NURS 3021H Clinical Pracce Focused on Chronic Disease Management – Fall 2022

Mid-Term Evaluaon Final Evaluaon

Student: Naomi Su

Clinical Instructor: Laura Gallinger

Clinical Placement Hospital: PRHC Unit: C2

Date: 12-Oct-22

Missed Clinical Hours: 0 Missed CLC Lab Hours: 0

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

Each objecve should be awarded one of the following rangs:

Midterm:
Sasfactory Progress (SP): The student consistently demonstrates su"cient knowledge, and skill and ability to safely pracce or
achieve the objecve 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 me; and the instructor reasonably ancipates that if the student
connues at the current pace of pracce and achievement, the student should be able to fully meet the objecve at the end of
the course.

Needs Development(ND): The student demonstrates su"cient knowledge and ability to safely pracce or achieve the objecve,
but requires more teaching support and guidance; or the student demonstrates knowledge but needs more pracce 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 me; and the instructor reasonably ancipates that if the student focuses his/her learning in the required area, and
gains su"cient pracce, the student has the potenal to meet the objecve at the end of the course.

Unsasfactory Progress (UP): The student does not consistently demonstrate su"cient knowledge, or skill, or ability to safely
pracce or achieve the objecve, 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 me; and the instructor reasonably
ancipates that if the student connues at the current pace of pracce and achievement, the student is not likely to meet the
objecve at the end of the course.

Final:
Sasfactory (S): The student consistently demonstrates su"cient knowledge, and skill and ability to safely pracce or achieve
the objecve 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.

Unsasfactory (U): The student does not consistently demonstrate su"cient knowledge, or skill, or ability to safely pracce or
achieve expected objecves, 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 Pracce Evaluaon

Progress
Course Objecve Evidence/Indicators Evidence/Indicators
MIDTERM FINAL
1. Demonstrate accountability and responsibility in Student: Student:
the teaching-learning relationship.  Charng on EPIC – I thoroughly
complete .owsheets for vital
Progress Midterm Progress Final signs, head to toe assessment,
and daily care for all my paents. I
 SP  S chart throughout the day if I
 ND  U toilet, provide care, take vitals, or
 UP Clinical Instructor:
anything needs to be noted.
 Med administraon – I’ve had to
opportunity to administer
medicaons twice now. To
prepare for medicaon
administraon, I make drug cards
for the medicaon I will be giving
to my paents. I familiarize myself
with the details of the
medicaons such as indicaons,
side e2ects, etc. I also check
parameters on the MAR in the
case I should hold medicaons.
 Nurse-student relaonship – I
introduce myself to my nurse(s)
and idenfy my tasks for the day.
I report to them if there are any
concerns with my paent. I let
them know where I will be if they
need me and o2er my help when
I am free.

Clinical Instructor:
2. Explain the experience of chronic illness in Student: Student:
individuals receiving care in chronic care settings  Hopeless – While I’m with my
paents, I like to build a
Progress Midterm Progress Final relaonship with them that goes
beyond compleng nursing tasks.
 SP  S I like to ask them about their life,
 ND  U the hospital experience, home,
 UP and their family. A common Clinical Instructor:
theme that I have seen in
individuals living with chronic
illnesses and staying at the
hospital long term for care and
recovery is hopelessness. A lot of
paents feel hopeless because
there is no discharge date in sight,
and all they want to do is go
home. It is important to
acknowledge this as a nurse, and
share with them their progress,
encourage them during physio,
and involve them in care
planning.
 Home – A few of my paents are
long-term residents of C2 and will
remain in a chronic care se:ng
for the rest of their life. I realized
this and tried to make them feel
more at home. I would talk to
them about beyond healthcare, I
would st bump my paent that
rolls around the halls, and I would
joke around with my paents to
make them laugh.
 Ostomy bag – One of my nurse’s
 paents has an ostomy bag which
they empty and clean themselves.
It was very rewarding to watch
them do this and get more insight
into the chronic care experience
for paents. I also got to help my
nurse with changing the bag, and
that was very interesng to see.

Clinical Instructor:

3. Interpret critical aspects of the person’s Student: Student:

experience of chronic illness in relation to the  Head to Toe Assessment – I’ve
nursing process such as common signs and conducted head to toe
symptoms, responses to treatment, patterns of assessments on all of my paents.
coping, and impact on individual and family Through these assessments I am
relationships. able to get a baseline for the day.
Progress Midterm Progress Final These assessments give me a
beer understanding of the Clinical Instructor:
 SP  S paent’s disease/injury and its
 ND  U
progression.
 UP
 Purposeful rounding – Even when
I am done all my tasks for the day,
I ensure that in between call bell
answering and charng, I
complete purposeful rounding.
Purposeful rounding and checking
on my paent a<er an
intervenon – medicaon,
reposioning – lets me see if
there is a therapeuc e2ect taking
place.
 Family involvement in care – one
of my paent’s mother comes to
visit almost every other day. The
sta2 have really goen to know
 her, and I got to meet her as well.
It is eye opening to see the e2ect
a chronic condion has on not
only the paent but the family.
And it is important to involve the
family as a support system in the
care process as well. When I
would do purposeful rounding, I
always made sure to check in with
my paent’s mom and see if she
needed anything.

Clinical Instructor:

4. Identify symptoms and common medical Student: Student:

treatments of selected chronic illness.  Tracheostomy Care – One of my
paents has a trach, and I am
Progress Midterm Progress Final responsible to complete trach
care daily. It is important to keep
 SP  S trach tubes clean in order to
 ND  U prevent infecons, mucus plugs,
 UP and breathing problems. Trach Clinical Instructor:
care involved changing the inner
cannula, gauze pad, cleaning the
trach site, and the Op .ow Airvo.
 Pneumonia oxygen therapy – My
paent was admied for
pneumonia and as a result has
oxygen therapy PRN via nasal
prongs. As per my nurse, I had to
adjust the amount of liters based
on my paent’s oxygen
saturaon.
 Diabetes – A couple of my
paents are diabecs and require
blood glucose tesng QID. I got to
 watch my nurses do this task, and
based on the sliding scale, I got to
administer the insulin.

Clinical Instructor:

5. Demonstrate select nursing and collaborative Student: Student:

interventions related to caring for the person with  G-Tube medicaon – I got to
chronic illness such as specific assessments, administer medicaons via g-tube
medication administration, physical and chemical and this was a really good
restraints, enteral feeding & residual volumes, learning experience as I’ve only
NG tube insertions, wound care, patient- administered PO meds in the
controlled medication administration pumps.
past. I had to pull the meds from
the ADU, double check it on the Clinical Instructor:
Progress Midterm Progress Final MAR, scan my paent and the
drugs, ensure of paent
 SP  S iden ers, rights of drug
 ND  U
administraon, and prepare the
 UP
medicaon. I was working with
both tablets and liquid
medicaon. I had to .ush the G-
tube with a turbulent .ow,
administer my meds, and .ush
again.
 Wound care – I was able to
partake in wound care for a
vascular wound to the lower
extremies for one paent. As
this was a sterile procedure, I
pracced asepc technique just
as I did in lab, and it was great to
pracce my skills in real life. My
paent did not experience any
pain when I did the dressings.
 IV inseron – I got to help my
clinical instructor out with an IV
 inseron. I got to prime the line
and prepare all the supplies she
needed. I also got to .ush the IV,
spike NS and run it with the help
of my clinical instructor.

Clinical Instructor:

6. Identify potential consequences/complications of Student: Student:

select chronic illnesses and related interventions.  Mucus plug – my paent with a
trach’s O2 saturaon kept
Progress Midterm Progress Final dropping down to 85% and with
suconing, their oxygen
 SP  S saturaon would not stabilize.
 ND  U Eventually RT was paged, and
 UP they came to the rescue. I had the Clinical Instructor:
opportunity to watch them work.
A series of methods were used to
dispel the mucus plug. The
paent’s oxygen therapy was
turned up to 100%, in order to get
more oxygen into the paent. RT
inslled their trach with NS
because the NS breaks up the
chemical bonds in mucus, which
will make it easier to sucon. As
well, RT used an Ambu bag in
order to create posive pressure
to encourage the paent to cough
up the mucus plugs. It was very
interesng and educaonal to
watch, and I also got to ask RT
quesons a<erwards about the
whole process.
 Pain – one of my paents
experiences a lot of pain before

7. Under the supervision of a Registered Nurse,
demonstrate safe, competent, evidence-
informed, holistic nursing practice with clients
with chronic illness
a. Use a wide range of effective
communication strategies and
interpersonal skills to appropriately
establish, maintain, re-establish and
terminate the nurse-client relationship
b. Demonstrate accountable, responsible
physiotherapy sessions. As an
intervenon, my nurse and I
administered a PRN analgesic 30
minutes before their
physiotherapy session in order to
reduce the pain they might
experience.
 Pressure wounds and sores – One
of the complicaons that result
from having a chronic illness that
might leave a paent bed bound
or unable to reposion
themselves is pressure wounds
and sores. From being on the unit,
I’ve learned a lot about the
importance of skin integrity.
Intervenons I’ve done during my
clinical placements have been
reposioning Q2hrs, applying
barrier cream, straightening out
bed sheets and hospital gowns,
using pillows and moonboots to
elevate and separate bony
prominences.
Clinical Instructor:
Student: Student:
 Culturally safe care – One of my
paents is Indigenous, and their
culture is an important part of
their self-identy. I provided
culturally competent care by
being aware of the history behind
the discriminaon o<en faced by Clinical Instructor:
Indigenous people in a healthcare
 and ethical practice se:ng. It was very important for
c. Engage in respectful, collaborative, me to acknowledge this and
therapeutic and professional respect my paent’s culture. I
relationships o<en listened to what my paent
i. Demonstrate therapeutic use of had to say, learned a lot about
self their culture, and explained
ii. Create a culturally safe everything I was doing.
environment
 Shower – Physiotherapy makes
d. Apply nursing models and theories
e. Demonstrate health promotion and my paent very red and sweaty.
illness prevention practices A<er their physiotherapy
f. Demonstrate patient advocacy sessions, I o2ered and gave my
g. Predict outcomes of nursing care paent a nice hot shower. Since
h. Evaluate client response to nursing care nurses can get very busy, my
i. Critically appraise own practice in paent had only received 3
relation to nurse-client/family showers in the last 5 months
interactions and as a member of the since being in the hospital. It felt
health care team nice to do something special,
even something simple like a
Progress Midterm Progress Final shower, for my paent. The next
day, my paent said they slept
 SP  S through the night, had the best
 ND  U sleep in the hospital they’ve had
 UP so far, and it was because of the
hot shower. It feels rewarding to
know that I am making a
di2erence in my paents lives.
 Head to toe – One of my paents
in nonverbal and deaf, so I was
very nervous to do a head to toe
assessment on them as I wasn’t
sure how I was going to
communicate with them. Through
the use of pen and paper,
showing the paent what I was
doing – ex. showing them my
stethoscope – and my very
 limited knowledge of ASL, I was
able to conduct a head-to-toe
assessment. This was a great
experience because I won’t
always have paents that are
Ox3, cognively intact, able to
communicate, so it is important
to be able to adapt and change
your methods around to bene t
the paent.

Clinical Instructor:

8. Critically appraise own practice in relation to Student: Student:

nurse-client/family interactions and as a member  Answering call bells – I made an
of the health care team e2ort to answer call bells, even
call bells that weren’t for my
paent. By helping around the
unit, I was able to interact with
di2erent paents, meet new
Progress Midterm Progress Final people, and feel like I was apart of Clinical Instructor:
the health care team.
 SP  S  Helping my nurse – When the unit
 ND  U was short sta2ed, my nurse had a
 UP 5 paent load. To help her out, I
obtained the vital signs for all of
her other paents, not just mines.
My nurses and I bond well
because of communicaon and
team work. This e2ort made me
feel like a part of the healthcare
team.
 Purposeful rounding – A<er
compleng all my tasks, I did
purposeful rounding to ensure my
 paents were safe, comfortable,
and didn’t need anything. By
doing this I got to interact with
my paents more, talk to them,
get to know them and by the end
of the week we had a great
nurse/paent relaonship.

Clinical Instructor:

9. Participate in professional development based Student: Student:

on reflective practice and critical inquiry  Debriefs a<er clinical – at the end
of the clinical day, we would do
Progress Midterm Progress Final debriefs as a group and discuss
our highs and learning
 SP  S opportunies for the shi<. This
 ND  U was a great way to re.ect on the
 UP events of the day, what I enjoyed, Clinical Instructor:
and what I need to improve on. I
will take this informaon and
apply it in my future pracce to
be a beer nurse.
 Self-re.econ – At the end of
clinical, on my own me, I would
re.ect on my day. I would write
down and think about everything
I did that day, what went well,
what I could’ve done di2erently,
and what my goals are. By doing
this, I get to be really honest with
myself, learn more about myself
as a person, student, and a future
nurse, and I can use this in my
future pracce.
 SILO assignment – One of the
assignments I completed was the
 Self-Iden ed Learning
Opportunies. Here, I got to list
my strengths, weaknesses, goals,
and intervenons to reach these
goals with my clinical instructor.
This assignment required
re.econ on my learning
opportunies for the semester.

Clinical Instructor:

This secon to be lled out by the Student Areas of Strength Student Areas of Strength
student.
1. Self Con dence 1.

2. Re.ecve 2.

3. Taking Iniave 3.

Student Areas for Future Student Areas for Future

Development Development

1. Time Management 1.
- Waking up earlier
- Preparing supplies the night 2.
before
- Organizing me using a 3.
planner
2. Thinking about other’s opinions
- Remember that I am here for
my own learning
- Being con dent in what I
know
 3. Working with paents of
varying levels
- Increasing exposure to other
paents with varying
physical and cognive levels

Clinical Instructor Summave Comments:

Naomi is progressing very well at midterm. Naomi has great PSW experience that is evident as she cares for her patients during clinical.
Naomi is very attentive to her patient’s needs; she answers call bells and always follows through on her care. Naomi demonstrates her
leadership abilities by regularly assisting her fellow group members when providing personal care for patients and prioritizing care.
Naomi is professional, punctual, intuitive and engaged. Naomi takes initiative at clinical by answering call bells, volunteering for new skills
and asking questions as needed. Naomi always creates therapeutic relationships with her patients and their loved ones. Naomi brings a self-
made head to toe assessment form to ensure she doesn't miss systems in her assessment. In week 3, I had the privilege of observing Naomi's
head to toe assessment on her patient who was deaf. She did a fantastic job performing her assessment including the patient every step of the
way. It was truly heartwarming to witness.
As we progress through the rest of the semester, I encourage Naomi to continue working on her time management skills. I see Naomi easily
transitioning into a knowledgeable RN ready for practice. I wish her well as she progresses in her studies. Keep up the excellent work,
Naomi!
Clinical Pracce A4endance (8 Hours Per Shi6)

Shi6 1 Shi6 2
Week 1 8 8
Week 2 8 8
Week 3 8 8
Week 4 8 8

Total number of clinical pracce hours absent: 0

Clinical Pracce Outcome (completed by Clinical Instructor): Sasfactory Unsasfactory

Clinical Learning Centre

Total number of clinical simulaons completed 3 / 3

Total number of labs completed 3 / 3

Clinical Learning Centre Outcome (completed by Course Lead): Sasfactory Unsasfactory

Signature of Course Lead: __________________________________Date:      

November 5, 2022
Signature of Clinical Instructor: __________________________________Date:      

Signature of Student: ______________________________________Date: 10/21/22