1.

1) I have applied many concepts from the humanities, sciences and social sciences within

my practice at the Loch Lomand Villa. One of the concepts I have applied to my clinical

rotation from Anatomy and Physiology is blood circulation and how it travels through the

body. One of the resident’s I was caring for has Peripheral Vascular Disease (PVD)

which is a condition that restricts blood flow to and from the heart. My knowledge of

blood circulation was of great help when developing nursing interventions for this

resident. Some of the nursing interventions I developed for this resident was to place legs

in a slight dependence to promote arterial flow, information that I derived from Anatomy

and Physiology. Another intervention was promoting active and passive range of motion

exercises as this helps to prevent venous stasis and further circulatory compromise.

In intro to psychology I learned about mental illnesses and why people with these

illnesses behave the way they do. This provided aid in my clinical rotation when caring

for a resident with bipolar disorder. My intro to psychology class gave me insight on

some of the behaviors he/she was displaying such as mood swings, anxiety, symptoms of

depression and irritability.

1.3)

I have applied many concepts from nursing, social sciences, and growth and

development, to promote health and wellness. One of the main concepts I have used is

applying my knowledge of communication with a client that has dementia to my practice

that I derived from NURS 1032. I applied my knowledge by talking to the resident in a
 slow, calm tone and using simple language that was familiar to the resident. I gave clear,

simple directions one at a time using a step-by-step approach. If the resident became

confused I gave gentle redirection and modified my language until the resident

understood what was being asked of him/her. If the resident's attention lapsed I would

supply a brief moment of rest before trying to regain the client’s attention. I have applied

the concept of touch as a form of communication in my practice. I have found that touch

can be a very useful form of communication and the residents I have cared for have

responded well to touch. I have found it eases anxiety and provides comfort for the

patient when they cannot communicate with you. I have also applied the skills I have

learned in the lab component of NURS 1235 to my clinical practice. These skills include

bed bathing, vital signs, Back in Form, ROM/position, mobility aids, bowel elimination

and urinary elimination.

2.2) I have applied this concept by educating the resident I was caring for on the importance

of range of motion exercises to prevent contractures. I encouraged the client to perform

active-assistive range of motion exercises on the client’s weaker arm which the client

does not move often. I then educated the client on the importance of these exercises to

prevent contractures and explained what a contracture was. Another example of applying

this concept is educating a resident I was caring for on the importance of turning every 2

hours to prevent the formation of pressure ulcers in this resident’s coccyx area. With

every resident I have cared for, I incorporated health education into the resident’s care by

having them engage in ADLs. I instructed the residents to wash their hands and face as

well as perform ADLs to their utmost capability. This helps the resident maintain

autonomy and physical function.

2.3) I have developed many different communication skills and techniques throughout my

clinical rotation. I have developed these skills through various challenging clinical situations. I

had many residents refuse care. I used negotiation to encourage the client to receive care. With

residents with dementia I altered my approach due to he/she’s cognitive decline. This includes

talking to the resident in a slow, calm tone and using simple language that was familiar to the

resident. I gave clear, simple directions one at a time using a step-by-step approach. If the

resident became confused I gave gentle redirection and modified my language until the resident

understood what was being asked of him/her.

I developed many culturally appropriate communication techniques throughout my clinical

rotation. I did this by reading the residents background/likes/dislikes sheet above the bed. This

aids in developing an understanding of this resident’s own culture. Knowing the clients

background and likes and dislikes can give you a better approach when communicating with this

client. Discussing a topic relevant to the resident’s culture can encourage a resident with a

cognitive decline to communicate more.

2.4)

I have demonstrated this concept by checking in with the RA or LPN that is assigned to my

resident on my clinical shift before going on break and giving updates on the resident when

needed. I am eager to watch/help with the care of a client when the task is beyond my scope of

practice. I have also demonstrated this by asking relevant questions when needed about the

resident I am caring for related to their care plans and preferences. I work effectively and

cohesively with my peers to give the best quality of care and provide care that cannot usually be

done due to lack of time and resources such as ambulating with a client. I provide assistance to
my fellow student nurses often and give report to them following my assistance. I regularly

check with my instructor for feedback and ask for help when needed. This feedback has aided

myself in developing adequate care plans for my resident each week.

3.2) Before each clinical shift the student nurses are given a resident assignment typically

consisting of 2 residents. It is my responsibility to educate myself on the client before the clinical

shift and provide an up to date care plan for the resident. This is done by relating the resident’s

information to a nursing diagnosis. I do this by applying critical thinking skills when formulating

a nursing diagnosis. For example, I noticed my resident had very little mobility and remained in

the same position for most of the day. I determined this resident was at risk for impaired skin

integrity due to her low mobility and lack of repositioning throughout the day. I encouraged the

resident to ambulate and the resident complied. This provided the resident with a relief of

pressure from the coccyx area and aided in maintaining the resident’s mobility.

3.3) I made the decision with the clinical instructor to document a finding of white sediment in a

resident's urine in the resident's care plan. The decision was made based on the resident's history

of UTIs, the presence of foul odor, white sediment, and dark yellow colour of urine. I made a

draft copy of the assessment and the clinical instructor reviewed it before I documented the

assessment in the resident's care plan. Finally, I, as well as the instructor signed off on the

documentation. I also made the decision to position client in the prone position to relieve

pressure off back to prevent pressure ulcers. Client expressed that he/she felt relief from pressure

and reddened area on lower back had disappeared. I made the decision to perform AM care on

client in bed to ease resident’s anxiety related to he/she’s bipolar and anxiety disorder. This
 resident expressed anxiety when ambulating, so to avoid increasing the he/she’s anxiety I made

the decision to perform AM care with the resident in bed. This helped to ease some of this

resident’s anxiety.

3.4)

 I have knowledge of the nursing process - assessment, planning, caring, and evaluation.
 I have knowledge of anatomy and physiology, and the normal structure and functions of the
human body.
 I use critical thinking, professional judgment and reasoned decision-making to develop care
plans.
 I apply knowledge consistently when providing care for physiological needs to prevent
development of complications.
 I apply critical thinking and clinical judgment in maintaining a client's physical safety.
 I establish and maintain a caring environment that helps clients achieve health outcomes.
 I establish and maintain appropriate professional boundaries with clients and other team
members.
 I have the ability to receive constructive feedback from health care worker and my clinical
instructor
 I respect the confidentiality of all health information and especially the client's personal and
health data.
 I know my scope of practice and abide by it.

I complete a self-assessment following every clinical shift. This helps to focus on what skills I
have performed in the hours of my clinical shift and what I need to improve on for my next shift.
Self-assessment is an integral part of learning and improving. During one of my clinical shifts I
improved upon my care plan following self-reflection. Upon caring for my resident and
developing an understand of his/hers needs I revised this residents care plan to include risk for
impaired skin integrity due to his/hers increasing decline in mobility and lack of repositioning
throughout the day. I implemented several nursing interventions to maintain skin integrity, these
include repositioning the client every 2 hours, applying the resident’s protective ointment to the
coccyx area PRN, and inspect the skin for redness and breakdown with special attention to the
resident’s bony prominences. These interventions were successful in maintaining intact skin.

I have developed an understanding of the Standards of Practice for Registered Nurse from the

NANB. For example, I perform care for residents only within my scope of practice. This is

evidenced by informing the staff at the Loch Lomond Villa that applying a medicated ointment is

beyond my scope of practice when asked to do so. I maintain resident’s privacy and

confidentiality during each of my clinical shifts. This is evidenced by making sure the curtain is
pulled in the resident’s room before performing any care. I maintain the resident’s confidentiality

by omitting any biographical information from my care plans and shredding all documents with

biographical data before leaving the clinical setting. Finally, I advocate for the resident’s I care

for. This is evidenced by being persistent with staff when their assistance is needed for the care

of the resident e.g. ceiling lift. I make sure the resident is not made to hold his/her bladder for

long periods of time as this compromise the residents health.

I have used self-reflection to develop a professional identity throughout my clinical shifts. I have

reflected upon my strengths and weaknesses as a student nurse and continue to develop critical

thinking skills that aid in my practice. My attitude throughout my clinical experience has

developed greatly and I now have a better appreciation for the elderly through my experience

working at a long-term care facility. I have a better understanding of dementia and its effect on

the human’s cognitive function. I have also learnt to change my communication strategy while

caring for a resident with dementia. This has helped me care for the resident more effectively and

has helped with easing the confusion that comes with ADLs for these residents.

I have developed an awareness of my learning style, which I have identified as visual learning.

When learning in clinical I seek to watch my clinical instructor or a staff member to perform the

skill before I attempt. This helps me visualize how I will perform the skill. This also maintains

the resident’s safety by assuring I am well educated on how to conduct the skill.

I assume responsibility for my own learning by taking the vitals of residents when needed. This

is evidenced by my last clinical shift where I took the vitals of 4 residents. This increased my
confidence in performing this skill. I also assume responsibility for my own learning by taking

the initiative to assist with and observe any procedures that are beyond my scope of practice. I

believe I have learned a great deal from the staff and my clinical instructor during my clinical

experience.

I have demonstrated the understanding of the Nursing Student Handbook’s guidelines and

policies in relation to my student nursing practice. I adhere to the dress code and arrive to clinical

on time for every shift. I have arrived to clinical unprepared (without my care plan), in the future

I plan to make sure to prepare myself adequately for my clinical shift the night before. I practice

within my scope while in clinical and provide safe, comprehensive care to the residents of the

LLV. I make sure to adhere to the lift policy of the LLV and make sure 2 staff operate the lift. I

adhere to the confidentiality policy of this establishment by omitting any biographical

information from my care plans and shredding all documents with biographical data before

leaving the clinical setting as mentioned before.

I have related social justice to my care of residents at the LLV. This is evidenced by my

advocacy for the resident’s right to the best possible care. With limited time and resources many

residents are not given the opportunity to ambulate. A resident I was caring for benefits from

ambulating daily, this resident has a goal that consists of him/her being able to ambulate as far as

it would take to get to a car. This resident expresses hope for being able to ambulate this far so

he/she could go for a drive. We as student nurses have more time throughout the shift to provide

more comprehensive care to the residents we are assigned, this includes ambulating a client.

Another example of relating my practice to social justice is a situation in which a resident

expressed the need to empty his/her bladder. This resident was left for 20 to 30 minutes due to
lack of staff available to operate the ceiling lift. This poses health risks for this resident such as a

UTI. I advocated for my resident and was persistent with finding staff available to help. When

staff was available to lift the resident he/she was told that he/she could not attend an activity

anymore as the lift would take too much time. The resident then expressed that he/she did not

have to urinate anymore and refused to be toileted. This could have been avoided if more staff

had been available to help the resident, as he/she would not have had to wait 20-30 minutes and

could have both been toileted and taken to the activity. I have provided advocacy for my client

many times throughout my clinical experience and have found it is needed a great deal in

establishments that lack the necessary staff and resources to provide the best possible care.

Upon completing my final self-reflection following my last clinical shift (March 30th, 2017) I feel I have
improved upon many physical skills (bed bathing, suppository, vital signs etc.) as well as mental skills
(critical thinking, motivation, self-assessment etc.) and have developed a new outlook on working with the
elderly and residents with dementia. I have achieved my learning goal of improving my competence in my
ability to establish therapeutic relationships with residents. I have done so by becoming familiar with the
resident's background, likes and dislikes, goals, illnesses and finally the resident themselves. Doing so
has aided in developing a trusting, safe nurse-client relationship. I have identified many strengths in my
performance within my clinical experience. These include critical thinking; my instructor has told me
multiple times I have strong critical thinking skills. I have also developed strong self-reflection skills that
have helped me improve my clinical performance. I have identified my weaknesses throughout clinical as
well, these include remembering to incorporate body mechanics into my care, coming unprepared, and
not seeking feedback as frequently as needed.