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NURS 3021H Clinical Practice Focused on Chronic Disease Management

Final Evaluation

Student: Alicia Jeffery

Clinical Instructor: Wendy Symons

Clinical Placement Hospital: PRHC Unit: D2

Date: Mar. 24, 2018

Missed Clinical Hours: 8 Missed CLC Lab Hours: 0


NURS 3021H Clinical Practice Mid-Term Evaluation
Program Goals 3000 Level Outcomes
Students graduating from this program will be: On completion of 3000 level courses students will be
able to:
1. Prepared as generalists entering a self-regulating Fully understand how to practice in a self-regulating
profession in situations of health and illness. 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.
2. Prepared to work with people of all ages and genders Understand the complexity adults, of all genders, to achieve
(individuals, families, groups, communities and optimal health.
populations) in a variety of settings.
3. Expected to have an enhanced knowledge of the program Use a critical perspective in applying the foci to nursing
foci: indigenous, women's and environmental health and knowledge and practice.
aging and rural populations.
4. Prepared to learn to continuously use critical and scientific Integrate critical reflective evidence-informed care using
inquiry and other ways of knowing to develop and apply multiple ways of knowing.
nursing knowledge in their practice.
5. Prepared to demonstrate leadership in professional nursing Develop and embody leadership at the point of care.
practice in diverse health care contexts. Expand awareness of leadership in nursing.
Identify strategies to develop leadership potential.
6. Prepared to contribute to a culture of safety by Anticipate, identify and manage risk situations.
demonstrating safety in their own practice, and by Demonstrate awareness of resources related to risk
identifying, and mitigating risk for patients and other management.
health care providers
7. Able to establish and maintain therapeutic, caring and Engages in deliberative personal centred relational practice to
culturally safe relationships with clients and health care assist individuals, families and communities to achieve health.
team members based upon relational boundaries and Acknowledge own potential to contribute to effective
respect. collaborative team function.
8. Able to enact advocacy in their work based on the Advocate for individuals, families, and communities
philosophy of social justice. recognizing the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.
9. Able to effectively utilize communications and Integrates and applies critical thinking to the use of
informational technologies to improve client outcomes. information technology and dissemination strategies as related
to clinical outcomes.
10. Prepared to provide nursing care that includes Critically assess the individuals, family and community health
comprehensive, collaborative assessment, evidence- status.
informed interventions and outcome measures. Collaborate to identify priority health needs.
Identify evidence informed interventions and health outcome
evaluation in complex care situations.
Before completing the evaluation form, students and preceptors should review the objectives and sub-objectives. While
students and preceptors should comment on each of the seven course objectives, it is not necessary to write comments about
each sub-objective. It is better to provide specific and detailed comments about a few sub-objectives than to write broadly
about many.

Each objective should be awarded one of the following ratings:

Midterm:
Satisfactory Progress (SP): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve
the objective with an average level of teaching support and guidance; or the level of performance is what the instructor would
expect of an average student at that level and point in time; and the instructor reasonably anticipates that if the student
continues at the current pace of practice and achievement, the student should be able to fully meet the objective at the end
of the course.

Needs Development(ND): The student demonstrates sufficient knowledge and ability to safely practice or achieve the
objective, but requires more than average teaching support and guidance; or the student demonstrates knowledge but needs
more practice to achieve the competency; or the level of performance is below what the instructor would expect of the
average student at that level and point in time; and the instructor reasonably anticipates that if the student focuses his/her
learning in the required area, and gains sufficient practice, the student has the potential to meet the objective at the end of
the course.

Unsatisfactory Progress (UP): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or
achieve the objective, even with constant, intensive teaching support and guidance; or the level of performance is far below
what the instructor would expect of the average student at that level and point in time; and the instructor reasonably
anticipates that if the student continues at the current pace of practice and achievement, the student is not likely to meet the
objective at the end of the course.
Final:
Satisfactory (S): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve the
objective with an average level of teaching support and guidance; or the level of performance is what the instructor would
expect of an average student at that level.

Unsatisfactory (U): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or achieve
expected objectives, even with constant or intensive teaching support and guidance; or the level of performance is far below
what the instructor would expect of the average student at that level.
NURS 3021H Clinical Practice Evaluation

Progress
Course Objective Evidence/Indicators SP/S ND UP/U
1. Demonstrate accountability and responsibility in the - I always complete my assignments on time
teaching-learning relationship. - I am always early for my shift, labs and
SIM and always in uniform with my
identification badge
- I am always prepared with the necessary
knowledge
- Made adjustments to the way I did my
pre-clinicals as suggested by my clinical
instructor
- Discovered error in labelling of bowel
movement sheet and reported it to clinical
instructor and charge nurse
- Alerted clinical instructor and course
instructor in advance of having to miss a
shift
- Completed extra work to make up for
missed clinical shift
- Completed and passed my post-clinical
presentation
2. Explain the experience of chronic illness in individuals - Interacted with a patient and his visitors
receiving care in chronic care settings the day before he was going for MAiD
- Was empathetic with a patient with ALS
who was unable to talk. Used
communication board and iPad for
communicating with this patient.
Successfully built a therapeutic
relationship and patient showed
appreciation
- Supported a patient and the wife of a
patient after they were told that the
patient would likely never return home. I
experienced their suffering during this
difficult transition
- I have supported a family of an
unconscious patient and listened to their
experience of this event
3. Interpret critical aspects of the person’s experience of - I have listened to patients who have said
chronic illness in relation to the nursing process such as they are ready to die. I was able to talk
common signs and symptoms, responses to treatment, with these patients comfortably about this
patterns of coping, and impact on individual and family and acknowledged their feelings
relationships. - I have interacted with many family
members throughout this placement and I
have tried to find answers to each of their
questions. I understood how the illness of
their family member could be affecting
them and I supported them during this
process.
- Assessed pain before and after
administration of pain medications
- I have experienced and witnessed the
grieving of a family who experienced a
death
4. Identify symptoms and common medical treatments of - Used information gathered for clinical
selected chronic illness. presentation to identify symptoms in a
patient with ALS
- Developed a care plan for patient with ALS
and a patient with pneumonia
- Continued to complete pre- and post-
clinicals each week, ensuring to research
and fully understand each diagnosis,
associated signs and symptoms and two
possible medical treatments/diagnostics
for the diagnosis. I was able to progress to
caring for two patients.
- I identified what each medication was for
before administering it
5. Demonstrate select nursing and collaborative interventions - Inserted another subq line
related to caring for the person with chronic illness such as - Prepared and administered medications
specific assessments, medication administration, physical through subq line
and chemical restraints, enteral feeding & residual - Discontinued a subq line
volumes, NG tube insertions, wound care, patient - Started an enteral feed
controlled medication administration pumps. - Titrated supplemental O2 based on
physician’s order
- Completed an admission assessment on a
patient. Obtained nasal and rectal swabs
to test for VRE and MRSA.
- Completed all skills in lab correctly
- When patients had dressings, I assessed
them periodically throughout the shift to
ensure they were dry and intact
- Completed a bladder scan on a patient
with suspected urinary retention
- Completed post-mortem care including
removing a foley catheter
6. Identify potential consequences/complications of select - I noticed that a patient had a sudden
chronic illnesses and related interventions. change in mental status and had started
to be very confused and disoriented. I was
able to get help from the nurse to look up
his history and I assessed the patient to try
to identify what could have caused this
change in mental status. We discovered
the patient had a history of dementia and
that the infection he had may have caused
this. We ensured the patient’s safety by
putting on bed alarms, ensuring his things
were within reach and continued to
monitor him. We reported this change to
the night nurse.
- During one shift, a patient was asking me
about her prognosis and her future plans.
She was not getting treatment for a small
bowel obstruction (SBO) and was
switching to comfort care. She was asking
about the pathophysiology of what
happens when you do not treat the SBO. I
had some idea of what happened but
since we were never taught what happens
when you do not treat this condition, I
asked a nurse for help explaining it to the
patient.
- On this palliative floor, the care for some
patients switches from trying to cure the
disease, to symptom management and
comfort care. I provided support and care
for patients in ways that would make
them more comfortable, such as providing
warm blankets, repositioning and
administering anti-anxiety medications
and analgesics
7. Under the supervision of a Registered Nurse, demonstrate - I continued to apply a nursing theory to
safe, competent, evidence-informed, holistic nursing my clinical shifts each time I write my
practice with clients with chronic illness post-clinical
a. Use a wide range of effective communication - I continued to always wash my hands and
strategies and interpersonal skills to appropriately don and doff PPE correctly to prevent the
establish, maintain, re-establish and terminate the transmission of illnesses
nurse-client relationship - Used communication board and iPad to
b. Demonstrate accountable, responsible and ethical
communicate with a nonverbal patient
practice
- Built a therapeutic relationship with a
c. Engage in respectful, collaborative, therapeutic
and professional relationships client. The client began to laugh, share
i. Demonstrate therapeutic use of self more information and reached out to hold
ii. Create a culturally safe environment my hand. I evaluated this response as
d. Apply nursing models and theories being positive.
e. Demonstrate health promotion and illness - I encouraged all patients to do as much
prevention practices care for themselves as they could. This
f. Demonstrate patient advocacy ensures that patients are maintaining their
g. Predict outcomes of nursing care independence while also ensuring they
h. Evaluate client response to nursing care receive the care they need
i. Critically appraise own practice in relation to - I encouraged patients to eat and to
nurse-client/family interactions and as a member ambulate as I know this is important for
of the health care team illness prevention and health promotion
- I watched and helped a nurse call Trillium
Gift of Life about organ donation after a
patient’s death
8. Critically appraise own practice in relation to nurse- - I continued to collaborate with my peers
client/family interactions and as a member of the health and the staff on the floor. I am constantly
care team asking others for help and asking if there is
anything I can do to help them.
- I asked a nurse for help talking to a patient
when I did not know the answers to the
questions the patient was asking about
her prognosis. I listened and observed
carefully as the nurse was talking with the
patient to improve my relational skills
- When I am asked to perform a skill I have
already performed, I let one of my peers
perform the skill if they have not done it
before. I think this is only fair and
respectful. If everyone has already done it,
then I take the opportunity and perform it.
9. Participate in professional development based on - I have completed another reflection. This
reflective practice and critical inquiry enabled me to examine my actions and
feelings and find ways to improve my
practice
- Attended an in service about a new
product that was starting to be used on
the unit
- I identified that I needed to work on my
assessment of lung sounds. I set this goal
and each clinical shift I listened to my
patient’s lungs and tried to identify the
lung sounds I was hearing. I asked my
clinical instructor for help with this skill.
- I have completed 2 reflections this
semester
- Added all assignments and reflections
from this clinical placement to my
portfolio.
- I have identified two goals for my pre-
consolidation placement and I added
these goals to my portfolio
- Received an email from a lab instructor
indicating that she was impressed with my
performance in SIM the previous week
and that she has noticed my progression
and hard work since my first year in the
program

Areas of Strength Identified by Student

1. Documentation

2. Willingness to help others

3. Active listening skills

Areas for Future Development Identified by Student

1. Respiratory assessment

2. Confidence in abilities

3. Reviewing skills in preparation for fourth year clinical placements (such as catheter insertion, IV medication
administration, subcutaneous lines) for fourth year

Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment)
Clinical Practice Attendance (8 Hours Per Shift)

Thurs Fri Thurs Fri


Week 1 8 8 Week 6 8 8
Week 2 8 SIM Week 7 8 SIM
Week 3 8 8 Week 8 8 0
Week 4 8 8 Week 9 8 SIM
Week 5 8 SIM Week 10 8 8

Total number of clinical practice hours completed: 120 /128 Hours

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