ࡱ> `c_M bjbj!! 4HKGiKGi  xx8\pd<u<w<w<w<w<w<w<$?pB<?|<xxk<^x8u<u<67<u:|8a<<0<9`CC8u:u:C:<<<C X >: CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS - SCHOOL OF NURSING Learning Contract for BSN 423 (Community- Based Nursing)  Student Name: ________________________Phone_______________Email address_____________ 1. Agency Name: _______________________Phone_________________Fax ___________________ Agency Address: ______________________________________________________________ 2. Nursing Administrator / Contact Person: ___________________________________________ 3. Preceptors Name: ____________________________Preceptors Title_____________________ Preceptors Phone: _____________________Preceptors Email Address: _____________________ 4. CSUDH Course Instructors Name______________________________Phone______________________ Email Address_____________________________________ In case of emergency, contact CSUDH School of Nursing at 310-243-3596 The number of hours of clinical experience required for this course are 72 preceptored hours. In addition, the student will complete 18 non-preceptored hours on his/her own time to meet the 90 hours required by the CA Board of Registered Nurse. Beginning Date__________________________________Final Date__________________________________  Practice Setting (Check all that apply): ( Public Health ( School Health ( Health Education ( Ambulatory Care (circle one) ( Other: _______________________ primary care specialty clinic  Preceptors Information (may attach curriculum vitae or resume in lieu of completing the information below.) 1. Educational Preparation: (list schools, dates, and degree conferred) ________________________________ ____________________________________________________________________________ 2. Professional license and/or Certifications (list applicable certificate/license numbers and registration dates) __________________________________________________________________________________________________________________________________________________________ 3. Present position and number of years in present position: _________________________________________  A copy of this form should be given to the preceptor and posted to EXXAT. BSN 423 Community-Based Nursing: Student Learning Outcomes Student Name:___________________________________Date: _________ Version (if resubmitted):_____ Student needs to discuss Student Learning Outcomes (aka Course Objectives) with the preceptor and fill out the Learning Activities and Evaluation Measures in the columns below. Student may add additional learning outcomes to meet personal professional goals. SLOsLearning Activities (Activities to Achieve the Objectives)Evaluation Measures1. Explore the roles and responsibilities of public health nurses in community-based settings. For example- Documentation in weekly progress notes, Preceptor Assessment of Student Progress Form, Verbal feedback from preceptor, Verbal feedback from clients, Completed teaching plan 2. Apply epidemiological concepts and evidence-based practice principles to assess and identify health-related problems of individuals, family, and community. 3. Plan and implement holistic nursing interventions to meet the needs of diverse patients, family, or community in relation to the agencys missions/goals to its patients. 4. Perform one planned health education session to a group in the community. 5. Evaluate the outcomes of nursing intervention (s) in order to improve quality of life of the individual, family, and/or community. 6. Observe and discuss how multidisciplinary providers collaboratively work together to meet the needs of individuals, family, and community. 7. Evaluate case management activities as they relate to Community Based Nursing, such as referral to community resources, multidisciplinary collaboration and coordination of care and services.      Preceptors signature indicates approval of the Learning Contract and Outcomes. 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