~.

HUMBER
School of Health Sciences

Practical Nursing Diploma Program

Final Clinical Evaluation Form
Student:

Rajinder Kaur

Course:

NURS 219-23

Dates:

Sept. 07,2014

Satisfactory

Student Number:

Practical Nursing Practice 3

to

Summary of Areas of
Practice

Competent and safe

practice in a professional,
legal and ethical
framework

Dec. 07,2014

Unsatisfactory
Student Comments:
Summary of clinical
experience

s:U

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i I comply with regulatory

standards, relevant
legislation, and the practice
setting's policies and
procedures. I reach prior to
the start of the shift, adhere
to the uniform code, and do
not wear it back and forth
from home to hospital. I
wear the badge supplied by
the hospital. I abide by
hospital's confidentiality
agreements such as not to
divulge confidential
information concerning
patients, hospital personnel.
I follow hospital's policies
to provide safe, competent,
compassionate care using
evidence based knowledge.
For instance, I develop
therapeutic, trustworthy
relationship with my client.
I do medical research about
patient's primary diagnosis,
I do research of prescribed

iIr---

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821 332236

Faculty Comments:
Summary of clinical
Experience

S
I agree with all your
comments.
Rajinder has improved over
the course of this clinical in all
areas of safe patient care.
With experience, now she can
perform many skills safely and
with confidence. She has
demonstrated her
understanding of this clinical
outcome with many clinical
examples from her practice. I
remind Rajinder to be
especially careful to check the
MAR several times when
taking out her medications so
that she always has the
correct dosage and time.
Rajinder is always in clinical
early looking up her patient
information in the Kardex and
chart and writing this on her
organizational plan for the day.

2
medications such as action,
indication, dose, route, side
effects. Hence, I hope to get
S.
ii I act in a responsible,
ethical, and accountable
manner. I perform hand
hygiene before and after
patient care, I wear gloves
while taking patient care,
and dispose them off before
leaving the room. I am
respectful of client's values,
culture, and religion. I
establish a therapeutic,
trustworthy, and caring
relationship. For example, I
inform the patient and
obtain consent before
giving any kind of care,
medication. If patient is in
disturbed mood, I develop
therapeutic communication
and listen to them. In order .
to be accountable for my
work I clarify wherever I
am uncertain. For example,
while emptying a urine
drainage bag I asked PSW
to watch me while opening
and closing of spigot.
Hence, I hope to get S.
iv I utilize evidence
informed practice and a
theory based approach to
care. For example, my
patient is in comatose state.
I gathered information
about his prior medical
history, personal life his
relation with his wife and
adult children rather than
assuming about his life. I
am there with him

emotionally, for example I

address him with his name,
ask him how he is doing?
Smile and make eye
contact. I perform nursing
care in a skillful,
comforting, anticipating and
protecting way, because I
feel that he would have
done these acts by himself
if it was possible for him to
do.
My patient is bed ridden,
immobile, and has
tracaheostomy. When
giving bed bath and other
hygiene measures, I keep
him in supine position for a
minimum time. I understand
that nursing him in semi
recumbent position will
substantially decrease the
aspiration of gastric
contents and reduce
incidence of pneumonia.
Hence, I hope to get S.
v I ensure client safety and
a safe environment while
giving nursing care. For
example, I make sure that
when my patient is
transferred to a wheel chair,
the chair is locked, his seat
belt is on, his personal
belongings are within his
reach so that he may not
have to over reach them to
grab them. My patient has
Hepatitis B. when dealing
with body fluids I always
wear gloves and remind my
fellow student to wear
gloves when she is helping
me. After nursing care we
dispose off those gloves

immediately in garbage. We
make sure that we may not
touch anything else with
those gloves. I establish and
maintain a safe and caring
environment. Therefore, I
hope to get S.
vi I ask questions and
clarify plan of care
whenever I am uncertain.
For example, my patient has
type 2 diabetes. Kardex
states glucometer BID. I
clarified with RPN if
glucose test has to be done
before meals or after meals;
at breakfast, lunch or dinner
time. I learnt that glucose
test has to be done before
meals at breakfast and
dinner time. Hence, I hope
to get S.
viii I demonstrate
understanding that role of a
nurse within a health care
setting encompasses taking
care of clients at physical,
psychosocial,
developmental, cultural, and
spiritual level. For instance,
my patient got agitated
when her son left the room
who had come to visit her.
She is at high risk of fall
and wanted to get out of bed
to look for him. I
maintained therapeutic
communication with her to
calm her down till her son
came back who had gone
out to get coffee. On his
arrival she became happy.
Hence, I hope to get S.

Communication

s:Du:

i During post conference

and discussions with our
teacher, I participate and
share the information with
my batch mates. For
example, I could define
what is Rh factor and what
is meant by autologous
transfusion. I gave the
presentation on Delirium.
Therefore, I hope to get S.
ii I document clearly,
accurately, concisely in a
timely manner. For
instance, my patient had
seizure. I observed and
recorded the details of the
event.
Events preceded the
seizure: Patient is bedridden
Seizure on set: 1657 hrs
Events during seizure:
Jerking of left arm and left
leg
Twitching of left side facial
muscles
Flushed skin.
Repeated blinking of eyes.
Post ictal assessment:
Tired, exhausted, sleepy.
Nursing Interventions:
Positioned the patient to
right side.
Assessed breathing
pattern.
Provided physical safety

5
I agree with your comments.
Rajinder has greatly improved
with the Meditech
documentation over the
semester. She consistently
reports to staff as required and
documents all pertinent
information in a timely manner.
Her understanding of this
course outcome is
demonstrated by her clinical
practice examples.

during seizure.
Assessed trauma to
mouth, tongue, lips,
cheek mucous.
I verbally reported the
above information to the
nurse in charge and
documented in meditech.
Hence, I hope to get (S).
vi I retrieve information
from meditech regarding
patient's primary and
secondary diagnosis. It
helps me in researching for
medical diagnosis and
identifying nursing
diagnosis. By reading
patient's profile I learn
patient's medical history.
This helps in understanding
the under laying causes of
medical diagnosis as well as
nursing diagnosis. I collect
patient's lab data; it helps to
determine if the lab values
are within normal range or
not, and patient is showing
signs of improvement or
not. Once I have identified
medical diagnosis, nursing
diagnosis, and lab data; I
seek information from
relevant nursing research,
experts and literature to
establish priorities for
nursing care. Therefore, I
hope to get S.

Caring relational practice

S:D

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i Idemonstrate behavior
that contributes to an
effective and therapeutic
nurse client relationship. I
engage in relational practice
through a variety of
approaches that demonstrate
caring behavior appropriate
for clients. For example,
one morning my patient was
upset and agitated. He
refused to eat breakfast and
take medication. He was
again and again saying that
he wants to go out. He did
not like my presence.
However, Iestablished a
caring environment by
telling him that Iam not
only a nurse, Iam your
friend too. Iwill give you
hygiene care, get dressed in
street clothes, and make you
sit in the chair. When your
family will come, you can
go out with them. Ifurther
asked him to shake hand
and become friend; to

I agree with your comments.

Rajinder has consistently
provided care in a caring and
compassionate manner. She
is always respectful of clients,
peers, staff, and clinical
teacher. Her mood is cheerful
and uplifting.

Rajinder's understanding of
this clinicaloutcome is
demonstrated by her many
clinicalexamples.

which he agreed. I also told

him to that he can share
with me if anything is
bothering him. In this way
tension of the situation
began to ease. He began to
eat breakfast and took his
medication. After breakfast
I gave him hygiene care,
changed his clothes and
with the help of a PSW put
him in the chair. He became
calm and was happy for the
whole day. Therefore, I
hope to get S
ii I establish therapeutic
caring, compassionate, and
culturally safe relationships
with clients and health care
team members. For
example, my patient wants
to feed herself. When she
was feeding I stayed by her
side encouraging her effort,
watching if she is
swallowing her food
properly, how much food
she has finished. In order to
learn how to empty urine
drainage bag I
compassionately asked a
health care team member if
she can demonstrate me the
skill, to which she agreed.
In this way I learnt how to
empty a urine drainage bag.
Hence, I hope to get S.
iii I demonstrate
therapeutic use of self to
foster client well being. For
example, My patient is in
comatose state and is
unresponsive. However, I

respectfully assist him with

nursing needs such as
hygiene, medication,
turning, positioning .I create
a healing environment at
nonphysical level, for
example, I learnt that my
patient has estranged
relation with his two sons
and wife because of his
alcohol and drug addiction
habit; recently, one of his
son has started visiting him
sometimes. I can speak my
patient's mother tongue,
therefore, I talk to him in
that language. It helps in
making a spirit filled
connection. Hence, I hope
to get S.
iv I am aware that beliefs,
values, and personal
experiences have effects on
relational practice. For
example, my patient is a 50
years old man. One day he
was upset and irritated. He
refused for oral care refused
to eat breakfast, take
medication. He did not even
like my presence in the
room. However, his
behavior towards me did
not bother me at all. I
understand that people at
this age are career oriented
sexually and physically
active, whereas my patient
is bed ridden, dependent for
activities of daily life. I
thought if I am at his place,
I would feel the same as he
is feeling now. Hence, I

1'.

hope to get S.
viii I provide effective
education to client where
ever needed. For instance,
my patient is a fussy eater
and sometimes refuses to
eat. At that time I explained
to her the value and benefits
of eating food, how by
eating food she will feel
energetic and gain health.
Therefore, I hope to get S
Leadership and advocacy

s. I1d

U:

iii I provide feed back to

my peers and accept feed
back from peers and
members of inter
professional health care
team. For instance, I was
giving hygiene care with
my fellow student to her
patient. I observed that she
did not clean the palms of
patient's hands. At that time
I pointed out to her that
patient's palms should be
cleaned and according to
the instructions of
physiotherapist small size
towels should be placed in
between the hands.
Further, my patient is
always in semi fowler
position and has enteric
(enteral) feed tube.
However, he slides down in
the bed. I put him in supine
position and with the help
of my fellow student began
to pull him up. At that point
she told me that I should

S
I agree with your comments.
As she has gained experience
and comfort on the Complex
ward, Rajinder has more
confidence to approach the
staff and ask for assistance.
She will provide feedback to
her peers in a positive
manner. Her pleasant
disposition contributes to a
positive work environment.
Rajinder demonstrates
understanding of this outcome
through her clinical examples.

tf
stop the feed. Therefore, I
hope to get S.
v I support client's rights
for self-determination and
choice. For example, my
patient wants to feed
herself; she does not like to
use straw to drink liquids.
She likes to drink liquids in
a cup. I support her decision
and let her feed herself the
way she wants. Hence, I
hope to get S
vii I consult and
collaborate when carrying
out health and nursing
practices that are in the
interest of the public and
protect the public through
collaboration and
consultation. For example,
my patient has hepatitis B.
Whenever my fellow
student works with me to
take care of my patient, I
remind her that she should
wear gloves while dealing
with body fluids of the
patients such as wiping the
spit (sputum), tears.
Therefore, I hope to get S.
Plans of care: Meeting
Clients Needs and Mutually
Agreed Expected Outcomes

S:

k.l

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ii I develop holistic and

client centered theory based
plans of care. For instance,
my client has COPD and
has UTI. I need to make
sure that her oxygen level
and oxygen saturation
should always be
maintained according to

S
I agree

with your comments.

Rajinder has collected

informationabout her clients
from the kardex, chart and
computer meditech on a daily
basis before her day so that
she can plan and organize her
work. Prioritizationand time
management have improved
over the semester as she has
become familiarwithall the

kardex. Her fluid intake

should be monitored and
encouraged. Her physical
safety should be assured as
she has high risk of fall.
Therefore, I hope to get S.
iii I use knowledge, skill
and judgement to assess
clients prioritize needs and
outcomes. For instance,
lack of movement places
the patient at high risk for
respiratory complication
such as accumulation of
mucus, pneumonia. Also
there is risk of skin
breakdown. Therefore, I
change patient's position
every 2 hours. Therefore, I
hope to get S.
v I safely and competently
implement and evaluate
nursing assessments and
nursing interventions. For
example, in the morning
when I go to my patient's
room for hygiene care,
while introducing myself I
make head to toe
assessment and implement
nursing interventions.
Evaluate outcomes of care
provided by health care
providers of previous shift.
I respond appropriately to
rapidly changing situation.
Therefore, I hope to get S.
vii I organize workload and
develop time management
skills to meet nursing
responsibilities. For
example, I give oral care to

routines and skills. She is able

to assess and prioritize their
needs and implement and
assess her nursing
interventions. She
demonstrates understanding
of this outcome by her clinical
practice examples.
2 Nursing Care Plans were
submitted Step 1 and Step 2satisfactory.

13>.
my patient, and set up his
breakfast table. In the
meanwhile I help my fellow
student in giving hygiene
care for her patient and set
up breakfast table. When I
return back to my patient, I
give him hygiene care and
transfer him to the wheel
chair with the help ofPSW.
Hence, I hope to get S.

Collaborative Practice

s. ~J

U:

ii I contribute as a member
of the interprofessional
health care team to respond
to the changing needs and
expected outcomes of
clients. For example, my
patient had seizure. I noted
down onset time, what
happened during the
seizure, autonomic sign,
post ictal assessment. After
seizure I did respiratory
assessment of the patient. I
reported all the information
to the in charge nurse of the
next shift so that they may
do suctioning in their shift
as it will prevent the
accumulation of mucus in
the airways. Hence, I hope
to get S.
iii I seek out assistance and
consult with members of the
inter professional health
care team to carry out
nursing care for my patient.
For example, my client was
upset and agitated. I was

S
I agree with your comments.
Rajinder has worked well with
the PSWs, RPNs, and RNs on
this unit learning from each
one their specific roles. It has
been difficult to connect with
other interprofessionals on the
team, as they do not work on
Sundays.
Rajinder shows understanding
of this outcome by her clinical
examples.

t If.
trying to calm him down
through my therapeutic
communication skills. At
the same time I asked PSW
and RPN to tell me how
more effectively I can help
my patient to calm down.
They talked to my patient
using their therapeutic skills
of communication. They
told me that I should leave
him alone for a while and
then come back to check
him. Therefore, I hope to
get S.
iv I work in teamwork to
meet expected client outcomes. For example, my
patient had bowel
movement, since my fellow
student was busy, I asked
PSW for help and with her
help I changed my patient's
briefs and gave him hygiene
care. Hence, I hope to get S.
v I interact with members
of the health care team
respecting their unique role
and competencies to learn
nursing skills. For example,
I learnt from a PSW how to
put table for food across the
bed while keeping side rails
up. I learnt from RPN how
by opening a capsule we
can mix it's medication into
the crushed medication.
Hence, I hope to get S.
Quality Assurance

S:[E]

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iii I Create, implement, and

evaluate a learning plan

s
I agree with your comments.
Rajinder has created a
learnino plan with goals to

consistent with the Quality

Assurance program (eNO).
For example, I identify
nursing diagnosis on the
basis of medical diagnosis.
Based on the severity of
diagnosis, I prioritize
nursing diagnosis and
initiate nursing
interventions that can
achieve goals and expected
outcomes needed to
improve patient's condition.
Therefore, I hope to get S.

improve her care includingthe

nursing process, to develop
better criticalthinking,and to
be more knowledgeable about
best practices. She is a
reflectivestudent always
lookingfor feedback and ways
to improve her practice.
Rajinder collaborates with
staff, peers and clinical
teacher to determine the best
outcome for her patients. She
understands the outcome and
has provided examples from
her clinicalpractice.

iv I seek out learning

opportunities and feedback
that foster professional
development, and integrate
them into practice. For
example, my teacher helped
me in figuring out time
factors in math questions.
Later when she asked me
same questions, I answered
them correctly. Hence, I
hope to get S.
v I utilize nursing research
to foster professional
development. For instance,
my patient has doctor's
order for an anticoagulant
'Lovenox'. I researched
regarding medication's use,
dose, route. I researched for
the type of syringe to be
used, site of injection, angle
at which needle should be
inserted in the skin fold. I
learnt that after
administration of injection
site of injection should not
rubbed or massaged. I also
reviewed the technique of

---~

removing medication from

the vial such as, inject into
the vial the amount of air
equal to the fluid that needs
to be withdrawn. When I
gave injection to my
patient, I was sure and
confident about the
administration of
medication. Therefore, I
hope to get S.
Critical Thinking, Problem
Solving and Decision Making

S:D

U:

5
I agree with your comments.

i I utilize critical thinking

skills in nursing care. For
example, my patient cannot
take thin fluids. After
giving her corticosteroid
bronchodilator, I gave her
thickened orange juice to
drink as oral care measure.
Hence, I hope to get S.
iii Plan to improve critical
thinking, problem solving,
and decision making is as
such:
Critical thinking- What do I
know about my patient's
condition?
What is my patient's
condition?
What else should I know to
understand the condition
better or improve it?
How can a specific therapy
affect the client?
What are other options
available?

Rajinder has consistently

developed better critical
thinking and decision-making
skills as she has gained
experience on this ward. She
is interested in learning about
her client's medical diagnoses
so that she can make informed
choices about their care.
Rajinder demonstrates
understanding ofthis outcome
by her clinical examples.

17
Problem solving- If a
problem arises, then to
obtain information and use
that information in addition
to what is already known to
solve the problem.
Decision making- In case of
problem to choose a course
of action from several
options, and make a
decision to implement it to
solve the problem. Hence, I
hope to get S.
v I prioritize patient's
nursing care. For example,
my patient has type 2
diabetes and his blood
glucose has to be monitored
before breakfast. My patient
is a fussy eater, however, I
make sure that he eats some
part if his breakfast after
glucose monitoring. Then I
administer his medication
which he can take with rest
of his breakfast at his own
pace. I keep reminding him
that it is very important to
eat in order to maintain
blood glucose level
Therefore, I hope to get S.

I have read and understand thls form and Its contents

Attendance: 0 days absent

Punctuality: Excellent (always early!)

Final grade: Satisfactory

Student Signature:

Rajinder Kaur

FaCUlty.Signature:

Elaine ~illar?

Rajinder,

Date: 2014/12/02
co

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December 5, 2014

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It has been a pleasure having you as my student and seeing you gain experience over the course
of this semester. All the best in your future endeavors. Elaine