1. Comprehensive Exam Orientation Department of Physiological Nursing UCSF School of Nursing Fall 2012 Theresa Koetters, RN, MS, CNS Roxanne Garbez, RN, PhD, ACNP

2. Outline of Comp Process Description of the project Description of the project The Comprehensive Exam Handbook The Comprehensive Exam Handbook Qualifying for the examination Qualifying for the examination Important dates Important dates Technical requirements Technical requirements Resources Resources

3. The Assignment The purpose of this paper is to evaluate your ability to: The purpose of this paper is to evaluate your ability to: –Critique research as it applies to your area of specialization. –Apply advanced knowledge to clinical practice. –Apply writing skills to the dissemination of nursing information; scholarly paper –Consumer of research

4. Critical Points Thirty (30) page paper (maximum) Thirty (30) page paper (maximum) Three exam options Three exam options –Critical Literature Review (CLR) –Problem-solving (PS) –Research proposal

5. The Handbook You can download a copy of the Comprehensive Examination Handbook from the UCSF School of Nursing website You can download a copy of the Comprehensive Examination Handbook from the UCSF School of Nursing website http://nursing.ucsf.edu/student-resources

6. How to Qualify for the Examination How to Qualify for the Examination You are eligible in the last quarter you are enrolled in course and clinical work. You are eligible in the last quarter you are enrolled in course and clinical work. If you have completed ALL course work with the exception of the comp exam you may submit the exam while on filing fee status for a reduced fee. If you have completed ALL course work with the exception of the comp exam you may submit the exam while on filing fee status for a reduced fee.

7. Filing Fee Status Talk with your advisor. Talk with your advisor. You qualify if you have completed ALL course and clinical work. You may not take courses of any type if you are on Filing Fee status. You qualify if you have completed ALL course and clinical work. You may not take courses of any type if you are on Filing Fee status. Apply and pay filing fee to OAR Apply and pay filing fee to OAR Can be used for second attempt Can be used for second attempt Filing fee status can be used only once. If you pay filing fee then do not submit your comp you must pay full tuition for a subsequent quarter. Filing fee status can be used only once. If you pay filing fee then do not submit your comp you must pay full tuition for a subsequent quarter.

8. Advance to Candidacy Before you can be issued your individualized Comp Number, YOU MUST ADVANCE TO CANDIDACY. Before you can be issued your individualized Comp Number, YOU MUST ADVANCE TO CANDIDACY. Advance to Candidacy forms are available from the Office of Admissions and Registrar. Forms can also be downloaded online. Advance to Candidacy forms are available from the Office of Admissions and Registrar. Forms can also be downloaded online. After you submit your form Graduate Division notifies Office of Student Affairs. OSA will then generate your Comp Number. After you submit your form Graduate Division notifies Office of Student Affairs. OSA will then generate your Comp Number.

9. The Last Quarter of Course and Clinical Work Advance to Candidacy any time before the first week of the quarter in which you plan to turn in the comp. Advance to Candidacy any time before the first week of the quarter in which you plan to turn in the comp. No incompletes on record. No incompletes on record. Current in payment of fees. Current in payment of fees.

10. Know the Important Dates- Spring 2013 Number pick up date: Number pick up date: –Between April 9 and April 22 Submit comp by Noon Submit comp by Noon –April 23 Notification of results Notification of results –May 23

11. Technical and Procedural Points Format Format Submission Submission Scoring Scoring

12. Formatting Expectations APA 6th Edition format Margins 1 inch on all 4 sides of page Can separate syllables at the end of a line 30 pages of text, not counting title page, reference list and appendices Title should reflect content No abstract Double-spaced, 12 point uncompressed font (Acceptable font examples: Times New Roman, Arial)

13. Submission Requirements One single-sided original of the comprehensive examination One single-sided original of the comprehensive examination Three double sided copies Three double sided copies Completed face sheet attached to each copy of the exam Completed face sheet attached to each copy of the exam Separate paper with student’s name, address, home and work number, and other pertinent information that facilitates the student being contacted if necessary Separate paper with student’s name, address, home and work number, and other pertinent information that facilitates the student being contacted if necessary It is the student’s responsibility to ensure that the comprehensive exam is submitted by 12 noon on the due date It is the student’s responsibility to ensure that the comprehensive exam is submitted by 12 noon on the due date

14. 14 Face Sheet In order to pick up your number you must complete the face sheet and return it In order to pick up your number you must complete the face sheet and return it –List your specialty –Topic –Suggested readers ID number is given to you to be placed on your comp ID number is given to you to be placed on your comp

15. Reading and Scoring Student may select up to five preferred readers (not required) Student may select up to five preferred readers (not required) Student is not guaranteed a preferred reader Student is not guaranteed a preferred reader Readers use a standard scoring system Readers use a standard scoring system Student will be given the faculty comment sheets at the end but not the scoring sheets Student will be given the faculty comment sheets at the end but not the scoring sheets

16. Plagiarism Evidence of plagiarism results in a failure of the comprehensive exam. Evidence of plagiarism results in a failure of the comprehensive exam. Plagiarism can become grounds for dismissal from the School of Nursing. Plagiarism can become grounds for dismissal from the School of Nursing.

17. In Case of Failure Pass/fail discrepancy goes to a third reader. Pass/fail discrepancy goes to a third reader. Exam fails if two readers fail it. Exam fails if two readers fail it. May retake exam only once. May retake exam only once. Must submit second exam within 5 quarters. Must submit second exam within 5 quarters.

18. Vital Resources Vital resource—Department Administrative Assistants Vital resource—Department Administrative Assistants –CHS Kathryn Young –PN James Negri –FHCN Maria-Elena Sotelo –SBS Brandee Woleslagle Comprehensive Exam Coordinators Comprehensive Exam Coordinators –CHS Beth Phoenix & Dana Drew-Nord –PN Theresa Koetters & Roxanne Garbez –FHCN Karen Duderstadt & Barbara Hollinger –SBS Susan Chapman

19. Additional Resources Advisors- topic and format Advisors- topic and format Specialty faculty Specialty faculty Sample comps on reserve Sample comps on reserve Office of Student Affairs for tutors and editors, contact Judy Martin-Holland Office of Student Affairs for tutors and editors, contact Judy Martin-Holland Consider other arrangements Consider other arrangements –Typist –Paid tutors and editors –Peers as editors and proofreaders Create a timeline Create a timeline –See sample provided

20. Comprehensive Exam 2012-2013 SEPOCTNOVDECJANFEBMARAPRMAYJUNJULAUG Identifying the phenomenon of interest Refine topic outline Advance to Candidacy Topic generation Faculty input re: topic Literature review Faculty input re: topic outline Draft #1 Colleagues read paper for clarity and organization Draft #2 Pick up Comp # Edit Submit Comp Advance to Candidacy: Before end of Winter Quarter Pick up Comp # from Departments: From 4/09/13 to 4/22/13 Submit Comp to Departments: 4/23/13

21. WORK HARD, DO WELL! Extensions, examination by mail, summer comps, oral exam are available only by special arrangement. Read the corresponding section of the comp handbook. Extensions, examination by mail, summer comps, oral exam are available only by special arrangement. Read the corresponding section of the comp handbook.

22. 22 Part 2

23. 23 Sample Examinations On reserve in each of the departments On reserve in each of the departments Ask your advisor and/or your department's comprehensive examination coordinator Ask your advisor and/or your department's comprehensive examination coordinator

24. 24 Other Resources UCSF SON website UCSF SON website

25. 25 Choosing a Theory A theory should further clarify or explain your topic A theory should further clarify or explain your topic Nursing theory not required Nursing theory not required Explain your theory in the text—don’t depend on diagrams in the appendix Explain your theory in the text—don’t depend on diagrams in the appendix

26. 26 Theory or Conceptual Framework A theory is a structure that enables you to explain a phenomenon. There is no right or wrong theory--it is all in how you want the argument you want to make. A theory is a structure that enables you to explain a phenomenon. There is no right or wrong theory--it is all in how you want the argument you want to make.

27. 27 Possible Mechanisms Underlying the Increased Risk of Type 2 Diabetes in People on Atypical Psychotrophics PhysiologicalHPA axis and sympathetic nervous system hyperactivity resulting in overproduction of cortisol. GeneticsDiabetes only occurs in those with a genetic predisposition. Co-moridityThe diabetes is really due to alcoholism or binge eating. Socio- cultural Due to socioeconomic, disability, marital status, access to health care Health careProviders fail to adequately monitor overall health. BehavioralInactivity, diet, smoking due to the psychiatric illness Medicationside effects, appetite stimulation and subsequent weight gain

28. 28 Possible Titles The Relationship Between Atypical Psychotropic Use and Diabetes Mellitus: The role of Genetics The Relationship Between Atypical Psychotropic Use and Diabetes Mellitus: The role of Genetics Sociocultural Factors in the Development of Diabetes Mellitus in Patients with Severe Mental Illness Sociocultural Factors in the Development of Diabetes Mellitus in Patients with Severe Mental Illness

29. 29 Types of Examinations Research Proposal (check with your advisor as early as possible) Research Proposal (check with your advisor as early as possible) Problem-solving Problem-solving Critical Literature Review Critical Literature Review

30. 30 Research Proposal To evaluate a student’s ability to identify a significant research question relevant to nursing practice, and to design a methodology for addressing the question. To evaluate a student’s ability to identify a significant research question relevant to nursing practice, and to design a methodology for addressing the question. Study does not have to be carried out Study does not have to be carried out Must have access to UCSF faculty with research experience to mentor you Must have access to UCSF faculty with research experience to mentor you

31. Research Proposal Good choice if you plan to build on this topic for future research or doctoral work Good choice if you plan to build on this topic for future research or doctoral work Could be taken back to your workplace for implementation if approval given by institution Could be taken back to your workplace for implementation if approval given by institution

32. Research Proposal Scoring Total Points – 330 Total Points – 330 –Area 1 – Study and Context – 63 –Conceptual Framework and Literature Review - 126 –Methodology – 126 –Technical (grammar, organization, use of APA format) – 15

33. The Comprehensive Exam is Pass/Fail Points needed to pass - 231 Points needed to pass - 231

34. 34 Problem-solving Examination Purpose: To evaluate the student’s ability to effectively communicate the resolution of a problem in an area of specialization. Purpose: To evaluate the student’s ability to effectively communicate the resolution of a problem in an area of specialization. Describes an identified need stemming from a discrepancy between what is or what could/should be. Describes an identified need stemming from a discrepancy between what is or what could/should be.

35. 35 Choosing a Problem-solving Topic Can be a problem on an individual or a systems level. Can be a problem on an individual or a systems level. Must be appropriate to the clinical situation Must be appropriate to the clinical situation –Think of a situation that is challenging to you Must be feasible! Must be feasible! Must be measurable! Must be measurable!

36. 36 Examples of Problem-Solving Topics Initiating an Oral Care Program in a Nursing Home Initiating an Oral Care Program in a Nursing Home Post-Partum Depression: Transition to Motherhood Post-Partum Depression: Transition to Motherhood ICU Nurses’ Knowledge Deficit Regarding Hemodynamic Monitoring ICU Nurses’ Knowledge Deficit Regarding Hemodynamic Monitoring Loss of Venous Access and Dialysis Delay in End Stage Renal Disease Patients Loss of Venous Access and Dialysis Delay in End Stage Renal Disease Patients

37. 37 Problem-solving Cautions Instituting a delirium treatment program in acute care setting Instituting a delirium treatment program in acute care setting –Is delirium identified? Multiple etiologies…what will the intervention be? How will you measure this? Improving parenting skills by identifying temperament in toddlers in preschools Improving parenting skills by identifying temperament in toddlers in preschools –What is meant by “parenting skills?” How will you get access to preschools? Is there literature that indicates that identifying temperament will change parenting behavior?

38. 38 The Problem and its Environmental Context Clarity of the Problem Clarity of the Problem Significance of the Problem Significance of the Problem Clarity of Setting Clarity of Setting Clarity of Roles and inter-relationships Clarity of Roles and inter-relationships

39. 39 The Problem and its Environmental Context Clarity of the Problem Clarity of the Problem –Who is solving the problem APN APN –Where the problem occurs ICU ICU –What is to be accomplished Improve Nurses’ Knowledge Improve Nurses’ Knowledge –Target population ICU Nurses ICU Nurses

40. 40 The Problem and its Environmental Context Significance of the Problem Significance of the Problem –Importance of the problem to patients or profession –Accurate Hemodynamic Monitoring is essential for ICU patients

41. 41 The Problem and its Environmental Context Clarity of the Setting Clarity of the Setting –Home, hospital, nursing home –Intensive Care Unit

42. 42 The Problem and its Environmental Context Clarity of Roles & Inter-relationships Clarity of Roles & Inter-relationships –Describes functions of individuals sig to problem, their roles and influence on the setting –ICU nurses, Clinical Nurse Specialist, Head Nurse

43. Literature Review Quality of references Quality of references Addresses elements of critique Addresses elements of critique Quality of critique and interpretation Quality of critique and interpretation Quality of theoretical discussion Quality of theoretical discussion

44. 44 Intervention, Implementation & Evaluation Expected Outcomes Expected Outcomes Defensibility Defensibility Realism Realism Clarity & Appropriateness of Intervention Implementation Clarity & Appropriateness of Intervention Implementation Clarity & Appropriateness of Evaluation Procedure Clarity & Appropriateness of Evaluation Procedure

45. 45 Intervention, Implementation & Evaluation Clarity of Expected Outcomes Clarity of Expected Outcomes –Improvement of Nurses Knowledge evidenced by improvement on post-test scores

46. 46 Intervention, Implementation & Evaluation Clarity & Appropriateness of Implementation Clarity & Appropriateness of Implementation –Outline procedures for implementing the intervention and ensuring they are appropriate –Educational intervention was three-fold Self-study, then 4 hour mandatory class, bedside guides developed Self-study, then 4 hour mandatory class, bedside guides developed

47. 47 Intervention, Implementation & Evaluation Clarity & Appropriateness of Evaluation Procedure Clarity & Appropriateness of Evaluation Procedure Delineates specific measurable and appropriate evaluation criteria Delineates specific measurable and appropriate evaluation criteria –Pretest and post-test measure of ICU nurses’ knowledge is measured –Number of incident reports are analyzed regarding monitoring

48. 48 Intervention, Implementation & Evaluation Defensibility Defensibility –Demonstrates intervention has potential for substantial improvement in the problem Realism Realism –Feasibility of intervention –Will an educational intervention be possible?

49. 49 Technical Criteria Grammar and spelling Grammar and spelling Organization of paper Organization of paper APA format APA format

50. 50 Caveats Must have a feasible, effective and defensible evaluation method Must have a feasible, effective and defensible evaluation method Do not wait until the end to decide on method of evaluation Do not wait until the end to decide on method of evaluation When writing, do not always start with the beginning of the paper and progress to the end or your evaluation will suffer. When writing, do not always start with the beginning of the paper and progress to the end or your evaluation will suffer.

51. 51 Problem-solving Scoring Total Points - 330 Total Points - 330 –Area 1 – The Problem - 105 –Area 2 – Literature Review - 105 –Area 3 – Intervention, Implementation, Evaluation - 105 –Area 4 – Technical (grammar, organization, APA) -15 EACH SECTION IS EQUALLY WEIGHTED SO PLAN FOR 10 PAGES PER SECTION!

52. 52 Critical Literature Review Choosing a Topic Pose a question Pose a question Do initial searching Do initial searching There is enough research, but no synthesis of findings or clear direction There is enough research, but no synthesis of findings or clear direction You want to argue a point that has some evidence, but is not established practice You want to argue a point that has some evidence, but is not established practice

53. 53 Critical Literature Review Topic or Issue Clarity of topic or purpose Clarity of topic or purpose State in 1 sentence! State in 1 sentence! The purpose of this paper is to examine the literature related to the diagnosis of BNP in heart failure The purpose of this paper is to examine the literature related to the diagnosis of BNP in heart failure

54. 54 Topic or Issue Significance of topic Significance of topic 4.8 million in US have HF, 50% are rehospitalized in 6 mos., there is no lab test for diagnosing HF, BNP might provide better method for evaluation of SOB than symptoms 4.8 million in US have HF, 50% are rehospitalized in 6 mos., there is no lab test for diagnosing HF, BNP might provide better method for evaluation of SOB than symptoms

55. 55 Literature Review – Examples Evaluating cognitive function after stroke Evaluating cognitive function after stroke Family presence during resuscitation Family presence during resuscitation HRT in perimenopausal women HRT in perimenopausal women BNP levels in the diagnosis of heart failure BNP levels in the diagnosis of heart failure Evaluation of depression in adolescence Evaluation of depression in adolescence

56. 56 Some evidence exists, but practice is not well delineated Should diabetics use ACE inhibitors to prevent renal impairment ? Should diabetics use ACE inhibitors to prevent renal impairment ? This is well-established by scientific study and standard of practice in most settings. This is well-established by scientific study and standard of practice in most settings. Is it safe to give people with stage 4 kidney disease ACE inhibitors to prevent progression? Is it safe to give people with stage 4 kidney disease ACE inhibitors to prevent progression? Practitioners have been hesitant to give people with stage 4 CKD ACE inhibitors for fear of increasing creatinine or potassium to dangerous levels. Practitioners have been hesitant to give people with stage 4 CKD ACE inhibitors for fear of increasing creatinine or potassium to dangerous levels.

57. 57 Literature Review Quality of References Quality of References Elements of Critique Elements of Critique Quality of Critique Quality of Critique Theoretical Discussion Theoretical Discussion

58. 58 Literature Review Quality of References Quality of References –References significant to the problem area – classic & current while noting gaps in research literature if any

59. 59 Literature Review Organization of review Organization of review Rationale for selected articles, describe how organized Rationale for selected articles, describe how organized How many articles should you critique? How many articles should you critique? These journal articles were chosen because they include…….and the oldest is reviewed first…. These journal articles were chosen because they include…….and the oldest is reviewed first…. Quality of references – key classic and current literature Quality of references – key classic and current literature

60. 60 Literature Review Elements & Quality of Critique – Articulate Main Points Elements & Quality of Critique – Articulate Main Points –Sample –Design –Procedure –Measures –Results –Conclusions

61. 61 Literature Review Theoretical Discussion Theoretical Discussion Must address the foundation of your question or problem Must address the foundation of your question or problem –Example: Sepsis and EGDT Use Physiologic theory to explain why EGDT is appropriate for septic patients Use Physiologic theory to explain why EGDT is appropriate for septic patients Use Change Theory if you want to implement EGDT in a new setting that manages septic patients Use Change Theory if you want to implement EGDT in a new setting that manages septic patients

62. 62 Literature Review Critique Quality of Theoretical discussion Quality of Theoretical discussion Theoretical approach to the topic Theoretical approach to the topic

63. 63 Literature Review Critique Addresses elements of critique Addresses elements of critique –Sample –Design –Procedure –Measures –Results –Conclusions

64. 64 Literature Review Critique Quality of critique and interpretation Quality of critique and interpretation YOUR ASSESSMENT OF THE STUDIES YOUR ASSESSMENT OF THE STUDIES Too small of a sample size to give power to find a difference between those with and without HF, authors were biased b/c they knew the BNP level and may have changed treatment, only generalizable to men… Too small of a sample size to give power to find a difference between those with and without HF, authors were biased b/c they knew the BNP level and may have changed treatment, only generalizable to men…

65. 65 Make a Table! Organize your literature into a table to compare and contrast Organize your literature into a table to compare and contrast Describe each study Describe each study

66. 66 Literature Review Discussion and Application Critical and original analysis Critical and original analysis Integration and synthesis of research articles Integration and synthesis of research articles Implications for practice Implications for practice Future research Future research

67. 67 Discussion and Application – Where students get stuck! Critical and original analysis Critical and original analysis Final summary of the literature Final summary of the literature

68. 68 Identifies gaps in literature, implications for practice, need for further research STICK your neck out there! Make your opinion known, however you must base it on the critique of the literature you presented rather than your opinion. STICK your neck out there! Make your opinion known, however you must base it on the critique of the literature you presented rather than your opinion.

69. 69 Literature Review Scoring Total Points - 330 Total Points - 330 –Area 1 – Topic or Issue - 70 –Area 2 – Literature Review - 165 –Area 3 – Discussion & Application - 80 –Area 4 – Technical (grammar, organization, APA) 15 LITERATURE REVIEW 50% OF THE PAPER

70. Most common reasons why comps fail Started too late to put in necessary time and effort Started too late to put in necessary time and effort Did not meet with advisor to make sure you are on track Did not meet with advisor to make sure you are on track Did not follow the advice of your advisor Did not follow the advice of your advisor Primary editor was someone whose english composition skills were not adequate to give you appropriate feedback on your writing Primary editor was someone whose english composition skills were not adequate to give you appropriate feedback on your writing

71. 71 I PASSED!