Name:

Lisa Barker
LYNCHBURG COLLEGE
NURSING PROGRAM
NURSING 336L
FINAL CLINICAL EVALUATION

Clinical Rating - Clinical Evaluations will be recorded as Outstanding, Satisfactory, or Unsatisfactory. A Satisfactory or Outstanding rating is needed to pass Nursing 336-L and Nursing
336. Students are expected to use skills learned in previous courses.
KEY:

OUTSTANDING
SATISFACTORY
UNSATISFACTORY

(O) = Consistently demonstrate clinical outcomes above those expected at this level.
(S) = Consistently achieve clinical outcomes expected at this level.
(U) = Unable to achieve clinical outcomes expected at this level.

Clinical
Outcomes

Course
Objectives

1. Plans and
organizes care
in selected
clinical
situations for
children, the
family unit,
and/ or
community
pediatric
population, by
making
appropriate
practice
decisions.

1.1 Supports nursing practice with knowledge

related to the care of well and ill children, the
family unit, and the pediatric population:
a. Anatomy/ Physiology/ Pathophysiology
b. Communication Theories
c. Teaching and Learning Principles
d. Nutrition Principles
e. Growth and Development Principles
f. Family Theory
g. Parenting Styles
h. Vulnerable Families
i. Pediatric Prevention/ Health Promotion/
Anticipator} Guidance
j. Pharmacological Principles in Pediatric
Nursing Practice
k. Immunization Principles

FACULTY
O S U

STUDENT & FACULTY

Evaluative Comments & Examples

Because clinical experiences in (he hospital setting were limited,

most of my experiences have been one-on-one with children,
primarily (at this point - I have one more clinical left - EPOD) in
the school / early learning program settings.
A. Anatomy/Physiology/Pathophysiology - In working with the
children. I did use my knowledge of Anat/Phys/Patho to evaluate
and assist with issues such evaluating a fall - checking the
integrity of the patella and mobility of the joint to assess if it was
likely only a superficial injury. Also, in evaluating a backward
fall (hit head) on metal handrail and a whack on the head with a
hockey stick, I assessed for swelling, palpated for pain/tenderness
on the head and checked pupillary response (and rechecked again
after watching both children for ~ \ minutes). I also assisted a
child who had Prater-Willi Syndrome, who having had recent
surgery for scoliosis. her incision was itching terribly. Rather than
putting a topical on it that may compromise the incision -still
showing significant granulation -1 ran an ice cube over it to cool it
and ease the itching.. There were several occasions like these,
where know ledge of anatomy & physiology - as well as the patho
of the issue the child was dealing with, was required.
B. Communication Theories - After learning how effective
communication strategies van1 by the age of the child. I was able
to understand the effective use of communication (especially
watching the teachers in the early learning program), and was able
to be more effective personally in my communication with
children, both when providing care and when interacting with
them in more "observational" type situations.

C. Teaching and Learning Principles ~ I was able to work with a

child in one of the early learning programs (Hutcherson) and help
her build a tower. I taught her how to place some of the boxes to
make the tower more stable so she could build it higher. Even
though she didn't understand the underlying principles, she was
able to understand that the change in placement of the
blocks/cardboard boxes did make a difference because she used
similar placement of the boxes after I showed her what to do a
couple of times. It was not exact, but she changed what she was
originally doing to try to do it like I showed her. 1 helped stead} it
as she built it. and she was able to make a very tall tower that she
had to show to everyone. She was very proud of how tall it was.
D. Nutrition - My most poignant experience related to nutrition
principles during clinicals was related to a diabetic crisis in a cliild
experiencing hypoglycemia. Even though this was not necessarily
related to how nutritionally balanced his diet was (it had to do with
the control and maintenance of his glucose level) it was evident
that it was critical for him. because this kid was crashing.
I also was able to appreciate the issues some children have with
eating because of their conditions (CP. MD. etc.) because they
may have issues swallowing or their neurological challenges leave
them unable to feed themselves or even hold utensils. I was able
to tube feed a child who was unable to feed herself at all - and it
made ine sad to think that she would not be able to experience the
texture and flavor of food which we take for granted.
E. Growth & Development Principles - I was able to see firsthand
how children progress through different stages of development,
and in some instances (ie., Hutcherson Early Learning Center) I
was able to see examples of children within the group who were
slightly behind the other children developmental!}', how they acted
how they were handled by the teachers, and how they were
perceived by the other kids. I was also able to see the difference in
children's levels of self-consciousness - especially as they enter
adolescence - for example I treated one young man who did not
want the other kids to see him receiving treatment for a hand rash.
F. Family Theory - One experience to illustrate understanding
family dynamics was with an infant who was having issues with
spitting up. The mother was overfeeding the child, and one of the
issues was that she needed to be taught to cut back on the feedings.
The father did not appear to be part of the family unit because the
grandmother was the one who was present with the mother as
support, and the sister brought in one of the siblings for a visit. It

\ve were there to learn and she was very forthcoming about the fact
that she was bottle-feeding because she had used marijuana and
felt it was safer for the infant not to breastfeed.
G. Parenting Styles - At EPOD I worked with a young lady (15
yrs old) who had overdosed on Wellbutrin and aspirin. She was
also a "cutter". Her mother was with her and she was overbearing
and controlling (with her daughter and in general). I asked the pt
if she needed anything and her mother said "I think she's feeling
better. She just needs some rest". I then asked the patient if there
was anything I could do for her.. I said "How about you - is there
anything I can do for you? Would you like a Pepsi?" She said
"Yeah, a Pepsi would be great -Thank you". It was not surprising
to see this child acting out. Her mother did not seem warm and
comforting to her at all.
I. Pediatric Prevention/Health Promotion/Anticipatory Guidance My experience with teaching health promotion, prevention and
anticipatory guidance is very limited. I did however, talk to the
mother of the infant who was spitting up and told her that her baby
may not be hungry- when she is crying, that it may be some other
type of discomfort, and that normally babies on formula would
have ~ 2-3 oz. every 2-4 hours - that this is normally adequate.
J. Pharmacological Principles in Pediatric Nursing Practice Even though I have administered meds to pediatric patients on a
few occasions. I am very aware that meds for children are not just
a matter of giving smaller doses. There are many unique
considerations that have to be taken into account (esp in infants)
such as the difference in absorption, distribution, excretion and
metabolism of drugs - which can have a huge impact on toxicity
levels. Also factors like decreased protein binding, conditions a
child might have, as well as a more permeable blood-brain barrier
will effect which drugs and what dosage should be given to
children.

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K. Immunization Principles - I have not given any immunizations

nor provided relative counseling, but I am aware of the education
that is necessary - especially for some parents on the merits of
immunization and the importance of adhering to the prescribed
schedule.
an
interesting situation because the infant's mother

understood

1.2 I have written care plans, and accessed children and families.
and gathered data from the paper charts, as well as electronic
charts, such as provider notes, and diagnostic study results. I have
also gathered important information from both the family and the
patient through both casual conversation and direct questioning to
gather both subjective data and objective data.

1 .2 Develops written plan of care for children

and families.
a. Assesses families usingo data collected from
the chart, patient, significant others, and
health care providers.
b. Identifies at least four appropriate nursing
diagnoses based on assessment data and
prioritizes appropriately based on greatest
need.
c. States outcomes in measurable patient
behavioral goals.
d. Plans interventions based on scientific
rationale and documents resources used to
support interventions.

2. Uses the
nursing process
to provide
culturally
sensitive care to
children and
families

Using this data I have identified at least 5 or 6 nursing diagnoses

based on the data and patient engagement, and prioritized them in
order of greatest need as a guide by which to work toward patient
outcomes which can be measured and evaluated either by patient
behavior or laboratory data. The interventions are then developed
to address these diagnoses and they are performed to provide care.
promote healing, illicit a response, prevent a negative outcome, or
provide comfort, or have some other beneficial effect.

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The rationales associated with the interventions 1 provide are based

on learnings acquired throughout tlu's curriculum, research and
readings relative to the subject (cited), or sometimes just common
sense.

e. Evaluates patient goals (outcomes) using

evaluation data.

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2. 1 Provides nursing care to children, families.

and pediatric population.

2.1 I have provided care for both children and families, but have
not had an opportunity to address any existing cultural issues that
have effected patient care.

2.2 Identifies culturally sensitive issues that

impact the nursing care of sick and well
children.
2.2 Demonstrates skills in child, family, and
population assessment techniques.
2.4 Recognizes the effects of culture and
socioeconomic status on the family response
to parenting and the care of the sick and well
children.
2.5 Competently and safely executes
pediatnc-specific psychomotor nursing skills
while using an organized sequence and
understanding rationale.

2.2 When working with children and their families, 1 have used
the assessment techniques that are appropriate for the age of the
child (r/t physical assessment such as head circumference, chest
circumference, etc. and appropriate behavioral assessment such as
movements, nonverbal communication etc) and use family
communication and interaction with each other as well as
questions and general conversation to learn about their situation
and what their needs might be. what their level of knowledge
might be and where they can benefit from additional info or
teaching.
I use the information gathered while caring for the patient and
conversing with the family to learn about the family members,
what the structure of the family is. their socioeconomic status and
what the dynamics of the family are - as much as possible.
depending on the cooperation of the family members .

When providing care. I try to organi/.c and plan my moves to allow

a smooth flow of activity, minimi/e duplication of effort, exercise
care to avoid tugging of lines or tubing, and try to cluster as many
activities as possible to avoid excessive interruption of the patient
and family.

2.6 Identifies nursing care priorities (nursing

diagnoses) while in clinical setting.

Also while providing care. I monitor the patient keeping in mind

what their condition is. but watch for signs of any status change,
which could mean a temporary (or permanent) shift in priorities. I
also keep in mind that patients may not want to discuss certain
information in front of their family.
3. Communicates
effectively
using age
appropriate
communication
techniques
(verbally) and
in writing, by
accurately
documenting
patient care.

One of the first things I do when meeting a patient is try to gauge

their communication style and their openness to communication,
as some patients may be more quiet and reserved and others may
be more outgoing - and I do the same with the family to better
understand how to approach them.

3.1 Establishes rapport with clients and their

families through therapeutic
communication.
3.2 Demonstrates effective teaching utilizing
teaching and learning principles.

I provide teaching where possible regarding care or what to look

for if mere are issues that need attention, and encourage questions,
indicating that if I don't have the answer for them right away. I
will find out the information and get back to them as quickly as
possible.

3.3 Performs select psychosocial nursing

interventions appropriately, including:
a. Coaching
b. Comforting
c. Assisting
d. Listening
e. Counseling

In working with patients. I provide coaching such as when they arc

trying to do something they may be having difficulty with (such as
ambulating if they are weak or trying to get them to eat just a little
more of their meal if they really need to eat.
I try to provide comfort when needed, and if appropriate, empathy
or sympathy when the patient has a need to feel understood. I am
also a good listener - trying to not only hear what the patient is
saying but also what they may actually mean if their words and
actions/gestures don't match.

f Collaborating
g. Managing
3.4 Uses and comprehends developmentally
appropriate communication techniques
with children of all ages.
3.5 Demonstrates skill in documentation,
including:

If the patient needs counseling, regarding things such as healthy

behaviors, self care activities etc. I provide information to them
and sometimes engage them with questions to help them come to
their own conclusion so that the information has more meaning.
I feel that I have been very successful in communicating with each
of the different age groups 1 have worked with and they have been
very comfortable in talking with me when I have been providing
care or when I have been assessing to determine what the issue is
and "where it hurts", "how it feels" so that I know better how to
approach the issue.

a. Documents assessment data, nursing

actions, and client responses in a complete.
organized, legible manner.

The documentation that 1 have completed in these clinicals has

primarily been informal (ie.. in schools), but this was the method
used. It was specific, and detailed with a history of the issue.
action taken and outcome. In some instances the info was logged
into the computer, and sometimes info was kept in a log book, but
it was always documented.

b. Accurately graphs anthropometric

measurements on growth charts.

IN the hospital setting, the documentation was thorough and

complete so that the upcoming shift would have the appropriate
data and information to work with in understanding the patient's
status and progression during the shift.

c. Documents an HPI that reflects current

assessment data in a concise format.

I have had few instances thus far that have required graphing
measurements on growth charts, but I have done this and do
understand it's purpose.
4. Collaborate
with
appropriate
healthcare team
members to
provide
rv
effective
nursing care
and accomplish
care goals.

4.1 Establishes satisfactory relationships and

rapport with members of the health care team.

At EPOD I worked with several pts and their families, working

with my main nurse getting vitals and assisting with assessments
and with the technicians who were coming to work with the
patients (respiratory, orthopedic, and X-ray) to help in any way
possible.

a. Obtains report from primary nurse/ preceptor

of client assignment
b. Identifies when assistance is required and
obtains it.
c. Report s-off when leaving the clinical setting.
4.2 Collaborates with health care providers to plan
and execute patient care.
a. Transmits relevant data about clients.

The nurse would give me a quick report of what was going on with
the patient, and I was also able to look at the patient's chart to get
more detailed info, which also helped me have a better idea of
some of the questions I needed to ask the pt/family.
In all my clinical settings I ask for assistance if I am unsure of
something (information or procedure) and have always received
very helpful guidance. 1 also notify the nurse I have been working
with at any time I need to leave the unit, and advise if there is
anything they need to be aware of with a patient before I go.

b. Shares plans for patient care.

c. Demonstrates client advocacy in clinical
setting.

When preparing to provide care to patients. I discuss the care with

the nurse in charge to be sure that they agree with what I am doing
(that it is the proper action, and that it is in compliance with their
protocol). I also am conscious about trying to be sure that as mam
needs as possible are met for the client while I am working with
them. (For example, when a 1 5 month old child came in with a
fever, she was crying and irritable and after the initial assessment
and Tylenol, I asked her mother if she needed to have her diaper
changed because even though that's a small tiling, it would be
more comfortable for the child to have a fresh diaper, and she did
need one).

5. Relate nursing
research and
evidence based
practice
findings to the
nursing care of
pediatric clients
and their
families.

I have often researched conditions that I am not familiar with or

that I would like to learn more about so that I may understand the
etiology or treatment of the condition. I prefer to look at the
research of several different sources and compare findings so that I
have a more complete overall picture and to see if there is
consistency or identity what variability there may be between
sources. I also try to identify ways to be able to use the
information "in practice" if the opportunity should arise.

5.1 Begins to utilize nursing research in

pediatric nursing.
a. Distinguishes nursing research studies and
evidence based practice from other nursing
literature.
b. Understands and articulates the relationship
between nursing research and pediatric
nursing practice.
c. Identifies ways to effectively integrate
research into pediatric nursing practice.

I have used research to learn ways to measure stress responses in

children (via cortisol levels - using salivary swabs), and have a
much greater, more in-depth understanding of Myelomeningocele
and Hydrocephalus due to referring to various research studies and
ongoing research by institutions such as Children's Hospital of
Philadelphia and Cincinnati Children's Hospital, who have found
that performing the repair prior to birth leads to a much better
outcome

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d. Utilizes nursing research to plan care for

the well, acutely ill, and/ or chronically ill
child, the family unit, and/ or the pediatric
population.

One of my greatest passions is researching (in a wide variety of

disciplines) so that 1 may share the information so that something
posit ive can come from it.
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5.2 Shares relevant nursing research with

colleagues.
6. Recognizes
and uses
management
skills to
organize
nursing care for
pediatric
patients in the
clinical setting.

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I feel that I am effective in setting priorities in nursing actions and

I work well with team members to accomplish the goals of care for
my patients as well as being ready to assist others when a true need
arises.

6.1 Sets priorities for nursing actions.

6.2 Identifies members of the health care team
and their roles in a variety of settings.
6.3 Identifies appropriate health team
members and community resources to
provide collaborative family care.
6.4 Organizes assignment efficiently and
effectively.
6.5 Manages material resources appropriately.
6.6 Adapts routine nursing procedures
according to developmental age of child.
6.7 Adapts nursing care to minimize stress in
pediatric clients and families.

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Although the opportunities have been limited in the hospital

setting thus far. I do know what disciplines there are available to
assist patients and I am familiar with the wide variety of
community resources that are available to patients and families.
Centra has a wide array of resources for patients and families, and
there are societies and foundations that also offer assistance in a
variety' of ways.
I have learned through the curriculum as well as through clinicals
how to work effectively with children of various ages as well as
their families in order to provide the best possible care for them
and provide them comfort as well as a positive environment to
make their convalescence as positive an experience as possible. I
also incorporate play when appropriate and possible because I
believe it helps build trust with a child, plus it can help make their
situation a little more bearable.

6.8 Incorporates play into the care of pediatric

patients.
6.9 Performs psychomotor skills with
increasing independence.

7. Demonstrate
professional
behaviors and
values in the
pediatric
healthcare
setting.

7.1 Assumes responsibility and accountability

for own nursing care activities of children
and their families.
7.2 Maintains patient confidentiality.
7.3 Seeks assistance from clinical faculty and
other health providers appropriately.
7.4 Actively seeks learning opportunities.
7.5 Uses constructive feedback to improve
nursing care.
7.6 Uses self-evaluations to identify own
strengths and areas for growth.
7.7 Discusses personal values, beliefs, and
previous experiences that may affect caring
behaviors.
7.8 Submits completed assignments on time.
7.9 Engages in self-reflections to identify
personal areas in which further growth is
needed.
7.10 Facilitates group discussions with peers
to facilitate learning opportunities for all.
7.11 Arrives on time for clinical.
7.12 Adheres to the agencies" policies and
established course policies.

I also feel that my psychomotor skills are adequate, and with

additional experience 1 will continue to develop my comfort level
so that I may continually improve. I am very comfortable with the
basics (vitals etc.) but I know I could benefit from additional
hands-on experience in the hospital setting.

I always assume personal responsibility and accountability for my

nursing care activities - for all patients and their families. I also
am very aware of patient confidentiality and take it very
seriously at all times.
I do seek advice or guidance when 1 have a question so that the
next time I encounter the same situation I will already know the
information or what needs to be done.
I do actively seek learning opportunities and like to share what I
have learned when there is someone else who can benefit from it
Regarding feedback. 1 welcome and appreciate all feedback
because that's how everyone learns, and I believe that nursing is
absolute!}' a continuous learning process, regardless of the
specialty involved.
I feel that I do use self-evaluations to reflect and see what I would
do differently so that I can improve when face with the same
situation again. I do discuss my personal values and beliefs and
previous experiences and listen to others' as well because no one
person has all the right answers and best ideas.
I have been involved with and participated in group discussions
where I have shared helpful information and learnings, but 1
have not facilitated group discussions - but I would absolutely
like to because I thoroughly enjoy sharing helpful information.
I have been on time for all clinicals except one (I was - 7 minutes
late for one clinical).
I do need to improve on submitting my assignments on time. (It
would probably help if I did not tend to spend as much time
researching and reflecting before and during completing
assignments).
1 do adhere to the agencies" policies, as well as those of LC. as I
am aware that I represent LC when in any clinical setting.

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