Transcript Comprehensive Exam Orientation

Comprehensive Exam
Orientation
Spring 2013
Roxanne Garbez, RN, PhD, ACNP-BC, CNS
Outline of Comp Process






Description of the project
The Comprehensive Exam Handbook
Qualifying for the examination
Important dates
Technical requirements
Resources
The Assignment

The purpose of this paper is to
evaluate your ability to:
– Critique research as it applies to your
area of specialization
– Apply advanced clinical and theoretical
knowledge to practice
– Utilize writing skills to disseminate
nursing information using a scholarly
paper
– Demonstrate you can be a consumer of
research
Critical Points


Thirty (30) page paper
(maximum)
Three exam options
– Research Proposal
– Critical Literature Review
– Problem-solving
The Handbook

You can download
a copy of the
Comprehensive
Examination
Handbook from the
UCSF School of
Nursing website
How to Qualify for the
Examination


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.
Filing Fee Status





Talk with your advisor
You may not take courses of any type if you
are on Filing Fee status
Apply and pay filing fee to OAR
Most frequently used for second time comp
exam submission
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 the
subsequent quarter you submit your comp
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.
After you submit your form Graduate
Division notifies Office of Student Affairs.
OSA will then generate your Comp Number.
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
One incomplete on
record allowed
Payment of fees
required for number
Know the Important
Dates- Spring 2013



Number pick up date:
– Between April 9 and April 22
Submit comp by Noon
– April 23
Notification of results
– May 23
Technical and Procedural
Points

Format

Submission

Scoring
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)
Submission Requirements

One single-sided original of the
comprehensive examination plus three
double sided copies
– Next fall submission likely PDF, no hard copies



Completed face sheet
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
Face Sheet

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
14
Reading and Scoring




Student may select up to five preferred
readers (not required)
Student is not guaranteed a preferred
reader
Readers use a standard scoring system
Student will be given the faculty
comment sheets at the end but not the
scoring sheets
Plagiarism


Evidence of
plagiarism results in
a failure of the
comprehensive
exam.
Plagiarism can
become grounds for
dismissal from the
School of Nursing.
A Comp Does Not Pass



One pass and one
fail from two
readers goes to a
third reader for
decision
Exam fails if two
readers fail it
May re-submit
exam once within 5
quarters of first
submission
Vital Resources

Vital resource—Department Administrative
Assistants
–
–
–
–

CHS Kathryn Young
PN James Negri
FHCN Kathryn Keihl
SBS Brandee Woleslagle
Comprehensive Exam Coordinators
–
–
–
–
CHS Beth Phoenix & Dana Drew-Nord
PN Roxanne Garbez
FHCN Karen Duderstadt & Barbara Hollinger
SBS Susan Chapman
Additional Resources




Advisors- topic and
format
Specialty faculty
Sample comps on
reserve
Office of Student
Affairs for tutors
and editors, contact
Judy Martin-Holland

Consider other
arrangements
– Typist
– Paid tutors and
editors
– Peers as editors and
proofreaders

Create a timeline
– See sample
provided
Comprehensive Exam
2012-2013
SEP
OCT
NOV
DEC
JAN
Identifying the
phenomenon of interest
FEB
MAR
APR
MAY
JUN
JUL
AUG
• Advance to Candidacy: Before end of Winter
Quarter
Topic generation
Faculty input re: topic
• Pick up Comp # from Departments: From
4/09/13 to 4/22/13
Literature review
• Submit Comp to Departments: 4/23/13
Refine topic outline
Faculty input re:
topic outline
Advance to
Candidacy
Pick up
Comp #
Draft #1
Colleagues read paper
for clarity and organization
Draft #2
Edit
Submit
Comp
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.
Sample Examinations


On reserve in each of the departments
Ask your advisor and/or your
department's comprehensive
examination coordinator
22
Other Resources

UCSF SON website
23
Choosing a Theory



A theory should further clarify, support
and explain your topic
Nursing theory not required
Explain your theory in the text—don’t
depend on diagrams in the appendix
24
Theory or Conceptual
Framework

Theory is the format that enables you
to explain a phenomenon. There is no
right or wrong theory--it is all in how
you want to frame the argument you
want to make.
25
Possible Mechanisms Underlying the
Increased Risk of Type 2 Diabetes in
People on Atypical Psychotrophics
Physiological HPA axis and sympathetic nervous system hyperactivity
resulting in overproduction of cortisol.
Genetics
Diabetes only occurs in those with a genetic
predisposition.
Co-moridity
The diabetes is really due to alcoholism or binge eating.
Sociocultural
Due to socioeconomic, disability, marital status, access
to health care
Health care
Providers fail to adequately monitor overall health.
Behavioral
Inactivity, diet, smoking due to the psychiatric illness
Medication
Side effects, appetite stimulation and subsequent weight
gain
26
Possible Titles


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
27
Types of Examinations

Research Proposal (check with your
advisor as early as possible)

Critical Literature Review

Problem-solving
28
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.
Study does not have to be
implemented
Must have access to UCSF faculty with
research experience to mentor you
29
Research Proposal


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
Research Proposal
Scoring

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
The Comprehensive Exam
is Pass/Fail
 Points
needed to pass - 231
Critical Literature Review
Choosing a Topic




Pose a question
Do initial searching
There is enough research, but no clear
synthesis of findings or clear direction
You want to argue a point that has
some evidence, but is not established
practice
33
Critical Literature Review
Topic or Issue

Clarity of topic or purpose
– State in 1 sentence!

The purpose of this paper is to
examine the literature related to the
efficacy of using BNP to diagnose
patients with heart failure
34
Topic or Issue

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 effective evaluation of
SOB than symptoms
35
Some evidence exists, but
practice is not well delineated


Should diabetics use
ACE inhibitors to
prevent renal
impairment ?
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?
Practitioners have been
hesitant to give people
with stage 4 CKD ACE
inhibitors for fear of
increasing creatinine or
potassium to
dangerous levels.
36
Literature Review




Theoretical Discussion
Quality of References
Elements of Critique
Quality of Critique
37
Literature Review


Theoretical Discussion
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 Change Theory if you want to implement
EGDT in a new setting that manages septic
patients

38
Literature Review

Quality of References
– References significant to the problem
area – classic & current while noting gaps
in research literature if any
– Avoid multiple articles from the same
overall study (different purposes but
same sample, methodology, statistics,
etc.)
39
Literature Review


Organization of review
Rationale for selected articles, describe how
you organized your paper
– The journal articles were chosen because they
include…….and the oldest is reviewed first….


How many articles should you critique?
Use well written AND perhaps not so well
written research articles – the heart of the
critique process is identifying why they may
have similar study questions and yet end up
with different results
40
Literature Review

Elements & Quality of Critique –
Articulate Main Points
– Sample
– Design
– Procedure
– Measures
– Results
– Conclusions
41
Literature Review
Discussion and Application
Critical and original analysis
 Integration and synthesis of
research articles
 Implications for practice
 Future research

42
Literature Review Critique

Synthesis and interpretation
– YOUR ASSESSMENT OF THE STUDIES
– Too small of a sample size to have 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
43
Make a Table!


Organize your literature into a table to
compare and contrast
Describe each study
44
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.
45
Technical Criteria



Grammar and spelling
Organization of paper
APA format
46
Literature Review Scoring

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 IS
50% OF THE PAPER
47
Problem-solving Comp


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.
48
Choosing a Problem-solving
Topic


Can be a problem on
an individual or a
systems level.
Must be appropriate
to the clinical
situation
– Think of a situation
that is challenging to
you


Must be feasible!
Must be measurable!
49
Examples of Problem-Solving
Topics




Initiating an Oral Care Program in a
Nursing Home
Post-Partum Depression: Transition to
Motherhood
ICU Nurses’ Knowledge Deficit
Regarding Hemodynamic Monitoring
Loss of Venous Access and Dialysis
Delay in End Stage Renal Disease
Patients
50
Problem-solving Cautions

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
– 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?
51
Criteria for Scoring Comp

Clarity of the Problem

Significance of the Problem

Clarity of Setting

Clarity of Roles and inter-relationships
52
The Problem and its
Environmental Context

Clarity of the Problem
– Who is solving the problem

APN
– Where the problem occurs

ICU
– What is to be accomplished

Improve Nurses’ Knowledge
– Target population

ICU Nurses
53
The Problem and its
Environmental Context

Significance of the Problem
– Importance of the problem to patients or
profession

Accurate Hemodynamic Monitoring is
essential for ICU patients
54
The Problem and its
Environmental Context

Clarity of the Setting
– Home, hospital, nursing home
– Intensive Care Unit
55
The Problem and its
Environmental Context

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
56
Literature Review




Quality of theoretical discussion
Quality of references
Addresses elements of critique
Quality of critique and interpretation
Intervention, Implementation
& Evaluation





Expected Outcomes
Clarity & Appropriateness of
Intervention Implementation
Clarity & Appropriateness of Evaluation
Procedure
Defensibility
Realism
58
Intervention, Implementation
& Evaluation

Clarity of Expected Outcomes
– Improvement of Nurses Knowledge
evidenced by improvement on post-test
scores
59
Intervention, Implementation
& Evaluation

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
60
Intervention, Implementation
& Evaluation

Clarity & Appropriateness of
Evaluation
– 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

61
Intervention, Implementation
& Evaluation

Defensibility
– Demonstrates intervention has potential
for substantial improvement in the
problem

Realism
– Feasibility of intervention
– Will an educational intervention be
possible?
62
Caveats


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.
63
Problem-solving Scoring

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!
64
Most common reasons why
comps fail




Started too late to put in necessary time
and effort
Did not meet with advisor to make sure you
are on track
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
I PASSED!
66