NURS 3021H Clinical Practice Focused on Chronic Disease Management – Fall 2023

Mid-Term Evaluation X Final Evaluation X

Student: Elizabeth Sweetman

Clinical Instructor: Desiree Langer

Clinical Placement Hospital: NHH Unit: 1A

Date: November 22, 2023

Missed Clinical Hours: 0 Missed CLC Lab Hours: 0

 NURS 3021H Clinical Practice Evaluation
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 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 consistently 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 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 consistently 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 consistently 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 consistently 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
MIDTERM
1. Demonstrate accountability and responsibility in Student:
the teaching-learning relationship. I have been able to demonstrate
accountability and responsibility in the
Progress Midterm Progress Final teaching-learning relationship as I have
been able to use feedback from both my
X SP  S CI and my peers to better my practice. In
 ND  U specific I had gotten feedback that my
 UP head-to-toe assessment could be
improved therefore I focused on
bettering it and asked my peers for
advice and to watch me and by next
clinical my head-to-toe assessment had
improved significantly. I have also
demonstrated accountability and
responsibility by continuously being on
time, and following through with
everything I need to accomplish in the
day.
Evidence/Indicators
FINAL
Student:
I have continued to demonstrate
accountability and responsibility in the
teaching-learning relationship throughout
clinical. I have demonstrated this through
arriving on time and prepared for each
clinical with my patient information and
drug cards. I have also demonstrated this
when having the opportunity to teach my
peers skills that I knew that they did not.
Clinical Instructor:

Clinical Instructor: Elizabeth has

demonstrated this learning objective on
several occasions over the last few
weeks. For example, she consistently has
taken initiative to answer call bells and
assist other nurses to support their
patients. She arrives on time and
prepared for clinical shifts. She promptly
introduces herself and her role to
patients and staff. She is taking
accountability for learning, seeking
further learning opportunities.
2. Explain the experience of chronic illness in Student:
individuals receiving care in chronic care Throughout clinical thus far I have begun
settings to further understand the experience of
chronic illness in the hospital setting. I
Progress Midterm Progress Final have come to understand the complexity
of having the illness and how many
X SP  S different factors contribute to patient’s
 ND  U wellbeing. These factors include social
 UP support, economic factors, self-
management, emotional well-being and
more. Caring for those with chronic
illness is also greatly a team effort as
there is significant involvement with the
occupational therapist, physiotherapist,
social work as well as the nurses, PSWs,
doctors. Chronic illness also focuses
greatly on the improvement of the
patients in a greater scope preparing
them to go home and maximizing their
abilities rather than primarily focusing
on treating the illness.
Clinical Instructor: Elizabeth
demonstrated this learning objective, as
each week she continues to submit a well
thought out and comprehensive care plan
focused on the patient’s chronic illness as
well as their psychosocial needs.
3. Interpret critical aspects of the person’s Student:
experience of chronic illness in relation to the As a majority of the patient’s I’ve had
nursing process such as common signs and have been in rehabilitation for falls and
symptoms, responses to treatment, patterns of
Student:
I have gained a greater understanding of
chronic care through the semester. I
understand that in chronic care, there is a
greater priority on ADLs than in acute care. I
have also learned that there is a greater
need to monitor mental well-being in
chronic care as they are often going through
a life adjustment which can be difficult on
them which I have seen. Lastly, I continued
to understand how chronic care involves a
large team of care for the patients best
well-being to help them prepare for
discharge to be able to look after
themselves.
Clinical Instructor:
Student:
In this placement, many of the patients i
had were receiving care for falls. After
 coping, and impact on individual and family injuries, I’ve been able to see having numerous patients with this type of
relationships. commonality between the various injury, I have been able to identify
Progress Midterm Progress Final patients. Their care is often focused on similarities between them that has helped
improving their mobility and ability to do
me to better understand the care that I can
X SP  S ADLs which most of the patients seem so provide for them. Many patients experience
 ND  U enjoy as they like the activity. I have also
poor coping after a fall and have less desire
 UP learned that confusion often to get up and do their ADLs throughout the
accompanies these falls and that is day. I have learned from this that it is
something to look for in all patients. important to encourage patients to get up
Coping varies between all patients and explain the benefits of it to them. I have
depending on their length of stay, also learned that families of patients in
support and how they’re improving. chronic care often need support as well.
These families are often preparing for their
Clinical Instructor: Elizabeth shows an loved one to come home and going through
understanding of how chronic adjustments themselves which they are not
illnesses can impact a patient’s ability getting sufficient emotional support for.
to cope with activities of daily living. Lastly, I learned that in many patients, I
She participated in learning regarding large barrier in their recovery and being
therapeutic positioning and seeks able to move by themselves comes from the
learning opportunities to better pain that they are experiencing. Because of
understand her patient’s experience. this, it is important as a care provider to
work with the patient to develop relaxation
techniques and provide pain medication
when needed.

Clinical Instructor:

4. Identify symptoms and common medical Student: In patients with fall injuries,
treatments of selected chronic illness. treatments have included wound care
and staples removal if they have had
Progress Midterm Progress Final surgery as well as checking on any
bruising they may have. Physiotherapists
X SP  S and occupational therapists are heavily
 ND  U involved in their plan of care to improve
 UP their mobility. It is also very important to
encourage patients to move on their
Student:
Patients with fall history frequently have
pain and may require assistance to move
around. Because of this it is important to
work with them to develop relaxation
techniques as explained above. They also
often have underlying chronic conditions
such as hypertension and diabetes which
require medication and can be helped with
 own when they can and to ambulate
them to prevent bed sores.

Clinical Instructor: Elizabeth has worked

hard towards being competent and
thorough when completing her head to
toe assessments. She can identify the
diet plans. Lastly, they must move often to
importance in symptom assessment and
prevent bed sores whether than it moving
monitoring. She completes care plans to
themselves, getting out of bed or changing
assist in developing her knowledge and
the patients side that they’re laying on.
understand of chronic illness of her
patient.

5. Demonstrate select nursing and collaborative Student: Student:

interventions related to caring for the person Assessments done on patients within the Assessments in chronic care consist of head-
with chronic illness such as specific rehab unit consist of CAM, Braden scale to-toe as well as fall risk, CAM, Braden
assessments, medication administration, and a full head-to-toe. Medications vary scale. Other nursing interventions include
physical and chemical restraints, enteral with individuals as many are taking morning care and ADLs when applicable to
feeding & residual volumes, NG tube insertions, medication for other health issues they the patient. Many patients are on numerous
wound care, patient-controlled medication have such as HTN for example and they medications for various health issues and
administration pumps.
are often on medication for pain as well may have to be crushed depending on the
which helps to increase their ability to patient’s swallow ability.
Progress Midterm Progress Final mobilize.
X SP  S
 ND  U
 UP
Clinical Instructor:
Clinical Instructor: Elizabeth is meeting
this objective as evidenced by the
examples she has provided.
6. Identify potential consequences/complications Student: Student:
of select chronic illnesses and related When given pain medicine for fall Potential complications of falls or fractures
interventions. injuries, the patient may be slightly more can include injury to other areas of the body
sedated which could impact their ability such as pneumothorax from rib fracture.
Progress Midterm Progress Final to mobilize as well as increase their risk Patients may become constipated from
for fall. Without mobilizing the patients inactivity requiring laxatives. Chronic illness
X SP  S are at an increased risk for bed sores can also impact patients mental wellbeing
 ND  U and inability to care for themselves. as they adjust to a new lifestyle.
 UP
Clinical Instructor: Elizabeth has really
improved in developing her head to toe
assessment. She can prioritize all her
assessments such as pain and CNS, then
utilize them to interpret her findings. Clinical Instructor:
Elizabeth can document her care and
assessments according to evidence
informed practice. She can focus on the
primary diagnosis to develop and
appropriate care plan and relate the
information to her patient. She is
developing her understanding of the
pathophysiology of a chronic illness and
understanding the consequences of
various treatments and interventions or
lack thereof.

7. Under the supervision of a Registered Nurse, Student: Student:

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
During my chronic placement I have
successfully established a therapeutic
relationship with each of my patients so
that they feel comfortable with me
caring for them. I have also
demonstrated ethical practice with all of
my patients by gathering consent,
providing privacy and educating them on
I continued to demonstrate competent
practice with my patient’s throughout the
semester. I did this through developing
therapeutic relationships with each of my
patients by having frequent conversations
with them and expressing interest in their
care. I also engaged in developing
professional relationships with my
 and ethical practice what I’m doing. I have engaged in classmates. These professional relationships
c. Engage in respectful, collaborative, professional relationships as well with allowed me to ask for help from my peers
therapeutic and professional the nurses as well as my peers as they when needed as well as help them tasks. I
relationships have helped me with various skills and I have continued to critically appraise my
i. Demonstrate therapeutic use of have helped them. own practice throughout the semester as I
self reflect on my practice to find areas I felt
ii. Create a culturally safe Clinical Instructor: Elizabeth is very good confident in and areas that I thought I could
environment
at establishing therapeutic relationships approve on.
d. Apply nursing models and theories
with her patients and her patients enjoy
e. Demonstrate health promotion and
illness prevention practices having her provide safe, competent care.
f. Demonstrate patient advocacy She provides her patients with health
g. Predict outcomes of nursing care teaching. She works well with her peers
h. Evaluate client response to nursing and the 1A staff. Elizabeth demonstrates
care ethical considerations by maintaining Clinical Instructor:
i. Critically appraise own practice in confidentiality and only using initials to
relation to nurse-client/family identify her assigned patient. She
interactions and as a member of the maintains protocol for COVID 19
health care team screening, demonstrates good hand
hygiene and knows to use proper us PPE.
Progress Midterm Progress Final

X SP  S
 ND  U
 UP

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

nurse-client/family interactions and as a At the end of each clinical shift I have
member of the health care team been able to reflect on areas of
improvement and consider things I
would like to do better. I consider my
interactions with patients and how I
could improve my therapeutic
Progress Midterm Progress Final relationships as well as reflect on my
own practice and things I can do to be
X SP  S more successful such as managing my
 ND  U time better.
 UP
As mentioned above, I continued critically
appraise my own practice throughout the
semester. I reflected on my interactions
with patients to identify areas that I felt
good about as well as areas I thought I
didn’t do as well as I would have liked. I also
reflected on my interactions with the nurse
as I learn to work in a team to consider
things I could have done better in regards to
communicating with my nurse and taking
initiative. Finally, I reflected on my
 interactions with family as I considered if I
should have provided or offered further
support to them when applicable.

Clinical Instructor: Elizabeth is very

aware of her scope as a nursing
student and is comfortable
communicating with staff and families
regarding patient care. Clinical Instructor:

9. Participate in professional development based Student: Student:

on reflective practice and critical inquiry By reflecting on my practice each shift as After reflecting on my practice at the end of
well as using feedback from my CI I each shift, I ensured that I incorporated
Progress Midterm Progress Final believe I have improved in my practice areas of improvement into my next shift. I
within the past few weeks and plan to also considered feedback from my CI to
 SP  S continue reflecting and becoming better improve my practice. Finally I professionally
X ND  U in my practice. developed through observation and
 UP discussion with my peers to consider how I
could improve considering their practice.

Clinical Instructor: Elizabeth participates

in discussion, both informally during
practice and in debrief. She frequently Clinical Instructor:
seeks further learning opportunities and
advocates for herself and her peers.

This section to be filled out by the Student Areas of Strength Student Areas of Strength
student.
1. Therapeutic relationships 1. Therapeutic relationships

2. Reflection on practice 2. Assessments

 3. Follow through with patients 3. Time management

Student Areas for Future Student Areas for Future

Development Development

1. Time management 1. Medication knowledge

2. Charting 2. Better knowing nursing standards

3. Medication knowledge 3. Working as a team

Clinical Instructor Summative Comments:

Elizabeth is currently progressing as expected. She is currently meeting the learning objectives at midterm and continues to develop her skills
and time management.

Clinical Practice Attendance (12 Hours Per Shift)

Shift 1 Shift 2
Week 1 12 12
Week 2 12 12
Week 3 12 12
Week 4 12 12
Week 5 12 12

Total number of clinical practice hours absent: 0

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

Clinical Learning Centre

Total number of clinical simulations completed 5 / 5

Total number of labs completed 5 / 5

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

Signature of Course Lead: __________________________________Date: _____________________

Signature of Clinical Instructor: Date:

Signature of Student: Elizabeth Sweetman Date: November 22, 2023