Self Assessment

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

NURS 151S Practical Nursing Practice 2 Summer (PN, 01-May-2016 - 24-Jul-2016)
Student : Jeongseon Choi
Clinical Teacher/Preceptor : XXXXXXXXXXXXX
Program Coordinator : XXXXXXXXXXXXX
Location : University Health Network/Toronto Rehab University
Avenue Site
Placement Setting : Rehabilitations Units
Unit/Office/Clinic : 9 South Stroke Rehab
Period : 01-May-2016 To 24-Jul-2016
Student hours : 168
Required Hours : 168
Validated hours : 156
Teacher comment for validated hours:
one missed clinical week 13

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.

J.C. : Was aware of regulatory standards and follow-up with all procedures and policies

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

J.C. : When patient needed privacy or lone time I gave him all the time they needed.

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

professionals.

J.C. : I make sure to follow-up with nurses or clinical teacher if I have any doubt on patient care.

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

J.C. : When I was doing bed bath for the first time, I tried to refresh what I've learned from previous class and follow the steps

Satisfactory Satisfactory
1. 5 Ensure client safety and a safe environment.

J.C. : Before transferring patient, I would assess the chart to see how mobile they are and explain how we are going to transfer the patient. I would

explain one by one to make sure patient feels comfortable

Satisfactory Satisfactory
1. 6 Ask relevant questions to clarify understanding of the plan of care and whenever uncertain.
J.C. : When doing head to toe assessment, i would ask relevant question for their alertness and cognition and as I go along with the care I would

explain why we are doing it.

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

J.C. : When I was transferring patient to toilet, she was in such a rush that she did not listen to my instructions and I was afraid that she might fall due

to her immobility. She did not understand me due to language barrier so when the family member came to visit I explained the situation and make

sure that she is aware of what is happening.

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

J.C. : I would remind myself the 8 rights and if I have any doubts on assessment I would refer back to my assessment book or ask the teacher

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

Student has conducted herself in a professional manner, abiding by the legal and ethical framework. Student has complied with UNH and
Humber policy on dress code (Clean Humber scrubs, clean white shoes, tidy appearance, no bracelet, no rings, but watch on wrist only)
Student has demonstrated her ability to identify her weakness and strength by completing a student profile at the beginning of this clinical
rotation as well as a learning plan submitted on week 4. Student has submitted a learning plan in week 12 for her future clinical placement
and demonstrated her ability to reflect on her current clinical practice and further identify three learning goals to meet her needs. In a
context of post conference meeting and individual dialogue with her CI, student has engaged in multiple discussions related to this clinical
rotations such as ; falls risk prevention strategies, medical emergency, code blue, multidisciplinary team for stroke rehab, etc. In week1-4,
student came prepared for the topics covered in lab days and actively participated with discussion and activities in the lab setting.

2. ACCURATE AND RELEVANT COMMUNICATION

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

J.C. : I was able to attend team meeting in the unit. They were discussing the roles when patient is dismissed and how to prevent a fall and

medication error. I thought it was great idea to chart it on bulletin and discuss the prevention

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

J.C. : I have documented each time there was an incident and assessment to make sure I am not fogetting as I document. The nurse showed me

how to document patient's cognition each day electronically.

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

J.C. : I have reported any doubt or incident to the nurse or my teacher for any concerns.

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

J.C. : For patient with language barrier, I have used simple words, body language and picture chart that they had on the wall to communicate.

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

(PHIPA)

J.C. : I am aware that all patient's information is in confidential matter and I would not discuss their issue outside of clinical time

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

J.C. : Used UHN site to look through data and more information on medical condition
Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Student is aware of importance of maintaining patient privacy and confidentiality - it has been discussed in a context of post conference.
Student has documented on patient's paper chart; 1. flow sheet for ADLs, vital sign and pain assessment findings 2. patient's paper chart;
narrative note for head to toe assessment findings and update of activities of patient 3. MAR; post medication administration. Student has
completed documentation thoroughly, clearly, and professionally in a timely manner according to policies of the unit. Student has been
concise and clear in her communication with her patient, her assigned nurses, 9 South team members, and her CI. Throughout the shift,
student has updated the primary nurse of current vital signs and of any changes/concern.Student is also actively engaging in discussion in
post conference on various topics. Student has been engaged with allied health team members (via therapy sessions, physio in-service,
verbal communication and documentation), and she is encouraged to continue to communicate with different team members (OT, PT, SLP,
SW, Pharmacy, RD, MD, Unit Clerk, etc) for patient care/issue or plan of care if appropriate, using a SBAR framework.

3. CARING RELATIONAL PRACTICE

Satisfactory Satisfactory
3. 1 Utilize effective communication techniques.

J.C. : Used alternative method to communicate with patient in language barrier such as picture image and body language

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

and health care team members.

J.C. : The patient was in distress mode when his appetite wasn't working at where it should be. I gave him my word of encouragement and told him

to keep trying.

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

J.C. : I have utilized therapeutic use of self and client's well being by building support, feeling empathy and by engaging in their lifestyle as if they are

yours.

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

relational practice.

J.C. : I keep telling my patient to keep trying their best and that they would not fall behind but be ahead of everyone else if they don't give up.

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

appropriately.

J.C. : I have consulted with the health care team regarding patient's complain on medication. Patient thinks that the medication is causing the rash

so we have informed the doctor and modified accordingly.

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

professional health care team.

J.C. : I was aware of patient's concern and their confidentiality before any procedure. I had to make sure the patient was treated differently.

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

clients choices and decisions.

J.C. : I had to take into consideration of their religion and their diet that follows. Came across a patient that was fasting but had to convince him that

fasting now would be risky and that it would make him more weak. We had to explain the importance of nutrition and that it is critical now to eat each

meal healthy.
 Satisfactory Satisfactory
3. 8 Provide effective client education.

J.C. : When it was time for meds, the patient was self medicating for eye drops. We had to teach him how to give drops more effectively.

Teacher comments for CARING RELATIONAL PRACTICE :

Student strives to be respectful of parents and families while providing her care. Student understands the importance of the family a vital
component to the wellness of the patient and provides them with support. Student has been given her assigned patient's information a
couple of days in advance, researched about patient's admitting diagnosis, other co-morbidities, medications, and any other treatment
required for her patient before coming to her clinical day, and come to clinical fully prepared. This allows student feel comfortable with the
care she's providing to her patients. Student has been assigned to patients that are on self-medication regimen in order to prepare them for
discharge, and student has demonstrated an understanding of this practice and the importance of assessing patient's ability and
willingness to comply with the self medication administration.

4. LEADERSHIP AND ADVOCACY

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

J.C. : I have recognized a conflict from a peer so I stepped in and kindly explained the consequence and came up with resolution to accommodate it.

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

J.C. : When we have our daily conference in sharing our experiences I thought it was great way to bring up what went good or bad. It would be great

time to get feedback and to hear how the others view it differently.

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

client, self, others, and quality practice.

J.C. : When we did head-to-toe assessment together, it was great to see the different techniques of peers and that our discussion afterwards were

very helpful.

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

professional health care team.

J.C. : Our daily conference in discussing our strength and weakness gave us a great feedback on how the others might do it differently.

Satisfactory Satisfactory
4. 5 Support clients rights for self-determination and choice.

J.C. : When the patient refuse to take med at one point thinking that that med is causing the rash, we could not push the patient to take it but instead

we got the doctor to prescribe a different med or stop the medication at certain point

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

J.C. : When one of the nurse recognized that the patient fell, we had to fill out an incident report and monitor patient's vital sign every 15 mins for one

hour to make sure the patient is safe

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.

J.C. : I have consulted with nurse to discuss any issue or concerns regarding patient's comfort level.
Teacher comments for LEADERSHIP AND ADVOCACY :

As a group, student has used problem solving for such issues; no access to locker room, missed one clinical day for Victoria day and
how/what we can do to make up, etc. And, they we were able to come up with an alternative way to resolve issues experienced along the
way. Student has demonstrated leadership skills in the lab setting by demonstrating many skills in a small group or big group size.
Student is an active listener and has thrived to advocate for her patients (via consulting with her CI, assigned nurse, allied health and
documentation in regards to the identified concerns of patient) Student can continue to welcome opportunities to take leadership roles and
continue to collaborate with various healthcare team members.

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.

J.C. : When patient refuse to eat meal at the dining table we brought the meal to their bedside and monitor their intake of food and med.

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

competently in writing and orally.

J.C. : We made a note that when patient was experiencing a rash, she applied home care cream which didn't make it all that effective and had to find

an alternative later.

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

J.C. : Every morning when we greet patients, we ask on their preference to bath and move forward with patient care

Satisfactory Satisfactory
5. 4 Provide information that contributes to the evaluation and refinement of plans of care.

J.C. : When giving patient care, I would explain why and what I will be doing so that the patient feels comfort.

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

based and within skill abilities.

J.C. : I found out when we are assessing patients and providing intervention, we do not have to follow step by step in what the book says as long we

don't miss out on main details.

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

J.C. : Before proving patient care, we would check the mars and chart to make sure that we are providing all the needs of patient and that we are not

breaching any socioeconomic status nor religious practice.

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

manner.

J.C. : When we were assigned to two patient, I had to organize my morning time so one patient gets bath before breakfast and that one gets after

and to get assurance that patient is okay with it.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Student has completed concept map for her patient each week and outlined what she believes the patient's unique needs and expected
outcomes based on patient's medical history (admitting diagnosis and co-morbidities) as well as patient's needs. Based on that, student
was able to identify three nursing diagnoses with specific nursing interventions to achieve that. Student has been provided with patient
information beforehand by her CI, however, when on the unit, student takes initiatives to thoroughly review patient's paper chart to look for
more information about her patient (diagnostic test result, lab values, history about patient's acute illness, and assessment findings by
different team members (OT, PT, SW, SLP, Pharmacy, RD). Student has demonstrated an ability to work on time management skills as well
as prioritize her care thoroughly the day with an increased workload (2 patient assignment for three weeks towards to the end of this
semester).

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.

J.C. : Each week the health care team member would have a meeting regarding patient care and discuss any issues or concerns or alternative

methods.

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.

J.C. : The nurse would inform me for any updates or change of status in patient's information so that when we are giving care, we can act accordingly

Satisfactory Satisfactory
6. 3 Seek out assistance and consult with members of the inter-professional health care team.

J.C. : When I was doing catherization for the first time, I had my teacher and my peer to help out with the care to make sure I was doing it correctly.

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

J.C. : When we are assessing patient for the time, we would gather up as group to observe and discuss any findings.

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

changing environment.

J.C. : We would explain the benefit the OT, PT therapy and to encourage patient on their improvement so that they don't feel discouraged or weak in

prolong bedrest.

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

J.C. : Every clinical day we have different nurse staff. We would first explain our role and any suggestions on how they like us to do patient care.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

By doing a concise and thorough documentation on her patient's chart, it is one way to collaboratively work with interprofessional health
care team members. Student has encouraged to engage with them in person during patient's therapy session, at the nursing station, or any
in-service session offered for our group). There have been multiple occasions that interprofessional health care team was a topic for
discussion; different roles assigned to them for patient care, particularly related to stroke rehab were identified and discussed in a group.
Student has attended a physiotherapy in-service about a safe patient transfer and verbalized her new learning with her group.

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.
J.C. : After documenting fall incident report, the nurse told me to keep monitoring patient for any signs and symptoms of mobility or cognitive function.

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

J.C. : When we do our daily conference, it gave us an opportunity to give and receive feedback on our strengths and weakensses

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

(CNO).

J.C. : We would assess our peer on their performance and give feedback. We would develop a learning goal and work out way through it. We would

reflect on our weakness and possible things we can do differently

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

integrate these into practice.

J.C. : We would monitor any injection or new techniques on peers or nurses if they have any unusual finding on patient

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

J.C. : We would always do three checks before medication and keep monitoring their health status for unusual s/s

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

J.C. : I am aware of evidence-informed practice and that whatever we do is in all confidential matter

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Student is aware of her strengths and weaknesses (while doing her learning plan (2), she participated in self-reflection and identified those
areas). Self-evaluation as well as peer feedback for the student have been reviewed by the student and student has completed a learning
plan for her future clinical experience. At the end of each clinical day, student has had an opportunity to share their day, any new learning,
and by doing so, participate in self-reflection of what she has learned and what area she needs to work on more, etc. Student has had a
chance to look at multiple resources related to stroke, stroke care, stroke rehab, and heart health published by Heart and Stroke
Foundation. Student has revisited to those resources as her clinical day goes on to find information her patient (i.e. risk factors, common
medications, etc). Student is aware of the importance of knowing/following best practice guideline for her patient care (also the importance
of making decision based on those best practice framework or theory) Student is encouraged to continue to do research about her patient
information using various resources (textbook, video, UHN policy-procedure, journal article, etc) and continue to link information in a
meaningful way for her patients.

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.

J.C. : As a nurse, you plan and implement a care but when unexpected situation comes you would need to find an alternative. I didn't come across

any unexpected situation but my peer had experienced a situation where one medication found in the dining table. We had to search through all

kardex to find out which patient takes the medication and ask the patient if they remember taking them.

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.

J.C. : Our daily concept map helped us in with patient's conditions such as s/s, outcomes, risk factors and possible nursing diagnosis. It helped us to

be aware that these are possible scenarios that can come up with in patients.
 Satisfactory Satisfactory
8. 3 Use self-reflection to design a plan to improve problem-solving and decision-making skills.

J.C. : Receiving feedback from nurses helped me to prepare better when giving medication. We should always monitor patient's condition and on

their preference to take meds.

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

provide safe and competent care.

J.C. : I have utilized an alternative method to assess patient to meet the requirement.

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

J.C. : When I had to do multiple tasks, I would tell the patient that I would be right back at a certain time.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

J.C. : When I was giving injection for the first time, I make sure to review the steps and show confidence. I knew for a fact that if I am nervous, the

patient will be nervous and feel uncomfortable.

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

J.C. : I know where my weakness and strength comes. In a situation if I had to perform an assessment or plan of care where I am not familiar with, I

would ask my teacher or nurse to monitor me to make sure I am on top of everything.

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

Student has completed concept maps each week in a meaningful way for her assigned patient. Student has spent time reading patient's
chart in an attempt to gain more information about the patient in more details, and try to incorporate the information to her concept map as
well as her patient care. Student has began to demonstrate a prioritization strategy/skill for her patient care for this clinical rotation
(patient's needs/priority can constantly change due to medical condition, treatment, therapy, patient's request, or unit needs), especially
towards to the end of the semester with an increased workload of having two patients. She always reports abnormal findings promptly to
her primary nurse or her CI. Student is able to provide effective care for her patients despite their differences in willingness to participate in
their care. Student deepened her understanding of chest pain and its management as well as code blue situations, different roles (first
responder, second responder, code blue leader, code blue nurse, charting nurse, respiratory therapist, anesthesiologist, most responsible
physician, ICU physician, unit clerk, chaplain, nurses on the unit, etc) and commonly given medications in code blue situations.

9. SIM number of hours

9. 1 SIM number of hours

J.C. : 8

R.M.K. : 6

Teacher comments for SIM number of hours :

as per student

Student Final Summary with Strategies for Continued Growth

I want to be more proficient in head to toe assessment, prioritizing tasks and more knowledgeable in medication usage.
Teacher Final Summary with Strategies for Continued Growth

Student has a humanistic nursing manner with a caring demeanor at the bedside while maintaining a professional boundary. She tries her best to
provide culturally sensitive care. Student has successfully demonstrated comprehensive approach to nursing practice as well as critical thinking skills
to link clinical presentation to patient's diagnosis/comorbidities/recent surgery/procedure. Student is a great team member who is always willing to
help. She has shown initiatives in trying new skills as well as taking challenging patients when given a choice. Student can continue to welcome
opportunities to take leadership roles and continue to collaborate with various healthcare team members.

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

Student Comment

Thank you.