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NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Mid-Term Evaluation
Student: Gabrielle Gagnon
Clinical Instructor: Lindsay Greene
Clinical Placement Hospital: PRHC

Unit: D2

Date: February 17th, 2016


Missed Clinical Hours: 0

Missed CLC Lab Hours: 0

NURS 3021H Clinical Practice Mid-Term Evaluation


Program Goals
Students graduating from this program will be:
1. Prepared as generalists entering a self-regulating
profession in situations of health and illness.

2. Prepared to work with people of all ages and genders


(individuals, families, groups, communities and
populations) in a variety of settings.
3. Expected to have an enhanced knowledge of the program
foci: indigenous, women's and environmental health and
aging and rural populations.
4. Prepared to learn to continuously use critical and scientific
inquiry and other ways of knowing to develop and apply
nursing knowledge in their practice.
5. Prepared to demonstrate leadership in professional nursing
practice in diverse health care contexts.
6. Prepared to contribute to a culture of safety by
demonstrating safety in their own practice, and by
identifying, and mitigating risk for patients and other
health care providers
7. Able to establish and maintain therapeutic, caring and
culturally safe relationships with clients and health care
team members based upon relational boundaries and
respect.
8. Able to enact advocacy in their work based on the
philosophy of social justice.
9. Able to effectively utilize communications and informational
technologies to improve client outcomes.
10. Prepared to provide nursing care that includes
comprehensive, collaborative assessment, evidenceinformed interventions and outcome measures.

3000 Level Outcomes


On completion of 3000 level courses students will be
able to:
Fully understand how to practice in a self-regulating
profession.
Analyze clinical situations and reflect on individual roles of the
nurse as it impacts upon patients and the nursing profession.
Rationalize the link between health and illness.
Understand the complexity adults, of all genders, to achieve
optimal health.
Use a critical perspective in applying the foci to nursing
knowledge and practice.
Integrate critical reflective evidence-informed care using
multiple ways of knowing.
Develop and embody leadership at the point of care.
Expand awareness of leadership in nursing.
Identify strategies to develop leadership potential.
Anticipate, identify and manage risk situations.
Demonstrate awareness of resources related to risk
management.
Engages in deliberative personal centred relational practice to
assist individuals, families and communities to achieve health.
Acknowledge own potential to contribute to effective
collaborative team function.
Advocate for individuals, families, and communities
recognizing the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.
Integrates and applies critical thinking to the use of
information technology and dissemination strategies as related
to clinical outcomes.
Critically assess the individuals, family and community health
status.
Collaborate to identify priority health needs.
Identify evidence informed interventions and health outcome
evaluation in complex care situations.

NURS 3021H Clinical Practice Mid-Term Evaluation


Course Objective
1. Demonstrate accountability and responsibility in the
teaching-learning relationship.

2. Explain the experience of chronic illness in individuals


receiving care in chronic care settings

Progress
Evidence/Indicators
-I always come to clinical placement
on time and prepared for the shift
ahead.
-I always complete the required
preperation prior clinical (research
medications, diagnosis, comorbities,
identify areas of focus, etc.) to ensure
that I am fully prepared to provide
the best care possible for my
patient(s).
-Always ask my clinical instructor for
any clarifications whenever I am
unsure of something.
-Week 2: I met a patient who was in
the hospital with an exercerbation of
her COPD, something she typically
managed from home. The chronic
care/hospital setting did not sit very
well with her and she was struggling
with coping. I explained to her why
she it was good for her to be here
and also explained to her what she
could expect from her experience
here. I also discovered that her meds
were not being given to her on the
same schedule as she does them at
home which was causing her a lot of
anxiety. Simply fixing the timing of
her meds made a significant
difference in her chronic are setting
experience.
-Week 3: I was assigned to an older

Satisfac
tory

Unsatisfac
tory

male patient who had been on the


floor for over 6 months with a
diagnosis of prostate cancer and
orthostatic hypotension. This
diagnosis has had him bedridden for
pretty much the entirety of his
stay.This has led him to become very
reliant on others to meet his needs
and care. From his understanding of
his dx of orthostatic hypotension he
did not think it was possible to get
out of bed. Therefore, I explained to
him what this diagnosis signified and
was even able to get him up in a
chair using the lift for the first time in
over 6 months.
-Week 2: I was assigned to a 95 year
old female with lung CA with mets
who was experiencing some
confusion. At some instances she
would become extremely confused
and also frustrated with her
difficulties with breathing. Seeing as
her family could not always be there
with her due to other commitments
such as work or children, I would sit
with her and answer all her questions
(there were plenty) and also explain
to her why she was on the palliative
floor and why she was experiencing
this SOB and inc. WOB and why she
had nasal prongs.
3. Interpret critical aspects of the persons experience of
chronic illness in relation to the nursing process such as
common signs and symptoms, responses to treatment,
patterns of coping, and impact on individual and family
relationships.

-Each night prior to clinical I ensure


that I understand the pts Dx, Hx, Tx
and Rx. I make notes so that I can
review them and clarify any gaps with
my clinical instructor.

4. Identify symptoms and common medical treatments of


selected chronic illness.

-Wk 4 I was able to apply my


knowledge of the pathophysiology
and S/S of a pleural effusion and lung
CA which helped me to conduct a
comprehensive and focused
respiratory assessment. I understood
the procedure for a thoracentesis and
was then able to explain this further
to my anxious patient and anticipate
potential complications. My increased
knowledge allowed me to provide
adequate patient teaching to ease
her anxiety.
-Week 5: I had a patient with very
advanced COPD who was within last
stages of end-of life. Using my
previously learned knowledge of the
pathophysiology and S/S of COPD I
was able to anticipate further
changes in status and better describe
to the family what was going on with
their loved one. I had many
opportunities to interact with the
family members during this week.
-Week 4: I educated a patient who
had pleural effusion on the symptoms
she might expect and also explained
to her the thoracentesis procedure as
she was scheduled to have her first
one that afternoon.
-Week 4: I had a patient with DVT and
was able to identify symptoms
(swelling in affected leg and perhaps
some pain or soreness in the calf)
and also educate the patient able
potential consequences or signs to
look for and when to notify health
care practitioners. I also explained to

5. Demonstrate select nursing and collaborative interventions


related to caring for the person with chronic illness such as
specific assessments, medication administration, physical
and chemical restraints, enteral feeding & residual
volumes, NG tube insertions, wound care, patient
controlled medication administration pumps.

her which medications in her regimen


were for this purpose and what their
mechanism of action was in order to
try to prevent the blood clots. I also
discussed with her the
possibility/benefits of compression
stockings in prevention of DVT.
-Week 5: Was able to identify the
symptoms of COPD (SOB, incr. WOB,
chronic cough, wheezing, weight loss,
lack of energy) and identify the
common medical treatments for it
( mostly a combination of
inhalers/nebulizers for this specific
patient).
-Week 4: my patient had a diagnosis
of lung CA and therefore I performed
a thorough lung assessment. I
systemically auscultated the lung
fields for breath sounds. I found that
air entry was diminished throughout
and heard coarse crackles at the
bases which was an expected finidng
for a patient with pleural effusion and
advanced lung CA.
-Week 1,2 & 5: Medation
administration (oral meds,
subcutateous injections, subcut line
meds, inhalers, nebulizers).
-Week 5: Inserted an in and out
catheter on male patient with an
enlarged prostate to get a urine
sample.
-Week 3 & 5 :insertion of
subcutaneous lines.
-Week 4: changed an ostomy
apparatus that had exploded and
further explained care for ostomy to

6. Identify potential consequences/complications of select


chronic illnesses and related interventions.

7. Under the supervision of a Registered Nurse, demonstrate


safe, competent, evidence-informed, holistic nursing

patient. On same patient performed a


nasal and ostomy swab for cultures.
-Week 4: Was assigned to a patient
with DVT. I identified what potential
consequences of this illness are
(pulmonary embolism) and possible
interventions that could
prevent/manage these consequences
such as anticoagulants, compression
stockings, tpa, etc.)
-Week 3: I was assigned to a patient
with prostate CA and after some
research prior to clinical was able to
understand and identify that
consequences I could anticipate were
urinary incontinence and the
possibility of mets. I encouraged him
to use the independent urinals as
much as he could and told him the
benefits of that over going in the
brief, however knew incontinence
could be a possibility.
-Week 2&4: I was assigned patients
with lung CA. Prior to my
assessments I identified some
complications that I could expect to
find such as SOB, pleural effusion,
pain and coughing up blood),
therefore, I educated my patients
about these potential consequences
of their dx and told them to notify me
if any of these were occurring so we
could administer the proper
intervention (analgesia for pain,
oxygen or deep breathing exercises
for SOB,etc).
a.Week 5: the patient assigned to my
partner that I helped out with had

practice with clients with chronic illness


a. Use a wide range of effective communication
strategies and interpersonal skills to appropriately
establish, maintain, re-establish and terminate the
nurse-client relationship
b. Demonstrate accountable, responsible and ethical
practice
c. Engage in respectful, collaborative, therapeutic and
professional relationships
i. Demonstrate therapeutic use of self
ii. Create a culturally safe environment
d. Apply nursing models and theories
e. Demonstrate health promotion and illness
prevention practices
f. Demonstrate patient advocacy
g. Predict outcomes of nursing care
h. Evaluate client response to nursing care
i. Critically appraise own practice in relation to nurseclient/family interactions and as a member of the
health care team

difficulties communicating verbally as


he struggled with articulating his
thoughts, therefore I went and found
him a notepad and had him written
his concerns/questions that he had
for us.
b. Every week I come to clinical fully
prepared and on time. I ensure that
all my duties/responsibilities are
fulfilled correctly and ethically and
always consult my clinical instructor
in times of doubt.
c.On palliative especially, therapeutic
relationships are essential with both
the client and their families. The
family dynamic is a significant part of
this experience and thus I have
formed therapeutic relationships with
my clients and their families to
collaboratively work together to
better their experience. When the
end of life is nearing , I allow and am
respectful of families practicing
whatever cultural ritual they practice
and ensure a safe environment for
them to be with their loved one by
offering to help or askng if they need
anything and ensuring their loved
one is comfortable (not restless or
agitated) as they try to say their
goodbyes.
d. Every week in post clinical, I relate
the interventions I have done to
nursing theories such as Kolcabas
Comfort
theory,
orem's,
Roy's
adaptation model, etc.
e. I taught a family the importance of
PPE and showed them how to

properly donn and doff before and


after entering their loved one's room.
f. In week 4 as aforementioned I had
a patient who was used to managing
her own medications and once in the
hospital
did
not
have
any
involvement in this anymore. I
advoated for her to be able to have
more involvement in her own care
and to perhaps get her meds
changed to the schedule she was
managing herself at home which was
working really well for her.
g&h. All weeks when I am providing
any
given
care
(giving
pain
medications, administering oxygen) I
always predict what the desirable and
likely outcomes are to ensure that the
interventions are effective and worth
doing. Also, I consider the patient's
response to these interventions. For
example, after putting oxygen on
somebody I will always go and check
on them periodically to ensure that
they are comfortable and to evaluate
their response and if they feel like it
is helping at all.
i. see below. (same question)
8. Critically appraise own practice in relation to nurseclient/family interactions and as a member of the health
care team

-I had a patient who had a dx of lung


cancer and was to be discharged
home. She was very anxious about
this, therefore, I sat down with her
and had her tell me all about her
concerns and what she understood of
her dx. From there I communicated
her concerns (with her permission) to
the RN that was assigned to her and

9. Participate in professional development based on reflective


practice and critical inquiry

discussed collaboratively with the RN


and the patient about interventions
that could facilitate her transition
back home.
-In the first few weeks, there was a
patient whom I had built a good
therapeutic relationship with not only
her but also with her daughter. The
daughter would come in everyday at
the same time when all the nurses
would be very busy and thus could
not give her an update on her
mother. Therefore, I would sit with
her and answer as many of her
questions as she could and whatever
I was not entirely sure of I would ask
an RN and relay the message ask
promptly as I could. In palliative
espcially, I have found that your
relationship with the family is just as
important with that of the patient.
-I participate in reflective practice
every week following placement by
reflecting on my experience that
given week, I do this by:
-identifying what I learned
-what interventions I did
-what I will take away from that
week.

Clinical Instructor Comments (All areas marked as unsatisfactory must have a


comment)

Signature of Instructor:

Signature of Student: Gabrielle Gagnon


18/02/2016

Date:

Date: