Self Assessment

2016 - 2016 - NURS 151 Practical Nursing Practice 2 Final (201508)

NURS 151 Practical Nursing Practice 2 (PN, 12-Jan-2016 - 07-May-2016)
Student : Kriz Lee Velasco
Clinical Teacher/Preceptor : Marlene Sutherland
Program Coordinator : Wendy Chow
Location : William Osler Health Centre/Brampton Civic Hospital
Placement Setting : Agency
Unit/Office/Clinic : N3 ACE
Period : 12-Jan-2016 To 07-May-2016
Student hours : 168
Required Hours : 168
Validated hours : 156
Teacher comment for validated hours:
Had one absent day on March 15 this term.

I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes Student Rating Teacher Rating

1. COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK

Satisfactory Satisfactory
1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies and

procedures.

K.L.V. : All throughout the semester I have complied with the hospital's as well as the school's regulatory standards and policies and procedures. I

attend each week on time and in full uniform per regulations. I abide by the rules and regulations of William Osler Hospital by following the given

contract before the start of our placement. I follow the IPAC methods such as the four point rule of hand hygiene as well as cleaning the hospital

equipment after each use in the clinical setting, I also respect the policies of the hospital in order to avoid any unnecessary circumstances with my

colleagues. I also comply by the 8 rights of administering medication in order to avoid any medical errors.

Satisfactory Satisfactory
1. 2 Act in a responsible, ethical and accountable manner.

K.L.V. : I respect all the people around me and do not act rashly in order to avoid any conflicts with my colleagues. I work as a team member and not

just an individual, I make sure to help others around me and act in a responsible, ethical and accountable manner. I follow through with the

instructions given to me in order to provide the best care for my client in a safe environment for me as well as others around me.

Satisfactory Satisfactory
1. 3 Determine strengths and limitations and when to consult and seek assistance from other

professionals.

K.L.V. : I am expected to know and have practiced basic skills as a nurse such as taking vital signs, doing a head to toe assessment, performing

hygiene, documentation and administering medications. I am aware of my own capabilities, I do not act alone unless I am confident enough to perform

a procedure on my own. When in doubt I make use of my resources such as my peers, my instructor, and staff around me to help when I find my self

unsure of something or in need of clarification.

Satisfactory Satisfactory
1. 4 Use evidence informed practice and a theory-based approach to care.
K.L.V. : I continue to enforce the theory -based skills I have learned in school in order to provide the best care for my clients. I make sure to develop

a therapeutic relationship with my client by following the guidelines we learned in theory class in order to build a comfortable and trusting relationship

in order to provide the best care for them. By respecting, being attentive, and listening carefully to what they say help me build a therapeutic

relationship. I provide privacy when procedures are being done, I follow the four points of hand hygiene in order to prevent the spread of infections, as

well as follow the 8 rights when administering medications to provide a safe and the best care for my clients.

Satisfactory Satisfactory
1. 5 Ensure client safety and a safe environment.

K.L.V. : In order to provide the best care for my clients, I have to come up with a plan that works for myself that will help me accomplish all my

responsibilities in a timely manner. I make sure to do my research before the shift in order to know vital information for my client when providing care,

such as knowing what medications are for, knowing how to do assessments and prioritizing information I gather from my assessments all help me to

ensure client safety. It is my responsibility to keep a safe environment for my client therefore I make sure to attend to them when they need help, i

keep the railings up as an appropriate restraint hen they're a risk for fall and needs assistance when getting up. I make sure that call bells are withing

their reach as well as their aids when leaving them unattended

Satisfactory Satisfactory
1. 6 Ask relevant questions to clarify understanding of the plan of care and whenever uncertain.

K.L.V. : Before any shift I make sure to do my research in order to familiarize myself with my client's situation and their needs of care. When I come

across something I'm uncertain of, I know to ask the staff, my instructor, or to check the computer to help clarify and help me understand things better.

I make sure to communicate with my head nurse when it comes to following the plan of care for my clients in order to avoid any incidents where I am

uncertain of what to do.

Satisfactory Satisfactory
1. 7 Identify ethical and unsafe situations and seek appropriate assistance to resolve these.

K.L.V. : Keeping a safe environment for myself and my client by following protocols has allowed me to avoid any unsafe situations. this criteria has

been met all throughout the semester by knowing when to ask for assistance when an ethical and unsafe situation is encountered.

Satisfactory Satisfactory
1. 8 Demonstrate understanding about the role of the student nurse.

K.L.V. : Having the opportunity to experience taking care of a patient on my own has helped me to understand more of my role as a student nurse.

Being responsible of someone else other than myself has been an exciting opportunity, with the help of the my peers around me I am able to go

through my responsibilities in a day in an effective timely manner. I have learned to be more organized in the clinical setting and am able to finish my

tasks such as giving medications, hygiene (mouth care, peri care, bath, change diaper), fixing the bed, and doing procedures in a timely manner.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
Kriz Lee has practiced safely, competently and ethically, complying with the policies and procedures of WOHS and CNO. She has
incorporated the policies that guide safe patient care in the area of medication administration, mobility and nutritional guidelines such as
dietary restrictions for patients with swallow limitations. She has mobilized patients during activity; following the guidelines laid out by
physiotherapist and nursing staff to ensure patient is ambulated and transferred safely. She has followed IPAC standards for hand hygiene
and isolation regulations. She has ensured patient equipment is used safely, being mindful of breaks, position of bed and chairs; and
ensuring patients are able to reach the call bell system.

Student has acted in an accountable manner in preparing for clinical by researching all relevant patient related information to ensure they
are providing safe nursing care that reflects the care need for individual patient. Has researched patient specific medical diagnosis in
order to understand the nursing care needs required
She is able to determine strengths and weakness by practicing self-reflection and incorporating guidance provide during feedback on how
she could improve her practice, incorporating this feedback in her practice to achieve beneficial methods of conduct in the practical
setting. For example learning how to structure her day to have better time management and how to engage in conversations with her
patients to better her communication skills.

Used theory-based approach to practice by implementing the theoretical content gleaned during her first and second semester of learning
in the academic setting. This has been evident in her knowledge base as she has been able to discuss patient care need with instructor
appropriately. Kriz Lee has an excellent grasp of theory based practice and is able to utilize her knowledge base to provide nursing care at
the beginners level of learning. Kriz Lee is always able to tell me about the diseases process of disorders such as COPD. HTN, Diabetes,
Renal Disease, CHF, Edema and Pneumonia. She is always well prepared at all times and is always willing to learn.

Has been able to ask relevant questions to clarify and guide actions and task appropriately and safely, example if she needed to clarify her
understanding of medical diagnosis and medication usage, clarify medical terminology and clarify information found in patient chart,
Kardex and MARs

Has demonstrated understanding of the role of the student nurse by applying academic learning appropriately in the clinical setting. She
has worked as a part of the care team at all times and working well with peers to provide safe nursing care.

2. ACCURATE AND RELEVANT COMMUNICATION

Satisfactory Satisfactory
2. 1 Participate in team sharing and discussions.

K.L.V. : I always participate in our team sharing and discussion meetings at the end of every shift. I am able to answer questions and give direct

answers accordingly about my clients condition and how I ensured safety the best type of care that day.

Satisfactory Satisfactory
2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.

K.L.V. : I am able to document clearly, accurately, concisely and in a timely manner using written and electronic methods throughout my day by

following my plan on how I am going to go about in my day. I am now able to document procedures I have done to my client such as head to toe

assessment, administering PRN medications, taking vital signs, and providing daily care for my clients accurately without the guidance of my

instructor.

Satisfactory Satisfactory
2. 3 Report relevant information to the appropriate personnel.

K.L.V. : I am able to communicate with my head nurse and peers about information I have gathered throughout the day that involves the care plan for

my client. I always report to my nurse my vital sign findings in order to ensure no complications with my client as I continue through the day with their

medications and plan of care. I ask questions when I am uncertain of something in order to prevent incidents that are out of my scope of capabilities. I

make sure to report any abnormal readings such as low/high BP, pulse, respiration, pain level, and low oxygen saturation in order to come up with the

most appropriate care for my clients situation.

Satisfactory Satisfactory
2. 4 Utilize communication techniques with the client and inter-professional health care team.

K.L.V. : I make sure to be in the room and showing respect when an inter-professional health care team is talking to my clients , this allows me to

know what is going on with my client not only in the nurses perspective but also in other aspects such as their food intake, their mobility status as well

as procedures such as their dialysis or rehabilitation.

 Satisfactory Satisfactory
2. 5 Maintain privacy and confidentiality according to the Personal Health Information Protection Act

(PHIPA)

K.L.V. : I comply by the privacy and confidentiality regulation according to the Personal Health Information Protection Act (PHIPA) because I know

how to completely respect my clients personal matters. In order to keep a trustworthy relationship between my client and I, I have to ensure to not

disclose any information regarding their condition to others that do not need to know their information. I do not share my clients information with my

peers, family or anyone that do not have the authorization on gaining my clients information.

Satisfactory Satisfactory
2. 6 Use technology to retrieve information including research, data and other information.

K.L.V. : I am capable of retrieving information and researching related information such as patient history, past laboratory values, and past vital signs

regarding my client from the electronic medical records. I know how to research information that will help me with my care for my client, and also I

know how to retrieve data that is necessary for me to know in order to go about with my day such as my clients mobility status and scheduled

medications.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Kriz Lee has been able to participate in team sharing and discussion by building on her confidence in speaking to the healthcare team.
She has been able to communicate with nursing staff during shift report to collected and provide necessary information on plan for
patients care. She has documented appropriately in the EMR, patient MAR and communicated patient related information to staff nurse,
charge nurse and clinical instructor appropriately to ensure all involved is aware of plan for patient care and any changes to plan of care
accordingly.

Has been able to build on confidence to utilize communication techniques with the client and also involved family members in discussion
as appropriate, for example to translate and instruct patient when language barrier is present. Kriz Lee has been able to communicate with
inter-professionals such as physiotherapist and occupational therapist in efforts to plan and deliver appropriate nursing care for patients.
She has maintained privacy and confidentiality when discussing patient care needs and ensuring all conversations regarding patient is
done with confidentiality in mind.

Has been able to utilize the electronic documentation system to document and research patient care related information such as lab
values, patient history, results of test and procedures and notations from healthcare staff such as nurses and physicians that is found in
the patients EMR

Kriz Lee has grown a great deal in her communication skills during the clinical as indicated by the comment made above. She is much
more comfortable communicating with those around her as she gained greater experience in the clinical setting.

3. CARING RELATIONAL PRACTICE

Satisfactory Satisfactory
3. 1 Utilize effective communication techniques.

K.L.V. : I develop a therapeutic relationship with my client through communicating with them in a respectful manner. In order to provide the best care

for my client I have to build a trustworthy relationship for them to fully be comfortable with me as their caregiver. I also show respect to my client's

family when interacting with them in order for them to trust me with their loved ones.

Satisfactory Satisfactory
3. 2 Demonstrate therapeutic caring, compassionate, and culturally safe relationships with clients

and health care team members.

K.L.V. : I pay attention to my clients cultural background and ask how they would prefer to be taken care of in terms of their own reserves and

preferences. I do not act on how I see things in my perspective, I am respectful to the cultural differences between my client and I as well as others

around me. I reflect on my opinions in order to avoid conflicts as well as discomfort for my client and other health care team members. I do not enforce

what I think may be right, instead I follow and consider my peers' suggestions in order to provide the most effective care in the hospital setting.

Satisfactory Satisfactory
3. 3 Apply knowledge of therapeutic use of self and identify its effect on client well-being.
K.L.V. : Reflecting on the cultural difference between my client and I, I know when to keep my opinions to myself and to not enforce my beliefs on

how to do things such as providing care for my client. For example, in different cultures touch is a sensitive matter, therefore I often ask whether it is

okay for me to touch them before doing procedures. Asking for permission allows me to show that I respect them as a person as well as their beliefs if

touch is a sensitive topic for them. I do not assume other peoples beliefs therefore I do not stereotype based on their looks or the color of their skin.

Putting my own beliefs aside allows me to provide the best care for my client according to their preferences and beliefs and allows them to be

comfortable and at ease around me.

Satisfactory Satisfactory
3. 4 Use self-awareness to identify the effects that beliefs, values, and personal experiences have on

relational practice.

K.L.V. : Acknowledging the various differences between one culture and another changes how a person should act in order to build a therapeutic

relationship. In order to implement the most effective care for a client, the emotional and spiritual aspect should also be taken into regard and not only

their physical diagnostic. We can't treat patients by looking at them as a disease we need to be able to incorporate everything about them and treat

them as a whole to provide the best care. Putting my own preferences and beliefs aside allows me to see and think in my clients perspective

regarding their plan in achieving their well-being.

Satisfactory Satisfactory
3. 5 Interact with clients and members of the inter-professional health care team; and, consult

appropriately.

K.L.V. : I interact with my head nurse in order to provide an effective care plan for my client regarding their medications or their daily hygiene as well

as assessment results. In regards to the inter-professional team members, I ask questions as well as fill them in in what my client may have told me

regarding a plan that was implemented unto them by a different health care member such as dietitian and physio therapist. For example, I had a client

who weren't happy with their new meal plan, therefore we had a meeting with their dietitian to implement a new meal plan which would work for the

doctor's recommendation as well as incorporating the clients preferences.

Satisfactory Satisfactory
3. 6 Apply knowledge of practices and systems that support the diversity of clients and the inter-

professional health care team.

K.L.V. : I have enough knowledge and understanding on cultural differences to know how to act around the vast diversity of people I encounter int he

hospital setting. I know how to put my own opinion and beliefs aside in order to provide the best care, I also know how to show respect towards other

inter-professional health care team and acknowledge that they have the best judgment when it comes to their own specialty therefore I should not

interrupt or doubt their knowledge.

Satisfactory Satisfactory
3. 7 Apply knowledge of clients cultural, religious, and other beliefs and values as these influence

clients choices and decisions.

K.L.V. : Encouraging my client to incorporate their own beliefs and practices with our plan of care in order to better themselves in their own pace and

preferences. I do not implement my own belief when caring for a client because I am well aware of our cultural differences, and it is disrespectful to

decide for other people that I have no other relationship with other than a client-nurse relationship.

Satisfactory Satisfactory
3. 8 Provide effective client education.

K.L.V. : By implementing our plan of care, I can explain to my client why we have to do and encourage them into doing things in order to achieve

their well-being. When patients know why we have to enforce certain procedures they are more willing to do it because they have enough knowledge

as to why they have to cooperate instead of just forcing them to what they are told to do. For example, before asking a patient who has been bed

ridden for days, it is important to explain to them the pros of why they need to get up and start moving. With the client knowing the rationale behind

this order, they are more willing to participate.

Teacher comments for CARING RELATIONAL PRACTICE :

Kriz Lee has utilized effective communication techniques when interacting with staff, patients, allied healthcare professionals, each other
and instructor.
Has demonstrated therapeutic caring and culturally safe nursing care by being mindful of the cultural needs of patient population such as
dietary restrictions and privacy needs for prayer and meditation.

Has used self-awareness to identify the effects that beliefs, values and personal experience has on relational practices such as being
mindful of how ones individual experiences may related to the experience of clients and their families for example understating how illness
and mindset of health influence individual patient behaviors
She has consulted with staff, and physio appropriately when she needed directions, clarifications and additional information that would
benefit the nursing care being provided.

Has applied knowledge of practices and systems that support the diversity of the client population of the ACE unit. These clients are
elderly and require a great deal of care, they have varied cultural backgrounds and student has been mindful of this when providing
nursing care. Kriz Lee also been mindful of patients religious beliefs that influence choice, again such as diet needs and giving patients
the opportunity to have time to pray during the day.
She is mindful of cultural diversity and cafe needs for patients with varied cultural beliefs, respecting their care needs as appropriate.

4. LEADERSHIP AND ADVOCACY

Satisfactory Satisfactory
4. 1 Recognize conflicts and strategies for resolution.

K.L.V. : I am aware of the proper strategies in conflict resolutions, such as removing the person form the problem and keeping a calm atmosphere as

much as possible in order to avoid further conflict. This criteria was met during our clinical setting.

Satisfactory Satisfactory
4. 2 Demonstrate leadership skills that foster group work and a positive learning environment.

K.L.V. : I am now able to take care of a patient confidently on my own, however still with some guidance. I have learned and polished my new skills

such as documenting, head to toe assessment, doing bed bath, as well as administering medications on my own. Having this knowledge I am able to

help with my peers when they need a hand in our hospital setting.

Satisfactory Satisfactory
4. 3 Identify opportunities to improve health care service and nursing interventions by advocating for

client, self, others, and quality practice.

K.L.V. : By communicating with my nurses I am able to implement the best care for my client regarding results I may find as an abnormal finding such

as a high/low BP and with holding medications accordingly. Implementing non pharmacological strategies to help relieve a patients pain such as re-

positioning or giving them more pillows for comfort or allowing them to get some rest if they need to by doing my tasks quicker yet still accurately.

Satisfactory Satisfactory
4. 4 Provide feedback to peers and accept feedback from peers and members of the inter-

professional health care team.

K.L.V. : I acknowledge my peers evaluation of me and work on the skills mentioned in order to better myself. We as a team encourage each other in

our clinical setting and help one another if needed therefore we see and observe how each one works in the hospital setting. Having the opportunity to

learn and give constructive criticism to one another helps all of us grow and improve on our nursing skills.

Satisfactory Satisfactory
4. 5 Support clients rights for self-determination and choice.

K.L.V. : By encouraging my clients to do as much as they can and allowing them to decide on what they would prefer to do throughout the day allows

to promote independence. According to their own capabilities I allow them to feed them self as well as perform their morning hygiene with assistance

if they are capable of doing so. During medication administration or performing procedures I always tell my client what I am about to do and why I

need to do them in order to give them the choice to either refuse or to let me proceed.
 Satisfactory Satisfactory
4. 6 Respond appropriately to unsafe, unacceptable, and unprofessional behaviours.

K.L.V. : There was no incident in the hospital setting whereas I needed to respond to an unsafe, unacceptable and unprofessional behavior.

Satisfactory Satisfactory
4. 7 Consult and collaborate when carrying out health care and nursing practices that are in the best

interests of the public and protect the public through collaboration and consultation.

K.L.V. : I often consult with my peers regarding procedures I am unsure of, if I really am not confident with something I ask my nurse or my instructor

for clarification and assurance in order to avoid harming myself and my client in doing a procedure I do not know. I am well aware of my capabilities

with providing a safe environment for my client therefore I also am aware when I have issues with a procedure or a situation. I do not act rashly and

always consult and collaborate with my colleagues when implementing the plan of care.

Teacher comments for LEADERSHIP AND ADVOCACY :

Kriz Lee has been able to understand the theory supporting conflict resolution and has been able to demonstrate leadership skills. This
has been evident as student has taken part in discussions with nursing team regarding patient care needs, clarifying plan of care as
necessary. Engaging in discussion with peers regarding best approach to plan of care for their individuals patients. They have worked
very well together to foster an environment conducive to learning.

Kriz Lee has advocated for patients by informing appropriate individuals regarding changes in patients plan of care for example when
patient is having difficulty with voiding or having too many bowel movements that required changes in their care interventions. Kriz Lee
has been able to engage in activities that encourages providing feedback to her peers and wither receiving feedback as well. They have
been able to assess each others skills and capabilities and give each other directions accordingly on how thy might improve their basic
nursing skills.

She has consulted and collaborated with staff members, instructor and peers in efforts to provide beneficial nursing care to her patients,
supporting client choice at all times by providing client with the information they require to make decisions concerning their care. For
example, during meal times encouraging patient to eat or to hold off eating based on how the patient felt or based on medications the
patient received such as oral and s.c diabetic meds.

Kriz Lee has shown growth and development in her leaderships skills. She was very quiet at the start of the semester but has been able to
build her knowledge regarding leadership qualities and demonstrated them appropriately over the course of the clinical practicum.

5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES

Satisfactory Satisfactory
5. 1 Incorporate the unique needs and expected outcomes into individual clients plans of care.

K.L.V. : When giving care to a client we must care for them as a whole and not just their diagnosis. We have to consider other aspects to why the

client is in the condition they're in by assessing their emotional status and their environment prior to their diagnosis. In gaining knowledge of the

clients background we as health care providers are able to widen the scope of our knowledge and come up with a more accurate plan that will

promote well-being as well as to prevent future recurrence of their condition. Taking the client's cultural differences and preferences into

considerations when implementing our care of plan will provide the client security as we continue with our care.

Satisfactory Satisfactory
5. 2 Develop theory-based plans of care that are holistic and client centered and are articulated

competently in writing and orally.

K.L.V. : With my research and being able to come up with concept maps for each client I have taken care of, I was able to develop a theory-based

plan that is holistic and client centered that provides the most effective care for my client. Being able to come up with a plan of care that goes pass

beyond their diagnosis that will help with their situation such as considering their emotional status or inability to cope with their current condition is an

example of a holistic and client centered care.

Satisfactory Satisfactory
5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.
K.L.V. : With enough practice of making a concept care plan as well as doing assessments, I am now knowledgeable enough to know how to

prioritize my clients needs. I have to focus on what needs to be focused on in order to avoid further complications and what intervention would give

me the best result regarding my clients condition. For example, when caring for a patient who is vomiting but also is complaining of pain we must

prioritize assessing the reason why they have been vomiting rather than focusing on their pain because when the vomiting is fixed it might also relieve

the clients pain.

Satisfactory Satisfactory
5. 4 Provide information that contributes to the evaluation and refinement of plans of care.

K.L.V. : Taking vital signs and pointing out abnormalities and doing a head to toe assessment on the client all contributes to the evaluation and

refinement of plans of care. When taking vitals we have to make sure that blood pressure is within normal range, or if taking anti-hypertensives we

have to make sure that the blood pressure isn't too low in order to avoid hypo-tension. When giving laxatives we have to be aware of the clients bowel

movement in order to be able to reassess the dosage or the type of medication to be administered or when it should be stopped. Also with diabetic

patients when administering insulin a blood glucose reading must be implemented in order to provide the appropriate dosage to promote health and

not harm the client.

Satisfactory Satisfactory
5. 5 Safely and competently carry out nursing assessments and nursing interventions that are theory-

based and within skill abilities.

K.L.V. : Having the knowledge of what is a normal and an abnormal reading when doing vital signs and assessing the client helps with carrying out a

competent and safe nursing care for my client. Being able to re-assess and re evaluate the clients condition when needed in order to know what care

should be implemented is a skill within my scope of practice. Being aware of what I am expected to know how to do such as administering

medications, documenting and assessing my client helps me complete my responsibilities as a nursing student.

Satisfactory Satisfactory
5. 6 Carry out nursing care that reflects the practice decision-making framework.

K.L.V. : Following a clients morning routine by providing them with the hygiene care they need in order to keep them clean also to assess their skin

integrity in order to avoid further skin complications. Making sure to put cream when their skin is dry or cleaning them up, when incontinent, in order to

preserve their skin integrity. Taking my clients blood pressure, blood glucose or checking the pulse rate prior to administering medications according

to their situation reflects the practice decision-making framework.

Satisfactory Satisfactory
5. 7 Complete nursing care responsibilities and nursing interventions in an organized and timely

manner.

K.L.V. : I am now able to do a full head to toe assessment, do my vital signs, administer medications and still have time in the morning to feed my

client breakfast and do their hygiene. With practice I have become organized with my responsibilities and finish them all in a timely manner with extra

time to do research on my client.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Kriz Lee has ensured she is meeting the unique care needs for her patients she has cared for clients with Renal Disease, Cardiac disorders,
Diabetes, Hypertension, COPD, CHF and Pneumonia etc. and has always ensured she knew their unique care needs for these etiologies as
they related to the specific patients.
During the time caring for these patients she has been able to provide holistic nursing care again that is specific to the individual patients
diagnosis and care needs.

She has been able to utilize knowledge of the disease process for example understanding the diseases process of Renal insufficiency ,
Hypertension etc. and what to expect for nursing care, monitoring intake and output, assessing lab values and monitoring blood pressure.
In the case of her diabetic patient, monitoring blood sugars; for clients with respiratory ailments, understating to monitor respiratory rate
and oxygen saturation levels. She has been able to safely carry out nursing care based on the fact that she has researched the patients
conditions and as such, understood the care needs required, utilizing theory based assessment and nursing interventions. She has been
able to carry out nursing care that reflects the decision making process such as holding diabetic medications when the patients blood
sugars levels are too low, holding patient B/P meds when their blood pressure is too low, holding bowel routine medications after
assessing the clients bowel movement activity; holding medications for patients going to Hemo Dialysis. Has also been able to assess
patient for activity, having them limit activities based on their energy levels if they are fatigued.

Kriz Lee has been able to provide nursing care in an organized manner for this latter half of the clinical. She is able to plan her day utilizing
a work plan and is able to complete hygiene care needs, perform treatments, administer medications and document the nursing care
provided in a timely manner. She has had excellent time management and organization during her time in the clinical setting.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

Satisfactory Satisfactory
6. 1 Work with clients and members of the inter-professional health care team to assess clients,

determine health needs, and to achieve mutually agreed expected outcomes.

K.L.V. : Being prepared for the worst outcome when researching for a clients diagnosis, i am able to come up with a care plan of my own according

to the knowledge I have learned in school and in our clinical setting. With pain being most of our clients concern in the hospital setting, and with my

knowledge of pain medications I am able to come up with an appropriate plan to help relieve their needs by consulting and agreeing with other

members of the health care team that it is the best solution in order to achieve the expected outcome.

Satisfactory Satisfactory
6. 2 Contribute as a member of the inter-professional health care team to respond to the changing

needs and expected outcomes of clients.

K.L.V. : Being a student nurse, I was able to take full responsibility for my actions with changes in my clients situation. Luckily no drastic changes has

occur to any of my client therefore I was able to act quickly and effectively when my client begins to complain of pain or may feel some nausea. I

implement my plan of care according to the clients changing needs by consulting with my nurse about my plans before implementing them.

Satisfactory Satisfactory
6. 3 Seek out assistance and consult with members of the inter-professional health care team.

K.L.V. : I ask for help and consultation when I am unsure of what to do, I do not act on my own when an unexpected situation arises. I know my

limitations and my capabilities therefore I make use of my peers and colleagues in order to provide a safe and effective care plan for my client. For

example, I do not decide on my own whether my client should walk with one assist or two, I would need to talk to their physiotherapist to accurately

figure out my clients capabilities in order to help them safely.

Satisfactory Satisfactory
6. 4 Use teamwork, consensus building, and conflict resolution skills.

K.L.V. : We as a group implement teamwork each day we attend our clinical setting by helping each other out when in need. We make decisions

together regarding how to effectively perform procedures in relation to the clients care plan. I have yet to encounter any conflict in our clinical setting.

Satisfactory Satisfactory
6. 5 Describe effective, collaborative, and consultative strategies to meet clients needs within a

changing environment.
K.L.V. : Allowing the client to understand their diagnosis and condition will allow them to understand why some changes needs to be implemented.

Helping them to come up with a plan in order to change their lifestyle and diet according to their own pace and preferences will encourage them to

actually implement such plans.Consulting with the family and asking for their help with implementing a change will help the client to fulfill the plan in a

better and safer environment.

Satisfactory Satisfactory
6. 6 Interact with members of the health care team respecting their unique role and competencies.

K.L.V. : Each week of the clinical setting I was able to interact with different members of the health care team, I respect each of them by allowing

them to do their own responsibilities and not interrupting and making decisions for them. Each member has their own roles and competencies

therefore we must relay our trust for each other because we all have the same goal which is the achieve our client's well-being.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

During her time on the ACE unit, Kriz Lee has arrived at the stage in her learning where she can comfortably work with allied staff and staff
members in a way that meets the expected outcomes of the patient. She has been able to provide basic nursing care, provide nutritional
care, ambulate patients, send and receive patient to test and procedures while working with the health care team members in a
collaborative effort.

She has been able to seek assistance as needed when providing care to patient, for example if she needed assistance in bathing and
ambulating patients. Provide hygiene care needs when patient was incontinent of urine or stool and skin care; and also if she needed
direction for administration of medications and treatments. She has interacted with members of the healthcare team in these instances
appropriately.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

Satisfactory Satisfactory
7. 1 Act in the best interests of clients and protect clients from harm through collaboration and

consultation with members of the inter-professional health care team and through competent and safe

practice.

K.L.V. : I ask questions regarding my clients condition when an inter-professional health care team member visits their room. I stay and talk to them

in order to gain knowledge on different aspects of how they're taking part in taking care of my client such as rehabilitation, nutrition and procedures

such as dialysis. I collaborate with my colleagues by asking for assistance, in order to prevent an unsafe environment for myself and my client as well

as to provide the best care for the patient.

Satisfactory Satisfactory
7. 2 Participate in self-reflection to identify strengths, areas for improvement.

K.L.V. : I am able to reflect on my strengths and weakness by going through how my day went each week and identifying what skills I need to

practice and improve in order to be a better health care provider. With the help of my peer and instructors feedback I am able to come up with a plan

on how to improve my skills as well as how to implement care plans in a more effective way. Acknowledging my weakness allows me to gain

motivation on being better for my future.

Satisfactory Satisfactory
7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance program

(CNO).

K.L.V. : As the semester went by I have gained confidence and improved more on my nursing skills by following learning plans that I have created in

order to help me achieve what I intended to achieve. I am now more confident with documenting accurately and in a timely manner, taking vital signs

has become easier and a more polished skill as well as doing a head to toe assessment, administering medications is also a skill that I have improved

a lot on through practice and implementing my learning plans.

Satisfactory Satisfactory
7. 4 Seek out learning opportunities and feedback that foster professional development; and,

integrate these into practice.

K.L.V. : I utilize my instructors feed back and use each time we talk as a learning opportunity in order to improve my nursing capabilities. I ask

questions when I come across something I am unsure of in order to effectively provide the best care for my clients. I practice and refresh my memory

by watching videos on how to do certain procedures in order to build confidence as well as gain more knowledge.

Satisfactory Satisfactory
7. 5 Utilize nursing, health and other theory and literature to improve nursing practice.

K.L.V. : When I am uncertain of a procedure or a medication administration I ensure to utilize nursing, health, and other theory and literature to

improve my skills. I use my resources to help clarify and assure that what I know is the most effective or the right way to perform certain procedures. I

can easily retrieve information that I need from the electronic medical records, MAR, KARDEX and patient charts as well as medicine books which are

all available in our unit to help me improve my nursing practice and assist and reassure me with procedures I am expected to do.

Satisfactory Satisfactory
7. 6 Use a theory-based approach and evidence-informed practice.

K.L.V. : Knowing the rational behind procedures and medications is a skill all health care providers should acquire. It is important to know the

meaning behind why we do things the way we do in a hospital setting as a student nurse. Our goal is to provide the best care for our clients therefore

we should be aware of the reason why we perform procedures and also be fully aware of how to act when unexpected situations occur. Performing

theory-based procedures such as hand hygiene allows me to not only protect my client but also myself from acquiring any infection from our work

setting. Being familiar with medications allows me to enforce the theory behind how each medications work and why my clients are taking them, also

following the 8 rights of medications prevents myself from making any medical error that may harm my client.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Kriz Lee has been able to protect patients from harm as she ensured she had the correct instruction for providing safe nursing care at all
times. She would ensure she knew the patients diet, activity tolerance, nursing care needs and researched medications as necessary prior
to administering them.

She has been able to self-reflect on her performance, taking the time to practice and change methods of conduct when she needed to
improve a skill or learn a different method to accomplishing task. She has practiced how to administer s.c. injections, administering
inhalation treatments, ambulating patient in a different way to achieve safe transfer.

She seeks out learning opportunities by assisting the nursing staff in providing care for patients other than the one she is assigned to,
offering her a broader learning opportunity as she cares for other patients with varied health challenges and health needs. She has been
able to utilize literature and theory from her academic studies such as books, online courses, simulation practice labs and medication
administration drug books.

8. USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY

Satisfactory Satisfactory
8. 1 Utilize problem-solving skills to inform decision making in all aspects of nursing care.

K.L.V. : With the knowledge I have learned and practiced all through my first year of nursing school I am able to comprehend different situations and

come up with a plan on how to tackle them effectively. I am able to come up with a solution when I come across situations that may be problematic.

For example, when a client refuses to take their medication I know how to try to encourage them and inform them why they would need to take them

rather than going straight to my head nurse and making them responsible for solving a simple problem. I encourage independence for my client in

order to help them with their wellness and to help them gain their confidence with doing things on their own.

Satisfactory Satisfactory
8. 2 Use problem-solving and decision-making skills to assess clients and to determine nursing

diagnoses, expected outcomes, nursing interventions, and evaluative criteria.

K.L.V. : I am now more comfortable with making a concept plan in order to provide the best care for my client. Being well informed with how different

diagnosis affects patients, I know which aspects of my clients situation needs to be prioritized in order to provide the most effective care. For example,

for my client who had a very limited mobility I had to make sure to re-position and them every couple hours in order to keep their skin intact, I also

make sure to clean them up in order to avoid long exposure to moisture which also helps to prevent skin breakdown.

Satisfactory Satisfactory
8. 3 Use self-reflection to design a plan to improve problem-solving and decision-making skills.

K.L.V. : I am aware of areas I need to improve on, every week after shifts, I reflect on what worked best for me and did not in order to come up with a

plan on how to better myself the next time I attend the clinical setting. I practice skills that needs improvements such as administering SC injections

and taking manual blood pressure in order to perform better while caring for my clients.

Satisfactory Satisfactory
8. 4 Utilize knowledge from variety of nursing, health, and other theory into nursing practice to

provide safe and competent care.

K.L.V. : Being aware of my clients capabilities I am able to provide a safe and competent care by not forcing myself beyond my limits, I often ask for

assistance when doing procedures I know I can't do alone. Using appropriate restraints only if needed in order to reserve my clients dignity and not to

make them feel incapable of doing things on their own, this also helps build a therapeutic relationship by allowing the trust between us grow by

reassuring them that I am capable of taking good care of them.

Satisfactory Satisfactory
8. 5 Use prioritization strategies for client care.

K.L.V. : As the weeks went by in our clinical setting, I have learned how to plan my day according to the priority of what my client needs most in their

plan of care. Working with the geriatric population, checking their vitals and doing proper assessments gave me enough information as to what to

prioritize with my care. As most of our client had weakness or pain of some sort which caused some immobility, skin integrity and pain management

were mostly my priority. Administering medications on time in order to follow the doctors regimen and also to control pain, if needed, was a strategic

skill I needed to develop in order to provide the best care for my client. Knowing to re position and turn my client every 2 hours, as well as to

encourage ambulation was also a priority in terms of client care in order to keep their skins intact.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

K.L.V. : I have learned how to mange my time wisely and effectively therefore I am now capable of keeping a more professional and accountable

stature in our clinical setting. I know how to take responsibility for my actions and I also know how to improve on skills I need to improve on. I take my

instructors comments as a learning experience in order to better myself as a health care provider and to continue to demonstrate professionalism and

accountability as a member of the hospital staff.

Satisfactory Satisfactory
8. 7 Recognize strengths and limitations and seek appropriate assistance and support.

K.L.V. : When caring for my client I make sure that safety for the both of us is always implemented. When doing procedures I make sure I'm

confident to do it on my own without harming my client, however if I know I will need help I make sure to ask a peer for help in order to provide a safe

environment for my client and myself. I do not act on my own accord when it comes to assisting my client with getting off the bed, I make sure I know

their mobility restrictions in order to avoid any incidents. When giving medications I make sure to report to my head nurse before administering any

PRN meds or scheduled medications that may have needed a prior vital sign reading suhc a BP and pulse readings for digoxin or metropolol.

Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY :
 Kriz Lee is able to utilize problem solving skills for example, able to think through care needs for patient when there is an unplanned
change in schedule or medications changes are made. Able to assess patient for pain medication usage and if they have not had the
required amounts of urine output for the shift.

She is able to utilize knowledge such as pathology when discussing lab values for patient with elevated potassium, low hemoglobin due to
Chronic Kidney Disease. Also able to assess patient with hyper/hypo glycemia, administer or hold sc and oral diabetic medications
accordingly based on findings. Able to assess patients with COPD, asthma and pneumonia and understand the respiratory assessment
finding as it pertains to lung auscultations. Also able to understand the use of puffers and inhalation treatments to treat these disorders.
Able to understand the assessment process for patients with edema to limbs and assess for pitting edema specifically. Able to assess
normal and abnormal vital signs and report finding appropriately to nursing staff and to instructor. Demonstrating professionalism and
accountability at all times during the clinical experience. Kriz Lee has cared for patients with Foley catheters and understood the nursing
care required for such interventions.

9. SIM number of hours

9. 1 SIM number of hours

K.L.V. : 6

M.S. : 6.

Teacher comments for SIM number of hours :

Has utilized the SIM lab as a means to aid in her development and learning of theoretical content that guides her ability to critically think
through care need for patients.

Student Final Summary with Strategies for Continued Growth

I need to continue practicing my medication administering skills specially using injections and puffers. i also need to practice how to do new
procedures we learned this semester such as wound care, catheter care and NG tube care in order to be more prepared for the future.

Teacher Final Summary with Strategies for Continued Growth

Kriz has meet the criteria required for a satisfactory pass this clinical. She has managed in her role as a student, administering medications and
treatments for patient in her care. She has given medications via PO, Inhalation, and S.C safely with good techniques at the beginners level.

Kriz Lee is encouraged to continue to be attentive to her academic studies by continuing her learning in areas such as anatomy and physiology,
pathophysiology and medication usage in treatment of disease. She will benefit from these studies as she continues the PN course for the next
semester. She is to continue using her text books and other literature/resources for learning as she continues in the PN nursing program.

Student's References

CNO, Theory notes, William Osler contract policy, Humber College's Clinical Setting Policy and Regulatiion

Grade Satisfactory Unsatisfactory

Referred to Clinical Excellence Committee (CEC)

Program Coordinator Feedback

The Program Coordinator has reviewed the evaluation Yes No

Student Sign Off

I met with my Clinical Teacher/Preceptor and discussed my evaluation Yes No
In general this evaluation accurately reflects my performance Yes No

Student Comment

It was a great experience, it was unfortunate for me to have missed one clinical day due to a cold.