excellent
5 (5%) - 5 (5%)
The response accurately and clearly identifies the
Quarter/Term/Year, all Student Contact Information, and all
Preceptor Contact Information.
Good
4 (4%) - 4 (4%)
The response identifies the Quarter/Term/Year, and at least 90%
of Student Contact Information and Preceptor Contact
Information.
Fair
3.5 (3.5%) - 3.5 (3.5%)
The response identifies the Quarter/Term/Year, and at least 80%
of Student Contact Information and Preceptor Contact
Information.

61. Poor
0 (0%) - 3 (3%)
The response is inaccurate, incomplete, or is missing
identification of the Quarter/Term/Year and/or identifies less
than 80% of Student Contact Information and Preceptor Contact
Information.
Feedback:
Part 2: Individualized Practicum Learning Objectives:
Explain 3 Individualized Practicum Learning Objectives that
address your self-assessment of the skills found in the Clinical
Skills Self-Assessment, are SMART (i.e., Specific, Measurable,
Attainable, Results-Focused, Time-Focused), and meet the
requirements for this course.
Each Practicum Learning Objective must describe planned
activities, mode of assessment, and PRAC course outcome(s)
addressed for the skills you would like to improve from your
self-assessment.
--

62. Levels of Achievement:
Excellent
69 (69%) - 75 (75%)
The response clearly, accurately, and thoroughly explains 3
Individualized Practicum Learning Objectives that address the
self-assessment of the skills found in the Clinical Skills Self-
Assessment. They are SMART (i.e., Specific, Measurable,
Attainable, Results-Focused, Time-Focused) and meet the
requirements for this course.
For each Learning Objective, the response clearly, accurately,
and thoroughly describes planned activities, mode of
assessment, and PRAC course outcome(s) addressed for the
skills to be improved from the self-assessment.
Good
60 (60%) - 68 (68%)
The response accurately explains 3 Individualized Practicum
Learning Objectives that address the self-assessment of the
skills found in the Clinical Skills Self-Assessment, are SMART
(i.e., Specific, Measurable, Attainable, Results-Focused, Time-
Focused), and meet the requirements for this course.

63. For each Learning Objective, the response accurately describes
planned activities, mode of assessment, and PRAC course
outcome(s) addressed for the skills to be improved from the
self-assessment.
Fair
53 (53%) - 59 (59%)
The response somewhat vaguely explains 3 Individualized
Practicum Learning Objectives that address the self-assessment
of the skills found in the Clinical Skills Self-Assessment. They
may not all be SMART (i.e., Specific, Measurable, Attainable,
Results-Focused, Time-Focused), or fully meet the requirements
for this course.
For each Learning Objective, the response somewhat vaguely
describes planned activities, mode of assessment, and PRAC
course outcome(s) addressed for the skills to be improved from
the self-assessment.
Poor
0 (0%) - 52 (52%)

64. The response inaccurately or incompletely explains 3
Individualized Practicum Learning Objectives that address the
self-assessment of the skills found in the Clinical Skills Self-
Assessment. Some or all are not SMART (i.e., Specific,
Measurable, Attainable, Results-Focused, Time-Focused),
and/or do not meet the requirements for this course.
For each Learning Objective, the response has a vague,
inaccurate, and/or incomplete or missing description of planned
activities, mode of assessment, and PRAC course outcome(s)
addressed for the skills to be improved from the self-
assessment.
Feedback:
Part 3: Projected Timeline/Schedule:
Describe your practicum timeline/schedule:
ᵒ Number of weekly hours projected to work on your practicum
ᵒ Number of weekly hours for professional development
--

65. Levels of Achievement:
Excellent
14 (14%) - 15 (15%)
The response includes a clear, accurate, and thorough
description of the practicum timeline/schedule, including
number of weekly hours projected to work on the practicum and
number of weekly hours for professional development.
Good
12 (12%) - 13 (13%)
The response includes an accurate description of the practicum
timeline/schedule, including number of weekly hours projected
to work on the practicum and number of weekly hours for
professional development.
Fair
11 (11%) - 11 (11%)
The response includes a somewhat vague description of the

66. practicum timeline/schedule, and may be missing details about
the number of weekly hours projected to work on the practicum
or number of weekly hours for professional development.
Poor
0 (0%) - 10 (10%)
The response includes a vague, incomplete, and/or inaccurate or
missing description of the practicum timeline/schedule,
including number of weekly hours projected to work on the
practicum or number of weekly hours for professional
development.
Feedback:
Written Expression and Formatting—English Writing Standards:
Assignment follows correct grammar, mechanics, and proper
punctuation.--
Levels of Achievement:

67. Excellent
5 (5%) - 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Good
4 (4%) - 4 (4%)
Contains 1-2 grammar, spelling, and punctuation errors.
Fair
3.5 (3.5%) - 3.5 (3.5%)
Contains 3-4 grammar, spelling, and punctuation errors.
Poor
0 (0%) - 3 (3%)

68. Contains ≥ 5 grammar, spelling, and punctuation errors that
interfere with the reader’s understanding.
Feedback:
Total Points:
100
Name: PRAC_6675_Week2_Assignment2_Rubric
Assignment 2: Practicum Experience Plan (PEP)
As you establish your goals and objectives for this course, you
are committing to an organized plan that will frame your
practicum experience in a clinical setting, including planned
activities, assessment, and achievement of defined outcomes. In

69. particular, they must address the categories of clinical
reasoning, quality in your clinical specialty, and interpersonal
collaborative practice.
For this Assignment, you will consider the areas you aim to
focus on to gain practical experience as an advanced practice
nurse. Then, you will develop a Practicum Experience Plan
(PEP) containing the objectives you will fulfill in order to
achieve your aims. For this practicum experience, be sure to
develop goals and objectives that allow you to synthesize
knowledge and skills related to assessment, diagnosis, and
treatment planning.
To Prepare
· Review your Clinical Skills Self-Assessment Form you
submitted last week and think about areas for which you would
like to gain application-level experience and/or continued
growth as an advanced practice nurse. How can your
experiences in the practicum help you achieve these aims?
· Review the information related to developing objectives
provided in this week’s Learning Resources. Your
practicum learning objectives that you want to achieve during
your practicum experience must be:
· Specific
· Measurable
· Attainable
· Results-focused
· Time-bound
· Reflective of the higher-order domains of Bloom’s taxonomy
(i.e., application level and above)
· Discuss your professional aims and your
proposed practicum objectives with your Preceptor to ascertain
if the necessary resources are available at your practicum site.
· Select one nursing theory and one counseling/psychotherapy
theory to best guide your clinical practice. Explain why you

70. selected these theories. Support your approach with evidence-
based literature.
· Create a timeline of practicum activities that demonstrates
how you plan to meet these goals and objectives based on your
practicum requirements.
The Assignment
Record the required information in each area of the Practicum
Experience Plan template, including 3–4 measurable practicum
learning objectives you will use to
facilitate your learning during the practicum experience.