US Army Medical Department Center and School Academy of Health Sciences Graduate School US Army Graduate Program in Anesthesia Nursing

INDIVIDUAL STUDENT ASSESSMENT PLAN 6F-66F

CONSTANCE L. JENKINS Lieutenant Colonel, AN Director, US Army Graduate Program in Anesthesia Nursing

SCOTT W. SHAFFER Colonel, SP Dean, Graduate School

DENISE L. HOPKINS-CHADWICK Colonel, AN Dean, Academy of Health Sciences

DATE APPROVED:

TABLE OF CONTENTS I.  PREFACE ............................................................................................................................ 1  II.  COURSE DESCRIPTION. ................................................................................................... 1  A.  Purpose ........................................................................................................................... 1  B.  Scope .............................................................................................................................. 1  C.  Prerequisites ................................................................................................................... 1  D.  Service Obligation ........................................................................................................... 1  III.  COURSE REQUIREMENTS ................................................................................................ 1  A.  Academic Standards ....................................................................................................... 1  B.  Nonacademic Standards ................................................................................................. 2  IV.  PURPOSES OF GRADED EVENTS. .................................................................................. 3  V.  POLICIES/PROCEDURES. ................................................................................................. 3  A.  Examination/Evaluation Procedures ............................................................................... 3  B.  Reteach/Retest................................................................................................................ 4  C.  Student Counseling ......................................................................................................... 4  D.  Grading............................................................................................................................ 5  E.  Probation ......................................................................................................................... 6  F.  Academic Standing ......................................................................................................... 7  G. Student Relief/Recycle .................................................................................................... 7  VI.  SPECIAL RECOGNITION FOR STUDENTS. ..................................................................... 8  VII.  ELIBILITY FOR DIPLOMAS/CERTIFICATES OF COMPLETION. ..................................... 9  VIII.  PROCEDURES FOR ARMY STUDENTS TO OBTAIN DOCUMENTATION OF ACADEMIC COMPLETION. ............................................................................................................................. 9  IX.  ACADEMIC EVALUATION REPORTS ............................................................................. 10  X.  COURSE EVALUATION MECHANISMS. ......................................................................... 10  APPENDIX A ............................................................................................................................ A-1  Objectives ........................................................................................................................ A-1  APPENDIX B ............................................................................................................................ B-1  Course Title and Credit.................................................................................................. B-1  APPENDIX C ............................................................................................................................ C-1  Cited Regulations/Policy ............................................................................................... C-1  APPENDIX D ........................................................................................................................... D-1  Phase 2 Clinical Improvement Diagram ....................................................................... D-1  APPENDIX E ............................................................................................................................ E-1  Student Acknowledgement Statement......................................................................... E-1  i

INDIVIDUAL STUDENT ASSESSMENT PLAN (ISAP) 6F-66F US Army Graduate Program in Anesthesia Nursing

I. PREFACE. This course is designed to fill the needs of the military and the Department of Veterans Affairs (DVA) by providing highly qualified entry-level practitioners in anesthesia nursing. This assessment plan establishes policies, assigns responsibilities, and prescribes procedures for the execution of the 6F-66F, US Army Graduate Program in Anesthesia Nursing (USAGPAN). The policies, procedures, and responsibilities prescribed herein shall apply to student members of all US military services and DVA civilians participating in this training program. II. COURSE DESCRIPTION. A. Purpose. The purpose of the USAGPAN (6F-66F) is to educate and develop military and DVA students to serve as entry-level practitioners in anesthesia nursing who also function as nursing leaders. Successful completion of this curriculum qualifies students to take the National Certification Examination (NCE) for Nurse Anesthetists administered by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). The course also provides students with theoretical and quantitative analysis skills, enabling them to evaluate and conduct scientific and evidence based research. B. Scope. The USAGPAN is dedicated to the education and development of clinicians, trained in the complexity of practice at the doctoral level and competent in the unique skills of anesthesia nursing. The USAGPAN is a 2-phase course of study. Phase 1 consists of 51 weeks of comprehensive didactic coursework and Phase 2 consists of 97 weeks of clinical experiences and additional didactic content. The curriculum is established with and approved by the affiliate university, Northeastern University (NU). The USAGPAN curriculum adheres to the educational standards and guidelines of the Council on Accreditation (COA) of Nurse Anesthesia Educational Programs. Further, this curriculum qualifies graduates to write the NCE. Upon successful completion of the entire program (122 semester hours), the student will receive a Doctor of Nursing Practice (DNP) in Nursing Anesthesia from NU. The USAGPAN is fully accredited by the COA. C. Prerequisites. As listed in the Army Training Requirements and Resources System. D. Service Obligation. 1. Military students who complete the 36-month course are obligated for 60-months of active duty service in addition to any other obligated service. For students who do not complete the entire program or are recycled, their obligation is calculated on an individual basis by their respective Human Resources Command (HRC) in accordance with (IAW) Army Regulation (AR) 351-3, Professional Education and Training Programs of the Army Medical Department. 2. The DVA civilian students who complete the 36-month course are obligated for 36-months of service in addition to any other obligated service. For students who do not complete the entire program or are recycled, their obligation is calculated on an individual basis by the DVA. III. COURSE REQUIREMENTS A. Academic Standards.

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. 1. Students are evaluated on their ability to accomplish the stated objectives. The overall objectives, terminal learning objectives (TLOs), and course outcome objectives for this program are described in Appendix A, Objectives. Students must pass all course outcome objectives to successfully complete this program. These objectives are required by the COA. 2. The 6F-66F course standards require students to maintain a cumulative grade of 80 percent (B) or greater in each course conducted in Phase 1 and Phase 2. B. Nonacademic Standards. 1. Standards of Conduct. Standards of conduct relative to cheating, disrespectful behavior, personal appearance, substance abuse, insubordination, etc. are defined in this ISAP IAW US Army Medical Department Center and School (AMEDDC&S) and Fort Sam Houston (FSH) Regulation (Reg) 351-12, Enrollment, Relief, New Start/Recycle, Administrative Disposition, and Counseling of Student Personnel. Each student will read the contents of this ISAP. They will sign and date a statement signifying they have read and understood the document (Appendix E, Student Acknowledgement Statement). 2. Physical Training. a. Physical fitness and weight control standards are essential to the mission of the Army. As stipulated in AMEDDC&S & FSH Reg 351-12, Army 6F-66F students are required to pass a semi-annual Army Physical Fitness Test IAW Army Physical Readiness Training (FM 7-22), Standards of Medical Fitness (AR 40-501), and meet weight and height standards IAW the Army Weight Control Program (AR 600-9). Air Force students are required to demonstrate compliance with the Air Force Physical Fitness Program (AFI 36-2905). The results are documented on the student's Service School Academic Evaluation Report (AER) in Phase 1 and Phase 2. The DVA students are required to attend any formally scheduled physical fitness classes and encouraged to participate at the level of their ability. b. Military students are measured for height and weight, and a diagnostic servicespecific physical fitness test is conducted within the first week of reporting to Phase 1. Students are measured for height and weight and administered the service-specific physical fitness test for record in October and April (Army) and May (Air Force) of Phase 1. Those who exceed weight for height standards and/or fail the physical fitness test are referred within command channels for appropriate action to include relief from the program. Phase 2 has similar requirements regarding the fitness test, recognizing site-specific and service-specific differences. c. Waivers of physical fitness test standards by the Dean, Academy of Health Sciences (AHS), AMEDDC&S, may be granted for bona fide medical conditions (profile) verified by local military medical authorities. d. Military students failing to meet physical fitness or weight control standards prior to graduation are counseled and processed IAW the regulations listed in paragraph 2a. Failure MAY disqualify the student from receiving a diploma and the award of 66F Area of Concentration (AOC) or 46M3 Air Force Specialty Code (AFSC), prevent eligibility for writing the NCE, and/or warrant separation from the military. e. The DVA student will provide evidence of ongoing compliance with physical fitness standards upon entry into Phase 1, upon reporting to Phase 2, and prior to writing the NCE by receiving Certificate of Fitness signed by their Employee Health Office.

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3. Pregnancy Policy. Because some of the training circumstances can cause danger to pregnant students and/or the baby, pregnant students are counseled regarding the health effects from exposure to waste anesthetic gases IAW Technical Bulletin (TB) Medical 510 (Appendix C, Cited Regulations/Policy). If the student becomes pregnant while enrolled in the course, the student can be processed IAW AR 600-8-24, Officer Transfers and Discharges. The USAGPAN Director and obstetrician, in conjunction with the company commander, decide if the student can continue the training. IV. PURPOSES OF GRADED EVENTS. A. To provide measurable outcome criteria for granting a certificate of completion from the AMEDDC&S and for granting a Doctorate in Nursing Practice in Nursing Anesthesia from NU. B. To monitor student progress in meeting course objectives. C. To measure the degree to which the student has achieved the stated course objectives. D. To provide feedback to students on academic progress or achievement.. E. To provide the USAGPAN Director feedback on the effectiveness of instruction and instructional materials. F. To evaluate content presented IAW COA standards. G. To rank-order students. H. To assign academic grades for reporting to NU. I. To support decisions for counseling, academic or nonacademic probation, and relief procedures. J. To obtain substantive on-going course evaluation data. V. POLICIES/PROCEDURES. A. Examination/Evaluation Procedures. 1. Objectives. Students are tested and evaluated throughout the program. Course objectives serve as the basis for this testing. A complete list of course outcome objectives are found in Appendix A, Objectives. 2. Didactic Evaluation. Students are evaluated for didactic knowledge using a variety of methods which may include examinations (oral and written, performance/practical), quizzes, papers, oral presentations, projects, group activities, and class participation. Correct English grammar and spelling are expected for any written work and points are deducted for errors.

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3. Clinical Evaluation. During Phase 2, clinical evaluations are completed as such: TERM 1

(LEVEL 1)

TERM 2 TERM 3&4 TERM 5&6

(LEVEL 1) (LEVEL 2) (LEVEL 3)

1 per day Not Less Than Not Less Than

1 per day 1 per week 1 per two weeks

4. The clinical evaluation tool used in Phase 2 addresses both general and specialty areas of nurse anesthesia practice. All clinical faculty members have input into these evaluations. The student reviews and signs these clinical evaluations. A student signature means the student received the evaluation and read it. If the student does not concur with the evaluation, the student will write a statement that he/she does not concur and sign the evaluation. All students will provide self-evaluation input, either verbally or in writing, into each evaluation. The student will also make a self-evaluation entry in the end of term student evaluation. The clinical performance objectives increase in number and complexity as the student progresses through Phase 2 and the student will be held to a corresponding increase in accountability. Persistent clinical deficiencies or failures, as defined in the Guidelines for Clinical Evaluation, will be grounds for probation or relief. The Guidelines for Clinical Evaluation handout is provided to each student during Phase 2 orientation. B. Reteach/Retest. Not Applicable C. Student Counseling. 1. Counseling sessions. Counseling gives the student regular time throughout the course to review academic progress. It affords frequent opportunities for counselors to affect the academic and professional development of students. Students may request counseling with course faculty at any time during the course. 2. Assignment of counselors. In Phase 1 and Phase 2, each student will be assigned a Certified Registered Nurse Anesthetist (CRNA) instructor as a counselor. a. Routine counseling. The student will, at a minimum, meet with his/her counselor monthly in Phase 1, and at the close of each term in Phase 2 (IAW AMEDDC&S & FSH Reg. 351-12). The student's progress is discussed, summarized in writing on the routine counseling form, and presented to the student. The student is provided the opportunity to take an active part in self-evaluation and express his/her views in writing on the counseling form. b. Threshold counseling. Students may receive counseling in addition to routine monthly counseling. (1) Students may have various issues (physical, mental health, family, financial, etc.) impacting their performance at any time during the course. The student may seek the guidance of their academic chain of command for issues other than those covered during routine monthly counseling as follows: Phase 1: Assigned CRNA counselor

USAGPAN Director

Phase 2: Assigned CRNA counselor

Phase 2 Director

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USAGPAN Director

(2) A student will receive counseling after each examination failure and for any course average less than 80 percent. Any student failing an exam is required to make an appointment for counseling with the course instructor within 24 - 48 hours of the exam review. The student must also make an appointment with their CRNA counselor after they have seen the course instructor. c. Additional counselors. Community Behavioral Health and Stress Management counselors are available to the students Legal assistance officers are also available. 5. Counseling session documentation. a. Each counseling session must be documented, dated, signed by the instructor, and signed by the counselee along with a statement to the effect, “I have been counseled on this date”, or “I concur/nonconcur with this counseling statement.” The student digitally signs the counseling form to indicate that he/she was counseled and did review the written statements, even if the student does not concur with the written evaluation. b. All unscheduled counseling must be documented in the counseling record and countersigned by the student within 24 hours. This provides proof that the student is aware of any negative or positive information on record about him/her. D. Grading. 1. Letter, percentage, and pass/fail grades. Written and performance (practical) evaluations are given periodically throughout the 6F-66F course. These evaluations are graded on a letter grade or percentage point system. Written examinations are scheduled when related instruction is complete and vary in length, depending on how many and what type of class hours are covered by the examination Instructors may opt to administer an unscheduled quiz during a block of instruction. In Phase 1, the grades are final five working days after the examination review. Grades are reported to NU using the following guidelines: GRADE A B C D F

PERCENTAGE EQUIVALENT 90-100 80-89.99 70-79.99 60-69.99 Less than 60

2. Final course grades are reported to two decimal points and are rounded to the nearest whole number as shown in the following example: 79.50 rounded to 80.00 79.49 rounded to 79.00 Grades are also converted to academic points for grade computation and determining class standing. Academic points are assigned according to credit hours (Appendix B, Course Title and Credit).

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E. Probation. 1. Purpose of probation. The purpose of probation is to help the student identify performance problems and their potential consequences. Should correction be ineffective, probation is used to instruct the student in ways to improve performance and to provide the student a means by which to measure improvement. 2. Reasons for probation are defined in AMEDDC&S & FSH Reg 351-12. 3. Criteria for nonacademic probation. Any student who displays personal behaviors that interfere with the conduct of class, fails to meet the prescribed standards of behavior, constitutes a habitual disciplinary problem, or in any way demonstrates unsuitability for the nursing anesthesia specialty, may be considered for nonacademic probation. 4. Criteria for academic probation. a. A student will be placed on academic probation if his/her average for that course is below 80 percent after the second graded event. If a course has only two graded events, probation will be initiated with the first graded event if it is below 80 percent. b. A student will be placed on academic probation for a minimum of four weeks from the date of the last substandard graded event. While on probation a student must meet with their counselor on a weekly basis. Probation ends when the student achieves a course average of 80 percent or better. If, at the end of the initial four weeks, the student fails to achieve a course average of 80 percent, probation will be extended for an additional four weeks. If the student completes probation and achieves a course average of 80 percent but then fails to maintain a course average of 80 percent, probation is re-instituted. The faculty will monitor the student's progress and recommend action as necessary. If it is statistically impossible for a student to achieve a course average of 80 percent, the student will be recommended for relief. c. Phase 2 students can be placed on probation for didactic and/or clinical failure (Appendix D, Phase 2 Clinical Improvement Diagram). Notification and discussion with the USAGPAN Director will be performed by the Phase 2 Director prior to instituting probation on any student. Length of probation is determined by the Phase 2 Director, depending on the nature of the failure (e.g., first observation of unsafe incident vs. pattern of similar repeated failures). The minimum initial probation period is four weeks, but can be extended. Probation ends when evidence of correction or sufficient improvement is demonstrated. If insufficient improvement is demonstrated by the end of the probation period including any extension, the Phase 2 Director initiates a recommendation for relief from the 6F-66F course with concurrence of the USAGPAN Director. The Phase 2 Director may decide that a student on probation will not participate in the clinical practicum at an affiliated site. Students may not graduate on probation status. 5. Procedures for probation. The student is notified of probationary status verbally and by letter. The letter states the category of probation (academic vs. nonacademic), reasons probation was initiated (i.e., failure to meet specific objectives), the anticipated duration of the probation, and suggestions for improving academic or nonacademic performance. The student acknowledges, by endorsement, receipt of the letter. Documentation of probation is maintained in the student's academic records for one year following his/her successful completion of the NCE for Nurse Anesthetists. After that time, all counseling/probation records are destroyed. Counseling/probation records of students who do not successfully complete the NCE are kept

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indefinitely (see COA policies and procedures). F. Academic Standing. A student is considered not “in good academic standing” when any of the following criteria applies: 1. Phase 1. Failed a course. On academic probation for sustained poor performance. (Continues to fail examinations) 2. Phase 2. At any time while on academic probation. G. Student Relief/Recycle. Standards, policies, and procedures for withdrawal/relief and administrative disposition of students, including the student appeal process, are described fully in AMEDDC&S and FSH Reg 351-12, and are further defined here. Relief may be processed for academic and/or nonacademic reasons. 1. Academic relief. a. Failure to meet academic standards as defined in this document. A student is also recommended for relief from the program for gross clinical negligence. Failure to meet the 6F-66F course standards for continuance results in dismissal from both the NU School of Nursing and the 6F-66F course. b. Sustained poor performance. Dismissal MAY be recommended for sustained poor performance, regardless of the cumulative grade point average. Sustained poor performance is defined as: (1) Failure scores on 50 percent of total graded events in a single core course (2) Average score less than 80 percent of total graded events. (3) Sustained poor performance is also defined as a pattern of “Fails Expectations” ratings for critical objectives on the Clinical Evaluation Tool. c. Faculty Committee. A 6F-66F faculty committee convenes to determine whether relief is warranted. The faculty committee bases its decision on the student's entire educational performance including student motivation, overall didactic/clinical performance in the course, and classroom participation. 2. Nonacademic relief. a. A student may be relieved from the 6F-66F course because of professional or personal misconduct whether the action(s) took place on or off-post or on or off-duty. No formal adjudication of guilt by military or civilian court, or under the provisions of Article 15, is required to support relief under this section. Conversely, the imposition of judicial or non-judicial punishment under the Uniform Code of Military Justice is not necessarily grounds for dismissal. b. A student may be deemed unsuitable for the military nurse anesthesia specialty based on failure to demonstrate acceptable professional or personal characteristics/attributes, which are considered requisite for success as a nurse anesthetist. The DVA civilian students are required to meet the same professional standards as the military students. Examples of unsuitable/unacceptable behaviors include, but are not limited to: consistently poor judgment,

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inability to establish effective working relationships with patients or peers, inability to cope with or inappropriate response to stress, and substance abuse. c. Academic cheating or plagiarism on any examination results in relief from the 6F-66F course. All individual papers, unless otherwise specified by the instructor, must reflect individual effort. Discussion before or during the completion of any exam is considered collaboration/assistance and is not authorized. Downloading anesthesia nursing care plans from the internet is considered to be cheating or plagiarizing. d. Any military student who exceeds weight for height standards and/or fails the for record physical fitness test is referred within the command channels and may be recommended for relief. 3. Voluntary Relief/Withdrawal. A student enrolled in the USAGPAN may request voluntary relief from any course which will result in voluntary relief/withdrawal from the program. This request must be in writing and state the full reasons for the request. The USAGPAN Director may accept such a request to avoid unnecessary administrative delay. The officer will be counseled IAW AR 600-8-24, paragraph 1-12. 4. Students have the right to the appeal process for any grievances (see AMEDDC&S and FSH Regulation 351-12). 5. Any student on academic or nonacademic probation is ineligible for any favorable actions such as awards, conferences, or any other action deemed favorable by the USAGPAN Director or Phase 2 Director. VI. SPECIAL RECOGNITION FOR STUDENTS. A. Phase 1. Class ranking is calculated on the basis of total earned academic points at the end of Phase 1. Students in the top 20 percent are eligible to receive the Sarah A. Halliburton Award for Excellence. The USAGPAN Director, with input from Phase 1 faculty members, determines the award winner. Criteria for selection include academic performance, leadership skills, and professional attributes. B. Phase 2. 1. In accordance with AMEDDC&S Reg 351-10, Student Achievement Recognition, class ranking is calculated on the basis of total academic points earned in the didactic portion of the 6F-66F course. Students in the top 20 percent of the class at the time of graduation are placed on the Dean’s List. The top-ranked student is designated Distinguished Honor Graduate (DHG) and the second-ranked student is designated Honor Graduate (HG). The third-ranked student may also be designated as HG if class size is greater than 30 at the time of graduation. 2. Students who distinguish themselves at each Phase 2 site may also be awarded Phase 2 site-specific awards. These awards, including predetermined selection criteria, are delineated in the site-specific student guides. 3. The Agatha C. Hodgins Memorial Award recognizes the top graduating nurse anesthetist of each CRNA program throughout the country. Each Phase 2 Director nominates one Phase 2 graduate for this award based on clinical performance and professional attributes. Of the nominees, the award is given to the graduate nurse anesthetist based on overall academic

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and clinical performance, professional attributes, research scholarship, NCE score and other accomplishments. The student who best represents the CRNA profession will be selected. C. These distinctions (except the Agatha C. Hodgins Memorial Award) are noted on the AER, Department of the Army (DA) Form 1059, and are formally recognized/awarded at the Phase 2 graduation ceremony. Certificates for DHG and HG are prepared by the Registrar’s office and signed by the Dean, AHS. The Agatha C. Hodgins Memorial Award is presented at the student's first assignment as a 66F as soon as practical. D. Students are ineligible for special recognition if they have received disciplinary action or counseling for improper behavior/personal conduct IAW AMEDDC&S Reg 351-10. VII. ELIBILITY FOR DIPLOMAS/CERTIFICATES OF COMPLETION. A. Reporting of Grades. Grades are reported to the NU/USAGPAN Program Coordinator who then submits the grades to the NU Registrar. B. The USAGPAN Director submits a roster of students who successfully complete Phase 1 to the Army Training Requirements and Resources System (ATRRS) manager, AHS not later than the Phase 1 closing date. C. The USAGPAN Director submits a roster of all 6F-66F course graduates to ATRRS, HRC, and DVA at the close of Phase 2. VIII. PROCEDURES FOR ARMY STUDENTS TO OBTAIN DOCUMENTATION OF ACADEMIC COMPLETION. A. Affiliation. Upon the successful completion of the entire curriculum (122 semester hours) the student receives a DNP from NU. B. Transcript requests and verification of completion: Academic transcripts are available from the NU Registrar. When you send your requests, include the following information: Name (including maiden or any other names) Current mailing address and telephone number Date of Birth Social Security Number/NU ID number College/programs attended; major course of study Year(s) attended Degree(s) received Number of copies you’re requesting Complete mailing address(es) where transcript(s) are to be mailed. Your signature Written requests are sent to: Northeastern University Attn: Transcript Office 118 HA 360 Huntington Ave. Boston, MA. 02115-5096 Verification of successful 6F-66F course completion is obtained from the Registrar/AMEDDC&S Academy of Health Sciences Training Program Management Division (MCCS-HC-TPR) 3630 Stanley Road Suite 243

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JBSA Ft. Sam Houston, TX 78234 Email: [email protected] IX. ACADEMIC EVALUATION REPORTS. A Service School AER, DA Form 1059, is filled out after completion of both Phase 1 and Phase 2, and one for each year of Phase 2 for US Army students. The three reports reflect all aspects of performance to include military, academic, physical fitness, and professional activities. Refer to the provisions in AR 623-3, Evaluation Reporting System, and guidance policies and procedures. The US Air Force and DVA students receive evaluations IAW their respective services. All students receive a diploma from NU and from the AHS at the end of Phase 2. X. COURSE EVALUATION MECHANISMS. A. Each Phase 1 student submits: 1. Didactic instructor critiques - includes interim and end of each course. 2. Course critiques – includes interim and end of each course. 3. Phase 1 critique immediately upon completion of Phase 1. 4. The USAGPAN Director receives all Phase 1 evaluations for review and distributes each instructor’s results to them. B. Each Phase 2 student submits: 1. Periodic clinical instructor critiques on full-time faculty and clinical adjunct faculty. 2. Phase 2 course critique upon completion of Phase 2. C. The USAGPAN Director reviews the Phase 2 student course critiques and the clinical instructor critiques and forwards collated reports to the Phase 2 Directors, citing identified strengths and weaknesses at each Phase 2 site. D. Invitations to the web-based USAGPAN supervisor's survey regarding recent graduates and the USAGPAN recent graduate (year out) survey are e-mailed to supervisors and graduates by the Senior Quality Assurance Specialist, within one year after graduation. The results of these evaluations are collated and reported to faculty at the USAGPAN faculty meeting. E. Phase 1 and Phase 2 faculty complete critiques of their respective site operations using the web-based evaluation platform. F. Critiques and evaluations are maintained by the Senior Quality Assurance Specialist, USAGPAN Program Director, and Phase 2 Directors until the next COA self-study and site visit are completed. G. Student scores on the National Self-Evaluation Examination, taken in Phase 2, and NCE are used to evaluate the effectiveness of the 6F-66F curriculum.

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APPENDIX A  Objectives A. The overall objective of the program is to produce leaders and clinicians educated in the complexity of practice at the doctoral level and competent in the unique skills of anesthesia nursing. The graduate nurse anesthetist is prepared to function as a leader advocating for quality patient care in time of peace, and when necessary, in time of war, civil disorder, natural disaster or humanitarian missions. B. Terminal learning objectives for didactic coursework are listed in the current Program of Instruction (POI). A copy of the current POI is available to students and faculty. Enabling objectives are listed in lesson plans/student handouts which accompany each course. C. Course outcome objectives: The course outcome objectives come directly from the COA Standards for Accreditation of Nurse Anesthesia Educational Programs. Graduates must have acquired knowledge, skills and competencies in patient safety, perianesthetic management, critical thinking, communication, evidence based practice and the professional role. Patient safety: The graduate must demonstrate the ability to: 1) Be vigilant in the delivery of patient care. 2) Refrain from engaging in extraneous activities that abandon or minimize vigilance while providing direct patient care (e.g. texting, reading, e-mailing, etc.). 3) Protect patients from iatrogenic complications. 4) Participate in the positioning of patients to prevent injury. 5) Conduct a comprehensive and appropriate equipment check. 6) Utilize standard precautions and appropriate infection control measures. Perianesthesia: The graduate must demonstrate the ability to: 1) Provide individualized care throughout the perianesthesia continuum. 2) Deliver culturally competent perianesthesia care. 3) Use a variety of current anesthesia techniques, agents, adjunctive drugs, and equipment while providing anesthesia. 4) Provide anesthesia services to all patients across the lifespan. A-1

5) Perform a comprehensive history and physical assessment. 6) Administer general anesthesia to patients with a variety of physical conditions for a variety of surgical and medically related procedures. 7) Provide anesthesia services to all patients, including trauma and emergency services. 8) Administer and manage a variety of regional anesthetics. 9) Function as a resource person for airway and ventilatory management of patients. 10) Maintain current certification in Advanced Cardiac Life Support (ACLS) Pediatric Advanced Life Support (PALS). Critical thinking: The graduate must demonstrate the ability to: 1) Apply knowledge to practice in decision-making and problem solving. 2) Provide anesthesia care based on sound principles and research evidence. 3) Perform a pre-anesthetic assessment prior to providing anesthesia and formulate an anesthesia care plan for patients to whom they are assigned to administer anesthesia. 4) Assume responsibility and accountability for diagnosis. 5) Identify and take appropriate action when confronted with anesthetic equipment-related malfunctions. 6) Interpret and utilize data obtained from noninvasive and invasive monitoring modalities. 7) Calculate, initiate, and manage fluid and blood component therapy. 8) Recognize, evaluate, and manage the physiological responses coincident to the provision of anesthesia services. 9) Recognize and appropriately respond to anesthetic complications that occur during the provision of anesthesia services. 10) Use science-based theories and concepts to analyze new practice approaches. 11) Pass the NCE administered by the NBCRNA. Communication: The graduate must demonstrate the ability to: 1) Utilize interpersonal and communication skills that result in the effective exchange of information and collaboration with patients and their families. A-2

2) Utilize interpersonal communication skills that result in the effective inter-professional exchange of information and collaboration with other healthcare professionals. 3) Respect the dignity and privacy of patients while maintaining confidentiality in the delivery of inter-professional care. 4) Maintain comprehensive, timely, accurate, and legible healthcare records. 5) Transfer the responsibility for care of the patient to other qualified providers in a manner that assures continuity of care and patient safety. 6) Teach others. Leadership: The graduate must demonstrate the ability to: 1) Integrate critical and reflective thinking in his or her leadership approach. 2) Provide leadership that facilitates intra-professional and inter-professional collaboration. Professional role: The graduate must demonstrate the ability to: 1) Function within legal and regulatory requirements. 2) Adhere to the Code of Ethics for the Certified Registered Nurse Anesthetist. 3) Interact on a professional level with integrity. 4) Apply ethically sound decision-making processes. 5) Accept responsibility and accountability for his or her practice. 6) Provide anesthesia services to patients in a cost-effective manner. 7) Demonstrate knowledge of wellness and chemical dependency in the anesthesia profession through completion of content in wellness and chemical dependency. 8) Inform the public of the role and practice of the CRNA. 9) Evaluate how public policy making strategies impact the financing healthcare. 10) Advocate for health policy change to improve patient care. 11) Advocate for health policy change to advance the specialty of nurse anesthesia. 12) Analyze strategies to improve patient outcomes and quality of care. A-3

13) Analyze health outcomes in a variety of populations and clinical settings. 14) Analyze health outcomes in a variety of systems. 15) Disseminate research evidence. 16) Use information systems/technology to support and patient care. 17) Use information systems/technology to support and improve healthcare systems. 18) Analyze business practices encountered in nurse anesthesia delivery settings.

A-4

APPENDIX B  Course Title and Credit

Year 1 SU SU SU SU FL FL FL FL SP SP SP SP

Statistics Methods Advanced A&P and Pathophysiology 1 Advanced Pharmacology for Nurse Anesthesia 1 Biochemistry for Nurse Anesthesia Advanced A&P and Pathophysiology 2 Scientific Inquiry and Epidemiological Concepts Advanced Health Assessment and Diagnosis Fundamentals of Nurse Anesthesia Practice 1 Advanced Pharmacology for Nurse Anesthesia 2 Fundamentals of Nurse Anesthesia Practice 2 Translating Evidence into Practice Health Care Informatics Total

2 6 5 4 5 3 4 9 4 9 3 3 57 SH

Year 2 SU SU SU FL FL FL FL SP SP

Leadership in Advanced Practice Nursing via Distance Learning Professional Aspects of Nurse Anesthesia Practice via Distance Learning Capstone 1 Nurse Anesthesia Role Practicum 1 Nurse Anesthesia Clinical Practicum 1 Healthcare Management via Distance Learning Health Care Policy via Distance Learning Nurse Anesthesia Role Practicum 2 Nurse Anesthesia Clinical Practicum 2

3 3 3 6 5 3 3 6 5

Year 3 SU FL FL FL SP SP

Capstone 2 Nurse Anesthesia Role Practicum 3 Nurse Anesthesia Clinical Practicum 3 Capstone 3 Nurse Anesthesia Role Practicum 4 Nurse Anesthesia Clinical Practicum 4 Total GRAND TOTAL

B-1

3 6 5 3 6 5 65 122 SH

APPENDIX C  Cited Regulations/Policy

AMEDDC&S & FSH 351-10

Student Achievement Recognition

AMEDDC&S & FSH Reg. 351-12

Enrollment, Relief, New Start/Recycle, Administrative Disposition and Counseling of Student Personnel Standards of Medical Fitness Professional Education and Training Programs of the Army Medical Department The Army Weight Control Program Officer Transfers and Discharges Evaluation Reporting System Army Physical Readiness Training Fitness Program Recognition Guidelines for the Evaluation and Control of Occupational Exposure to Waste Anesthetic Gases

AR 40-501 AR 351-3 AR 600-9 AR 600-8-24 AR 623-3 FM 7-22 AFI 36-2905 TB MED 510

C-1

APPENDIX D  Phase 2 Clinical Improvement Diagram

First Failed Day Informal Counselin No Improvement

Improvement Improvement

Formal Counseling

Continue to monitor Improvement

No Improvement

Memorandum for Record

Continue to monitor Improvement

No Improvement

Continue to Monitor Probation Improvement

No Improvement Off Probation

Recommend Relief/Withdrawal Additional Probation

D-1

APPENDIX E  Student Acknowledgement Statement

Acknowledgement of Individual Student Assessment Plan (ISAP) for the US Army Graduate Program in Anesthesia Nursing (USAGPAN) 1. I have read and understand the ISAP for the USAGPAN course. All of my questions pertaining to the ISAP were answered prior to signing this memorandum. 2. I have been informed of the counseling requirements IAW AMEDDC&S &FSH Reg 351- 12.

Print Name

Signature of Student

Date

E-1