NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Final Evaluation
Student: Marissa Rose-Morris
Clinical Instructor: Melissa Farrow
Clinical Placement Hospital PRHC
Missed Clinical Hours:

Satisfactory

Unit C2

Missed CLC Lab Hours:

Unsatisfactory

NURS 3021H Clinical Practice Mid-Term 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, evidenceinformed 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.

NURS 3021H Clinical Practice Final Evaluation

Course Objective
1. Explain the experience of chronic illness in individuals
receiving care in acute settings

Progress
Evidence/Indicators
March 5/6This week I had a pt that
had dementia with aggressive
behavior. Because of her aggressive
behaviour she was in a waist
restraint. The pt spent their days in
bed mostly sleeping. The pt is in a
room with another non-verbal pt, and
does not get much socialization
except for when their spouse comes
to visit. I knew that the pt enjoyed
singing so to improve their mood I
turned their radio on so they could
listen and sing along if they chose.
This seemed to improve the pts
mood and kept them awake and alert
for more of the day. The waist
restraint had a tendency to move up
the pts body as they slept, so I had
to boost them up the bed, and
reposition them often throughout the
day.
March 5/6My second pt this week,
suffered from an anoxic brain injury in
1998 and has since been in a
vegetative state. This pt lives in the
hospital and is bed bound, without
movement. For this patient I
preformed total care. This patient is
on a g-tube for feeds and has a
tracheostomy for their airway. I

Satisfac
tory
X

Unsatisfac
tory

2. Interpret critical aspects of the persons experience of

chronic illness in relation to common signs and symptoms,

made sure that when the pts feed

was running they were sitting up in
the bed so as to reduce the risk of
reflux and dysphagia. I also provided
the trach care for this pt to keep the
airway viable and clean. I also
preformed light suction throughout
the day to help the pt clear any
secretions. Since this pt cannot
inform anyone of their mental or
physical state, I did my best to keep
them comfortable and to speak to
them while I was in the room.
March 12My patient this week was
in hospital due to a CVA and TIA. The
patient was also admitted with
Wernickes encephalopathy, due to
alcoholism. This patient is cognitively
aware and w/c bound. During my
care for this patient, they were
drowsy due to Ativan being given
overnight to help calm them down.
The pt also has dementia and
becomes confused wanting to go
home, so they attempt to climb out of
bed on their own. To keep the patient
oriented and comfortable I made sure
to check in often as well as ask them
what they needed. Since the patient
was so drowsy that day they did not
want to get out of bed, I cleaned
them up in bed then readjusted their
position so they would be
comfortable.
--I now have a better understanding
of drugs used in the chronic setting. I

responses to treatment, patterns of coping, and impact on

individual and family relationships.

understand that pts that are hospital

bound and do not spend much time
outside need vitamin D supplements
to replace what they are not getting
from the sun. I have also gained a
better understanding of why certain
drugs are used, e.g. proton pump
inhibitors to decrease stomach acid in
pts with GERD.
--I have gained a better
understanding of the impact chronic
illness can have on relationships
through observing and speaking to
the different patients. Some of the
patients still have close relationships
with their families and others rarely
have anyone in to see them. From
this I gather that chronic illness
effects everyone differently, while
some may take the opportunity to
strengthen relationships with their
loved ones, others cannot handle the
illness and either push everyone
away or are left alone for other
reasons.
--As everyone reacts to chronic illness
on an individual basis, they also have
different coping patterns. There is
one patient on the unit who seems to
be having a hard time coming to
terms with their illness and that they
are not going to heal from it. This
patient and their spouse are still in
denial, which is the first stage in
coping with any Dx. Other patients
on the unit have already come to

3. Identify symptoms and common medical treatments of

selected chronic illness and disease process in individuals
receiving medical, rehabilitation or long term care.

terms with their illness and are

comfortable discussing what they
have and the path it has brought
them down. These patients have
accepted their Dx, and are coping
effectively.
Wernickes encephalopathy
Caused by chronic alcoholism
Thiamine deficiency
Symptoms
o Mental confusion
o Ataxia
o Opthalmoplegia
Treated with thiamine
supplement
Will need supplements for life
CVA
Caused by poor blood flow to
the brain
Symptoms are acute at onset
o Bilateral facial drooping
o Speech impairment
o Muscle weakness or
numbness
Pt is at risk for repeat strokes,
and is therefore put on
medications to reduce this risk
o Lower cholesterol
o Decrease clotting
(platelets)
o Dilate blood vessels
Pressure ulcers
Starts with skin breakdown due
to unrelieved pressure on bony
prominences

4. Demonstrate selected nursing and collaborative

interventions related to palliative approach, clinical
pathways, health promotion and self-management,
functional assessment, nutritional assessment,
musculoskeletal assessment, respiratory assessment,
head/neck/eyes/ears assessment, wound care and end of
life care.

If left untreated can grow in

size and depthsometimes
reaching the bone
Treated by repositioning to
remove the pressure from the
area, and applying a dressing
to promote healing
People who are bed or w/c
bound are at high risk because
they are not offloading the
pressure from these sites for
long periods of time
March 5/6During this week my
patient had a tracheostomy. I had to
preform trach care at the end of each
shift. For this I removed the dressing
and inner cannula. The inner cannula
was cleaned in hydrogen peroxide
mixed with normal saline. After
soaking in the peroxide, the cannula
was brushed through and then rinsed
in normal saline. While I cleaned the
cannula, my clinical instructor
preformed a deep suction to remove
any secretions from the airway. After
the inner cannula was dried I
replaced it into the tracheostomy. I
cleansed the area around the cannula
with normal saline and patted it dry
with gauze. I then replaced the
dressing surrounding the
tracheostomy opening. All of this
was done using sterile technique.
March 5/6My patient was on a
pureed diet with thickened fluids. This
patient was a full feed. In order to

5. Identify potential consequences/complications of chronic

disease process and related interventions.

ensure proper nutrition the patients

intake is monitored daily. The patient
ate adequate amounts of food, but
was also given a drink that had extra
nutritional value.
March 20I spent this day in
dialysis. While there I learned more in
depth about how the machines work.
I was also able to observe a button
fistula being used as well as an
indwelling catheter. The use of either
of these interventions is a mostly
personal choice, although there are
some medical reasons to choose one
over the other. The fistulas may also
be ladder fistulas where different
insertion sites are used each cycle.
One patient stated that she preferred
the button over the ladder because it
hurt less.
Feb 26I spent this day in the
wound clinic. Throughout the day I
saw multiple pts with different stages
of diabetic neuropathy. This is a very
common consequence of both type
one and type two diabetes mellitus.
The person loses feeling in their feet,
starting at their toes and moving up.
This loss of feeling causes the person
to injure their feet without knowing it,
and can lead to bone breaks and
amputations. If the neuropathy is
caught soon enough the pt can learn
to take special precautions with their
feet, which can include: offloading
using an orthotic, special diabetic

6. Under the supervision of a Registered Nurse, demonstrate

safe, competent, evidence-based, holistic nursing practice
with clients with chronic illness
a. Apply nursing models and theories
Self management
Motivational interviewing
Addictions
Palliative approach
b. Demonstrate therapeutic use of self
c. Engage with patients in an ethical and culturally
sensitive manner
d. Demonstrate health promotion and illness prevention

shoes, and checking their feet

regularly for injury.
March 12This week my patient had
a history of chronic alcoholism. This
has led to them being deficient in
thiamine. This deficiency has caused
them to have Wernickes
encephalopathy. Because of this Dx
the patient is now on a thiamine
supplement for the rest of their life.
March 20I spent this day at the
dialysis clinic. The patients attending
dialysis are all experiencing renal
failure and use the machines as an
artificial kidney. The renal failure can
be caused by different diseases,
including diabetes. This clinical day
showed me the end stage to many
diseases that affect the kidneys, and
what needs to be implemented for
those whose kidneys cannot filter
their blood. Once dialysis has
started, the patient must attend on a
strict schedule for the tolerated time.
--Each week I make sure that I am
aware of my pts diagnosis and
possible complications that go along
with it.
March 5/6I dealt with two nonverbal patients this week. In order to
ensure they were comfortable while
receiving care I made sure to inform
them of what was going on at all
times. I tried to follow any non-verbal
cues that my patients gave in order
to provide the best care possible.

practices
e. Demonstrate patient advocacy
f. Predict outcomes of nursing care
g. Evaluate client response to nursing care

7. Critically appraise own practice in relation to nurseclient/family interactions and as a member of the health
care team

--each week I engage my patients

conversation,
through
these
conversations I am able to gage their
mental state and mood.
If the
patients have any concerns I try to
address them, and if I cannot I will
approach their nurse to decide what
should be done. On March 12 my
patient was tired, and did not want
care done until later in the day. I
then went in periodically throughout
the day to ask if they wanted to get
up and into their chair, which they
refused each time. I spoke with their
nurse about this and they informed
me that the pt had been given Ativan
overnight due to restlessness, and
that we would leave them in bed until
they were more awake.
--attended report at the beginning of
each shift. Understood the concerns
of the nurses in regards to my
patients. Also helped me to
understand my approach to care for
each patient.
- I have introduced myself to my
patients nurse each week, and
inquired about any specific
needs that patient has. I have
reported any patient concerns
to my nurse during and at the
end of shift.
--Each week I approached my
patients with care and respect. I
always spoke to my patients and
asked them questions if they were

8. Participate in professional development based on reflective

practice and critical inquiry

able to answer. I made sure to let

them know what I was doing while in
the room.
--I wrote a reflection on my time in
the wound care clinic. This reflection
allowed me to explore my feelings
around patient care, and informed me
of possible outcomes of a patient in
ICU. This reflection also gave me an
opportunity to look at the policies of
care in an ICU.
-- Before and after each clinical week,
I research the diagnosis of my
patients so I can expand my
knowledge of these illness and their
treatments.
-- At the end of each clinical week,
and before clinical on med days, I
research the medications being given
to my patients. Through this I am
able to better understand a variety of
drugs and their uses.

Areas of Strength Identified by Student

1. relational practice
2. professionalism
3. wound care
Areas for Future Development Identified by Student
1. Reflective writing

2. medication knowledge
3. relational practice (both strength and future development as I believe I can always improve in
this area no matter how well I think I am doing)
Clinical Instructor Comments (All areas marked as unsatisfactory must have a
comment)

Attendance Hours Per Shift

Week
1
Week
2
Week
3

Thu
rs

Fri

Week 6
Week 7
Week 8

Thu
rs

Fri

Week
4
Week
5

Week 9
Week 10

Total number of clinical hours completed: /160 Hours

Clinical Component Outcome:
Satisfactory

Unsatisfactory

Clinical Learning Center Completed (to be completed by Course Lead)

Satisfactory

Unsatisfactory

Signature of Instructor:

Date:

Signature of Student:

Date: