Self Assessment

2016 - 2016 - Final NURS - 208 Course Learning Outcomes (201509)

NUR 208 Practical Nursing Practice 4 (PN, 06-Sep-2016 - 09-Dec-2016)
Student : Chet Raj Bhatt
Clinical Teacher/Preceptor : Nicolette Duperrouzel Nicholls
Program Coordinator : Judy Martin
Location : Toronto East Health Network/Michael Garron Hospital
Placement Setting : Agency
Unit/Office/Clinic : B3 Medicine
Period : 06-Sep-2016 To 09-Dec-2016
Student hours : 196
Required Hours : 196
Validated hours : 144
Teacher comment for validated hours:
Chet was ill one day and on Week 5 had no clinical due to reading week/thanksgiving.

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.

C.R.B. : I kept the personal health information of the clients confidentiol. I tries my best to provide ethical and quality care to the clients according to

CNO's practice standards and hospital's policy and procedures.

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

C.R.B. : I provided nursing care in responsible and ethical manner. I was always on time with proper nurssing uniform and student badge.

Satisfactory Satisfactory
1. 3 Determine how the three factor and practice decision-making frameworks influence client care.

C.R.B. : I did not get the complex patient because of my limited skill and ability as a student nurse. Similarly, the supprtive behaviour of health care

team, clinical instructer and resurces available at the hospital helped me to provide qulaity nursing care as well as develop my skills.

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

C.R.B. : I studied about the contraindication and adverse effects of medication before administering to patient. For example, I checked BP before

administering furosemide, and checked blood glucose level before injecting insulin to the patiens.

Satisfactory Satisfactory
1. 5 Carry out safety-based practices and risk management principles to ensure client safety and a

safe environment.

C.R.B. : I placed the bed in lower position with side rails up to ensure safety of the patient. Similarly, I asked for the help from other staff to transfer

the patient from bed to wheelchair.

 Satisfactory Satisfactory
1. 6 Ask questions and clarify the plan of care, unclear orders or directions, and whenever uncertain.

C.R.B. : I discussed about plan of care with patient, hospital nurse and clinical structure to provide care. I always asked about medication dosages to

clinical teacher whenever I was uncertain.

Satisfactory Satisfactory
1. 7 Demonstrate professional behavior by seeking assistance in situations in which there is unsafe,

unacceptable and/or unprofessional behavior.

C.R.B. : I asked for the assistance while transfering client from bed to wheelchair to maintain safety of the client. Similarly, we used strong side of the

client to transfer.

Satisfactory Satisfactory
1. 8 Demonstrate understanding about the role of the nurse within health care.

C.R.B. : As a student nurse, I followed hospital policy of nursing providing care to clients. I always administered the medication with guidance and

presence of clinical instructer. I always respected all the patients, helped them to feed breakfast and lunch who were unable to feed on thier own,

helped them to use washroom, and provided bed bath.

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

Chet has an understanding of what a nurses role entails, he acts in a responsible, ethical and accountable manner as he will clarify his care
plan or if he is uncertain of what to do, he practices according to the hospitals policies and procedures or by following best practice
guidelines. He realizes that the Three factor and decision making frameworks play an important part of influencing his client care. When
providing care to his clients he is diligent ensuring that he has the bed in the lowest position for the safety of his clients.

2. ACCURATE AND RELEVANT COMMUNICATION

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

C.R.B. : I participated in the discussion and shared the report at the end of the shif to the nurse. Likewise, I participated in conference with peers and

clinical instructer at the end of the shift, and shared the experience of nursing care.

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

C.R.B. : I documented all the nursing activities such as vital signs, head to toe assessment, administration of medication, clenaing, nutritional intake,

fluid input and output of the clients in the computer profile.

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

C.R.B. : I reported the severe pain of the client to the clinical instructer, and requested to administer narcotic drug to relief pain. Later, we administer

hydromorfine after discussion about client's pain status.

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

C.R.B. : I did not use elderly speak during communication with elderly patients. I called them with their name, used simple sentences, and allows

some time to understand and response the my concerns. I used yes/no question strategy to those who were unable to talk. Similarly, I discussed and

reported the client status to RN and RPNs of the hospital.

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

(PHIPA).
C.R.B. : I did not discuss the personal health infromation of the clients with others. I always maintained privacy by using curtains while providing

bedbath and perineal care.

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

C.R.B. : I used the computer program to retrieve the helath history, medication list, any new order, and shared client health status and progress with

health care team by charting and writing progress note.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Chet participates in team building by sharing information about his clients with other members of the health team, he researches
information that he is unsure about by using technology and also shares it with the health team, he documents care provided in the
computer charting system. He ensures his clients privacy by pulling the curtain when providing care, he ensures that he puts papers with
the clients information in the confidential waste. He has discovered that there are many ways to communicate with clients, although there
are times that he will not be able to communicate with them

3. CARING RELATIONAL PRACTICE

Satisfactory Satisfactory
3. 1 Use effective communication techniques.

C.R.B. : I did not use elderly speak during communication with elderly patients. I called them with their name, used simple sentences, and allows

some time to understand and response the my concerns. I used yes/no question strategy to those who were unable to talk.

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

health care team members.

C.R.B. : I intruduced myself to the patient and take consent before providing any nursing care. I obtained vital signs according to client's health

status, did head to toe assessment, provided medication prescribed for the patien. I always respected patients as well as members of health care tem,

and discussed about cleint health and the care that I provided to them.

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

C.R.B. : I spent some tiime with clients to discuss about health status and their food choice. I encourage some patients to take medications for their

fast recovery.

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

relational practice.

C.R.B. : I was aware of respecting the patients during clinial practice. I treated all elderly patients as adult and matured human by adressing their

name not by the word like honey, grandpa, grandma etc, and it made the residents' attitude positive towards me. I respected them and I received love

and respect from the resident too.

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

appropriately.

C.R.B. : I discussed with patients about thier food choice, improvement in health, pain level and ways to management, need to use washroom, and I

made a care plan and helped them accordingly. Similarly, I discussed about the patient's issues such as severe pain complaint, low temperature and

blood pressure to the nurse in time.

Satisfactory Satisfactory
3. 6 Support the diversity of clients and the inter-professional health care team.
C.R.B. : I was involved in care of patients from diverse cultural background, and with different health problems such as fracture, bipolar disorder,

cardiac failure, hypokalemia, diabetes, hypotension, myocardial infarction, hypertension, sleep apnea, stroke etc. I practiced the knowledge and skill

of care that I had learned in lab of college and from the course book to care for the diverse patients in the clinical practice. Similarly, I was also a part

of health care team in which I shared and discussed about patient's health problem and progression.

Satisfactory Satisfactory
3. 7 Display sensitivity and respect for clients cultural, religious, and other beliefs and values

influencing their choices and decisions.

C.R.B. : I always respected the patient from all religion, culture and beliefs. And, I communicated with the patients by their name but not by any

relational word like grandpa, grandma, honey, sweety etc. because it was clients' culture to be called by their name.

Satisfactory Satisfactory
3. 8 Provide effective client education.

C.R.B. : I provided effeective health education especially on safety because some of patients were in risk for fall. For example, patients were advised

to use call bell whenever they need anything, use walker and nonslippary shoes when they go to washroom etc.

Teacher comments for CARING RELATIONAL PRACTICE :

Chet has learnt that there are different ways to communicate with the clients, he uses communication techniques such as listening, being
attentive and acknowledging what he has heard. He develops caring and compassionate relationships with the clients that he has cared
for, he ensures that they have everything they require prior to leaving the room. He has realized that his beliefs, values and personal
experiences can aid in his building relationships with his clients and that clients are diverse in many ways (culture, ethnicity, religion etc.).
Chet has learnt how to interact with members of the interdisciplinary health team.

4. LEADERSHIP AND ADVOCACY

Satisfactory Satisfactory
4. 1 Apply appropriate conflict resolution skills in therapeutic client and other interactions.

C.R.B. : I and my clinical instructer requested client to have wanderguard put on but client refused and started to yelling. My clinical instructer

informed to client that such behaviour is completely unaccepted and was against hospital's policy. The client was also informed that he would not be

forced to have wanderguard put on if he did not want. The client behaviour was normal after such interaction.

Satisfactory Satisfactory
4. 2 Evaluate and refine leadership skills to develop solutions and create a positive work

environment.

C.R.B. : I assess the client from head to toe in every shift. I reprted the severe pain of the client and discussed about the need of strong pain relief

medication such as hydromorphine.

Satisfactory Satisfactory
4. 3 Provide feedback to peers and accept feedback from peers and members of the inter-

professional health care team.

C.R.B. : I got proper feeback from clinical teacher regarding medication administration, making concept map, charting the client helath information.

Similarly, I got effective ideas for client care from my peers, and I also provided feedback to my peers for making concept map and other information

on client care.

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

C.R.B. : I discussed the needs and choices of client with health care team provide quality care. I maintained the safety by placing bed in low position,

and maintained privacy by using curtains while providing quality care to the client.
 Satisfactory Satisfactory
4. 5 Support clients rights for self-determination and choice.

C.R.B. : I always respected the client and their choices. I did not force client to take medication and eat all the lunch when they refuse. Similarly, I

supported the client's choice to move outside of room and stay in the hallway after lunch.

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

C.R.B. : I placed the bed in lower position with side rails up for the patient with risk for fall to provide safety and to prevent any injury.

Satisfactory Satisfactory
4. 7 Collaborate and consult when implementing health care and nursing practices that are in the

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

C.R.B. : I used gloves, hand sanitizer, and all the PPE for some patients to prevent other patients, memebers of helath care team and myself from

infectious diseases.

Satisfactory Satisfactory
4. 8 Contribute to the creation of quality practice solutions and strategies.

C.R.B. : I developed the concept map for each patient in every shift to plan the nursing care and provided care accordingly.

Teacher comments for LEADERSHIP AND ADVOCACY :

Chet has developed his leadership role by taking charge of his clients care, he plans their care and will collaborate or consult with other
members of the health team to ensure that he is following nursing best practices or the policies of the facility. He plans the clients care
and will alter it based on the clients choices. Chet completed a peer review and submitted one for his peer as well,

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

Satisfactory Satisfactory
5. 1 Incorporate the clients unique needs and expected outcomes into holistic and client-centred

plans of

care.

C.R.B. : I feeded and administered medication through the G-tube to patient who was NPO.

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

competently in writing and orally.

C.R.B. : I developed the concept map with appropriane nursing diagnosis and interventions, and then carried out the care activities according to

concept map.

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

C.R.B. : I used the nursing knowledge and skill to care the patient during clinical practice. For example, while I asked patient to sit up from lying

position on bed, I assessed the dizziness of the patient, and then only helped him to go to washroom. It helped to prevent fall related injury.

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

C.R.B. : I involved in the care of the patient who was in hypoglymecic condition. So, we changed the plan of care and treat the low blood sugar level

first by providing orange juice to the patient immediately.

 Satisfactory Satisfactory
5. 5 Safely and competently implement and evaluate nursing assessments and nursing interventions

in a manner that demonstrates knowledge and skill.

C.R.B. : I obtained vital signs for the patient, and did complete head-to-toe assessment of the patient in every shift. I also assessed skin during bed

bath of the patient. Similarly, I checked the blood pressure before medication administration such as furosemide.

Satisfactory Satisfactory
5. 6 Use the Three-Factor and practice decision-making frameworks to guide practice.

C.R.B. : The considering of three factors client, nurse and environment helped me to provide specific and appropriate client care. I also applied

three factors framework to make decision, and the framework also determined my role as a student nurse.

Satisfactory Satisfactory
5. 7 Prioritize nursing care and nursing interventions in order to manage workload, time, and physical

resources.

C.R.B. : I prefered to administer insulin first for the patient who had high blood glucose at the meal time rather than providing bed bath and other

care.

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

Chet includes his clients unique needs when planning their care and incorporates the Three Factor and decision making frameworks when
looking at the client as a whole to guide his practice. He uses knowledge and skills learnt in school when assessing his clients, prioritizing
needs and outcomes and to help him to prioritize care and interventions in order to manage workloads and his time efficiently, (gathering
all equipment required to provide care to a client on isolation precautions prior to entering the room, organizing care so that he can provide
care equally to his clients.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

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

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

C.R.B. : I worked with inter-professional team of nurse, personal care assistant and clinical teacher to assess patients and identify the health needs. I

identified the need of pain relief medication after pain assessment. Also, I identified the hygiene care and did the bed bath, and bed making with new

bed sheet, pillow cover, blanket etc.

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.

C.R.B. : As a student nurse and member of the inter-professional care team, I reported the pain experience, low temperature of the patietn to the

nurse, and I provided pain medicatin and one more blanket to keep the patient warm. Later, patient's temperature was in normal range and had no

pain.

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

C.R.B. : I asked for the assistance of PCA and peer student to transfer the patient from bed to wheelchair, and ambulate the patient.

Satisfactory Satisfactory
6. 4 Use teamwork, consensus building, and conflict resolution skills to meet expected client

outcomes.
C.R.B. : I contributed as a student nurse and as one of the member of health care team to provide qualtiy care to the client. During clinical practice, I

did not experience any conflict with the member of health care team. Once, a client who had a bipolar disorder responded aggressively and refused to

have wanderguard to put on to me and my clinical instructer. The clinical instructer adviced the client not to behave unacceptable manner, and also

advised that he would not be forced to have wanderguard put on.

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

environment.

C.R.B. : The visitors were allowed to see the patient to feel home environment in the hospital. I also spent some time to talk to patient to identify their

needs and feelings for treatment.

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

C.R.B. : I interacted with clinical teacher, nurse, personal care assistant about the role a student nurse and did my job according to my role. For

example, I did hygiene care, head-to-toe assessment, and administration of medication etc as a student nurse.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Chet has interacted with members of the health team such as physiotherapy, occupational therapist, pharmacy other nursing members and
the physician and he has worked with his peers and buddy nurses as part of the team in providing care to his and other clients, he will
assess and collaborate his client, seek assistance when he needs help, to achieve the expected outcomes that were agreed upon.

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.

C.R.B. : I performed the role of student nurse, and provided care to the patients by consultating with members of interprofessional team to protect

them from harm while transfering from bed to the wheelchair, ambulating, feeding etc. I administered the medication using six rights of mediaction

administration.

Satisfactory Satisfactory
7. 2 Engage in ongoing reflective practice to identify strengths, areas for improvement; and, integrate

feedback into practice.

C.R.B. : I got a peer feedback on my strength and weaknesses. According to peer feedback and my own reflection, I identified my strength in head-

to-assessment, hygiene care, feeding and respecting patient's rights. I still need to be more active in medication administration and also need to

develop the skill of critical thinking.

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

(CNO).

C.R.B. : I created a learnig plan on the basis of my own reflection and peer feedbacks with 3 major goals to achieve. In a learning plan, I mentioned

the CNO's documents to review that are related to my goals, and also activities to acieve those goals, and I am still following those learning plans.

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

integrate these into practice.

C.R.B. : I tried to learn from all opportunities that I got during clinical practice. I asked many questions to members of health care professional at the

facility. Moreover, I discussed the care methods with peers, and implement them into practice. For example, I learned the method of administering

medication and I applied it in practice.

Satisfactory Satisfactory
7. 5 Use nursing research to foster professional development.

C.R.B. : I researched about the client health problem and ways to provide care to develop nursing plan. Likewise, I did reseearch about the use,

indication, contraindication, adverse effects of medication before administer to the patients that help to practice proffessional care.

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

C.R.B. : I checked the 6 rights of medication adminsitration at the facility while I got the opportunity to administer a drug to the client.

Satisfactory Satisfactory
7. 7 Apply knowledge of changes to the health care system, technology, and in society as these

affect nursing practice.

C.R.B. : The hospital needs to increase the number of vital sign obtaining machines because there are not enough machines in the facility and a

nurse needs to wait some time for the machine.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Chet bases his care on a theory based and evidence informed practice (monitor blood sugars prior to administering insulin, having the
client in an upright position if has a feed infusing via N/G, check N/G placement prior to infusing medications). Chet advised the instructor
of areas of learning that he required improvement or wanted experience in. He would research the medications prior to administering them
to improve his professional development. If he heard about a procedure or skill occurring on the unit he would ask to observe or
participate in the skill. He submitted his self reflection and developed concept maps for his clients.

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

Satisfactory Satisfactory
8. 1 Use critical thinking and problem-solving skills to inform decision-making in all aspects of nursing

care.

C.R.B. : One of the patient was in hypoglycemic condition at the start of the shift. Therefore, we decided to treat client's hypoglycemic problem than

providing morning care.

Satisfactory Satisfactory
8. 2 Use critical thinking, problem-solving and decision-making skills to assess clients and to

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

C.R.B. : The concept map was developped after the assessment of the patient probelms. Patient's health probelms were diagnosed and prioritized

the needs with expected outcomes, and provided care to the client in every shift.

Satisfactory Satisfactory
8. 3 Evaluate critical thinking, problem-solving, and decision-making skills and design a plan to

improve

these.

C.R.B. : I got feedbacks from clinical instructer and peers as well. Similarly, I also found my strength and weaknesses from my own practice reflection

which helped me to imrove my areas of weakness.

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

provide safe and competent care.

C.R.B. : I gained the nursing knowledge and skills from reading textbook, wathcing nursing care videos, practicing in college lab, and I utilize that

knowledge and skills in clinical practice. For example, I utilize the knowledge of bed making, wound care, medication administration during clinical

practice.

Satisfactory Satisfactory
8. 5 Prioritize effectively.

C.R.B. : Priority needs should be addresssed first during nursing care. I asked need for urinal for the patient before performing bedbath.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

C.R.B. : As a student nurse, I was assigned to care certain patients, and I was fully responsible for the care that I provided them such as wake up

them in the morning, help them in washroom activities, feeding breakfast and lunch who need assistance, safety care, medication administrations etc.

I demonstrated the professional quality by not disclosing their personal health information except with health care team members.

Satisfactory Satisfactory
8. 7 Use the practice decision-making and the nurse-client-environment frameworks to inform and

guide practice.

C.R.B. : My skills and capacity as student nurse, the information of the patient helath status and the resources avaialable in the hospital helped me

to take proper decision and provide competent care to the patients.

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

Chet is learning to critically think - he knows how to interpret the blood glucose results and administer insulin accordingly, he is learning
how to put information gathered through research, assessments and nursing diagnoses to anticipate outcomes and planning care. He
used PPE gear appropriately. He demonstrated professionalism and accountability by coming to clinical on time, in full uniform, when he
was ill he emailed the instructor to advise that he would not be attending clinical.

Student Final Summary with Strategies for Continued Growth

I learned and developed essential nursing skills such as skill of medication administration, catheter use, head to toe assessment, use of narcotics,
insulin admnistration and administering of IV therapy during this clinial placement. Such skills will help me to build up confidence and prepare for
clinical practice in next semester without the presence of clinial instructer. I am planning to keep study and continue to research on nursing skill, client
care, legal and ethical aspects of nursing profession, conflict resolution and critical thinking skills.

Teacher Final Summary with Strategies for Continued Growth

Chet is always eager to learn new skills or knowledge to aid with his professional development. I encourage him to continue researching his
medications, diagnoses and practicing the skills he has been taught, to continue working as a team and to reflect on the care that he provides, to seek
peer feedback in order to continuously improve. I also encourage Chet to have more confidence in himself as he has the knowledge but seems to
seek verification prior to proceeding with care. I encourage him to challenge himself by seeking more challenging clients, skills and procedures during
his preceptorship.

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