Fall 2016. DUE: Week 6, Saturday, 11:59 PM. See Course Schedule and Due Date
? Please complete the following worksheet and submit by the due date via the Blackboard Assignment Drop Box. (You can submit earlier if you wish). Use it as a guide to frame your clinical project. Consult with your Preceptor for review and comment before completing. Remember, your Preceptor may ask you to do a specific project. This completed form is the written part of the graded Assignment 3 Rubric and will keep you focused. You will complete this form via Blackboard. Submit completed worksheet to Preceptor once Clinical Faculty has reviewed and notified you that it is acceptable. Please do not solicit for any donations. If you plan to give yourself credit for written material, do not include the “UTA College of Nursing” or “Student Nurse” on your flyer. Please see your Clinical Faculty for assistance if you have any questions on the directions. This component is part of the 20% of your grade for Assignment Number 3.
STUDENT NAME: _____________________________________________________
CLINICAL SITE: ________________________________________________________
Is the project agency requested? YES ? NO ?
Project Description of Intervention
Give an overview of what the project is, how you will implement the project and what is the desired response? Describe your plan in action statements. If you are doing an educational presentation- submit an education plan to include goals, objectives, content outline, and method of evaluation.
Related Health Issue
What health issue or data supported the decision to develop this project?
Target Audience
Who is the target audience of the project? If multi-level, how is each level participating?
Smart Goals
List two SMART GOALS based on the goals of the project?

Clinical Outcomes
? Describe the desired outcome of the intervention?
? Specify what change in health status is anticipated from implementation of the recommended intervention.
? How would you measure it if time allowed? How would you evaluate the outcomes in a short term period (up to 3 months)? How would you evaluate the outcomes in a long term period (greater than 3 months)?
Project Evaluation
What evaluation tool will you use to assess the effectiveness of your teaching/project? Examples include: observation, teach-back/ return demonstration, written evaluation tool, such as post education questions.

Research Articles
• Upload 2 research papers to the Blackboard on the subject of the project.
• Write a paragraph that relates the significance of the two research articles you chose to your project. For example: What way(s) did the articles help you get a better understanding of the clinical project.

Scheduling
Targeted implementation date or project: Please note that it must be done before assignment #3 is due.
If it is a presentation, what date, time, and place will it be done? When will you submit education plan including objectives, outline and evaluation tool to instructor and preceptor?
If it is a brochure or written material when will it (the project) be submitted to your clinical instructor and preceptor?
Preceptor Support – please explain:
List any Material/equipment needed:
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