Multi Rater Competency Assessment

2015 - 2016 - NURS 253 Practical Nursing Pre-graduate Experience MRA Mid (201508)
NURS 253 Practical Nursing Pregraduate experience (PN, 18-Jan-2016 - 07-May-2016)
Student :
Clinical Teacher/Preceptor :
Advisor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Period :
Student hours :
Required Hours :
Validated hours :

Maria Christina C. Carnay

Wendy Samuel
Martha Lalor
Judy Martin
Village of Humber Heights
Agency
LTC
18-Jan-2016 To 07-May-2016
200
200
200

I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes

Student Rating

Teacher Rating

1. Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies and procedures of the
practice setting.

1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies and

Satisfactory

Satisfactory

procedures.
M.C.C.C. : I believe that I have followed the rules and policies in my clinical settings by making sure I am always in full uniform; that I am maintaining
confidentiality; most importantly I am being honest and doing my practice safely without causing any harm to patients.

1. 2 Act in a professional, responsible, ethical and accountable manner.

Satisfactory

Satisfactory

M.C.C.C. : I've acted in a professional, responsible, ethical and accountable manner by always coming to clinical prepared with the willingness to
learn. I know that I am accountable for my actions therefore before I administer any medications I would always do my checks to ensure that it is right
the medication.

1. 3 Use the three factor and decision making frameworks to determine strengths and limitations and

Satisfactory

Satisfactory

when to collaborate and consult with other professionals.

M.C.C.C. : Each semester I've created learning goals for myself to determine what my strengths and limitations are to figure out what I need
improvement on. Whenever I have questions I would always consult with my preceptor.

1. 4 Integrate evidence-informed practice and a theory based approach into nursing care.

Needs
Development

Satisfactory

M.C.C.C. : I think that I need more improvement on integrating what I've learned in class and all the research I made into my practice

1. 5 Assess practices and risk management principles and take action to ensure safety of clients,
self, and others.

Satisfactory

Satisfactory

M.C.C.C. : Many of the residents are at risk for fall therefore whenever they have to walk to go inside the dining room I would assist them or when
they have forgotten their walker I would get it for them to ensure their safety.

1. 6 Question and clarify unclear orders or directions and when uncertain.

Satisfactory

Satisfactory

M.C.C.C. : Whenever I am uncertain of something, I would always ask my preceptor for clarification. For example, there was a situation when a
patient was getting 24mg of a medication but a new order to reduce the dose to 12mg was done recently. The pharmacy had already sent the
medications before the new order was seen therefore the dose for that medication was still not changed. It was a capsule that had to be crushed for a
patient, therefore I asked my preceptor what was the right way to get half of that medication.

1. 7 Question, clarify or challenge questionable orders, decisions or actions by others.

Satisfactory

Satisfactory

M.C.C.C. : Being in a new placement with new residents and policies, I had a lot of questions for my preceptor.

1. 8 Respond in a professional manner to situations in which there is unsafe, unacceptable or

Satisfactory

Satisfactory

unprofessional behavior.
M.C.C.C. : I did not witness any unacceptable or unprofessional behaviour in the practice setting however I believe that I've responded in a
professional manner where there was an unsafe situation regarding a resident. This resident in the unit who does not have the strength to walk or
even stand anymore had recently fallen off from her wheelchair from trying to climb out. There was a time she tried climbing out again and I got to her
on time and saw her brakes were not on therefore she was sliding off again. Ever since then I'm always checking up on her and making sure that her
brakes are on.

1. 9 Demonstrate understanding about the role of the nurse within health care.

Satisfactory

Satisfactory

M.C.C.C. : I understand that the role of the nurse within health care is to be a great leader in ensuring that patients are delivered with a safe, ethical
and quality care. Therefore, it is important to respect everyone and work as a team with other healthcare members.

Teacher comments for Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies
and procedures of the practice setting. :
Maria is competent and is aware and practices in compliance with legal and regulatory frameworks and policies and procedures.

2. Communicate using strategies and technology to effect accurate and timely information sharing including data, research, and other
information.

2. 1 Contribute to team sharing and discussions.

Needs
Development

Satisfactory

M.C.C.C. : After learning about the residents and the practice setting I'll be able to participate more on discussions. I think I need more improvement
on team sharing and discussions.

2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.

Needs
Development

Satisfactory

M.C.C.C. : I've only documented in the medication administration record, signing when I've given the medication, or if it was refused or if it is on hold.
I've never documented a type of care in the computer only my preceptor can.

2. 3 Use effective communication techniques when reporting relevant information and providing
feedback to the appropriate members of the interprofessional heath care team.

Satisfactory

Satisfactory

M.C.C.C. : I believe that I have used effective communication techniques by always signing the medications I have given in the mar, or when a
medication was refused or on hold I would put the sign that says it was on hold or refused . I would also communicate with my preceptor whenever I
witness anything or have relevant information to report about a patient. For example, a patient complained of back pain to me and was dizzy which I
reported to my preceptor. My preceptor had to do a follow up since that patient had a recent fall.

2. 4 Evaluate and refine techniques used to communicate and share information with clients and the

Satisfactory

Satisfactory

interprofessional health care team.

M.C.C.C. : I would communicate to my preceptor by for example reporting any vital signs that was taken by me or when I reported that a patient
complained of pain. Further assessments were then done for that patient and found a bruise on the patient's back.

2. 5 Ensure privacy and confidentiality.

Satisfactory

Satisfactory

M.C.C.C. : I have ensured privacy and confidentiality by making sure any information about the residents or anything in the practice setting only stays
in the practice setting.

2. 6 Use technology to retrieve information including research and other date and to obtain and

Satisfactory

Satisfactory

forward information both within and outside the practice setting.

M.C.C.C. : I have used technology to go to my ebooks and to research information about the diagnosis that each resident has to have a better
understanding of their condition. I've also researched medications that was new to me and made sure I know the effects of all the medications I am
giving to the residents.

Teacher comments for Communicate using strategies and technology to effect accurate and timely information sharing including data,
research, and other information. :
Maria uses technology to communicate and research information

3. Engage in relational practice that is caring, compassionate and respectful.

3. 1 Establish therapeutic caring, compassionate, and culturally safe relationships with clients and

Satisfactory

Satisfactory

health care team members.

M.C.C.C. : I believe that I've showed a caring, compassionate and culturally safe relationships with clients and the health care team members by
respecting everyone in the practice setting.

3. 2 Establish a caring environment that supports clients in meeting their needs and outcomes,

Satisfactory

Satisfactory

managing their illness, or experiencing a peaceful death.

M.C.C.C. : I believe that I've showed a caring attitude with the residents by always assisting them when they need to get up and walk to the dining
room. Also, when they are trying to talk to me even when it doesn't make sense or it is hard to understand due to aphasia, I always try to understand
them of what they want/need and that I am always listening to them.

3. 3 Demonstrate therapeutic use of self to foster client well-being.

Needs
Development

M.C.C.C. : I believe that I need more development on demonstrating therapeutic use of self to foster client well-being.

Satisfactory

3. 4 Utilize relational knowledge and skills, and ethical principles to support clients and to interact

Satisfactory

Satisfactory

with health care providers.

M.C.C.C. : I've utilized knowledge and skills by understanding patients' rights and checking medications before I give it to them. Learning about gtube, medication administration, wound care and lifts transfers helps me interact with healthcare providers when certain skills needs to be done.

3. 5 Use self-awareness to identify the effects that beliefs, values, and personal experiences have on

Satisfactory

Satisfactory

relational practice.
M.C.C.C. : I am aware of my own beliefs and values and I know that I cannot impose these views on anyone else. It is important to know that
everyone is different in order to understand that different approach to care is needed on some individuals.

3. 6 Collaborate with clients, members of the interprofessional and health care teams; and, consult

Satisfactory

Satisfactory

appropriately.
M.C.C.C. : I believe that I've collaborated well with the health care team for example, I had a chance to do a wound dressing for a resident. My
preceptor and I worked together in order for me to learn and be able to correctly apply the new dressing for the resident. Another example is when a
psw was assisting a resident in the bathroom and I had to check if the resident obtained any bruises in her back due to a recent fall she had. We then
worked together to inspect and did found a bruise in the resident's back.

3. 7 Uphold practices and systems that support the diversity of clients and of the interprofessional

Satisfactory

Satisfactory

health care team.

M.C.C.C. : I think that I've uphold practice and systems that support the diversity of clients and of the interprofessional health care team by
understanding the different roles of the team and the different nationalities of the residents. I make sure that I am being nonjudgmental and that I am
showing respect with everyone.

3. 8 Provide effective client education.

Needs
Development

Satisfactory

M.C.C.C. : The residents in the unit I am in are all diagnosed with dementia and it's difficult for me to give an effective client education because they
forget or they don't understand therefore I need more development on this. For example, there is a resident who always remove a dressing and
scratches their wound and no matter how many times I tell that resident not to they would continue to do so.

Teacher comments for Engage in relational practice that is caring, compassionate and respectful. :
Marie shows compassion ' caring and respect to all our residents

4. Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the profession.

4. 1 Evaluate and refine leadership skills to develop solutions, resolve conflict, create a positive work

Needs
Development

Satisfactory

environment and organizational culture, and to strengthen advocacy role.

M.C.C.C. : Being in a new placement with new residents I focused more on learning about the place, the rules and the residents' names. I also
wanted to learn more about their diagnoses and their medications. After following my preceptor for a couple of weeks and researching everything I
need to know, I believe that I would be able to show my leadership skills to develop solutions and resolve conflicts.

4. 2 Provide feedback to peers and accept feedback from peers and members of the
interprofessional health care team.

Satisfactory

Satisfactory

M.C.C.C. : I am the only student in the unit therefore no feedback was given or received from peers. Only feedback from preceptor was received and
accepted.

4. 3 Advocate for clients, self, others, and quality practice environment.

Satisfactory

Satisfactory

M.C.C.C. : I respect my patient's decisions for example when they refuse a medication or when they want to sleep more, I do not force them to get up
for breakfast or to take their medications. I think it's important to be respectful of everyone and be caring for a quality practice environment

4. 4 Support clients rights for self-determination and choice.

Satisfactory

Satisfactory

M.C.C.C. : I've supported clients' rights for self-determination and choice by respecting their decisions, for example some residents occasionally have
moments when they want to be left alone, or they want to sleep more or they refuse their medication.

4. 5 Respond appropriately to unsafe, unacceptable, and unprofessional behaviors.

Satisfactory

Satisfactory

M.C.C.C. : There's a resident who has been recently started being aggressive to the staff and the residents. Also, that resident sometimes tries to
move other residents in a certain place that could harm them. When the staff tries to stop that resident from doing that, she would then start being
aggressive and be mad. To prevent the resident from harming other residents I would distract her or try to redirect the resident to her room. Therefore,
I believe that I've responded appropriately to unsafe or unacceptable behaviors.

4. 6 Demonstrate public protection and acting in the interests of the public through collaboration and

Satisfactory

Satisfactory

consultation with other members of the interprofessional health care teams.

M.C.C.C. : I believe that I've demonstrated public protection and have acted in the interest of the public by making sure that I am always washing my
hands before and after care. Also, when personal protective clothing needs to be worn, I would always wear it to protect myself and the other
residents on the unit from contamination.

4. 7 Contribute to the creation of quality practice strategies and solutions.

Needs
Development

Satisfactory

M.C.C.C. : I've been following my preceptor for a couple of weeks because I've been trying to learn about the unit and the residents. Now that it's
after midterms and I know my residents and what needs to be done I think that I can contribute more to the creation of quality practice strategies and
solutions.

4. 8 Assign, supervise, teach as appropriate, and provide feedback to unregulated care providers

N\A

Satisfactory

(UCPs) in collaboration with the interprofessional health care team.

M.C.C.C. : No UCPs were assigned, supervised, taught as appropriate or were provided feedback in collaboration with the interprofessional heatlh
care team.

Teacher comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
Maria is able to give information to other staff and advocate for clients that need assistance.

5. Integrate the nursing process into all aspects of nursing care and across diverse practice settings.

5. 1 Formulates clinical judgments that meet clients unique and changing health needs and priorities,
outcomes, and overall condition and incorporates these into evolving plans of care.

Satisfactory

Satisfactory

M.C.C.C. : When patient seems that they are in pain by moaning and by their facial expression, we would assess by asking if they're in pain or
where's the pain located. The medication administration record would them be checked for any prn medications for pain and would be given to the
patient who is moaning in pain.

5. 2 Devise evidence-informed plans of care that are holistic and client-centred.

N\A

Satisfactory

M.C.C.C. : Evidence-informed plans of care that are holistic and client-centred are already made specifically for each resident.

5. 3 Use clinical judgment to assess clients, prioritize needs, outcomes, and nursing interventions.

Satisfactory

Satisfactory

M.C.C.C. : I believe that I've used clinical judgment to assess clients, prioritize needs, outcomes and nursing interventions. For example, when there
was a situation I visited a resident in their room, I saw that the resident didn't look well and was not standing properly. I assessed the resident by
asking if they're feeling any pain and they said yes and also asked where it is located and when did it start. I then reported to my preceptor and further
assessments were made.

5. 4 Collaborate in the evaluation, refinement and modification of plans of care.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

M.C.C.C. : I always work with my preceptor with every care that needs to be given to patients.

5. 5 Safely and competently perform treatments and use techniques, and technology autonomously
and in collaboration with clients and members of the interprofessional health care team.

M.C.C.C. : I believe that I've safely and competently perform treatments and use techniques such as wound care and administering medications via
g-tube and changed its dressing along with my preceptor. I do however need more hands on practice in order to be more confident.

5. 6 Collaborate with the clients across the lifespan and with members of the interprofessional health

Satisfactory

Satisfactory

care team to create a client centered plan of care that is articulated with competence both in writing
and orally.
M.C.C.C. : I've collaborated and worked with my preceptor as a team to learn and give care to all the residents.

5. 7 Use awareness of own knowledge and skills, the three factors of nurse, client and environment

Satisfactory

Satisfactory

and the practice decision-making framework to guide practice.

M.C.C.C. : With everything I learned in class, the hands on practice I am having and the learning plans I've created helps me be aware of my own
knowledge and skills. This guides me with my practice by understanding when to consult and what I need improvement on.

5. 8 Manage workload, time, and physical resources to provide effective, efficient and ethical care.

Satisfactory

Satisfactory

M.C.C.C. : I've tried to organize my time throughout my day in clinical, by knowing when to change wound dressings, give medications, feed
residents and if there is time, I usually help with the PSWs.

Teacher comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :
Maria is able to give care to a diverse community

6. Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and holistic health care in a
complex and changing environment.

6. 1 Collaborate with clients to determine needs, mutually agreed health outcomes, approaches to

N\A

Satisfactory

care, and to evaluate care.

M.C.C.C. : Unable to collaborate with clients due to their condition. Residents already have their own individual care plans.

W.S. : We have had care conference with the interprofessional team and made mutually agreed outcomes.

6. 2 Contribute as a member of the interprofessional and health care teams to respond to changing

Satisfactory

Satisfactory

client needs and outcomes.

M.C.C.C. : There was a situation in the unit when we were short of staff and the PSWs that were there were also new at the floor. I helped them get
the residents up, washed and dress, I also helped with lift transfers therefore I believe that I've contributed well as a member of the interprofessional
and health care teams.

6. 3 Consult with and seek out assistance from members of the interprofessional health care team.

Satisfactory

Satisfactory

M.C.C.C. : Whenever I have questions or assistance I would always go to my preceptor to consult to and ask for clarification.

6. 4 Use teamwork, consensus building, and conflict resolution and leadership skills to meet

Satisfactory

Satisfactory

expected client outcomes.

M.C.C.C. : My preceptor and I would work as a team for example when we have to change a wound dressing, but the resident had a bowel
movement. We cleaned up the resident first together before applying the new dressing.

6. 5 Integrate effective, collaborative, and consultative strategies to meet clients needs within a

Satisfactory

Satisfactory

changing environment.
M.C.C.C. : Whenever there's changes for example with medication orders and there's wrong medication in the cart I would always ask my preceptor
first for consultation.

6. 6 Respect the unique role and competencies of all members of the interprofessional health care

Satisfactory

Satisfactory

team.
M.C.C.C. : I respect the unique role and competencies of all members of the interprofessional health care team by being non-judgmental and
respectful of them.

6. 7 Collaborate as a member of the interprofessional health care team to respond to changes in

Satisfactory

Satisfactory

nursing knowledge and practice and in the health care environment.

M.C.C.C. : I worked and collaborated with my preceptor with all the care that needed to be done with the residents such as wound care, changing gtube dressing and with maintaining patient safety.

Teacher comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
We have had 4 care conference with the interprofessional health team to discuss clients and teir needs.

7. Engage in Quality Assurance consistent with the regulatory framework.

7. 1 Act in the best interests of clients and protect clients from harm through collaboration and

Satisfactory

Satisfactory

consultation with other members of the interprofessional and health care teams and by through
competent and safe practice.
M.C.C.C. : I believe that I've acted in the best interest of clients and protect clients from harm through collaboration and consultation with other
members of the interprofessional and health care team and by through competent and safe practice. For example, when there was a problem with the
secured doors in the practice settings, all the teams worked together to watch each door to make sure that no clients were leaving and going to the
staircase because it could cause a fall and injury.

7. 2 Commit to Quality Assurance practice to identify strengths and areas for professional growth and

Satisfactory

Satisfactory

in accordance with the regulatory framework (CNO).

M.C.C.C. : I've committed to quality assurance practice in accordance with the regulatory framework by creating a learning plan in order to determine
strengths and limitations. This helps with setting a goal in order to improve and achieve competence.

7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance program

Satisfactory

Satisfactory

(CNO).
M.C.C.C. : I've created, implemented and evaluated a learning plan consistent with the Quality Assurance program and we would always send this to
our clinical instructor in my previous clinical placements. However this time, we are on our own and we don't need to send our learning plan to anyone
for marks. I've only created my learning plan for myself because it helps me determine what I need to work on. For example, one of my learning goals
was to do a wound care because I've never had chance to practice in my previous clinical placements. Now that I'm in my current placement, I had a
chance to do a wound care along with my preceptor.

7. 4 Assume responsibility to seek out feedback for colleagues and peers and learning opportunities

Satisfactory

Satisfactory

that foster professional development.

M.C.C.C. : I would seek out learning opportunities by asking my preceptor if I can practice certain skills such as administering medications via
gastrostomy tube in order to foster professional development.

7. 5 Consistently review nursing research and information about health care to improve competence

Satisfactory

Satisfactory

and to support clients.

M.C.C.C. : I have drug cards that I made for all the medication I need to know which helps remind me what the medication is for. Continuing
competence is important therefore I try to review all the lessons I've learned in class.

7. 6 Develop professional responses to health care system changes resulting from advances in

Satisfactory

Satisfactory

research, technology, and changes in societal and political forces.

M.C.C.C. : Changes were made in the practice setting for example measuring all the resident's blood pressure was every month and now it is only
measured when it is needed. The response made to those changes is by assessing patients who are ill or in pain, have recently fallen or the doctor
have ordered it then the vitals will be taken.

Teacher comments for Engage in Quality Assurance consistent with the regulatory framework. :
This is satisfactory

8. Use critical thinking, problem solving and decision making skills to meet the health care needs and expected outcomes of clients.

8. 1 Use critical thinking to inform decision making in all aspects of nursing care.

Needs
Development

Satisfactory

M.C.C.C. : I believe that I need more improvement on my critical thinking skills to inform decision making in all aspects of nursing care.

8. 2 Use clinical judgment to assess and refine assessments in collaboration with the

Satisfactory

Satisfactory

interprofessional health care team, formulate nursing diagnoses, plan nursing interventions, and
outline evaluative criteria.
M.C.C.C. : When I had a chance to do a wound dressing my preceptor and I would assess the skin and the wound of the patient and worked together
as a team to apply a new dressing for the patient.

8. 3 Evaluate and refine critical thinking, problem solving, and decision-making skills.

Needs
Development

Satisfactory

M.C.C.C. : I believe that I could still improve on problem solving, decision-making skills and with my critical thinking skills.

8. 4 Integrate knowledge from variety of nursing, health, and other theory into nursing practice to

Satisfactory

Satisfactory

provide safe and competent care.

M.C.C.C. : I believe that I can show more with regards to integrating the knowledge I've learned from my classes and all the research I made into my
practice.

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

M.C.C.C. : I believe that I've prioritize effectively especially with always making sure that the residents are safe. Many of them are risk for fall
therefore I always try to assist them and if I see something on the floor that could cause a fall I would remove it for a clear path.

8. 6 Demonstrate professionalism, responsibility, and accountability.

Satisfactory

Satisfactory

M.C.C.C. : I've demonstrated professionalism, responsibility and accountability by always coming to clinical prepared and making sure that I am
being honest with my practice.

8. 7 Use critical thinking, the practice decision-making framework and the nurse-client-environment

Needs
Development

Satisfactory

framework to inform clinical judgments and practice.

M.C.C.C. : I think there's some more room for improvement with the use of critical thinking skills and decision making skills.

Teacher comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
Maria is able to use critical thinking to help our clients

Student Midway Summary with Strategies for Continued Growth

I've followed my preceptor and understood the role of the nurse within the healthcare facility. I've seen how critical thinking, leadership, teamwork and
prioritization was done in the unit and how important it is with regards to delivering a safe and quality care. After following my preceptor and learning
about the unit and the residents I believe that I can show more with showing good quality practice. I've administered medication correctly with the right
patient and right medication. I've administered medication via g-tube as well. Wound care dressing and g-tube dressing was also done.
Documentation needs more practice however and the use of critical thinking skills. Overall, prioritizing the safety of patients was done and should be
maintained but confidence needs more improvement when doing skills.

Teacher Midway Summary with Strategies for Continued Growth

Maria has done well and should continue to be calm through everything.

Advisor Midway Summary with Strategies for Continued Growth

Continue to improve on your nursing skills.

Refer to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Grade

Needs Development

Satisfactory

Program Coordinator Feedback

The Program Coordinator has reviewed the evaluation

Yes

No

Student Sign Off

I met with my Clinical Teacher/Preceptor and discussed my evaluation

Yes

No

In general this evaluation accurately reflects my performance

Yes

No

Submitted Date: 04-Mar-2016 20:08

Unsatisfactory