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NURSING 3020 Clinical Evaluation

NURS 3020H

Clinical Evaluation
Final Evaluation

Student Name: Alicia Jeffery

Clinical Instructor: Holly Grieder

Missed Clinical Hours: 0 Missed Lab Hours: 0

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NURSING 3020 Clinical Evaluation

Program Goals
Graduates are generalists entering a self-regulating profession in situations of health and illness.

Graduates are prepared to work with people of all ages and genders (individuals, families, groups, communities and populations) in a
variety of settings.
Graduates continuously use critical and scientific inquiry and other ways of knowing to develop and apply nursing knowledge in their
practice.
Graduates will demonstrate leadership in professional nursing practice in diverse health care contexts.

Graduates will contribute to a culture of safety by demonstrating safety in their own practice, and by identifying, and mitigating risk for
patients and other health care providers
Graduates will establish and maintain therapeutic, caring and culturally safe relationships with clients and health care team members based
upon relational boundaries and respect.
Graduates will be able to enact advocacy in their work based on the philosophy of social justice.

Graduates will effectively utilize communications and informational technologies to improve client outcomes.

Graduates will be prepared to provide nursing care that includes comprehensive, collaborative assessment, evidence-informed
interventions and outcome measures.

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Progress
Objectives Satisfactory Unsatisfactory
Indicators/Evidence
1 Prepared to provide - I completed my preclinical tools thoroughly so that I knew what
nursing care that includes each patient would need and so that I could be prepared to
comprehensive,
collaborative assessment, demonstrate new skills if needed. I used my textbooks and the
evidence-informed internet to look for this information. Ex. My assigned patient
interventions and had a tracheostomy and a G-tube so I researched how to do
outcome measures. tracheostomy care and how to flush a G-tube before clinical. I
did this so that I would have some prior knowledge before
observing it being done, or so that I could do it supervised.
- Identified that I needed to practice my head-to-toe
assessments (due to not having ever done one on a patient
before and not being fully comfortable doing one). I took
initiative to make this a goal of mine and read over sample
head-to-toe checklists, watch videos of nurses doing them and
practice on friends to improve this skill.
- Researched different characteristics of wounds. Including types
of exudate (purulent, sanguineous, serosanguineous,
fibrinous), stages of pressure ulcers and what maceration
means. Maceration is the softening and breakdown of the skin
surrounding a wound which occurs from prolonged exposure to
moisture.
- Researched what needles to use when. The gauge of a needle
tells you the diameter of the hole where the medication comes
out. Smaller guage indicates a larger diameter. For IM
injections, it is recommended that you use a 21 or 23 gauge
needle that is 1-1.5inches long. For subcutaneous injections, it
is recommended that you use a 25 or 27 gauge needle that is
3/8-5/8 inches long.

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- Completed q4h neurology checks after one of my patients had


a fall and a suspected brain bleed. These neurology
assessments required being able to assess pupils, strength
bilaterally, orientation and confusion and speech abilities.
- Hung 3000mL of 0.9NS and adjusted drip rate after my patient
came back from getting a TURP. Correctly administered
medications (tablets, capsules and insulin) including performing
the three checks. Correctly used a glucometer to assess
patients’ blood sugar levels
- Observed an ABG draw and later looked up this diagnostic test
online to find out its uses.
- Assisted with an admission assessment of a patient who I
recognized was disoriented and confused. I recognized the
need for simpler instructions and the need to comfort the
patient in the situation.
- Put patient on 2L of O2 nasal prongs after his SpO2 was 89%
and he was complaining of SOB. 15 minutes later, I checked the
SpO2 again and got a reading of 95% and the patient also
stated that he felt less SOB. Therefore, I evaluated this
intervention as successful.
- Used the doppler to locate a patient’s pedal pulses when I was
unable to palpate pulses and noted edema and darker coloured
feet. I recognized that it would be important that the patient
had pulses in their feet since this would mean that they had
bloodflow to them. Ischemia is a possible issue with decreased
bloodflow. Having issues locating pulses can signify peripheral
vascular disease.

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2 Establishes and maintains - Learned alternative ways of communicating with patients when
therapeutic, caring and there are certain barriers to communication. Ex. One patient
culturally safe
relationships through had vocal cord paralysis, so I tried using mostly yes or no
effective communication. questions (so they could nod yes or no) and adapting to his
chosen method of using a whiteboard to communicate longer
sentences.
- Communicates with peers, clinical instructor and nurses on the
unit effectively. Asks for help whenever necessary (ex. If I need
an extra assist or help with a bath or help with a new skill).
- Asks nurses if they need any help whenever I have free time.
This enables me to experience/see more things each clinical
shift and can enable nurses to have time to do other things (ex.
Charting, giving meds).
- I give and receive report to/from the nursing student who is
assigned my patient. I ask the other student questions to clarify
whenever I’m unsure about something they have said and ask
questions whenever I feel that I need more information (ex. If
they forget to include if the patient gets up independently to
go to the bathroom, etc.). After giving bedside report, I always
ask the next student if they have any other questions before I
go and I make sure that I have introduced them to the patient. I
also make sure that the patient has everything they need
before I leave the unit at the end of my shift and I tell the nurse
that I’m leaving.
- Reassured patient by holding her hand and talking to her while
another student administered an IM injection.
- Learned how to communicate with a patient who is blind. Ex.
To introduce myself each time I enter the room, to explain
what I’m doing and orient the patient to the room. I helped this

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same patient to complete his pre-operation questions by


reading him the questions and then writing down his answers
- Asked nurses and my instructor for help as needed. Ex. Asked
for help to find dorsal pedal pulses and asked a nurse for help
with a head to toe assessment on a patient who was in a less
stable condition
- After completing my post-clinical presentation, I asked a few of
my peers for feedback about how I did. I feel that feeling
comfortable enough to ask for feedback is very important. I’m
glad that I made these relationships with my peers so that I can
rely on them for support and constructive criticism.
3 Applies the four ways of - Used personal knowing to set goals for myself during this
knowing and clinical experience this term. I have also thought about ways to
informational
technologies to reach these goals. Once I have met goals, I have come up with
effectively care for new goals to replace these met goals.
diverse, acutely ill - I engaged in reflection to write my first journal. This enabled
patients. me to think about what I had done, think about why I felt the
way I felt in the situation and enabled me to come up with
ways to improve. This can improve the patient’s experience.
- I have used personal and aesthetic ways to knowing and I have
acknowledged that I have misconceptions about how patients
feel about being in the hospital. I used to think that most
patients would want to leave the hospital as soon as they could
but I have come to realize that some patients do not want to go
home.
- I use technology to research new skills. I use the internet to
look up how to do these skills and I use Youtube to watch
videos about how to do skills.

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NURSING 3020 Clinical Evaluation

- I ask my clinical instructor, peers and nurses questions when I


don’t understand things. I have also asked my clinical instructor
to teach about proper needle/IV selection during a post-
clinical.
- During one clinical shift, there was a patient who fell. I
remembered that other students had talked about there being
a lot of paper work that needed to be filled out when a patient
falls in the hospital. When I told this patient’s nurse about the
fall, she was busy and it seemed like the nurse thought that the
paper work was not the most important thing for her to do.
Using an ethical way of knowing, I realized that it would be
unethical to not fill out the paper work. It can be difficult as a
nursing student to say something to nurses when you disagree
with them, but I knew this needed to be done so I reminded
her multiple times during the shift and asked to look over the
paperwork when she had completed it so that I would know
what the paper work entails in the future.
- Used personal knowing and reflection to write journal 2. I also
used personal knowing to reflect on all the new information
and skills I have learned this semester.
- Using the empirical way of knowing, I ensured that I was self-
teaching the weekly lecture material for NURS3000 after it was
affected by the strike.
- After weeks of being affected by the strike, I also reflected and
used empirical knowledge to examine my knowledge and skills
to ensure that I had enough knowledge in order to continue
practicing in a safe way.
- After helping to apply a dressing for a patient with
nephrostomies, I went home and researched this topic. I had

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NURSING 3020 Clinical Evaluation

never encountered this type of ostomy before and so I


researched how common they were, why they could be
needed and the care that is required.
4 Adheres to professional - I submitted all pre- and post-clinical tools on time each week.
practice standards and The forms were complete and I used resources (our textbooks
organizational polices to
contribute to a culture of and the internet) to engage in new learning when a patient had
safety. a diagnosis, test, etc. that I had never encountered before.
- I always was ready on time, in uniform and prepared for all labs
and clinical shifts.
- Always lowers patients’ beds and ensures the call bell is within
reach before leaving their room. Tidies rooms and removes trip
hazards. Ensures assistive devices (such as walkers and canes)
are within reach.
- Disposes of sharps into sharp containers in both the clinical
setting and in labs.
- Maintains confidentiality and disposes of any papers with
patient information into the shredder box before leaving the
unit.
- Always gets help from peers when a patient needs more than
one assist for ambulation. Uses proper ergonomics when
demonstrating tasks to ensure my own safety.
- Used proper landmarking and technique when administering
an IM injection in the deltoid muscle. 2 fingers down from the
bone at the top of the arm, without squeezing the skin.
- Uses correct isolation precautions and correct donning and
doffing. Contact precautions: gown and gloves, droplet
precautions: gown, gloves and mask with goggles. Correct
donning order: gown, mask, goggles, gloves. Correct doffing
order: gloves, goggles, gown, mask.
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- Washes hands at the four moments for hand hygiene (before


entering the room, before an aseptic procedure, after bodily
fluid exposure, and when leaving the patient’s room). Wrote a
narrative note every shift to practice my documentation
- Always made sure to do my three checks when administering
medications and made sure that I signed for any medications
that I had administered
- Always did research for my pre-clinicals. I researched each
patient’s diagnoses and co-morbidities, any skills that would be
needed for that shift and I researched every medication that
was on my list to administer.
- Always completed my post clinicals. Research necessary for
these included learning about diagnostic tests.
- Attended infection control presentation to learn about PRHC’s
policies about infection control and proper PPE. I volunteered
to don and doff the PPE in front of everyone, demonstrating
leadership.
5 Exercises leadership to - Asks peers how I can help them, especially when they look busy
enhance patient care, and and I am not. I support peers and offer suggestions whenever
support professionalism
in practice. they ask for ways to improve/do things differently. For
example, when doing bed baths with peers, I try partner with a
peer who has not worked as a PSW before. I try to support
them and help lead them through it so that in the future, they
will hopefully be more comfortable. I also try to show them
little things that I like doing (like using the soapy water to get
the EKG stickers off patient’s skin without hurting them).
- I make myself available to help my peers and other staff with
AM care once my patient’s care has been completed.

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NURSING 3020 Clinical Evaluation

- When my patient was discharged, I found a new patient for the


next nursing student. I researched his diagnoses, medical
history and drains, IVs and medications so that I could give
bedside handoff to her. This also helped the next student to
have a new assignment when arriving at the unit and since I
had done the extra work, she did not have to research things
once she arrived.
- During one shift, I was present with another nursing student
when a patient had a fall. I took the lead by calling a nurse for
help and by reassuring and checking on the patient. I also made
sure that the nurse had enough information to fill out
documentation as per hospital policy about the fall.
- Facilitated my post-clinical seminar to teach my peers about
cardiac tamponade
- Took initiative by volunteering myself to present my post-
clinical topic on the first possible day
- Took initiative to include myself in the care of my patients. Ex.
When I saw a nurse taking one of my patients down to xray I
asked to go. I told my nurses that I would be doing head to toe
assessments on my patients so that I could practice and that
they were welcome to do their own assessments afterwards

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

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NURSING 3020 Clinical Evaluation

Signature of Instructor___________________________________________________ Date _____________________________

Signature of Student_____________________________________________________ Date ______________________________

Attendance

Thurs Fri Thurs Fri


Week 1 8 8 Week 6 8 AM SIM
Week 2 8 8 Week 7 8 8
Week 3 8 PM SIM Week 8 8 8
Week 4 8 8 Week 9 8 PM SIM
Week 5 8 8 Week 10 8 8

Total number of clinical hours completed_____________

Clinical Component Satisfactory Unsatisfactory


(Please circle the appropriate outcome)

Clinical Learning Center Completed Not completed

Signature of Instructor____________________________________ Date_______________________________

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NURSING 3020 Clinical Evaluation

Signature of Student______________________________________ Date________________________________

Student Areas of Strength

1. Head-to-toe assessment and the corresponding documentation

2. Asking questions/for help when needed to further learning

3. Communicating and building therapeutic relationships with patients

Student Areas for Future Development

1. Knowledge about specific medications

2. Confidence in abilities

3. Assertive communication and dealing with conflict

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

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