Comprehensive Exam Orientation

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

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 knowledge to clinical
practice.
– Apply writing skills to the dissemination of
nursing information; scholarly paper
– Consumer of research

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

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

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 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
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.

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.
No incompletes on
record.
Current in payment
of fees.

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
Three double sided copies
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
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.

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

Vital Resources
Vital resource—Department Administrative
Assistants
– CHS Kathryn Young
– PN James Negri
– FHCN Maria-Elena Sotelo
– SBS Brandee Woleslagle
Comprehensive Exam Coordinators
– CHS Beth Phoenix & Dana Drew-Nord
– PN Theresa Koetters & 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 FEB MAR APR MAY JUN JUL AUG
Identifying the
phenomenon of interest
Topic generation
Faculty input re: topic
Literature review
• 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
Refine topic outline
Faculty input re:
topic outline
Advance to
Candidacy
Draft #1
Colleagues read paper
for clarity and organization
Draft #2
Pick up
Comp #
Submit
Comp
Edit

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.

Part 2
22

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

Other Resources
UCSF SON website
24

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

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.
26

Possible Mechanisms Underlying the
Increased Risk of Type 2 Diabetes in
People on Atypical Psychotrophics
Physiological
Genetics
Co-moridity
Sociocultural
Health care
Behavioral
Medication
HPA axis and sympathetic nervous system hyperactivity
resulting in overproduction of cortisol.
Diabetes only occurs in those with a genetic
predisposition.
The diabetes is really due to alcoholism or binge eating.
Due to socioeconomic, disability, marital status, access
to health care
Providers fail to adequately monitor overall health.
Inactivity, diet, smoking due to the psychiatric illness
side effects, appetite stimulation and subsequent weight
gain
27

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
28

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

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 carried out
Must have access to UCSF faculty with
research experience to mentor you
30

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

Problem-solving
Examination
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.
34

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!
35

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
36

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?
37

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

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
39

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
40

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

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
42

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

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

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

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
46

Intervention, Implementation
& Evaluation
Clarity & Appropriateness of Evaluation
Procedure
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
47

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

Technical Criteria
Grammar and spelling
Organization of paper
APA format
49

Caveats
Must have a feasible, effective and
defensible evaluation method
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.
50

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!
51

Critical Literature Review
Choosing a Topic
Pose a question
Do initial searching
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
52

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
diagnosis of BNP in heart failure
53

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 evaluation
of SOB than symptoms
54

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

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.
56

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

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

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

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

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
61

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

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

Literature Review Critique
Quality of critique and interpretation
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…
64

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

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

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

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.
68

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 50% OF THE PAPER
69

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!
71