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NURS 3021H Clinical Practice Focused on Chronic Disease Management

Mid-Term Evaluation Final Evaluation X

Student: Melissa Friskney

Clinical Instructor: Alicia Sale

Clinical Placement Hospital: PRHC Unit: C2

Date: March 25th 2018

Missed Clinical Hours: 8 Missed CLC Lab Hours: 0


NURS 3021H Clinical Practice Evaluation

Progress
Course Objective Evidence/Indicators SP/S ND UP/U
1. Demonstrate accountability and responsibility in - Throughout this placement I have demonstrated
the teaching-learning relationship. accountability and responsibility in the teaching-
learning relationship by showing respect to my
clinical instructor, peers and unit staff.
- I show up to each clinical shift on time, in proper
uniform and with the tools I require to be successful.
- I take responsibility for my patients’ care by
completing a pre-clinical before coming to clinical to
ensure I am well prepared and educated on the
patient’s diagnosis and history.
- I am accountable for my own actions by reviewing
skills before coming to clinical. For example, I was
required to perform trachea care so before coming to
clinical I reviewed the lab material on trachea care
and watched videos to familiarize myself with proper
technique.
- At clinical I am not afraid to ask my clinical instructor
questions when I am not sure how to perform a certain X
skill, this allows me to develop a better understanding
and improve as a nurse.
- Every shift I take the time to introduce myself to my
primary nurse and regularly check in with them to see
if there is anything I can assist with or observe to
broaden my clinical skills.
- I demonstrate respect to the C2 staff and my clinical
instructor.
- I work with my peers as a team to provide safe and
proper care to my patients. By working as a team we
are able to collaborate and put our patients’ best
interests before our own.
- I seek out new opportunities by asking the nurses
what I can do for them at the beginning of each shift
and see if they have any skills I have not done or
observed before.
- Work with my peers to share information and skills to
perform the nursing care required for my patients.
- I demonstrated accountability when I became sick
and, knowing I would put my patients at risk for
getting sick, I made the decision to not attend clinical.
Even though I would be missing important clinical
hours, I made sure to notify my clinical instructor and
course lead via the appropriate methods and times to
inform them of my absence.
Melissa is accountable to the Trent Nursing program by
having excellent attendance, arriving on time with all of her
pre-clinical preparation ready. She is respectful to the staff of
C2 and to her nursing peers and clinical instructor. She seeks
assistance and advice so that she can care for her patients
safely and effectively. She asks appropriate questions and
responds to the answers she is given. She always puts the
patient's best interests in mind before her own. Melissa seeks
out new opportunities and comes prepared with the
knowledge, skill, and judgment to perform the nursing care
required.
2. Explain the experience of chronic illness in - I have been successful in communicating and
individuals receiving care in chronic care observing the experiences of chronic illness in
settings individuals receiving care in chronic care settings. For
example, on an evening shift I had the opportunity to
talk to two patients about what it was like to live in
the hospital for months. Both of the patients expressed
how they found it very challenging to be away from
their families and how their illnesses had left them
feeling like burdens to their families. X
- This placement really allows you to take the time to
get to know your own patient but also other patients
on the floor. I always take the time to ask them what
brought them into the hospital, how long their stay
has been and how they are feeling about their illness.
Generally, when talking to people I have found they
feel frustrated and “can’t wait to get out of here”.
Many express how their life changed so quickly and
how they “can’t wait to get back to normal”.
- Hearing the patients’ stories and comments allows me
to provide patient teaching and educate them on their
chronic illnesses to help patients better understand
what is going on within their body.
- This placement has also shown me how important
support systems are in the illness process. For
example, I find patients who have frequent visits from
family and friends tend to be in happier moods and
are more accepting of their chronic illnesses.
- Most importantly, this placement has shown me that
every individual handles their chronic illness
differently and as a nursing student it is important that
I am supportive and help them in any way I can
whether it be talking to them or getting them a warm
blanket to help them through the illness process.
- I demonstrate my developing understanding of
chronic disease and the unique illness experience of
each individual by completing my pre- and post-
clinical assignments that are specific to each patient.
- In my post-clinical I demonstrate my understanding of
chronic illness by connecting my patient’s experience
to a nursing theory each week.
- I take several opportunities to ask patients, their
families and the nursing staff questions about the care
I am providing to ensure it is in the best interest of my
patient as they continue along their illness experience.
- This placement has shown me that for many patients
the hospital is their home. I try to be considerate and
understand this by taking my time to get to know
them, commenting on their room decorations and
keeping the room in a way that the patient likes.
- I work hard to develop strong therapeutic
relationships with my patients and their families but
am also professional by being able to end the
relationship at the end of the clinical shift.
- I have created individualized care plans that outline
safe and competent nursing care that include my
patients’ best interests.
- To make up for some of the time missed when I was
ill I created an hourly outline of the care I intended to
provide to my patient. This helped me identify and
organize their care both around their and my schedule.
- By having two patients at a time I have been able to
see how no two patients are the same and how every
individual experiences chronic illness differently. I try
to consider this when providing care.
Melissa has consistently shown through her pre and post
clinical assignments that she is gaining an understanding of
chronic disease and how it impacts an individual's life. She
asks appropriate questions of the patient and of the nursing
staff and reflects upon the care that she has given. She
understands that the patients at the hospital may be there for a
long time and she goes out of her way to "get to know" the
patients and make their time at the hospital as enjoyable as it
can be. She develops a good nurse-client relationship but is
able to professionally end that relationship at the end of the
week when clinical is complete. Melissa is developing a
good grasp on the fact that no two patients are the same, and
that no two disease process experiences in the hospital setting
are the same. She develops individualized care plans based
on what she sees is important to the patient and to the
patient's family, while providing safe, competent, healing
nursing care.

3. Interpret critical aspects of the person’s - A chronic illness is a disease the individual will have
experience of chronic illness in relation to the to cope with forever. It is a process that requires
nursing process such as common signs and changes to occur in order to achieve proper self-
symptoms, responses to treatment, patterns of management. A lot of the patients I have cared for
coping, and impact on individual and family have mobility impairments as a result of their chronic
relationships. illness. As a result, several patients are not managing X
effectively because of the inability to perform self-
care, lack of education around their illness and the
symptoms of their chronic illness. As a nursing
student I try my best to identify complications my
patients face because of this impairment through
observation and communication. I then try to provide
education and assistance to both the patient and the
family on how they can better manage this
impairment. When dealing with a chronic illness,
having a strong support system is critical. Every shift
I try my best to provide support to my patients
because it has enormous benefits to enhance quality of
life and the illness process.
- Each shift I complete a set of vital and a head-to-toe
assessment on my patients. I also make sure to
document the findings and address any concerns I
have by writing a progress note and consulting with
my paired nurse and clinical instructor.
- Each shift I complete accurate and effective
documentation by completing a vital graphic, bowel
chart, tick charting and progress notes. When charting
I focus on understanding what these findings mean
and seeking clarification when I do not understand.
- I always ensure that I care for my patients while
staying within my scope of practice. I perform
interventions with my patients such as encouraging
deep breathing and coughing, ambulation,
repositioning and toileting. When I am unable to meet
my patients’ needs on my own I seek help from my
clinical instructor or a nurse on the floor to ensure
they are receiving the best possible care they can.
- When providing treatment for my patients I reassess
their condition to ensure the treatment has been
effective. For example, I had a patient whose blood
pressure dropped to a significantly low number. As a
result, I continuously monitored their blood pressure
until it returned to the patient’s “normal”.
- During my placement I tried to educate my patients
about their care. For example, when giving
medications to my patients I ask them if they know
what they are for and share the knowledge I have with
them, so they can develop a better understanding of
the medications they are taking.
Melissa is able to complete vitals and a head to toe
assessment on her patient, including documentation in an
effective and efficient manner. She focuses on her findings
and what they mean, comparing them to previous
assessments. She cares for the patient within her own
limitations by encouraging such things as deep breathing and
coughing, encouraging ambulation and repostitioning, or by
seeking assistance from her clinical instructor or the nurse
responsible for the patient so that the patient's needs are met.
She reassess as patient's condition based on treatment they
have received and whether or not it has been effective. She
has provided reassurance to patients who have been impacted
by their chronic illness, particularly when it has affected their
activities of daily living. I would encourage Melissa to
continue to educate her patients and to promote health and
wellbeing. She can take the opportunity to explain and
recommend alternative therapies and provide her patients
with information and other resources that might help. By
listening to what is most important to the patient, but also
addressing what is important to their health, the goal is to
come up with a collaborative care plan.

4. Identify symptoms and common medical - By completing pre-clinical, reading charts and talking
treatments of selected chronic illness. to patients I have been able to identify symptoms and
common medical treatments for chronic illnesses.
Some of the illnesses, symptoms and treatment are as
follows:
- Spinal abscess: a rare condition that can potentially
cause permanent damage to the spinal cord. It is a
swollen area of tissue that has buildup of pus due to
X
infection of injured tissues. Some of the symptoms
include mobility impairment, low control of bladder,
numbness, tingling, headache and pain. A treatment
for spinal abscess is to locate the abscess so it can be
drained or removed. For example, some patients have
a laminectomy. During this procedure the patient will
be under anesthesia and the surgeon will open the
abscess and drain the pus and fluid instead. Then they
will wash the left-over bacteria out with NS. Patients
will often be prescribed antibiotics as well.
- Decreased mobility is an impairment in which the
patient lacks the strength to walk, grasp, or lift
objects. It may also be difficult for the patient to use
one or more of their extremities and may require aids
such as a walker for their mobility. To help improve
the patient’s mobility you need to encourage periods
of activity and rest, set the patient up with assistive
devices to help improve their mobility and perform
ROM exercises with the patient
- Each shift I complete comprehensive head-to-toe
assessments and sets of vitals. I am also able to
understand the meaning of these findings and act on
them accordingly. I also update my nurse and clinical
instructor of any new findings and collaborate with
them on a plan of care for each individual patient.
- Completed a case study presentation for post-clinical
identifying signs, symptoms and treatment of chronic
illness and explored the unique illness experience of
the patient in the case.
- Several patients I cared for in this clinical rotation had
hip fractures. A hip fracture is a break in the upper
quarter of the femur bone and the extent of the break
depends on the forces that are involved. Even though I
had several patients who had this diagnosis, each
patient’s illness experience was unique. Some patients
were able to ambulate on their own while others
required a mechanical lift to transfer them from their
bed to wheel chair. I think this really demonstrates the
point that everyone has a different experience with
their illness and how they cope with it.
Melissa's vitals and head to toe assessments are well done.
She documents efficiently and effectively. She is able to
understand the meaning of her findings and reacts to them
appropriately based on what she has learned and within her
limitations. She brings all concerns forward to her nursing
instructor and to the most responsible nurse of the patient.
From her research, Melissa is able to understand the disease
process and bring that into the clinical setting and apply it to
his patient. She understands what medications are ordered
for her patients and what their effectiveness should be. She
recognizes symptoms of chronic disease and plans her care
around those findings to alleviate stress on the patient.
5. Demonstrate select nursing and collaborative - During this placement I have demonstrated a number
interventions related to caring for the person of nursing interventions related to caring for a person
with chronic illness such as specific with a chronic illness such as head-to-toe assessments,
assessments, medication administration, catheter flushes, subcutaneous injections, blood sugar
physical and chemical restraints, enteral levels, bed baths, night care, oral care, turning and
feeding & residual volumes, NG tube insertions, positioning, patient-centered care, building
wound care, patient controlled medication therapeutic relationships, tracheostomy care, enema,
administration pumps. charting, wound care and Foley catheter removal.
- I have also observed packing wound care and catheter
insertions.
- During this placement I have had the opportunity to
work with a gastrostomy tube. This consisted of
priming enteral feeding tube, setting up the feeding
pump, monitoring for tolerance, water flushes for
hydration and to prevent clogging. As well as
monitoring the site and understand the reason for
X
treatment.
- I removed a Foley catheter from a female patient and
had several experiences caring for patients with a
Foley, emptying and irrigating a Foley catheter using
NS.
- I have also inserted a Foley catheter on a female
patient and maintained sterile technique.
- I have also used a bladder scanner to monitor the
amount of urine in my patient to determine if a Foley
catheter insertion was required
Well performing tracheostomy care I suctioned with a
Yankaeur section and a 14 French suction catheter
under the supervision of my clinical instructor. When
cleaning the inner cannula. I used sterile technique.
As well, I cleaned the exterior portion of the stoma
and changed the dressing using clean technique.
- Performed simple toe dressings using inadine and
non-bordered mepilex, using clean technique. I also
cleaned the area with NS. When performing this
dressing change I consistently checked in with my
patient to determine how they were tolerating the
procedure.
- I also had the opportunity to remove staples from my
patient’s right hip and apply steri strips.
So far in this clinical rotation on C2, Melissa has had the
opportunity to work with a gastrostomy tube, including
priming enteral feed tubing, setting it up on the feeding
pump, monitoring for tolerance, flushing the tube with water
for hydration and to prevent clogging, monitoring the site and
changing the dressing, and understanding the necessity for
such treatment. She remembered to keep the patients head of
the bed up at least 45 degrees to prevent aspiration. Melissa
has had the opportunity to remove a foley catheter from a
female patient and has had experience caring for, emptying
and irrigating a foley catheter using normal saline and sterile
technique. She has also watched catheter insertions on both a
female and male patient. Melissa has also given
subcutaneous Heparin, which included selecting the proper
needle and syringe to use and administered with good
technique. Melissa has performed tracheostomy care on a
patient, including suctioning with the Yankaeur suction and a
14 French suction catheter while being supervised. To clean
the inner cannula she used sterile technique, and also cleaned
the exterior portion of the stoma and changed the dressing
with clean technique. She has also had experience working
with a Passy Muir Valve as well has how to care for and
monitor the need for humidified oxygen. She has also given
a soap suds enema. Melissa has come prepared with research
for these skills and asks appropriate questions, always
following the direction of her clinical instructor. She follows
up with the patient after everything she does to see how they
have tolerated each treatment.
6. Identify potential consequences/complications - As a result of their chronic illness several of my
of select chronic illnesses and related patients have mobility impairments. This makes it
interventions. challenging for them to transfer on their own, sit up in X
bed and complete their activities of daily living. As a
result, they require assistive devices to support them
such as walkers and, for many, mechanical lifts and
wheel chairs. Many patients report being frustrated
because they feel like they are a burden to their family
and lack independence. As a nursing student I try to
put interventions in place to help my patients better
cope with these complications. For example, when my
patient rings their call I try to respond as soon as I can
to help transfer them or assist them in their activities
of daily living.
- I also take time to build trust and therapeutic
relationships with my patients to allow them an outlet
to discuss what they feel are consequences and
complications of their chronic illnesses.
- During a clinical shift I was talking with a patient who
struggled with alcoholism. This was a very valuable
experience for me because it provided me insight into
what it is like to work through an addiction. The
patient talked to me all about their coping strategies
and the challenges/barriers he had to face to overcome
his alcoholism. The patient also expressed how it has
been easy not to drink when he was in the hospital but
is scared of the temptations once he leaves.
- During one week of clinical I had a conversation with
a patient who was struggling because her husband had
recently been admitted to the hospital for an acute
issue and as a result it made it difficult for the two of
them to see each other because they were on different
floors. This was challenging because the patient relied
on her husband to be a part of her support system and
she felt she no longer had that constant support. As
well, she struggled with how she could support him
while being in the hospital. I took this opportunity to
talk with my patient and listen to her concerns in
order to provide support. I also took time each week
to go and see her (even though I am no longer her
primary student) to check in and ask how she and her
husband are doing.
Melissa has shown that she pays attention to both the
objective and subjective findings of a patient's condition. She
has the knowledge to understand and evaluate how and why a
patient's condition may change. She also acknowledges how
having a chronic illness and having to stay in the hospital for
treatment can affect a person's life physically and
emotionally. She explains to her patients what to be aware of
in regard to their own chronic illness and teaches them how
they can help themselves and be as independent and safe as
possible. She encourages and assists her patients to mobilize,
turn and reposition often in order to prevent skin break down
and pressure ulcers and promote bowel motility and muscle
strength. She also encourages her patients to deep breath and
cough to avoid respiratorty complications. She has also had
the opportuntity to use Meditech to look up patient lab work
and, or diagnostic imaging reports on her patients,
facilititating a further understanding of the effects of chronic
illness.
7. Under the supervision of a Registered Nurse, - Each clinical shift I strive to perform safe, competent,
demonstrate safe, competent, evidence- evidence-informed, holistic nursing care. One way I
informed, holistic nursing practice with clients do this is by educating myself and researching on my
with chronic illness patients’ conditions before coming to clinical which X
a. Use a wide range of effective allows me to perform evidence-informed care.
communication strategies and - I practice safety by only performing skills within my
interpersonal skills to appropriately scope of practice and asking for assistance when I am
establish, maintain, re-establish and not sure how to properly do a skill. For example, I do
terminate the nurse-client relationship not break the sterile field when performing
b. Demonstrate accountable, responsible tracheostomy care.
and ethical practice - During placement I used effective communication
c. Engage in respectful, collaborative, strategies to create a nurse-client relationship by
therapeutic and professional introducing myself to my patient, taking time to get to
relationships know them, assisting them with their activities of
i. Demonstrate therapeutic use of daily living and explaining what I am doing when
self
ii. Create a culturally safe providing care. I also ask the patient what I can do for
environment them and if they have any questions for me about their
d. Apply nursing models and theories care throughout the shift.
e. Demonstrate health promotion and - I demonstrate accountable, responsible and ethical
illness prevention practices practice by arriving to clinical on time with all the
f. Demonstrate patient advocacy tools I require to be successful such as a completed
g. Predict outcomes of nursing care pre-clinical and I maintain confidentiality by not
h. Evaluate client response to nursing leaving my patient’s chart open unattended and
care ensuring privacy when care is being performed.
i. Critically appraise own practice in - I engage in respectful, collaborative professional
relation to nurse-client/family relationships by working with my peers to help care
interactions and as a member of the for patients and by providing up-to-date reports about
health care team my patient to my clinical instructor and primary
nurse.
- I apply nursing models and theories during each of
my clinical shifts and reflect on them in my post-
clinical write ups. For example, during week two of
clinical I applied the Nightingale’s Environmental
theory to my practice.
- I demonstrate health promotion by providing my
patients with accurate education on their chronic
illness. I practice illness prevention practices by
turning and repositioning my patients every 2 hours to
prevent pressure ulcers from developing.
- I advocate for my patients by bringing concerns they
have to their primary nurse. For example, my patient
expressed to me how they were experiencing a lot of
back pain, so I notified their nurse in order to put the
proper interventions in place to decrease the patient’s
pain.
- During my practice I make time to get to know my
patients and their families, to learn more about their
illness experience, coping strategies and health goals.
- I provide safe care by making sure patient’s beds are
in the lowest position, side rails are up, bed alarms are
turned on if needed, and the call bell is always in
reach. I also do hourly rounds on my patients to see
how they are doing and if there is anything I can get
for them.
- I develop therapeutic relationships with my patients
by spending time with them, being compassionate and
asking them how they are doing. For example, when I
go into a patient’s room in the morning I ask how they
slept the night before.
- I apply nursing theories and frameworks to each of
my patients’ unique illness experiences.
- I participate in reflectivity to continue to work on
improving my patient care.
- I try my best to maintain a clean and organized
environment and always ensure my patients are
comfortable by providing them with what they need
such as water and warm blankets.
- I follow hospital protocol and demonstrate hand
hygiene and infection control precautions.
- I report to the patient’s primary nurse when I notice
abnormalities upon assessment.
- Frequently assess and re-assess patient’s pain after
interventions have been put in place using the PQRST
tool.
- Advocate for my peers to perform certain skills if I
have already had the opportunity to perform them. For
example, my patient had two toe dressings, so I let
one of my peers who had never done a simple
dressing perform one of the dressing changes.
- I am upfront about my clinical abilities and concerns
by frequently reflecting on my practice and seeking
guidance from my clinical instructor and peers.
Melissa is attentive and she is compassionate. She brings a
very positive, calm demeanour to her nursing care. She
always asks the people around her how they are doing, or
how they are feeling and she listens carefully. She
continually provides safe care to her patients by ensuring that
their beds are close to the floor to prevent an injury from fall,
that 2 sides rails are up, that safety features such as bed
alarms and chair alarms are being used effectively, that their
call bell is within reach, and that she rounds on them hourly.
Melissa brings nursing theories and frameworks into her care
in a way that is special to each patient and with constant
refletion, comes up with ways of improving. She treats the
patient as a whole, encompassing their body and mind. She
develops good therapeutic realtionships and spends time with
her patients showing that she cares but knows how to end that
nurse-client relationship in good form at the end of the
clinical week. She keeps their environment organized and
clean and provides them with whatever they may need to
keep them comfortable. She follows hospital protocol and
demonstrates excellent hand hygiene and infection control
precautions.

8. Critically appraise own practice in relation to - The nurse-client/family interactions are a very
nurse-client/family interactions and as a important aspect of nursing, especially when dealing
member of the health care team with chronic illnesses. When I enter my patient’s
room and their family is their I make sure I take the X
time to introduce myself, talk to the family and make
myself available to the family by asking them if they
have any questions about their family member’s
illness.
- I also make a point to ask my patient about their
family/supports and communicate with them to
develop an insight into their family dynamic. For
example, I had the opportunity to meet my patient’s
son, this allowed me to observe how my patient and
her family interact and see the supports she has in
place at home. But it also gave me the chance to hear
about my patient’s condition from another perspective
and listen to some of the family members’ concerns. I
took this opportunity to provide family teaching and
educate the family on the importance of the patient’s
routine.
- I am always friendly towards the staff on C2 and
demonstrating eagerness to learn by asking my
assigned nurse how I can help them or if they have
any skills I could observe or learn during the shift.
- When I am not providing care to my patients I am
answering the call bell or assisting other students and
staff with their care.
- Throughout this placement I feel like I have
developed better relationships with the C2 staff and
peers which has allowed me to provide better care to
my patients.
- When asked by a family member for an update on the
patient I provided them with the information and
knowledge I had and any questions I was unable to
answer I directed towards the primary nurse, whom I
introduced the family to.
- I ensure I uphold confidentiality by only speaking to
people with in the patient’s circle of care about their
condition.
When talking to the staff and patients on C2, and from my
own observation, Melissa is praised for her friendly, genuine,
caring mannerism, reliability and eagerness to learn and help.
If she is not in her patient's room providing care, she is often
answering call bells and helping other nursing students and
staff. She sets a good example for the nursing profession.
Melissa continually reflects on the care that she provides and
the effect that she has on her patients so that she can be more
confident and competent each time she performs care. It is
great to see that Melissa has had the opportunity to involve
patients in their own care, provide teaching about health and
well being to her patients, and to involve family members and
support systems when able to. I look forward to seeing more
opportunity and development of these areas in the last half of
the semester. I encourage Melissa to continue to collaborate
with the nursing staff and other members of the
multidisciplianary team, to build that nursing student - staff
nurse relationship and keep providing the best care possible
for her patients. She has an important role in the health care
team.

9. Participate in professional development based - I participate in professional development based on


on reflective practice and critical inquiry reflective practice and critical inquiry by completing a X
post clinical each week in which I reflect on my
practice and connect it to a nursing theory. This helps
me reflect back on the care I provided throughout my
shift. I identify my strengths and areas of
improvement.
- I participate in critical inquiry by completing
additional research on my patients’ conditions such as
reading their chart in detail, going through medi-tech
to examine lab values and imaging and looking up or
asking others for clarification about aspects I do not
understand.
- I have completed a LEARN, looking back on my
attitudes of chronic care and reflected on how my
attitudes impacted my patient care.
- Each week during our post conference I participate in
discussion and comment on my feelings and
experiences I had on the floor that day.
- I seek feedback from my clinical instructor and peers
to allow myself to become more independent and
confidence in my nursing care.
- I attended an in-service on Medical Assistance in
Dying (MAiD) and participated in reflective practice
by sharing my thoughts and feelings about MAiD
during a group discussion with my clinical group and
a member of the MAiD team.
- During each of my shifts I provide a compressive
head-to-toe assessment on my patients allowing me to
identify my areas of care I need to focus on for each
individual patient.
Each week Melissa actively participates in post conference
discussion and shares her feelings based on her experiences
on the unit with her patients. She turns to her nursing
instructor for feedback and encouragement and takes
suggestions into consideration so that she can be more
proficient, more independent and so that she will believe in
herself more. Melissa's reflective journal was honest and
allowed the opportunity for Melissa to realize that every area
of nursing is important, and that patients dealing with chronic
illness have a lot to overcome.

Areas of Strength Identified by Student

1. Sterile technique and performing sterile procedures such a catheter insertion.

2. Communicating with my patient, peers, clinical instructor and unit staff.

3. Time Management and planning of care throughout the shift.

Areas for Future Development Identified by Student

1. Setting up, programming and administering IV medications.

2. Practice giving more injections and improving injection technique.

3. Develop a wider knowledge base of the medications my patients are receiving.

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

At midterm, Melissa is progressing as expected and is very eager to learn new skills. She comes to clinical with a
very positive and professional attitude and is prepared with the necessary resources to complete new skills with her
clinical instructor. Over the next five weeks, I would like to see Melissa be able to continue to become more confident
and efficient and to manage her time well as she moves from caring for 1 patient to caring for 2 patients. I would also
like to see how she continues to incorporate patients and their families into her care plan and strengthens her
teaching of health and well being in the chronic care setting, building on that essential therapeutic nurse-patient
relationship. I encourage her to continue to research and "put it all together" in terms of what she learns about
chronic illness, what she sees, how her care for patients develops and what she assesses from the condition of these
patients as we move along in this clinical rotation. I feel that this will be achieved as she learns to be more
comfortable and familiar in her surroundings and focuses on her efficiency and competency of skills. Specifically, I
would like to be able to give Melissa more opportunity to practice her sterile dressing technique and her subcutaneous
injections so that she becomes more proficient. As a student, the nurses on the unit appreciate Melissa’s willingness
to go above and beyond what is expected of her, answering call bells, and assisting any patients in need with a kind
and compassionate manner, but always practicing within her scope and informing the most responsible nurse of what
she has done. Melissa is a very valuable asset to her colleagues and her patients.

Clinical Practice Attendance (8 Hours Per Shift)


Thurs Fri Thurs Fri
Week 1 8 8 Week 6 8 8
Week 2 8 8 Week 7 SIM 8
Week 3 SIM 8 Week 8 8 8
Week 4 8 0 -ILL Week 9 SIM 8
Week 5 SIM 8 Week 10 8 8

Total number of clinical practice hours completed: 56/128 Hours

Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory X Unsatisfactory

Clinical Learning Centre

Total number of clinical simulation hours completed 14 / 14 Hours


Total number of lab hours completed 22/ 22 Hours

Clinical Learning Centre Outcome (completed by Course Lead): Satisfactory Unsatisfactory


Signature of Course Lead: Date:

Signature of Clinical Instructor: Date:

Signature of Student: Date: