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NURS 3021H Clinical Practice Focused on Chronic Disease Management

Mid-Term Evaluation Final Evaluation X

Student: Bethany Carr

Clinical Instructor: Sharon Tripp

Clinical Placement Hospital: 120 Unit: Rehab

Date: November 26, 2017

Missed Clinical Hours: 8 Missed CLC Lab Hours: 0


NURS 3021H Clinical Practice Mid-Term Evaluation
Program Goals 3000 Level Outcomes
Students graduating from this program will be: On completion of 3000 level courses students will be
able to:
1. Prepared as generalists entering a self-regulating Fully understand how to practice in a self-regulating
profession in situations of health and illness. profession.
Analyze clinical situations and reflect on individual roles of the
nurse as it impacts upon patients and the nursing profession.
Rationalize the link between health and illness.
2. Prepared to work with people of all ages and genders Understand the complexity adults, of all genders, to achieve
(individuals, families, groups, communities and optimal health.
populations) in a variety of settings.
3. Expected to have an enhanced knowledge of the program Use a critical perspective in applying the foci to nursing
foci: indigenous, women's and environmental health and knowledge and practice.
aging and rural populations.
4. Prepared to learn to continuously use critical and scientific Integrate critical reflective evidence-informed care using
inquiry and other ways of knowing to develop and apply multiple ways of knowing.
nursing knowledge in their practice.
5. Prepared to demonstrate leadership in professional nursing Develop and embody leadership at the point of care.
practice in diverse health care contexts. Expand awareness of leadership in nursing.
Identify strategies to develop leadership potential.
6. Prepared to contribute to a culture of safety by Anticipate, identify and manage risk situations.
demonstrating safety in their own practice, and by Demonstrate awareness of resources related to risk
identifying, and mitigating risk for patients and other management.
health care providers
7. Able to establish and maintain therapeutic, caring and Engages in deliberative personal centred relational practice to
culturally safe relationships with clients and health care assist individuals, families and communities to achieve health.
team members based upon relational boundaries and Acknowledge own potential to contribute to effective
respect. collaborative team function.
8. Able to enact advocacy in their work based on the Advocate for individuals, families, and communities
philosophy of social justice. recognizing the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.
9. Able to effectively utilize communications and Integrates and applies critical thinking to the use of
informational technologies to improve client outcomes. information technology and dissemination strategies as related
to clinical outcomes.
10. Prepared to provide nursing care that includes Critically assess the individuals, family and community health
comprehensive, collaborative assessment, evidence- status.
informed interventions and outcome measures. Collaborate to identify priority health needs.
Identify evidence informed interventions and health outcome
evaluation in complex care situations.
Before completing the evaluation form, students and preceptors should review the objectives and sub-objectives. While
students and preceptors should comment on each of the seven course objectives, it is not necessary to write comments about
each sub-objective. It is better to provide specific and detailed comments about a few sub-objectives than to write broadly
about many.

Each objective should be awarded one of the following ratings:

Midterm:
Satisfactory Progress (SP): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve
the objective with an average level of teaching support and guidance; or the level of performance is what the instructor would
expect of an average student at that level and point in time; and the instructor reasonably anticipates that if the student
continues at the current pace of practice and achievement, the student should be able to fully meet the objective at the end
of the course.

Needs Development(ND): The student demonstrates sufficient knowledge and ability to safely practice or achieve the
objective, but requires more than average teaching support and guidance; or the student demonstrates knowledge but needs
more practice to achieve the competency; or the level of performance is below what the instructor would expect of the
average student at that level and point in time; and the instructor reasonably anticipates that if the student focuses his/her
learning in the required area, and gains sufficient practice, the student has the potential to meet the objective at the end of
the course.

Unsatisfactory Progress (UP): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or
achieve the objective, even with constant, intensive teaching support and guidance; or the level of performance is far below
what the instructor would expect of the average student at that level and point in time; and the instructor reasonably
anticipates that if the student continues at the current pace of practice and achievement, the student is not likely to meet the
objective at the end of the course.
Final:
Satisfactory (S): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve the
objective with an average level of teaching support and guidance; or the level of performance is what the instructor would
expect of an average student at that level.

Unsatisfactory (U): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or achieve
expected objectives, even with constant or intensive teaching support and guidance; or the level of performance is far below
what the instructor would expect of the average student at that level.
NURS 3021H Clinical Practice Evaluation

Progress
Course Objective Evidence/Indicators SP/S ND UP/U
1. Demonstrate accountability and responsibility in the I have handed in all assignments on time.
teaching-learning relationship. I complete all pre clinical work and medication
preperation as well as post clinical work.
I believe Sharon and I have an open line of
communication if I need something from her and
I feel comfortable approaching her if I am in need.
The same goes for if I am doing something
incorrectly, she would correct me and help me in
a respectful and meaningful way.
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Prepared post clinical and facilitated in a
professional and effective way on Schizophrenia
2. Explain the experience of chronic illness in individuals I believe I met this objective when I spent time
receiving care in chronic care settings talking to a patient over two weeks. She talked
about her excitement to go home and get her hair
done and wear makeup. She also enjoys travelling
and is not use to spending so much down time in
bed. It made me realize that not all patients are
leaving to go to LTC but some are going home to
continue living their lives as they were before,
this is just a little stop on the road for them.

Another patient I talk with each week, had spent


their summer on the unit. The patient is very kind,
and often reminds me to think from the patients
prespective. I explained something I was doing
and he told me I needed to think about what the
other patient might be experiecing at the time. It
really opens my eyes when someone on the unit
is willing to help students slow down and open
their eyes to the patient experience on the unit.
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I have had numerous patients speaking about the
food offered on the unit, how it is decent enough
and there is variety but it doesnt compare to
being at home.

3. Interpret critical aspects of the persons experience of I believe I have met this objective when helping a
chronic illness in relation to the nursing process such as patient who some days can help themselves and
common signs and symptoms, responses to treatment, others needs full assistance. He often says he
patterns of coping, and impact on individual and family can't do it, or that he is sorry. I often tell him he
relationships. doesnt need to say sorry to me, we are trying to
help him to the best of our abaility but he feels
like since he can't help sometimes he should be
sorry for it.

Each morning a patients son brings him a coffee


and sits with him at breakfast, it is nice to see
such a positive reationship and the impact it can
have on the patient. He seems much happier and
social when his son is there and gets out of bed. I
have helped him other days when he barely
replies to me and seems very lathargic. The
difference between the two moods is dramatic
but also refreshing that a family support is there
for him.
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One week I had a patient become very angry with
me because she felt weak and couldn't get up. I
explained to her that I wasnt trying to rush her
and we could take our time to complete the task.
After a few moments she apologized and it is easy
to understand that taking our anger out on
someone can be easy to do when you are
frustrated when becoming fatigued so easily.

Another patient talked to me about how


frustrating it is to have this surgery that is
suppose to help her and how it isnt fair that it is
so hard after. She seemed very discouraged when
I help her with care, which then made it more
difficult for me to help since she was becoming
less willing to help. This can result in a very
negative cycle where she won't be seeing the
results she wants and won't continue to put in
the work if she isn't seeing the results.
4. Identify symptoms and common medical treatments of I believe I have completed this objective by
selected chronic illness. completing weekly pre-clinical and post clinical as
well as completing my preperation to give
medications on my selected days.

Patients I have worked with have had mobility


issues due to hip fractures to AFIB and spinal
compression fractures. Patient diagnosis and
ability must be clear before attempting to help
patient.

I will conitnue to research patient diagnosis and


treatments before every shift to continue
learning, there are a variety of different reasons
are on the rehab unit and every patient is
different.
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Attending all post clinicals and having a more
indepth understanding of a few chronic illnesses.

5. Demonstrate select nursing and collaborative interventions I believe I have met this objective by completeing
related to caring for the person with chronic illness such as a head to toe assessment on my assigned patients
specific assessments, medication administration, physical each shift and charting findings such as breathing
and chemical restraints, enteral feeding & residual and bowel sounds.
volumes, NG tube insertions, wound care, patient
controlled medication administration pumps. Completing vital signs on my two assigned
patients and other patients nurses require vital
signs for.
Though my patient was off unit on my two
medication days, I have assisted the nurse I am
assigned to in the process of medication
administration. I have been shown and can use
Pyxis, access a patient's eMAR, and scan patient
and medications using checks.
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Completing assessments on patients who have
edema or pain.
Completed two days of medication
administration.
6. Identify potential consequences/complications of select I believe I have completed this objective by
chronic illnesses and related interventions. looking into possible complications or reasons
why my patients are taking certain medications.
Also reviewing patients lab values to find out
possible problems is also very beneficial.

There are many complications that I have seen on


the unit the most common I have witnessed are
bed sores/pressure ulcers, constipation, hospital-
acquired pneumonia, and UTIs.
There are specific treatments for each one of
these complications but interventiosn taking
place before hand can stop the complication from
taking place or reduce the incidence.
7. Under the supervision of a Registered Nurse, demonstrate A) I try to be confident when talking to patients,
safe, competent, evidence-informed, holistic nursing as well as I keep an open-mind, I use active
practice with clients with chronic illness listening and giving time for patients to finish
a. Use a wide range of effective communication their thoughts if it takes a while to be
strategies and interpersonal skills to appropriately communicated. I try to use good body language
establish, maintain, re-establish and terminate the that is appropriate and eye contact.
nurse-client relationship In practice I try to maintain a positive attitude
b. Demonstrate accountable, responsible and ethical
when appropriate, as a nurse student I am a team
practice
player and assist RPNs and RNs on the unit who
c. Engage in respectful, collaborative, therapeutic
and professional relationships may need something done.
i. Demonstrate therapeutic use of self B) Practice within my nursing student scope of
ii. Create a culturally safe environment practice, and adhere to hospital and school
d. Apply nursing models and theories policies. Ask for assistance from nurses on the
e. Demonstrate health promotion and illness unit when needed, and seek help from other
prevention practices nursing students.
f. Demonstrate patient advocacy ------------------------------------------------------------------
g. Predict outcomes of nursing care Check with perceptor or assigned nurse if I have
h. Evaluate client response to nursing care
any concerns with vital signs found.
i. Critically appraise own practice in relation to
C) Using verbal and nonverbal forms of
nurse-client/family interactions and as a member
of the health care team communication as mentioned above to
communicate effectively with members of the
health care team and patients.
To create a culturually safe environment I have
reflected on my own culture, views and attitudes.
I can recognize stereotypes and avoid using them
as they can be offensive and not true.
D) During post clinical each week we look up a
nursing theory or framework that applies to our
patient the given week. Reflecting on theories
learned in class and through readings helps me
have a better understanding and fit my practice
to a theory.
E) I have been helping promiting health by
helping patients get to their physio class and
encouraging patients to attend exercise classes. I
also have provided morning care and showers for
patients who need assistance.
F) I have advocated for patients by letting their
nurses know if they require pain medication, and
in one case, one patient requires gravol daily as
she gets very nauseus.
G) Monitoring patients as they receive
medications, or after they have used the
bathroom after having some discomfort. Keeping
an open communciation between myself in
patients so I may know their feelings
before/during/after.
H) As stated before I tried to keep an open line of
communication between myself and patients. I
conducted pain assessments and asked questions
to determine their level of comfort or need.
8. Critically appraise own practice in relation to nurse- I have struggled in some situations on what to say
client/family interactions and as a member of the health to patients, one patient who has trouble
care team understanding is sometimes hard to
communicate with and it takes patience. In other
cases I am intimidated by some nurses working
on the unit, and find it hard to approach them
because I am nervous.
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9. Participate in professional development based on I believe I have met this objective by completing
reflective practice and critical inquiry my first reflection. For my first reflection I focused
on an event that stuck out in my mind to patient
and nurse safety, which happened on my 6th shift.
I focused on problems I saw with the situation
and how I think it could have changed for better
or worse. By reflecting I was able to learn from
the past if I ever come across a similar situation.
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Completing my second reflection based on a
situation I experienced with a patient who had
not been bathed in over a week.

Areas of Strength Identified by Student

1. Communication skills

2. Patient assessments and charting

3. Taking opportunities to see different aspects of the hospital to gain a more hollistic view
Areas for Future Development Identified by Student

1. More practice preforming wound dresses

2. Being more confident with my skills when offered a task

3. Using different version of Meditech then I am use to

Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment)

Clinical Practice Attendance (8 Hours Per Shift)

Thurs Fri Thurs Fri


Week 1 8 8 Week 6 8
Week 2 8 8 Week 7 8 8
Week 3 8 Week 8 8 8
Week 4 8 8 Week 9 0
Week 5 8 8 Week 10

Total number of clinical practice hours completed: 120 /128 Hours

Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory Unsatisfactory

Clinical Learning Centre

Total number of clinical simulation hours completed 3.5 / 14 Hours


Total number of lab hours completed 10 / 22 Hours

Clinical Learning Centre Outcome (completed by Course Lead): Satisfactory Unsatisfactory

Signature of Course Lead: Date:

Signature of Clinical Instructor: Date:

Signature of Student: Date: