Self Assessment

2016 - 2016 - NURS 151 Practical Nursing Practice 2 Final (201508)

NURS 151 Practical Nursing Practice 2 (PN, 12-Jan-2016 - 07-May-2016)
Student : Sarah Mann
Clinical Teacher/Preceptor : Sylvia Wojtalik
Program Coordinator : Wendy Chow
Location : Trillium Health Partners/Credit Valley Hospital
Placement Setting : Agency
Unit/Office/Clinic : 1 East
Period : 12-Jan-2016 To 07-May-2016
Student hours : 168
Required Hours : 168
Validated hours : 168
I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes Student Rating Teacher Rating

1. COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK

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

procedures.

S.M. : I comply with regulatory standards, relevant legislation and the practice settings policies and procedures by following the dress code set by

CVH. I adhere to the policies and procedures Credit Valley hospital has in place for patient care (Medication administration for diabetes (double

checks), Braden's scale done on Wednesday's, and bowel routine etc). I follow the regulatory standards set forth by the CNO (confidentiality and

privacy, professional standards etc)

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

S.M. : I act in a responsible, ethical and accountable manner by not being negative and talking bad about my patients or other health care

professionals. I make sure not to participate in inappropriate activities that would look bad upon myself and the nursing profession. I take report at the

beginning of the shift to transfer the accountability of the patient as well as at the end of my shift.

Satisfactory Satisfactory
1. 3 Determine strengths and limitations and when to consult and seek assistance from other

professionals.

S.M. : I am able to determine strengths and limitations and when to consult and seek assistance from other professionals. for example a patient of

mine seemed to have crystals in their urine. I noticed this when performing morning care. I took it upon myself to speak with the appropriate personal.

I thought it could have been because of medication the patient was taking but the nurse advised me that it was from the briefs. when the patient

urinates heavily part of the brief comes off in little crystal like forms.

Satisfactory Satisfactory
1. 4 Use evidence informed practice and a theory-based approach to care.

S.M. : I use evidence informed practice and a theory-based approach to care. When performing trach suctioning on 1e at credit valley if a patient as

had a trach for a long period of time it has been approved to use a clean procedure. However if the patient is immunocompromised the procedure

must be sterile.
 Satisfactory Satisfactory
1. 5 Ensure client safety and a safe environment.

S.M. : I ensure client safety and a safe environment by lowering the bed back to the lowest setting, making sure the call bell is within the patients

reach and I make sure they know how to use it. I tidy the room making sure nothing is in the way that might obstruct the client or harm them (ex.

tables, chairs). I make sure to lock the patient wheel chair and buckle them in to make sure the remain safe and free of harm. I make sure to explain a

procedure before performing it and making sure the patient understands what needs to be done. I always obtain consent to preform the procedure.

Satisfactory Satisfactory
1. 6 Ask relevant questions to clarify understanding of the plan of care and whenever uncertain.

S.M. : I ask relevant questions to clarify understanding of the plan of care and whenever uncertain. Example is when a patient had wore dentures. In

his MAR is said to clean the dentures before the patient eats breakfast. I wanted to make sure the patient wanted to have it done that way so I asked

them. The patient advised that I brush them after he eats and the ventured were left in a cup. I left the room to attend to another patient and came

back to check 30 minutes later. The patient had not eaten anything and would not speak to me. I went to the nurse also working with that patient on

that day and she came to help me. We washed his dentures and he was then able to eat his breakfast and talk to me. I will make sure next time to

follow the MAR more carefully. If I am not sure I will still speak with someone who can address the situation.

Satisfactory Satisfactory
1. 7 Identify ethical and unsafe situations and seek appropriate assistance to resolve these.

S.M. : I am able to identify ethical and unsafe situations and seek appropriate assistance to resolve these. For example I noticed a patient who is at

risk for falls walking on their own to the bathroom. Since the patient was not under my care I was not sure if it was the right patient that I knew to be at

risk. I turned to the charge nurse at the nursing station and asked her if the patient was supposed to be up on their own or if they needed help. She

advised for me to get the nurse in charge of that patient and so I did. Next time I will make sure to help the patient myself once I know for sure they

are risk for falls.

Satisfactory Satisfactory
1. 8 Demonstrate understanding about the role of the student nurse.

S.M. : I demonstrate understanding about the role of the student nurse by being accountable, following procedures, policies and regulations set forth

by Humber, CNO, and CVH. I work in a safe manner for my patients and myself. I do not preform procedure that I am not allowed to do as a student

nurse example blood glucose monitoring and phone orders from the doctors.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :

Sarah has successfully completed Practical Nursing Practice, Nurs 151 in the Winter 2016 and was evaluated based on the College of
Nurses Standards of Practice (CNO/SP) within the dimension of direct practice (weekly) at Trillium Health Partners, Credit Valley Hospital,
Complex Continuing Care Unit. Sarah demonstrates responsibility for her conduct and accountability to herself, patients and profession by
engaging in the learning process and self-evaluation as a learner. Much interest and enthusiasm were shown throughout this semester.
She has demonstrated evidence of accountability by being present; punctual for labs /clinical. Her attendance has been excellent and she
has met all the course objectives.

2. ACCURATE AND RELEVANT COMMUNICATION

Satisfactory Satisfactory
2. 1 Participate in team sharing and discussions.

S.M. : I participate in team sharing and discussions at the end of every clinical day. Recently we have been given assignments to research from the

CNO website about patient care and ethics related to the nursing practice. I was able to better understand the four controlled acts that us a nurses

and students are authorized to perform and also better understand how to maintain commitments to our clients. By researching these documents I

was able to help provide my classmates with a better understanding as well that will help them and myself be better nurses.

Satisfactory Satisfactory
2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.
S.M. : I document clearly, accurately, concisely in a timely manner using written and electronic methods. I have become more proficient and timely

about entering information (vitals, am care, and patient checks etc) into the computer. I have also become better at writing narrative documentation on

the status of how I received my patient and then documenting anything that deviates from the norm. I will continue to work on my narrative

documentation skills as I believe I can become even better.

Satisfactory Satisfactory
2. 3 Report relevant information to the appropriate personnel.

S.M. : I report relevant information to the appropriate personnel. I patients wife brought to my attention that the patient beside him needed to be

suctioned. I had not had the chance to do suctioning yet so instead of doing it myself I went and found the nurse working with that patient so she could

clear the patients airways to allow for proper oxygenation.

Satisfactory Satisfactory
2. 4 Utilize communication techniques with the client and inter-professional health care team.

S.M. : I utilize communication techniques with the client and inter-professional health care team. At CVH I have been able to use all different forms of

communication such as lip reading, charts, open and close ended questions etc. I have been able to learning how to communicate with patients that

are not able to use verbal forms of speech. It has been challenging but has helped me grow and become better able to understand what my client

needs.

Satisfactory Satisfactory
2. 5 Maintain privacy and confidentiality according to the Personal Health Information Protection Act

(PHIPA)

S.M. : When performing procedures I make sure to provide privacy. I keep my patients identity confidential and do not speak about them outside of

the workplace.

Satisfactory Satisfactory
2. 6 Use technology to retrieve information including research, data and other information.

S.M. : I use technology to retrieve information including research, data and other information. When I need to know lab data for my patient I go onto

the computer at CVH and search the values that I need to know. I also use the CVH website to do drug research to find the ones that are not in our

drug book.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Sarah recognizes the legal, professional as well as therapeutic trajectory of communication on the unit. Sarah participates in transfer of
accountability report by collecting important information from a previous shift. That information is taken into account when planning and
prioritizing the care for example, being aware of a need to perform tracheal suctioning or bladder irrigation. Sarah remains in touch with the
primary nurse at all times, updating and sharing information based on the assessment and observations. Sarah completes electronic
documentation recognizing prompt, accurate and frequent documentation of data to make it accessible to other health care professionals
for example an MRP seeking most recent vital signs, bowel elimination or intake and output. Sarah always seeks way to communicate with
her patients that are limited in their communication, for example by reading their lips, or asking closed-ended questions that her patient
can respond to by blinking for 'yes'.
Much attention has been delivered towards accuracy of words for example knowing the difference between incontinent, voided,
toileted.
Sarah shows respect to colleagues and maintains privacy, confidentiality, safe practices and professional behavior. Narrative charting,
using paper based method was implemented this semester and Sarah has been improving in organizing flow of described content. Sarah is
encouraged to continue practicing narrative charting with emphasis on Focus charting, sometimes called DAR (data, action, response) to
capture all her assessment findings, provided care and health teachings. No unprofessional conversations took place in clinical other than
the ones benefiting teaching and learning. Sarah always transfer the assigned patients to another student when going on breaks. Sarah is
encouraged to ensure that all important information has been shared with the covering nursing student, for example, monitoring enteral
feeds, or a need for a water flush, or reassessing the effectiveness of a given pain medication.

3. CARING RELATIONAL PRACTICE

 Satisfactory Satisfactory
3. 1 Utilize effective communication techniques.

S.M. : I am able to use effective communication techniques such as using general leads, open and closed ended questions, restating etc. I have had

the pleasure to work with patients who blink to communicate or use communication boards that help me understand what they need.

Satisfactory Satisfactory
3. 2 Demonstrate therapeutic caring, compassionate, and culturally safe relationships with clients

and health care team members.

S.M. : I demonstrate therapeutic caring, compassionate, and culturally safe relationships with clients and health care team members. An example is

when preforming a bed bath for my patient. We talked about life experiences and family and what it was like to move half way across the world. I have

tired to use therapeutic touch to have a better impact on my patients and hopefully show them that I care about them as people. I have also tired to

get to know the nursing staff better and understand them as well and why they chose to be part of the health care team.

Satisfactory Satisfactory
3. 3 Apply knowledge of therapeutic use of self and identify its effect on client well-being.

S.M. : I am able to apply knowledge of therapeutic use of self and identify its effect on client well-being. I have been able to utilize my voice and

listening skills as a therapeutic method. By talking with my patients and listening to what they have to talk about I have identified that it is having a

positive effect on the clients well being. They are more engaged and will to take part in their plan of care. I have also had a few patients, mine and

others, tell me that I will make a good nurse one day.

Satisfactory Satisfactory
3. 4 Use self-awareness to identify the effects that beliefs, values, and personal experiences have on

relational practice.

S.M. : I have seen how personal experiences can have effects on nurse and patient. for example I saw a patient that felt like their voice was not being

heard by the nurse. They started to get agitated and aggressive verbally with the nurse and the nurse then became the same way back to the patient.

If the nurse had of used a different approach and just listened to the patient the outcome could have been different. I have learned from this

experience to take my time with my patients and listen to what they have to say.

Satisfactory Satisfactory
3. 5 Interact with clients and members of the inter-professional health care team; and, consult

appropriately.

S.M. : I interact with clients and members of the inter-professional health care team; and, consult appropriately. We help each other preform

procedures and consult with each other and discuss what needs to be done with the clients plan of care. It is important to speak with all health care

members like RT, OT etc because working together will benefit the patient and our selves.

Satisfactory Satisfactory
3. 6 Apply knowledge of practices and systems that support the diversity of clients and the inter-

professional health care team.

S.M. : I apply knowledge of practices and systems that support the diversity of clients and the inter-professional health care team. I have cared for

patients of Jamaican, Polish and Canadian decent. I make sure to ask them how their cultures does things and I make sure to incorporate that into

their plan of care. I love learning about different cultures it helps me to understand why people may do thing differently then I do.

Satisfactory Satisfactory
3. 7 Apply knowledge of clients cultural, religious, and other beliefs and values as these influence

clients choices and decisions.

S.M. : I am able to apply knowledge of clients cultural, religious, and other beliefs and values as these influence clients choices and decisions.

However, to date, I have not gotten to work with someone using different religious beliefs but I have got to work with patients from different cultures

and I try as much as possible to make them feel like there values and beliefs are used with their plan of care. I try to talk to them about where they are

from and learn more about there culture.

Satisfactory Satisfactory
3. 8 Provide effective client education.

S.M. : I was able to provide a diabetic patient with some education on the right foods to eat. Nutrition is important with diabetes. I know that the

patient, if their blood sugar is low, they like to treat themselves to unhealthy foods like poutine. I asked them why they thought it was okay to eat

unhealthy foods when their blood sugar is low. The patient advised that they know they wont experience hyperglycaemia when their blood sugar is

low. I advised it was important even when their blood sugar is low to eat the right foods. Eating food with high salt levels can cause cardiovascular

diseases especially in patient with diabetes, it is a precursor, and food high in sugars and cause circulation problems etc.

Teacher comments for CARING RELATIONAL PRACTICE :

Sarah acknowledges herself as a caring practitioner and her conduct is guided by respect for cultural diversity and sensitivity.
Interest and well-being of patients have been a focal point for Sarah in a therapeutic nurse-patient continuum. Sarah crafts, maintains and
promotes respectful, collaborative, therapeutic and professional relationships. Sarah has been observed to identify areas that could benefit
from her providing health teachings to her patients, for example with diet and a diabetic patients or mobility and safety.

4. LEADERSHIP AND ADVOCACY

Satisfactory Satisfactory
4. 1 Recognize conflicts and strategies for resolution.

S.M. : I recognize conflicts and strategies for resolution. I saw a patient that was having issues with their care nurse. The nurse was not listening to

the patient and the conflict got heated both people were frustrated with each other. I recognize that I would address the situation differently to avoid

the conflict. I would hear the patient out and try and incorporate what they would like into their plan of care.

Satisfactory Satisfactory
4. 2 Demonstrate leadership skills that foster group work and a positive learning environment.

S.M. : I am able to Demonstrate leadership skills that foster group work and a positive learning environment. For example our clinical group was

having issues being able to take their break on time and it started to cause conflict for other. I took it upon myself to address the situation with the

group and my clinical teacher to come to a consensus that would work for the entire group. We were able to come to an agreement on the policy we

set in place when a break is missed.

Satisfactory Satisfactory
4. 3 Identify opportunities to improve health care service and nursing interventions by advocating for

client, self, others, and quality practice.

S.M. : I am able to advocate for client, self and others when it comes to quality of practice. I noticed that trach suctioning was not being done sterile. I

was concerned for patient and my self and brought it to the attention of my clinical teacher. We were able to ask an RT about the policy and procedure

they have in place and found that we could use clean trach care for that specific patient. I hope to see other opportunities where I can advocate for

client, self and others going forward.

Satisfactory Satisfactory
4. 4 Provide feedback to peers and accept feedback from peers and members of the inter-

professional health care team.

S.M. : I provide feedback to peers and accept feedback from peers and members of the inter-professional health care team. I make sure to let my

team mates know when they are doing a good job or provide them with information that might make things easier or better for them. I advised a

classmate when given a heparin injection to make sure to quickly insert the needle and when pulling it out to switch her right hand around so that it

make it easier to cap the needle and less likely to injure herself or prick herself with the needle.
 Satisfactory Satisfactory
4. 5 Support clients rights for self-determination and choice.

S.M. : I support clients rights for self-determination and choice. I had a patient that needed help to open breakfast items but once opened they liked

to be left alone to eat. I make sure to support my patients choice for advocacy and support them if I know that no harm will come to them.

Satisfactory Satisfactory
4. 6 Respond appropriately to unsafe, unacceptable, and unprofessional behaviours.

S.M. : I respond appropriately to unsafe, unacceptable, and unprofessional behaviours. I had a medication administration error, where a medication

was given 1 hour later then it should have. I had asked the nurse I was shadowing if should would be able to give the patient 2pm medications

because our clinical group had a physio meeting and she asked if I had given the 1pm medication. I had been busy with a patient and thought that all

the others patients medications were due at 2pm. The nurse started to get mad at me and talk down to me and the charge nurse heard the

conversation and started to do the same. My clinical teacher took me away from the situation and discuss with the charge nurse. She later spoke to

me and I will never make that mistake again. I gave the medication and the issue was resolved. I will make sure next time to be aware of all times

medication needs to me given.

Satisfactory Satisfactory
4. 7 Consult and collaborate when carrying out health care and nursing practices that are in the best

interests of the public and protect the public through collaboration and consultation.

S.M. : As a group we had the pleasure of speaking to OT's and got to discuss about how important collaborative care is the the patients health and

well being. It is in the best interest to work with each other because it will benefit the patient an help them to restore and hopefully fully recover. There

may be a day that the OT can not meet with a patient and by combining their work with ours, such as getting them out of bed and walking to the

bathroom, will help to improve their independence but also make them stronger and help them to be able to go home sooner.

Teacher comments for LEADERSHIP AND ADVOCACY :

Sarah provides leadership in an informal role with staff and colleagues when caring for her patients in need of being understood, comfort
measures and emotional support. Sarah contributes to strong and cohesive clinical team and has been a great addition to an organic and
positive learning environment. Sarah is encouraged to continue be a voice for her patients and recognize future situations requiring
conflict resolution strategies. Sarah demonstrates clarity in seeing situations that are either right or wrong from an ethical and legal
perspectives. She is encouraged to continue using her awareness and mindfulness in future situations.

5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES

Satisfactory Satisfactory
5. 1 Incorporate the unique needs and expected outcomes into individual clients plans of care.

S.M. : I am able to incorporate the unique needs and expected outcomes into individual clients plans of care. I have a patient that is incontinent of

urine and has to wear briefs. They have a heavy flow and require 2 briefs, I make sure to use the correct method for applying the two briefs.

Satisfactory Satisfactory
5. 2 Develop theory-based plans of care that are holistic and client centered and are articulated

competently in writing and orally.

S.M. : Every week I develop theory-based plans of care that are holistic and client centered and are articulated competently in writing and orally via

concept map. Each week I become better and better by taking the information that is client specific and using that in my physical plan of care.

Satisfactory Satisfactory
5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.

S.M. : I am able to use knowledge, skill and judgment to assess clients, prioritize needs and outcomes. Each week with my patients I determine what

is most important for that client such as keeping airways clear of secretions, monitoring blood glucose levels to make sure my patient is not hyper or

hypoglycaemic, or monitoring stroke patients for another set of manifestations (you want to make sure they don't have another one).
 Satisfactory Satisfactory
5. 4 Provide information that contributes to the evaluation and refinement of plans of care.

S.M. : After suctioning, I should use my stethoscope to listen to my patients lungs to make sure the suctioning was effective enough to clear the

patients airways. I also should make sure to the listen to my patients bowel sounds to make sure they are present before and after setting up

feedings.

Satisfactory Satisfactory
5. 5 Safely and competently carry out nursing assessments and nursing interventions that are theory-

based and within skill abilities.

S.M. : I performing the appropriate assessments for GI, Cardiovascular and Respiratory using theory bases approach and within my skill abilities and

bed bath care. I am able to perform effective trach suctioning using theory based and evidence base approaches as well

Satisfactory Satisfactory
5. 6 Carry out nursing care that reflects the practice decision-making framework.

S.M. : I carry out nursing care that reflects the practice decision-making framework. I was going to perform am care and my patient needed suctioning

done so I made sure my patient was suctioned first before performing the am care.

Satisfactory Satisfactory
5. 7 Complete nursing care responsibilities and nursing interventions in an organized and timely

manner.

S.M. : I am able to complete nursing care responsibilities and nursing interventions in an organized and timely manner. Some days do not always go

as planned but I do as best as possible. Vitals are performed at 7:30am, partial bed bath and get my client dressed and out of bed by 11:30. Over the

past few weeks I have become faster at my duties and am now working on becoming better with working on two patients care at a time.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :

Each patient in Sarah's care has been recognized as a unique individual with unique needs.
Sarah has cared for patients with myriad of diagnoses; few of them being: diabetes,Infarct, quadraplegia, spina bifida, hydrocephalus, CVA,
HTN, increased ICP, MS, hip fracture,Parkinsons's disease and dementia. She demonstrated good knowledge of these diagnoses when
caring for patients and collaborating with staff about patient related care. Medication research has been satisfactory on weekly basis.
Furthermore, weekly data collection and Concept Care Mapping reflected a strong ability to categorize patient information and prioritize
care using the nursing process.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

Satisfactory Satisfactory
6. 1 Work with clients and members of the inter-professional health care team to assess clients,

determine health needs, and to achieve mutually agreed expected outcomes.

S.M. : I have been able to sit in on a session with physic and OT therapists and the have given myself the knowledge on safe patient transfers and

how to make sure that clients try and do as many things they can on their own to help rehabilitate them back to health.

Satisfactory Satisfactory
6. 2 Contribute as a member of the inter-professional health care team to respond to the changing

needs and expected outcomes of clients.

S.M. : I have been able to respond to changing needs and expected outcomes. My patient was full code and has been changed to DNR. I did not

contribute to this outcome but I was prepared if something were to happen.

Satisfactory Satisfactory
6. 3 Seek out assistance and consult with members of the inter-professional health care team.
S.M. : When I had the issue with the nurse I was shadowing I had a difficult time understanding why I was getting into trouble when i believe the

nurse should have been checking up on me more closely. I was my mistake for not administering the medication on time but I believed that the nurse

should have been keeping a closer eye on me. I discuss this with my clinical teacher and she agreed. I no that I will never make that mistake again.

Satisfactory Satisfactory
6. 4 Use teamwork, consensus building, and conflict resolution skills.

S.M. : Week 13 our group members really utilized each other and together we were able to resolve conflicts that had been presented to us. A fellow

student help get our clinical teachers attention when I was having issues with the nurse I was shadowing and the charge nurse. I helped to relief the a

fellow student when a patient was asking for her and I knew she had to get her documentation done.

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

changing environment.

S.M. : I was able to collaborate and consult with an RT about the use of sterile versa clean technique for trach suctioning. The RT was able to advise

new evidence based practice showed it was okay to use a clean technique on someone who has had a trach for a long time and is not

immunocompromised.

Satisfactory Satisfactory
6. 6 Interact with members of the health care team respecting their unique role and competencies.

S.M. : I had the privilege of working with a nurse that I could see loved her role and was very knowledgeable about the standards of care on 1e at

CVH. I respect this nurse and loved watching her interact with all her patients. I will make sure to adopt this attitude and competencies she has I know

it will make me a better healthcare provider.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Sarah is a role-model for professional attributes of a becoming nurse. These attributes are rooted in a desire to provide and promote best
nursing care possible. She has been observed to share her knowledge with other classmates, patients and nurses. Collaboration with
patients has been distinguished and based on patient autonomy and respect for human life.
While advocating, Sarah is aware of her limitations as a nursing student and refrains from engaging in activities beyond her level of
autonomy and competency.
Sarah is encouraged to get to know all the key players on the unit , from environmental services to most responsible physicians (other
examples: OT, PT, SW, dietitians, pharmacists, SLP). This interaction with the members of the health care team and the unit will allow a
complete engagement in the patient care and needs.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

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

consultation with members of the inter-professional health care team and through competent and safe

practice.

S.M. : I acted in my patients best interest to protect them from harm by consulting with an RT about the use of sterile versa clean technique for trach

suctioning. The RT was able to advise new evidence based practice showed it was okay to use a clean technique on someone who has had a trach

for a long time and is not immunocompromised.

Satisfactory Satisfactory
7. 2 Participate in self-reflection to identify strengths, areas for improvement.

S.M. : I participate in self-reflection to identify strengths, areas for improvement. Currently my strength are performing assessment such as

respiratory, GI and cardiovascular assessment. I have over the semester developed skill to identify priorities of patients, concept maps and I have

gotten better with my documentation. I need to improve my documentation skills a little further but I am slowly getting there. I need to better manage

mine time when I have two patients and make sure to take my breaks.
 Satisfactory Satisfactory
7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance program

(CNO).

S.M. : I participate weekly on knowledge for you which is designed to foster CNO Quality Assurance Program.

Satisfactory Satisfactory
7. 4 Seek out learning opportunities and feedback that foster professional development; and,

integrate these into practice.

S.M. : I had not yet performed suctioning on a patient with a trach tube. I asked my clinical teacher if I would be able to work with a patient again that

had one so I could develop the skills needed to preform that procedure safety. I also had the chance to go with another students patient to watch

dialysis, that was a great opportunity to see if it was a unit I would like to work on in the future.

Satisfactory Satisfactory
7. 5 Utilize nursing, health and other theory and literature to improve nursing practice.

S.M. : I utilize during theory and practice for communication, advocacy, therapeutic nurse-client relationship and evidence based practice. I also

consulted with an RT to see new evidence informed practice that I will be able to use to improve my nursing practice. I also was able to talk with

physio therapists and OT's to see how safe patient transfers are performed and what I can do in order to incorporate there can plans into mine that

will benefit the patients.

Satisfactory Satisfactory
7. 6 Use a theory-based approach and evidence-informed practice.

S.M. : I would have used theory base approach for suctioning for sterile procedure but new evidence informed practice shows suctioning can be done

as a clean procedure for individuals who are not immunocompromised and have had a trach for a long time.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Sarah actively participated in lab and clinical activities; uses clinical time effectively and accesses appropriate resources to meet her
learning needs. Sarah seeks out learning opportunities by getting involved with other activities on the unit after completing her own
assignment, such as escorting a patient to hemodialysis or assisting the primary nurse with her duties . Sarah responds positively to
constructive feedback for improvement in caring for her patients. Sarah dresses and behaves professionally at all times.

8. USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY

Satisfactory Satisfactory
8. 1 Utilize problem-solving skills to inform decision making in all aspects of nursing care.

S.M. : I utilize problem-solving skills to inform decision making in all aspects of nursing care. I make sure to use therapeutic relationship to help when

communication is difficult, collaboration with other health care professionals when needed, and when I believe something may harm the client I will not

do it until confirmed that it is an effective way and it is safe to the client and myself.

Satisfactory Satisfactory
8. 2 Use problem-solving and decision-making skills to assess clients and to determine nursing

diagnoses, expected outcomes, nursing interventions, and evaluative criteria.

S.M. : Before and during clinical I refer to my concept map to make sure I have meet expected outcomes that I have made for goals and interventions

specific to my client. I evaluate the interventions and make sure they are working, if they are not I make sure to change the intervention to meet one

that will work.

Satisfactory Satisfactory
8. 3 Use self-reflection to design a plan to improve problem-solving and decision-making skills.
S.M. : After every clinical I go home and reflect back on the conversations that we have in debrief and I also think about the conversations I have with

my clinical teacher one on one. This helps me see areas of improvement and areas that I am good at. Once I knew that trach suctioning could be

performed doing a clean procedure I went home and watched videos on how to perform it again just to make sure I knew how and ask to have a trach

patient for the last two weeks in clinical to gain the skills needed to be comfortable and safe when performing the procedure. I also knew I needed

more work on documentation so I went home and practiced that as well.

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

provide safe and competent care.

S.M. : I make sure to used my text books, videos, evidence informed practice and clinical practice before CVH to provide safe and competent care for

my patients. Their safely is most important.

Satisfactory Satisfactory
8. 5 Use prioritization strategies for client care.

S.M. : I am able to recognize the priorities that are important to my client. My current patients need cleared airways for proficient oxygenation, and G

tube needs to be positioned properly and clear not clogged for the administration of medication and food for nutrition. Check foley bags for proper

drainage, check for fever could be found if infection is present. Make sure patient is eating and drinking adequate amount of foods needed to maintain

body requirements.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

S.M. : Every week I participate in transfer of accountability with the nurses and I demonstrate professionalism when doing so, never talking bad about

clients and making sure to be respectful.

Satisfactory Satisfactory
8. 7 Recognize strengths and limitations and seek appropriate assistance and support.

S.M. : I recognize strengths and limitations and seek appropriate assistance and support. When I am unsure about a procedure I ask if it is being

done properly or ask for a demonstration. I will also make sure to have my preceptor there the first time I preform the procedure to make sure I am

doing it correctly. Example when giving insulin and performing trach suctioning.

Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY :

Sarah possesses a very good foundation of knowledge and knowledge application derived from clinical experiences, current studies that
are compatible with current clinical setting. She demonstrates critical-thinking and evidence based rationales when providing care or when
engaging in a conversation with her teacher. When necessary, Sarah knows where to access learning resources and learning tools on the
unit. Daily assessment, plan, interventions and evaluation of care have been demonstrated. She is able to modify the initial plan as
needed, for example, looking up lab work or interpreting vital signs and deciding if specific medication needs to be given. Sarah recognizes
her limits of practice as a student and consults with teacher and staff appropriately. She is encouraged to extend and expand the current
knowledge to meet the current and future needs of complex patients and situations. Some of Sarah's clinical skills that required critical
thinking and decision making included: weekly and prn vital signs collection/interpretation, priority systems assessments, medication
administration ( oral, topical, via PEG tube, rectal, MDI, SC insulin, scheduled and using sliding scale), assistance with ADL, tracheal care,
tracheal suctioning, oxygen therapy, foley catheter care, bladder irrigation, enteral feeds initiation and monitoring, intake and output,
health teaching on diabetes.

9. SIM number of hours

9. 1 SIM number of hours

S.M. : 6

S.W. : 6
Teacher comments for SIM number of hours :

Sarah confirms that she attended and participated in three SIM sessions, 2 hrs each session.

Student Final Summary with Strategies for Continued Growth

This semester has been a great learning experience. I have been able to grow not only as a nursing student but also as a person. I have learn what I
am good at and what I need to focus more on to improve my skills. I have become proficient in documentation, assessments, therapeutic relationship
and prioritizing patients needs. I have learned how hard it is to time manage when you have more than one patient, but it is extremely important that
you stay alert because it will make you more safe while working. This is something I will work on in future practice next semester. I also would like to
work on collaborative care. I have got the chance to speak with physio therapists, OT's and RTs but I would like to work with them more to improve a
co-plan of can that will benefit the patient.

Teacher Final Summary with Strategies for Continued Growth

Sarah,
It has been a true pleasure working with you and having you in our clinical group this semester. I admire your work ethics and your commitment to
compassion, quality care and always seeing your patients as the 'heart' of the care plan. I know you will continue to expect the best from you and
others that you work with. Keep on striving and be the best you can be.

Grade Satisfactory Unsatisfactory

Referred to Clinical Excellence Committee (CEC)

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