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 : Jagrutiben Patel
Clinical Teacher/Preceptor : Cheryl Peters
Program Coordinator : Judy Martin
Location : William Osler Health Centre/Brampton Civic Hospital
Placement Setting : Agency
Unit/Office/Clinic : N4 Reactivation
Period : 06-Sep-2016 To 09-Dec-2016
Student hours : 156
Required Hours : 196
Validated hours : 184
Teacher comment for validated hours:
Student was absent from clinical in week 14 due to illness.

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.P. : I always make sure that I follow the hospital rules and regulations and always perform a safe practice. I make sure that I am always in a proper

uniform ( with hairs properly tied up, no jewelry, and puncture proof white shoes), perform hand hygiene before and after entering a patient room and

perform appropriate nursing skills within the scope of my practice.

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

J.P. : I act in a responsible, ethical and an accountable manner by arriving on time during my clinical, looking up the assigned patient sign to see if

there are any procedure needed to be done, giving medications on time in an appropriate manner, taking the vital signs two times during the shift,

doing a complete head to toe assessment and making sure to document it in the Meditech. I always show respect to my peers, my clinical teacher,

nursing staffs and the patient. And if I am given any task I make sure to complete it in a proper manner and on time.

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

J.P. : I always ensure to work in best interest of the patient. It is very important to maintain important principles such as autonomy and beneficence

that further govern client-centered care.

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

J.P. : Every week when I get my patient assignment, I do a detailed research of the medical diagnosis by going through the textbooks that is on

evolve. Like, when i had to give a subcutaneous injection i went through the evolve online videos to know the correct procedure to do so. If i find any

topic not described properly in evolve then I go through peer-reviewed journal and articles from online Humber library. This way I brush my knowledge

during clinical through theory-based approach.

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

safe environment.

J.P. : Clients safety is my first priority. After entering a patients room i make sure that the bed is in the possible lowered position, call bell and the

phone is within reach, all the necessary items are placed on the table and the table is near the patient bed, and I also make that the floor is clean and

no table or chairs or any other furniture is in the way of the way when the patient gets out of the bed to have a walk outside the room or to go to the

washroom. Before leaving the room i do everything mentioned above and also ask the patient, who needs assistance, if they want to go the

washroom, so that i can assist them.

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

J.P. : Whenever I am uncertain of any nursing practice, I make sure to clarify it by asking relevant questions to my clinical teacher, my peers and

nursing staff assigned to that patient so that I am able to provide a proper care without any mistake. Like after auscultating for bowel sound I was

unsure how to describe the sound while documenting it in the Meditech. So I asked my clinical teacher and she told me to document it as hyperactive

sound.

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

unacceptable and/or unprofessional behavior.

J.P. : Whenever I encounter any situation that is unsafe for my patient and myself i make sure that i seek appropriate assistance at that moment. Like

while giving bed bath to one of my patient with a severe Parkinson disease, I sought help from one of my peers because the patient was having a lot

of tremors and turning the patient on either side for cleaning the back and doing peri care was hard for a single person. Even while transferring one of

my patient from the wheelchair to the bed, I sought help from two of my peers so that the patient doesn't falls and is safe.

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

J.P. : Nurses play a big role in the health care team. After getting diagnosed with a particular condition, it becomes the responsibility to the nurse to

take a good care of the patient. Like, the unit where I am having my clinical, one nurse has eight patient. From the beginning till the end of their shift,

they make sure that they are giving a good care to the patient's. They do C.A.R.E rounding that makes them aware of any abnormal condition going

on with the patient. Advocate on behalf of the patient.

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

Jagrutiben practiced safely and competently and according to the policies and procedures of the clinical facility. She reviewed her
assigned patients' medications and reviewed the MAR with myself before administering the medications. Medications were safely
administered according to the rights of medication administration. Weekly she demonstrated responsible and appropriate care when she
encountered patients and families that shared different views from hers. She ensured patient safety by making sure the bed was in the
lowest position at all times and that the breaks on the wheel chairs were on while the patient was in them. As well she did patient
verification prior to medication administration.

2. ACCURATE AND RELEVANT COMMUNICATION

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

J.P. : During the clinical whenever I am off the unit, I help my peer by answering questions regarding documenting in the Meditech or sometimes help

them in bathing their patient. I actively take part in the post conference that takes place at the end of the clinical with my clinical teacher and my peers

and discuss any concerns and experiences that I had throughout the day.

Satisfactory Satisfactory
2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.
J.P. : I am pretty confident in the area of documenting now. As soon as i take my vital signs I document it instantly in the Meditech not waiting to do

so at the end. Now I am able to properly manage my time for doing the assessments, giving a bed-bath and giving the medications on time. Before I

was not pretty aware of the areas to focus during doing my assessment but now being familiar with the Meditech system, I am able to do head to toe

assessment concisely in a timely manner.

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

J.P. : I always report the relevant information to my primary nurse and clinical teacher. Like one of my patients Physiotherapy was at 0930. But at

1000 they didn't show up. I informed my primary nurse about this. hence she called the OT people and they came in after 20 minute.

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

J.P. : I always make sure that I am constantly communicating with my patient, the primary nurse and my clinical teacher. Everytime I take vital signs i

make sure that I am communicating with my primary nurse to provide her with the readings and letting her know that I would be documenting the

readings in the meditech. Even while taking the vital signs, giving the medications and while giving bathe i go on communicating with my patient so

that they are aware of what I am doing and make sure to explain everything before doing it so that if they have any concerns hey tell me.

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

(PHIPA).

J.P. : I always make sure to maintain privacy while drawing the curtains while doing any procedure. I ensure that that the patient's records are in the

patient file. I never look up any other patients details other than my patients to maintain privacy. Even I make sure that I don't discuss the findings of

my patients with any of my peers or any person out the hospital. Even if the patients discusses any personal information with me about his/her life i

make sure to keep the information to myself

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

J.P. : I always use technology to do a detailed research on various possible medical diagnosis before coming to the clinical. Like, I read the Jarvis,

Potter and Perry, and medical and surgical textbook to make myself more knowledgeable about any condition. Even I go through some online journal

and articles if I feel that the textbooks are not enough.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Jagrutiben actively participated in post conferences sharing new learning and ideas. Weekly she documented patient information online
using Meditech. She reported all abnormal lab values and abnormal patient findings to myself and the primary nurse. She communicated
well with her peers and members of the health care team. She used verbal and nonverbal techniques when communicating with patients
and families. She ensured privacy by refraining from discussing patient information in a public setting as well as making sure curtains
were drawn during patient care.

3. CARING RELATIONAL PRACTICE

Satisfactory Satisfactory
3. 1 Use effective communication techniques.

J.P. : I always use verbal and non-verbal communication technique and always make sure to ask open or close ended question depending on the

condition of the patient. The details of the proper communication technique I have learned from the Potter and Perry textbook and from my clinical

teacher.

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

health care team members.

J.P. : I always make sure to maintain a therapeutic caring, compassionate, and culturally safe relationships with clients and the health care team

members. With health care team members I always make sure to communicate properly with them and share any concerns that I have about the

patient or vice - Versa. Like, one of my patient wanted pain medication because of her back pain which was not allowing her to sleep. That day I was

assigned with only total patient care and not administering medication. I informed the nurse abut the patient request and made sure that the nurse

gave the medication to the patient.

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

J.P. : I always make sure that I apply knowledge of therapeutic use of self and identify its effect on client well-being. Like while taking care of the

patient I always go on communicating with the patient to know more about the patient, like if something is bothering them which we are not aware of. If

they report any concerns i make sure to look upon it and discuss it my primary nurse so that I am able to take a good care of my patient.

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

relational practice.

J.P. : I make sure that I keep aside my beliefs, values, and feelings while taking take care of my patient. Proper communication with the patient will

help us to know our patient values and beliefs and will make us aware of how we should act and talk with our patients.

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

appropriately.

J.P. : I always make sure that I am interacting with clients and members of the inter-professional health care team and consulting with them

appropriately. Like while I entered the room of my patient for giving the afternoon medication, I found my patient's wife present there. So while giving

the medication kept on communicating with the patient and the family members by letting them know about the medications, like why is he on it. Is this

way I was involving the family members in the care of the patient too.

Satisfactory Satisfactory
3. 6 Support the diversity of clients and the inter-professional health care team.

J.P. : I always make sure to apply my knowledge of nursing practice while taking care of my patient. If any of my patient is going back to the

retirement home, i make sure that they get all the possible care they should be getting. Like i make sure that the primary nurse informs the

physiotherapist or the occupational therapist to visit the patient in the retirement home and take care of them

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

influencing their choices and decisions.

J.P. : Whenever i start taking care of my patient I make sure that i communicate with them so that i get to know about their cultural background,

beliefs, and values so that i am able to provide a good care to my patient.

Satisfactory Satisfactory
3. 8 Provide effective client education.

J.P. : I always make sure that while i am taking care of my patient i am providing every bit details that i should be providing. Like while taking the

vital signs i let them know about their blood pressure and temperature reading. While giving medications i make sure I let my patient know about why

they are having that medication. Even before performing head to toe assessment I inform them and take their consent. Consent is needed because

the patients have the right to refuse and the right to ask about anything that's happening to them.

Teacher comments for CARING RELATIONAL PRACTICE :

Weekly Jagrutiben used effective communication when speaking with every one she encountered. She spoke multiple languages and often
served as a translator for her peers and members of the health care team. Jagrutiben collaborated with her peers, psw's, and the primary
nurse to provide safe and effective care to her assigned patients. She cared for multiple patients from a variety of background and she
treated each patient as an individual and respected their beliefs. She educated her patients by informing them the importance of calling for
assistance into and out of bed, as well as teaching them the importance of remaining upright at least 30 degrees after eating to prevent
aspiration.

4. LEADERSHIP AND ADVOCACY

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

J.P. : It is very important to apply conflict resolution skills while working with agitated client. In order to do so, I would listen to my client and give them

enough time to explain their concerns. I will make sure to decrease all the stimuli that will increase their agitation behaviour

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

environment.

J.P. : Whenever i find that any of my peer need help, whether that be in documenting the vitals signs or assisting in bed bath. I always make sure that

I am always available to my peers as a helping hand. Like one of my patient had communication problem with the patient so she was not able to

understand what the patient replied when she asked the patient if she wants a bath on the bed or shower. So my peer seeked my help. So i became a

translator for my peer and the patient. and also helped my peer in giving the patient a complete bath in the wash room. Once one of my peer needed

my help in boosting her patient up in the bed as the patient was total. So i happily helped my peer.

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

professional health care team.

J.P. : I have received feedback from my peers from the peer assessment that we did in the clinical at the end of the shift. Even I receive weekly

feedback from my clinical teacher that helps me to know that in which area in the clinical practice as a student nurse i need improvement. Weekly

evaluation also helps me to know my strengths and weakness.

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

J.P. : I always make sure to analyse the areas that needs improvement for nursing intervention in order to advocate for my client and myself

whenever necessary. For example, one of the patient, who was in the same room of the patient I was assigned to, was on diaper, complained that at

night no one changed her diaper at night and because of that she was not able to sleep properly. So I changed the diaper and before leaving i made

sure i informed the afternoon shift primary nurse to change the patients diaper after dinner so that she is able to get a good sleep.

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

J.P. : I always make sure that i always support the clients right for self-determination and choice. Like one of my patient wanted to sit up on the chair

after every meal but was not able to properly communicate because of language barrier. I made sure to inform the nurse before leaving so that she

makes the patient sit up on chair after dinner.

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

J.P. : So far I have not encountered with any situation that was unsafe but definitely came across a situation that was totally unacceptable and

unprofessional from my point of view. For example, I overheard some nurses talking about their patients, like why do they get the same patients, why

they have a hard patient and the other nurse has got an easy going patient. This kind of conversation was totally unprofessional and as a nurse we

should always respect our patients the way they are.

 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.

J.P. : I will make sure to collaborate with my peers, my clinical teacher and the primary nurse I work on the unit on the day of my clinical so that i am

able to provide the best nursing care to the patient I am assigned. Along with my peer's I was present in an education session about the new

colostomy pouch.

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

J.P. : I always take part in group discussions and give my suggestions to tackle certain issues.

Teacher comments for LEADERSHIP AND ADVOCACY :

Jagrutiben has not directly encountered conflict however she has discussed ways that she would've approach it such as maintaining
respect and informing myself or the charge nurse. She fostered a positive work environment by volunteering to translate for various
members of the health team. Also she was always willing to offer assistance to her peers and other staff members. She advocated for her
client that informed her that he was left in a wet diaper for the night. She informed the primary nurse as well as the oncoming nurse about
the patient's concerns to ensure that it did not occur again.

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.

J.P. : each week after getting my patient assignment, i do a quick research on my patients diagnosis and have a look at the patients progress note to

see whether the clients condition has progressed or detoriated after the admisiion. On the basis of all the information I make a care plan for my

patient, which helps me a lot while taking care of the patient.

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.P. : Whenever I get my patient assignment I make sure that i go through Jarvis, Potter and Perry, and medical and surgical textbook and read the

topics related to my patients medical diagnosis through out my shift which will help me to broden my knowledge about the patients diagnosis and take

a better care of my patient by making a good care plan for them.

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

J.P. : I always make sure to use knowledge, skill and judgment to assess clients, prioritize needs and outcomes. I make sure to use my knowledge

gained from my classroom training, textbook, and my clinical teacher while performing my nursing skill on my patients. Like one of my patients was

ordered for a neuro assessment every four hours. I made sure that I do it on time. Even the same patient was on a blood pressure medication. So I

made sure that I had the Blood pressure reading before i administered it because in the MAR it was mentioned that if the Blood pressure was low then

to hold the medication.

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

J.P. : I make sure that i take the vitals and do a proper assessment of my patients in an organized manner. I also make sure that i have proper

interventions to carry out on my patients. But suppose if the condition of the patient changes i make sure that i critically think and come up with new

interventions and outcome goals and discuss it with the primary nurse and my clinical teacher.
 Satisfactory Satisfactory
5. 5 Safely and competently implement and evaluate nursing assessments and nursing interventions

in a manner that demonstrates knowledge and skill.

J.P. : After getting the patient assignment i make sure to do a quick research on my patients medical diagnosis and come up with a good care plan. I

also prioritize the assessment based on my patients medical diagnosis and past medical history. I do so by going through the textbook, that is, Jarvis,

Potter and Perry, Medical and Surgical and some notes from the 1st semester NURS 101 course regarding safety of the patient.

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

J.P. : I always prioritize my nursing care for my patient. This helps me to properly manage my time for all the stuffs that have to do. Like in the

morning i take my patients vital signs and while doing it i do the pain assessment and the neurological assessment and then chart it immediately.

Then after breakfast i wash them in a away depending on the condition of the patient. I do a skin assessment while giving a bathe and after dressing

the patient i do the respiratory and the cardiovascular assess

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

resources.

J.P. : I always prioritize my nursing care for my patient. This helps me to properly manage my time for all the stuffs that have to do. Like in the

morning i take my patients vital signs and while doing do i do the pain assessment and the neurological assessment and then chart it immediately.

Then after breakfast i wash them in a away depending on the condition of the patient. I do a skin assessment while giving a bathe and after dressing

the patient i do the respiratory and the cardiovascular assessment. after the lunch i chart the ADL assessment. In this way I am able to manage my

time effectively and lessen work overload.

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

Jagrutiben incorporated each client's unique needs and expected outcomes by first inquiring about the patients' needs. For instance some
patients preferred warm water instead of cold water or some patients prefer if she opened up their meals and some preferred to exhibit
some independence and open up for themselves. With each encounter she identified herself , explained her role as a nursing student and
allowed the patients to be a part of the decision making process. Weekly she created a concept care map that detailed the patient's
diagnosis with plans for interventions and evaluations. Also we discussed her assigned patients' medical history, medications and head to
toe assessment findings during our one to one discussions. Prior to patient interaction she researched her assigned patients' medical
information and lab values in order to be prepared to provide safe and competent care.

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.

J.P. : After taking the vital signs i make sure that i provide the readings to my primary nurse. While doing the assessment if i find any abnormal

findings i make sure that i report it to my primary nurse and my clinical teacher. Like when I administered colace to one of my patient she had loose

bowel movement twice in an hour and was making the patient tired . So I informed the nurse about this so that they check the bowel movement before

administering the next dosage of colace.

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.P. : I always make sure to inform any abnormal findings from my patient to my clinical teacher and the primary nurse. Like when I got the

respiration rate of my patient as 24, i made sure to inform the finding to my clinical teacher and my primary nurse.

Satisfactory Satisfactory
6. 3 Seek out assistance and consult with members of the inter-professional health care team.
J.P. : i always make sure that i seek help from my peers or the nursing staff whenever i feel that one hand is not enough. Like i was giving bed bath

to a patient i had to be very careful in turning her as she had a severe back pain.So i seeked assistance of one of my peers to help me turn the patient

so that i was able to clean my patients back and give her a good peri care.

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

outcomes.

J.P. : I always used teamwork, consensus building, and conflict resolution skills. I always make sure to seek help, if needed from my peers while

taking care of my patient and whenever my peers need my help i make sure that i help them. For example, one of my peer had problem

understanding what the patient was telling while my peer was changing the patient diaper. Since i was able to understand the patient language, i

talked to the patient and then explained it to my peer about what the patient was saying. In this way we help each other in the unit

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

environment.

J.P. : It is very important to determine the needs of a client. As, there are various factors that can change the needs of a patient especially in post-op

patients. The change in vital signs or change in fluid status can change the whole plan of care

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

J.P. : I always try my best to interact with other health care member in a respectful way and try to limit my questions base on the role of that person

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Each week Jagrutiben collaborated with clients and members of the interdisciplinary team. She collaborated with the primary nurse to
provide care and treatment to the assigned patients. She collaborated with the psw to assist the patients perform their ADL's and she
worked with the PT and OT to perform ROM and help the patient to get closer to achieving full independence before returning to the
community. She collaborated with her peers to ensure that the patients were re positioned every 2 hours to prevent skin breakdown. She
sought assistance from myself and the primary nurse whenever she was uncertain.

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.P. : I always ensure safety of the client by performing good hand hygiene before entering the room and after leaving the room, take appropriate

safety precautions by making sure that the side rails are up and removing all the hazards that can cause patient's harm.

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

feedback into practice.

J.P. : I always make notes of whatever I performed in clinical. These notes help me in self-reflection.

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

(CNO).

J.P. : I always read the feedback given by my teacher on weekly basis and incorporate that into my learning plan. I also make weekly learning plan

that are within time limits and satisfied my priorities.

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

integrate these into practice.

J.P. : I actively participated in a dietitian in-service that provided me a lot of detailed information of their role and how important nutrition is in a care

plan of a client.

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

J.P. : I make use of different books and online resources to understand complex procedures and skills. I use peer-reviewed journals and readings to

boost my nursing knowledge. Like while making concept map for my patients diagnosis I always use the medical surgical book that's in the nursing

station.

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

J.P. : I always make sure to read Potter and Perry and Medical and Surgical book online on evolve while doing a research on my patient to enhance

my knowledge of any particular diagnosis of my patient.

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

affect nursing practice.

J.P. : I always try to read peer reviewed journals, CNO website, RPNAO website as those are good source of latest changes.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Jagrutiben acted in the best interest of clients by ensuring their safety at all times. For example she ensured that call bells are within reach,
side rails were up when the patients were in the bed and that the brakes were on when the patients were in the wheel chair. Weekly during
our one to one discussions she discussed new learning for the day and different ways of improving her competency, knowledge and skills.
Jagrutiben has sought out new learning opportunities and as volunteered to assist with major wound dressing changes, enteral feeds
setup and foley catheter insertion.

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.

J.P. : I always make sure that I utilize problem-solving skills to inform decision making in all aspects of nursing care. For example, while taking the

vital sign I noticed that therespiration of the patient was too high. So I informed my primary nurse about the finding. She said that was normal for the

patient because of his medical diagnosis. in this way i came to know that sometimes that seems abnormal is normal for some one.

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.

J.P. : I always make a draft of care plan before going to patients'room such as relating the nursing diagnosis with interventions and medications

provided. Like I make sure I know the data from the last Vital Signs taken to compare it while taking vitals signs. And I also make sure to know the lab

reports of the electrolytes and the INR of coumadin before giving the medication.

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

improve

these.
J.P. : On the floor when ever I am corrected by my clinical teacher about any procedure i make sure that I don't make any mistake the next time. For

example while giving my first subcutaneous injection I was giving it at an angle of 90 degree but my clinical teacher told me that it should be 45

degree. So next time I made sure that the angle was correct. Even through the weekly evaluation on K4Y i am able to know my strength and

weaknesses and made sure to work more on my weaknesses. Like in the beginning i used to seek help from my clinical teacher to document in the

meditech and used to take a long time in doing it. But now I am pretty confident in it and do it in no time.

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

provide safe and competent care.

J.P. : I always make sure to refer to my textbooks from semester one and two to broaden my knowledge about the medical diagnosis of my patient. I

make sure to watch the online videos that is on evolve on how to give puff, or an injection or feed through G-tube to know the proper procedure. Even

i refer to the textbooks to make my care plan and also refer to some online peer reviewed journals and articles to broaden my knowledge. For the

medication, mostly I go through the mosbys drug book but sometimes i also go through the pharmacology textbook to know about the classification of

the drug in detail.

Satisfactory Satisfactory
8. 5 Prioritize effectively.

J.P. : I always prioritize my duties when I am making the care plan for my patient. In this way it helps me to take a better care of my patient.

Sometimes the condition of the the patients changing while my on the floor, so at that i had to critically think and change my prioritization. Like one of

my patient with Parkinsons disease had risk for falls so i made sure that I keep checking on the patient frequently. SO while checking on the patient

once I found the patients head on the side rails. I ran to her and placed her safely on the bed.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

J.P. : to demonstrate professionalism and accountability i make sure that i am in the unit on time and in a proper uniform. Then i make sure to take

report from the night shift nurse about my patient along with my primary nurse. I then let my primary nurse know what I can do and cant do as a

student nurse. Like i cant give insulin and IV medication. So i let the nurse know that so that she can do it if had to.

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

guide practice.

J.P. : I always use decision-making framework that I learned from ethics class in order to deal with difficult situations

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

Weekly Jagrutiben used critical thinking skills in different ways. For instance she checked her patients' vital signs before administering
medications such as antihypertensives and beta blockers. she followed up with reassessing the vital signs after giving the medications.
She notified myself and the primary nurse if the blood pressure was below the defined limits and anticipated that the medication would be
held and the doctor be informed She prioritized her care, for example her assigned patients were given their scheduled medications on
time, ADL's were performed and the patients were dressed and transferred out of bed sometimes as early as 10AM. She integrated
knowledge that she gained from prior clinicals, text books and theory class into her nursing care. For instance she was able to discuss the
different types of insulin including its peak of action.

Student Final Summary with Strategies for Continued Growth

Overall, the whole clinical experience was great. I got an opportunity to work with different health care providers and supporting peers. Moreover, the
guidance and support received from my clinical teacher help me in learning new skills and procedures effectively. I got a chance to administer I.V
medications, ostomy care and dressing changes that enhance my skills and knowledge. I want to improve my critical thinking and decision-making
skills by implementing evidence-based research into practice. Moreover, i want to improve my time management skills by prioritizing different tasks.
Teacher Final Summary with Strategies for Continued Growth

Jagrutiben has progressed satisfactorily as a nursing student. She was able to perform a full head to toe assessment including checking pupils for
size and reaction, identifying adventitious lung sounds, checking apical pulse and checking pedal pulses. She was able to care for multiple patients
including administering medication safely. She was a great resource for translation to her peers and other members of the health care team. She
was prepared for clinical each week and she researched patient information prior to caring for the patients. At this point Jagrutiben is encouraged to
continue to seek out new learning to increase her current knowledge base and critical thinking skills. She can do that be continuing to request to
perform new interventions. Jagrutiben was a pleasure to teach. Wishing her all the best in her journey to becoming an RPN. Good Luck Jagrutiben

Program Coordinator comment

Clinical hours = 14 weeks x 14 hours per week ( 12 hours clinical l and 2 hours self directed study ) = 196 hours total - 12 hours for absence = 184
hours

Student's References

Potter & Perry and Medical and Surgical book.

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