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NURS1020 Clinical Course Evaluation

Mid-term Evaluation
Student: Natalie Selkirk
Clinical Instructor: Kristen Cecchetto
Missed Clinical Hours: 0 Missed Lab Hours: 0

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NURS1020 Clinical Course Evaluation
Program Goals
Students graduating from this program are prepared as generalists entering a self-regulating profession in situations of health and illness.
Students graduating from this program are prepared to work with people of all ages and genders (individuals, families, groups, communities
and populations) in a variety of settings.
Students graduating from this program are prepared to work with people of all ages and genders (individuals, families, groups, communities
and populations) in a variety of settings.
Graduates will learn to continuously use critical and scientific inquiry and other ways of knowing to develop and apply nursing knowledge
in their practice.
Students graduating from this program will be prepared to demonstrate leadership in professional nursing practice in diverse health care
contexts.
Graduates will be 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.
Students will demonstrate the ability to establish and maintain therapeutic, caring and culturally safe relationships with clients and health
care team members based upon relational boundaries and respect.
Graduates of this program will be able to enact advocacy in their work based on the philosophy of social justice.
Graduates will effectively utilize communications and informational technologies to improve client outcomes.
Graduates will be prepared to provide nursing care that includes comprehensive, collaborative assessment, evidence-informed interventions
and outcome measures.
Year One Goals
Define and describe the term 'self-regulating' and what it means to a part of a 'self-regulating' profession. Build a sense of identity between
building a sense of self and profession.
Demonstrate the ability to work with the aging populations in the residential settings.
Recognize the meaning and relevance of the five foci within the nursing program.
Define the ways of knowing and learning with a focus on critical and scientific inquiry.
Recognize the experience of leadership in nursing and undertake a leadership role in peer groups.
Articulate their role as individuals and professionals in providing safe nursing care.
Establish and maintain a professional relationship with peers and an engaged, caring, and culturally safe relationship with older adults.
Understand the concepts of advocacy and social justice. Begin to develop self-advocacy skills.
Explain the relevance of information and technology skills that are essential to safe health care.

Explain the components of the nursing process. Perform a basic biopsychosocial assessment of an individual.
Identify evidence-informed interventions and outcome measures with guidance.

Progress
Course Objective

Evidence/Indicators: (The student has ...)

Established therapeutic
nurse-resident relationships
in residential long-term care
settings

The following examples demonstrate how I have established

therapeutic nurse-resident relationships in a residential long-term
setting by:
1. Even though January 25, 2016 was my first day of placement
I was able to apply my skills in therapeutic communication. I
spent approximately 45 minutes with my resident; we spent
this time discussing everything from the weather, to her
telling me about her late husband, her six (6) children and her
past careers. This interaction was important and therapeutic in
that it allowed me to build trust with her; she felt comfortable
discussing very personal topics with me. Establishing this
trust with my resident at such an early stage allowed for me to
provide the best care possible, as she felt safe and
comfortable with my presence. Establishing trust is an
important aspect of the therapeutic nurse-resident
relationship.
2. Therapeutic communication can be as simple as introducing
yourself to the resident by name and discussing the purpose
of your presence. In addition to this, addressing the resident
by his/her preferred name also demonstrates therapeutic
communication. Therefore, I strive to meet this standard
every time I attend placement. I make a conscious effort to
introduce myself and make my presence known when I walk
into a residents room. I explain my actions before completing
them and I refer to all residents by their desired names to
show my respect for them.
3. I have gained an understanding of resident abilities,
limitations and specific needs related to his/her health
conditions by completing a care card. By determining

Progressing
well

Not meeting
expectation
s

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diseases and conditions that my residents have, I am able to
focus my care accordingly. For example, MG suffered a
stroke in 2009 (post CVA) that has lead to a slight right side
paralysis/weakness. This knowledge has made me more
conscious of her specific health conditions; for example when
she is involved in any weight bearing activities, I try to ensure
that a majority of her weight is directed toward her strong
side (left side), as this allows her to be more stable and
possibly reduce any negative outcomes such as falls. This
example demonstrates resident-centered care.
One of my goals from my learning plan is to demonstrate a body of
knowledge from nursing and other disciplines concerning current and
emerging health care issues by engaging in effective and efficient
therapeutic communication with vulnerable elders who have been
diagnosed with dementia in a long-term care setting. By being
aware of client diagnoses, modifying my communication styles to
account for any differences, researching and further understanding
dementia, actively listening and being fully engaged in conversations
and reflecting on resident interactions will allow me to achieve this
goal. Overall I feel as though I have established good relationships
with all the residents I have worked with, however over the course of
the rest of the semester I will continue to apply my current skills as
well as learn new skills.
Natalie consistently shows evidence of developing therapeutic
relationships by spending time with the long term care residents,
helping out when someone needs assistance and being friendly and
kind to all of the residents.
Performed skills relevant to
situating an individual
within his/her personal,
familial and community
context

The following examples demonstrate how I have performed skills

relevant to situating individuals within his/her person, familial and
community context:
1. A major part of MGs life is her family. One way that I was

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able to situate her into a familial context was by asking her
about her pictures in her room (she has several pictures of her
children, grandchildren and husband). By asking her about
these pictures I learned about her life with her husband, the
love she has for her children and grandchildren and how she
misses them, yet enjoys when they come to visit. It is evident
that MG thoroughly enjoys talking about and telling stories
about her family and their past.
2. Through using efficient communication I was able to get to
know MG in a personal way. One personal preference that I
noticed about MG is that she enjoys country music; she will
sit in her room and listen to country music for long periods of
time. The reason her love for country music stood out to me is
because of the way it changes her mood every time she listens
to it; I noticed a decrease in her anxiety levels and an overall
increase in her mood. She even expressed how she adores
Brad Paisley. By effectively communicating with MG I was
able to understand how big of an impact music has on her
personal life.
3. There are several ways in which I have demonstrated skills
for situating residents in their community context. For
example, by attending fitness class with MG I was able to
situate her (and myself) in her Centennial Place fitness
community. This is an important community for MG as it
encourages good health. On the other hand, on February 22,
2016 I was able to efficiently cue my resident to tell me about
the community she grew up in. She is from Jamaica, so it was
very interesting to hear stories about her past community
where she grew up.
Although I have been able to demonstrate these skills, I intend to
gather more personal, familial and communal information from my
residents. I will encourage my residents to partake in community
events within the facility, use cues (e.g. pictures) to gather

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information and ensure that I am actively listening and fully engaged
in conversation with my residents.
Natalie has performed skills such as assisting residents out of bed in
the morning, helping to toilet and bathe them and use mobility aids
in transporting residents to and from the dining hall and around the
home area (such as walkers and wheelchairs). Natalie has been able
to participate in using mechanical lifts and devices to move residents
in and out of bed and in the shower and tub room.
Developed and
demonstrated skills in basic
assessment techniques
relevant to the long-term
care population

The following examples demonstrate how I have developed and

demonstrated skills in basic assessment techniques relevant to the
long-terms care populations:
1. I have developed many useful skills by attending all classes
and labs. By attending NURS1002 (Introduction to
Foundational Practice Concepts) I have developed a better
understanding of geriatric nursing. Furthermore, by attending
NURS1020 (Clinical Practice Residential) labs I have been
able to develop skills including but not limited to: proper
feeding, vital sign assessments, bed making, lifts and
transfers and cardiac assessment.
2. On February 8, 2016 I had the opportunity to do full vital
assessments on three residents. This opportunity allowed me
to demonstrate some of the skills I have learned in my labs.
Taking these vital sign measurements allowed me to apply my
cardiac and respiratory assessment skills.
3. At the beginning of this semester I purchased my own blood
pressure cuff. I have been using it to practice my two-step
blood pressure measurements on my family and friends. This
is helping me develop my basic skills.
One my goals from my learning plan is I will demonstrate a body of
knowledge in nursing science by performing accurate blood pressure
measurements on three (3) residents in a long-term care setting.
Although I had the opportunity to do vital assessments on three

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residents, I was not able to do a manual blood pressure measurement
(due to lack of equipment). In order to successfully reach this goal I
think it is important for me to feel confident in this skill and
complete these manual measurements; therefore I plan to bring my
own blood pressure cuff and stethoscope.
Natalie has had the opportunity to do heart rates with her instructor
and did so with confidence. Natalie is able to assess the residents she
has worked with by asking them how they are doing and spending
time communicating with them. Over the last half of the semester I
expect Natalie will begin to use her assessment skills being taught in
lab and apply them in the long term care setting.
Demonstrated skills in
providing (resident) clientcentered support for
activities of daily living

The following examples demonstrate skills in providing (resident)

client-centered support for activities of daily living:
1. Some activities of daily living include: bathing, grooming,
toileting, feeding, dressing and transferring. I have had the
opportunity to partake in all of these.
a. I have helped with the bathing of the residents over
the past five (5) weeks. Bathing various residents has
shown me that it is a unique process for each person.
For example, due to MGs anxiety, she likes her
bathing to be done in a specific order.
b. I have personally groomed residents who were not
capable themselves, assisted with grooming and cued
grooming. For example, MG is not able to blow-dry
her own hair; therefore I did it for her. In contrast to
this, on February 22, 2016 my resident was able to
complete her own grooming however she just needed
some cueing to stay on task.
c. In terms of toileting, I have assisted residents in
getting to the toilet, assisted and completed pericare
after urination and bowel movements and I have
assisted in changing briefs of residents who have

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incontinence.
d. In terms of feeding, I have assisted and encouraged
residents with their feeding. For example on Monday
January 25, 2016 I assisted several residents with
feeding. Whether it was going to get them food or
drinks, physically assisting them with consuming their
meals, or encouraging them to eat (I encouraged them
that eating provides nutrients and energy for their
body and a well rounded diet is good for their health).
On this day one resident needed assistance with
feeding (was not physically able to feed herself). I
noticed that she seemed emotionally down when she
was sitting in the dining room; I went over to assist
her with her meal, and she smiled when I offered her
help.
e. In terms of dressing, I have encouraged residents to
assist in choosing their outfit for the day (I feel as if
this encourages a form of independence), I have fully
assisted residents with their dressing and I have cued
residents who are able to dress themselves.
f. In terms of transferring, I have demonstrated my
ability to participate in two-person manual transfers,
as well as used transferring mechanisms. For example,
MG is fairly mobile and requires only some assistance
when transferring, however I have worked with other
residents who require complete assistance when
transferring. In which case I was able to demonstrate
my understanding of how to use the mechanical lifts
in a safe and efficient way.
One of the main things I have learned about activities of daily living
is that although the activities themselves are the same, the ways in
which they are completed are very unique for each resident. This
uniqueness is due to factors such as cognitive state, physical capacity

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and chronic conditions. Another important aspect that I have learned
is that it is important to assist the residents, however it is also just as
important to encourage them to do as much as they can on their own.
This promotes both independence and the idea that if you do not use
it, you will lose it. For the remainder of this semester I plan to
continue to learn the unique ways in which each resident needs
assistance with their activity of daily living. I will do this by directly
asking the residence what type of assistance they need, I will refer to
their charts and I will ask the PSWs for any assistance when needed.
One of my goals from my learning plan incorporates me being able to
provide client-centered support for the activities of daily living; I believe
that as I work towards this objective I will also be working towards my
goal.

Natalie has consistently demonstrated skills in supporting ADLs. She

has been able to get the residents up in the morning and assist with
and/or perform morning care and toileting. She has demonstrated
the skill of feeding residents, doing some vital signs and bed making.
Developed knowledge about
the experience of residents
living in a long-term care
setting

The following examples demonstrate how I have developed

knowledge about the experience of residents living in a long-term
care setting:
1. After being at Centennial Place for five (5) weeks now, and after
working with a variety of residents I have learned that the
experience of residents in a long-term care setting is subjective to
each individual.
a. For example, I spoke with a resident on February 22, 2016
who expressed her negative experience of living in a longterm care setting. After she first mentioned that she feels
unsafe and unsecure I prompted her to tell me more. She
continued by saying that she does not feel as though it is
her home, she feels as though she is trapped. This woman
has quite severe dementia. She also expressed her negative
experience by telling me she never participates in social
events and does not intend to in the future.

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b. After speaking to MG I learned that she has mixed feelings
about living in a long-term care setting. She is very happy
to be alive (after suffering a major stroke); however she
often feels quite lonely and has expressed that she wishes
she could still live in her old home. I developed this
knowledge by prompting MG to tell me about her family
and her past. After analyzing MGs situation one thing that
I have noticed is that her heavy involvement in social
activities are what improve her experience in the long-term
care setting; one of her favourite gatherings is group
fitness.
With this being my first real experience in a long-term care setting I was
not sure what to expect. After speaking and interacting with various
residents I have become very intrigued with personal experiences. For the
remainder of the semester I plan to interact with more residents and ask
them about their experience within this setting. I also plan to do some
research on the aspects that affect ones experience, as well as interventions
that could possibly help improve their experience.

Natalie has developed knowledge about the experience of the

residents living in a long term care home by spending time with them
and developing good therapeutic communication skills. Natalie
started out the semester appearing confident and sure and has
continued on with that attitude throughout. She is not afraid to jump
in and do something new or help out. Natalie is at ease with
interacting with the residents.
Demonstrated safe and
ethical clinical practice at
the level appropriate for a
year one nursing student

The following examples demonstrate how I have demonstrated safe and

ethical clinical practice at the level appropriate for a year one nursing
student:
1. Even as a student-nurse it is my responsibility to provide safe,
compassionate and competent care. On February 1, 2016 I
demonstrated safe care when I assisted another student in
performing a bed bath and changing the brief of a resident who was
incontinent. This resident was not able to assist in any movements
during the process. We provided safe care by ensuring that the bed

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was at an appropriate height for us to work at. In addition to this
myself and the other student collaborated with one another to
minimize harm to the resident (e.g. rolling off the bed).
Incontinence can be a vulnerable situation, so we ensured that as
we performed this task we were acting in a compassionate way by
be empathetic and caring.
2. I have demonstrated ethical clinical care by maintaining privacy
and confidentiality. For example, it is our responsibility to collect
personal information to complete our assigned care cards. I ensure
that I only collect and disclose only the information necessary to
complete this task. Furthermore, I present this information with the
utmost degree of anonymity (e.g. using the residents initials rather
than their full name).
3. Another small way in which I demonstrate ethical care is by
ensuring dignity and privacy when I am caring for a resident. For
example, I always ensure that I close the residents door, especially
when I am performing a vulnerable task such as a bed bath or
pericare. This ensures that I am providing care in a discreet way
and minimizing the chances of intrusion.
4. I am always accountable for my actions. I clearly and truthfully
present myself in all situations with my full name, my title (e.g.
student-nurse) and my role. For example, when I was doing vital
assessments on a male resident, I first knocked on his door so he
was aware of my presence. Next I entered the room and introduced
myself with my name and ensured that he knew I was a student.
Before I began the process of taking his vitals I explained to him
why I was there, I also continued to explain the process on a stepby-step basis (e.g. I notified him that he may feel some discomfort
in his arm due to the blood pressure cuff).
Overall I feel as though I have achieved this objective. However, safe and
ethical practice is always important to incorporate into practice when
providing care. Therefore I will ensure that I continue to provide ethical
care by being compassionate, acting in a safe way, being competent with
my knowledge, promoting health and well-being, respecting the residents,
preserving dignity, maintaining privacy and confidentially, promoting
justice and being accountable for all my actions.

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Natalie is always very safe and cautious. If there is any doubt or if
she is unsure she seeks assistance from staff or her instructor. Natalie
is always respectful and professional towards the residents and the
staff at the long-term care home.
Participated in professional
development based on
reflective practice and
clinical inquiry

The following examples demonstrate how I have participated in

professional development based on reflective practice and clinical inquiry:
1. I have demonstrated professional development by ensuring that I
attend all classes and labs and complete all my assigned
readings/assignments. By doing this I am becoming competent with
my nursing specific skills. I am continuously enhancing my skills
and knowledge and judgment; this allows me to evolve as a nurse
and promote/provide the best care possible.
2. I have demonstrated my reflective practice by actively participating
in our weekly debriefings. By actively listening, I am learning new
skills and concepts that can help me with my practice. By me
contributing to the conversation I am teaching my classmates about
my knowledge and skills that I believe will help them with their
practice. For example, MG has high anxiety levels and tends to
display obsessive-compulsive disorder (OCD) behaviours. Through
research and working with MG I found that the best results were
achieved when I listened to what she wanted and complied with her
wishes. Something as simple as putting her bed sheets on in a
specific order eased her anxiety. By me sharing this with the group
I was able to provide them with information that they could apply
to their practice to achieve successful results.
3. I have demonstrated reflective practice by completing my weekly
journal entries. Writing my weekly journals allows me to reflect on
my emotions, strengths, weaknesses, what I have learned and how I
can relate it to my course work. This is important because it allows
me to put my thoughts into writing and allows for feedback from
my instructor. Journals allow me to reflect on my skills and decide
what I need to change and what I should continue doing in order to
get the best results possible.
Reflective practice is essential for professional development; therefore for
the remainder of the semester I will continue to attend all my classes and do

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the corresponding work. I will also continue to take an active part in
weekly debriefings and I will continue to write and submit my journal
reflections.

Natalie participates in post conference discussions and asks

questions when unsure. She hands in her weekly reflective note on
time and completes them well.
Examined personal attitudes
regarding the elderly and
other residents of long-term
care homes

The following examples demonstrate how I have examined personal

attitudes regarding the elderly and other residents of long-term care homes:
1. This is my first real experience working with a large group of
elderly people, so I did not know what to fully expect. Most of my
experience with elderly individuals has been through personal
interactions with my grandparents.
a. A major way I have examined my personal attitudes is
through the writing of my weekly journal entries. I find it
helpful for me to write about the events of the day and then
reflect on how I feel about the events and the residents
involved. This past week I went through all my journal
articles and examined my personal attitudes and I have
found that I have had mixed emotions over the course of
this placement (e.g. I have felt happy, sad, frustrated,
satisfied, etc.). For example I felt really happy and satisfied
when I helped successfully bathe a resident with Down
syndrome, however I felt discouraged when I was unable to
successfully understand and communicate with a resident
who had a cognitive impairment (dysphasia).
b. Another way in which I have examined my personal
attitudes is by discussing my experiences with my family
and classmates (ensuring that I comply with confidentiality
and anonymity rules). Being able to discuss my attitudes
with others and hear their feedback allows me to clarify my
emotions and views. Furthermore it allows me to hear their
thoughts and attitudes about the subject, allowing me to
compare and contrast them with mine.
I plan to work on this objective more over the remainder of this semester.

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By the end of this semester I hope to have a complete understanding of the
residents in a long-term care setting. I will do this through self-reflection,
journal reflection, communicating with others and by interacting with as
many different residents as I can so I can have a well-rounded and accurate
attitude.
Developed a basic
knowledge of the clinical
manifestations and relevant
nursing interventions of
chronic diseases

The following examples demonstrate how I have developed a basic

knowledge of the clinical manifestations and relevant nursing interventions
of chronic diseases:
1. I have developed a basic knowledge of dementia by working with
residents who have been diagnosed with the disease and by doing
research about the disease and interventions. A large majority of the
residents at Centennial Place have some form of dementia;
therefore I felt it was important for me to research the signs and
symptoms as well as interventions that I could apply in my
practice. For example, I read the Registered Nurses Association Of
Ontarios Best Practice Guidelines
(http://pda.rnao.ca/content/interventions-dementia) to learn about
behavioural interventions. I learned that the use of reminders such
as notes, cues and single day calendars can help with impairments
in the recall of recent events. Furthermore, I learned that providing
a safe and secure walking area is important when an individual
frequently gets lost; I was actually able to apply this intervention
by suggesting a walking route to a resident on February 22, 2016.
2. I have developed knowledge and learned about interventions by
asking the PSWs and nurses for input and help. The PSWs and
nurses work with these residents on a daily basis, so they know
what works and what doesnt work for specific residents. By
approaching the situation in an interprofessional way (interacting
with multiple health care professionals) I have been able to learn
and apply resident specific interventions. For example, one of the
PSWs suggested that if MG is showing signs if anxiety it is best to
let her relax and re-approach the situation at a later time.
3. I have only completed one care card, however I found it very
helpful to research health conditions and corresponding nursing
considerations. Although the health conditions were specific to

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MG, I have found that other residents have been diagnosed with the
same or similar conditions; having background information has
allowed me to be able to recognize the signs and symptoms and get
help or apply the appropriate interventions when needed.
Personally I do not think it is possible to ever fully meet this objective, as I
will always be introduced to new individuals who have multiple and
different health concerns. However, I will continue to complete my care
cards in order to develop a better understanding of chronic illnesses and
interventions. I will continue to ask for advice from the nurses, PSWs and
my instructor. I look forward to learning about more chronic diseases as I
work with new residents. One of my learning goals requires that I am able
to distinguish determinants of health that are unique to each individual
resident, I think that continuing to work towards this objective will also
allow me to successfully complete this goal.

Natalie has completed and handed in on time her first care card.
This was done very well and another one will be due in 2 weeks on
the current resident. This information will allow Natalie to start to
understand disease processes and develop critical thinking skills
when assessing her residents.

Clinical Instructor Comments (Any area marked unsatisfactory need to be commented on).
Natalie is progressing as expected at the year 1 level. She is very friendly and helpful on the home areas. Natalie is very confident
and not nervous to try something new. Keep up the good work. In the next 6 weeks I would like to see you applying the assessment
skills that you are learning in lab to your residents and reporting the information to me and trying to tie things together along with
diagnoses

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Signature of Instructor___________________________________________________Date____________________
Signature of Student_____________________________________________________Date____________________