NURSING 4020/21/22 Clinical Evaluation – MIDTERM
NURS 4020/21/22 Clinical Evaluation: Midterm
Student: Alicia Jeffery
Faculty Advisor: Jaime Sims
Nature of Clinical Practice (Check all that apply)
The setting is:
__x___Hospital/Inpatient Unit
_____Hospital/Ambulatory or Day Program
_____Hospital/Critical or Emergency care
_____Community/Community Health
_____Community/Home Care
_____Community/Long Term Care
_____Industry/Occupational Health
_____Other _________________
Preceptor: Pina Boni
Clinical Practice Site: KHSC- Kidd 6
Practice hours completed _____140________
The population is primarily:
_____Adults with medically-related health needs
__x___Adults with surgery-related health needs
_____Children or adults with mental health needs
_____Intrapartum families/mothers and newborns (not NICU)
_____Older adults requiring support
_____Healthy adults
_____Families/Neonates requiring critical care
_____Adults requiring intensive or critical care
_____Persons requiring emergency care
_____Children with medically or surgically related health needs
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NURSING 4020/21/22 Clinical Evaluation – MIDTERM

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.

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.

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Assessment for Midterm Evaluations:

Satisfactory Progress (SP): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve a competency 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.

Unsatisfactory Progress(UP): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or achieve a competency,
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.

Needs Development(ND): The student demonstrates sufficient knowledge and ability to safely practice or achieve a competency, 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.

Objectives
Indicators/Evidence
1 Within the scope of practice and knowledge of a fourth
year BScN student, continually demonstrates professional
conduct in accordance with CNO standards for nursing
practice and ethics:
a. Critically appraises own interactions with clients
and team members
b. Demonstrates accountability and accepts
responsibility for own actions and decisions
c. Demonstrates a professional presence and models
professional behaviour
d. Consistently identifies self by first/last name and
student designation to clients and team members
e. Displays initiative, self-awareness, and with time,
increasing levels of confidence in role
Progress
S UP U
- During shifts, when I discover something I do not know
enough about, I write the topic down and later research 
those topics/skills
- Introduces self to patients before assessment, explains what I
will be doing, re-introduces self when patients appear
confused/have forgotten who I am
- Displays initiative by being willing to learn and agreeing to
perform skills that I feel I am competent enough to perform
- With each shift that I complete, I am feeling more
comfortable with skills and more comfortable on the floor
and around the patients in general
- Each clinical shift, when I come across a topic that I do not
know about, I write this topic down on a list. Examples of
things I have put on my list: certain medications, certain

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f. Demonstrates effective and collaborative problem-
solving
g. Uses effective approaches to managing conflict
h. After critically reflecting on learning needs,
a. Recognizes individual competence within
scope of practice and seeks support and
assistance as necessary
b. Participates in professional development
surgeries, certain illnesses, and certain drug reactions. Later, I
research these topics so that the next time I encounter them,
I will have more knowledge and be able to provide better
care
- I made learning goals and developed a timeline to address
how to meet these goals. I am progressing towards my goals
of improving my assessment skills, applying dressings, skills-
based techniques and IV medication administration. I am also
exceeding my goal for the number of patients I am safely able
to care for.

Preceptor: Alicia has demonstrated significant progress on her clinical

skills. When she first started, she looked so terrified and quite honest
that she doesn’t have sufficient skills. i.e setting up secondary IV meds,
initiating feeds, applying wound dressings and the like. But she showed
her willingness to learn and listened to suggestions given. She observed
for the first and seconds shifts, asked questions and clarifications and jot
down notes. Made readings and researches about the diagnosis of our
patients/type of surgeries they had, so she can develop plan of care.
Alicia always introduces herself prior to providing care to patients. She
made her learning goals and is continually working on achieving them.

2 Within the scope of practice and knowledge of a fourth
year BScN student, continually demonstrates that the
primary duty is to the client, to ensure safe, competent,
ethical nursing care
a. Advocates and intervenes, as needed, to ensure
safety of the person requiring nursing care
b. Uses effective strategies to maintain a patient's
privacy and autonomy
- When I found a confused patient in the hallway, without 
pants on, I quietly and calmly covered her up and assisted her
back to her room, to maintain the dignity and privacy of the
patient
- I always checked arm bands for identifiers and confirmed
name and DOB with the MAR before administering
medications
- Disposes of all paper with patient-identifiers on it before
leaving the unit. Maintains patient privacy and confidentiality
- Followed the 10 rights of medication administration
- I always wear the correct PPE with correct donning and
doffing technique. For example, when caring for a patient

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with MRSA, I donned and doffed a gown and gloves with

correct technique.
- I practice the 4 moments of hand hygiene
- I promptly document all care I provided in the progress notes
section, Kardex, MAR and/or tick sheet as per hospital policy

Preceptor: I have observed Alicia and I agreed to her self evaluations

above. She always use patient identifiers every time she delivers care
esp. when giving meds and when sending patients off the unit for
procedure. She maintains patients’ confidentiality by keeping the charts
closed in the wall unit. She also makes sure that she always provides
patients with privacy by closing doors/curtains. To site an example, she
had a patient admitted to the floor but who had to stay in the hallway
temporarily on a stretcher while waiting for a bed to become available.
The patient had incontinent stools, so she asked assistance to wheel him
down to the sunroom, covered the glass windows with bedsheets and
eventually cleaned him up. My only suggestion is for her to try hard to
document initial assessments promptly in the progress notes esp. that
there are lots of healthcare team members using the chart, as much as
possible late entries should be avoided.

3 Within the scope of practice and knowledge of a fourth
year BScN student, demonstrates safe, competent and
ethical nursing practice in the area of relational practice:
a. Engages in critical self-reflection
a. evaluates own emerging competence in the
area of relational practice
b. identifies personal, professional and
systemic barriers to development
c. prioritizes learning in the area of relational
practice
b. Effectively uses self to initiate, maintain and
terminate relationships
a. creates therapeutic, caring, and culturally
safe relationships
- Evaluated competence and level of confidence at beginning of 
semester and acknowledged that I did not have enough
experience or knowledge to safely care for patients
independently. Also recognized that all equipment and supplies
used at this site are different than those I had been trained to
use. Discussed this with preceptor and independently made a
timeline to address when I would increase the number of
patients I cared for. Also researched the supplies and equipment
and completed the mandatory learning packages.
- Works with preceptor each shift and asks questions when I am
unsure and assists preceptor with other patients when needed.
Answers call bells for other nurses’ patients.
- Introduces self to patients during each assessment and re-
introduces self when necessary. Always introduces self to patient
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b. uses principles of supportive counselling
and motivational interviewing to help
clients set goals, identify problems, find
solutions
c. Demonstrates
i. empathy
ii. attentive listening and sensitive
questioning
iii. mutuality and reciprocity in
relationships
iv. advocacy
c. Works collegially and in concert with other health
professionals to facilitate appropriate, timely care
4 Within the scope of practice and knowledge of a fourth
year BScN nursing student, demonstrates safe, competent
and ethical nursing practice in the area of clinical decision-
making:
a. Informed by the discipline of nursing, integrates
nursing knowledge with knowledge from the basic
sciences, health sciences, humanities, research,
and ethics
a. Applies models, theories, and frameworks
from the discipline of nursing
family members as well. I always update the patient’s white
boards
- Listened and empathized with a patient who expressed sadness
after waking up from surgery with a permanent ostomy when
she thought she would be able to have a temporary ostomy. I
listened to, asked questions and allowed the patient to vent her
feelings.
Preceptor: Alicia can safely provide/deliver nursing cares to all her
patients. She asks questions and support regarding the proper usage of
unfamiliar equipment or for any skills that she’s not comfortable doing.
She deals with patients and families professionally, tries to answer their
queries and directs them to staff/preceptor if unable to deal with. Alicia
also fosters a therapeutic, caring and culturally safe environment in the
unit. She takes time to listen to patients and provides emotional support
if needed. She is very quiet and I suggest her to work collegially to other
health care members for better and effective delivery of care. Ie: physio,
PCA, RT, unit clerks and other nurses. Ex. If pt needs to mobilize with
physio, ask them what time they plan to do it so she can provide
meds/analgesia at least 30 minutes ahead so patient can do better with
mobilization, or coordinate with PCA when they’re doing a shower for pt
so she can plan to prepare supplies needed for dressing changes and
have time to request from stores if not available. Help to answer call
bells for other nurses to have opportunity to know other patients.
- Completes journals each week. Takes a considerable amount of 
time to reflect on the week in order to complete the journals.
- Administers all narcotic medications under the supervision of my
preceptor and ensures proper disposal of narcotics if necessary
- Disposes of all sharps and biohazardous waste in the correct
areas
- I applied Abdellah’s 21 Nursing Problems theory to the care I
completed on a patient for one of my weekly journals
- Applies Johnson’s 7 subsystems to patient care. An example from
practice: the patient’s affiliative subsystem consisted of her
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i. Chooses appropriate models for sister, her husband and a few close friends who visited her in the
specific client situations and clinical hospital and provided support. These individuals would also be
settings doing her care after discharge. The patient’s dependency
b. Continuously demonstrates critical inquiry, included the need for education and tracheostomy care. The
scientific inquiry, and clinical reasoning as patient was able to meet her ingestive and eliminative needs
evidenced by: independently. The subsystem of achievement also needed
a. Using new understanding to identify nursing interventions. The patient and her family stated they
problems, propose solutions, find evidence were feeling overwhelmed with performing the tracheostomy
for and against proposed solutions, and care so my preceptor and I helped to guide the sister through
evaluate proposed solutions performing it and helped when necessary. The needs of each
b. Challenging the status quo subsystem should be met in order to attain balance and stability
c. Performing focused reflection, connecting (aka health), according to Johnson.
new experiences to existing knowledge,
thinking creatively, using nursing judgment
Preceptor: Alicia was able to provide effective health teachings to pt and
family who are ready for discharge and needing to do own care at home
(like trach care and dalteparin injections). She was able to explain and
demonstrate them in the proper way and in return ask and observe them
do it.

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5 Within the scope of practice and knowledge of a fourth
year BScN student, demonstrates safe, competent and
ethical nursing practice in the area of planning,
implementing and evaluating nursing care:
a. Uses the nursing process to
a. recognize, gather and analyze data from
multiple sources to develop a plan of care
b. recognize actual or potential life-
threatening situations
c. implement appropriate interventions to
prevent complications
d. document and communicate assessment
data, plan of care, interventions and
patient responses or outcomes
e. teach the client, consistent with the acuity,
complexity, readiness, ability and needs of
the patient and family
b. Integrates own knowledge with the client’s
knowledge and preferences, and factors within the
health care setting, to plan, implement and
evaluate care
a. identifies gaps in own knowledge
b. Identifies client’s knowledge and
preferences
c. Seeks and evaluates new evidence to
support nursing action
d. Uses many kinds of evidence to inform
nursing actions
e. Recognizes the resources and limitations of
the health care setting
c. Appraises outcomes of nursing care
d. Demonstrates collaborative action within the
nursing and health care team
- Recognized a potentially dangerous situation when a patient’s
feeds had become disconnected and leaked during the night.
Patient indicated he felt that he had low blood glucose levels and
was symptomatic, so I got the help of my preceptor to test his
blood glucose levels and initiate the hypoglycemia treatment
pathway. Documented all care and continued to monitor after.
- Identified that decreased staffing and increased patient loads are
stressors affecting the interprofessional team
- Documents all assessments, input and outputs, IV fluids, 
medication administration, PRN administration. Spent time
during initial shifts to look at the methods of documentation
used on the unit so that I would be able to complete
documentation independently and correctly
- Always evaluates effectiveness of PRN administration to ensure
symptoms are managed effectively. For example, I administered
gravol for nausea and vomiting. About 30 minutes later, I
evaluated its effectiveness by asking the patient if their
symptoms had subsided. The patient stated less nausea and
vomiting and was feeling better. I evaluated this as effective and
documented this.
- When taking vital signs, many patients’ blood pressures have
been high. I evaluate this by first assessing if the patients have
symptoms, asking them if they usually have high blood pressure
and looking through their chart to see if they have a history of
hypertension or lf their blood pressure has been high the past
couple shifts. I also look and see if they have antihypertensive
medications ordered. I document all of these assessments and
alert my preceptor if I feel there is an issue or if I need help
assessing this
Preceptor: Alicia has been doing proper assessments, able to recognize
and report actual and potential life-threatening situations and provide
proper interventions. Example: patient with high blood pressure and
hypoglycemic patients. She knows the sequence of providing nursing
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a. Collaborates with other providers to assess
outcomes of health care
b. Identifies environmental, physical and
psychosocial stressors affecting the inter-
professional team
6 Within the scope of practice and knowledge of a fourth
year BScN student, demonstrates enhanced knowledge of
nursing and health related to indigenous populations,
women's and environmental health, aging and rural
populations, and other marginalized populations:
a. Identifies gaps in care delivery
b. Challenges status quo approaches to caring for
marginalized populations
c. Recognizes the unique pathophysiology of disease
states and implications for care of special
populations including those with prolonged lengths
of stay, bariatric patients and older adults
d. Consistent with student role and novice
practitioner, recommends and initiates changes in
practice
interventions to such, evaluates her nursing actions and documents them
in the chart.
- Read learning package about special diet and implications after 
bariatric surgery. Completed a paper about the marginalization
of bariatric patients for another course, which required research
into the subject. I will now be able to apply this knowledge with
future bariatric patients.
- I completed a discussion post about the marginalization of
patients with ostomies for another course. This required
research and reflection on my previous practice. I can now
understand the experience of this marginalized population.
- Cared for an older man with dementia. I frequently re-oriented
the patient to the hospital and frequently re-introduced myself. I
asked the patient simple, answerable questions. I gave the
patient some time and space when he became agitated, but
ensured he was safe from a distance.
- During one shift, I was assigned the care for an older man who
only spoke Cantonese. Since he did not speak English, it was
difficult to communicate with him. I used simple words and
gestures in order to assess him and his pain. The patient was able
to communicate this way. I also recognized resources such as
using a hospital-provided translator if this was necessary. I
recognized that the language barrier could have been a barrier to
his care
Preceptor: Alicia is flexible and able to provide individualized care to
indigenous, aging and marginalized populations. She was able to provide
effective care to a patient with a language barrier, a patient with
dementia and patients with ostomies and VAC dressings.
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7 Within the BScN student's scope of practice and
knowledge, assumes the responsibility and care of
patients:
a. Demonstrates safe and effective care of patients:
a. Initially, and with a high level of supervision
and support from the preceptor, the
student will manage an assignment of two-
three clients
b. By midterm, the student will be managing
at least 2/3 (e.g. approximately 3-4 on day
shift) the preceptor’s client assignment with
frequent support and guidance by the
preceptor
c. By the conclusion of the practicum, the
student will independently and with
minimal supervision by the preceptor,
manage an assignment equivalent to 2/3
the preceptor’s usual assignment.
b. A fourth year nursing student is able to carry out
the following nursing activities:
a. Assessment
i. Biopsychosocial, head-to-toe,
focused, mental status, pain
ii. Vital signs: TPR, BP, SaO2
iii. Situational stressors and coping
pattern
iv. Medication administration
v. Basic knowledge of the medications
prescribed
vi. Classification
vii. Purpose
viii. Possible side effects
ix. Adverse effects
x. Interactions with other drugs
- Made timeline addressing how I would progress with increasing
patient load. By week before midterm I have worked up to a 4-5
patient load on days and a 6 patient load on nights. Completing
all care and documentation with moderate guidance and help
from preceptor
- Shadowed preceptor and assisted with full patient load first two
shifts. Then had one heavy patient that I did care on with high
level of support and supervision. Now I am caring for up to 4-5
patients on days and up to 6 on nights.
- Completes head-to-toe assessment, vitals and documentation
with no to minimal assistance. Administers oral medication with
no assistance, administers medication through G-tube/J-tube
with minimal support, administers IV medication and feeds with
minimal support, administers subcutaneous injections with little
needed support. At the beginning of this clinical placement, I
required maximal assistance for all these tasks. With time, I have
become more independent.
- Uses username and password to log into the Omnicell to get
medications. Prepares medications before administering
- Primes and sets up primary and secondary IV lines with little
assistance. Sets up feeds with little assistance.
- Uses the hospital’s online resources to look up IV drug
compatibility and administers the IV medications in the correct
way as per this resource
- Takes bloodwork via venipuncture with maximal assistance
- Researches patient medications before administration
- Gives report to nurse who is covering my patients while I go to
break. Writes report on Kardex at end of shift with little
assistance
- Always comes to clinical shifts prepared, in uniform and on time
- Is always prepared and willing to learn. Asks preceptor for
clarification and support. Encourages preceptor to watch me
complete skills and asks for feedback
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xi. Appropriate dose/route
xii. Implications for nursing care
b. Health Teaching
i. Identify client/family learning needs
ii. Collaborate with team to develop
plan to meet client’s learning needs
iii. Implement aspects of plan within
scope of practice as a learner
c. Psychosocial/Relational Practice
i. Recognize and acknowledge client
distress as it arises
1. Demonstrate empathy,
active listening, sensitive
questioning
2. Apply principles of
motivational interviewing
3. Offer support
4. Engage in problem-solving as
required, in collaboration
with others as needed
ii. Team Communication
1. Discuss any abnormal
findings related to the
patient assessment with
preceptor, staff nurse,
physician, team member
2. Seek assistance/ask
questions before doing
procedures for the first time,
or for anything about which
is uncertain.
3. Report to team leader/staff
nurse when leaving the floor
- When administering medications, I always check the patient’s
wrist band with the MAR and ask the patient to state their name
and date of birth before administering medications. I engage in
patient + family teaching about medications. A patient's family
member asked what pantoprazole was and I explained it’s uses
and how it worked to the family member.
- Completed a discharge. I removed IVs and went over the
discharge summary paperwork with the patient, educating him
about care for his laparoscopic sites in the community and
answering questions he had about pain medications. Recognized
a potentially dangerous situation and told patient not to drive
while taking narcotics. I also ensured his wife was picking him up
from hospital due to administering narcotics earlier in the day.
- Completes all documentation with little assistance
- Took report from a nurse on another unit for a patient we were
receiving
- I assist patients with ADLs such as helping them to the bathroom,
changing briefs, repositioning patients, etc. I assist patients and
other staff members to ambulate and transfer patients. Have
assisted to transfer a patient with a slider board.
- After each shift, I reflect on my performance. For example,
during the fourth week of my placement, I took time to reflect on
how much I had improved in comparison to what I was able to do
during my first shift
Preceptor: Alicia has been handling a full patient assignment since after
her second week of clinical shifts. She only requires assistance from
preceptor if patient’s acuitiy rises/changes and if there are new nursing
skills that she’s not familiar with. She’s been taking 4-5 patients on day
shifts and 5-6 patients on nights. She only needs minimal supervision in
basic nursing cares, sometimes need reminders but most of the time,
delivering cares on time. She acknowledged that she still needs
assistance with venipunctures, so I suggest her to volunteer herself to do
bloodwork for other nurses especially on night shifts to have more
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and arrange for coverage of practice. Also work with other nurses to inform them that she’s willing to
patients help esp. if there are new/exciting skills such as insertion of foley
d. Basic Nursing Care/Activities of Daily Living catheter, initiation of heparin infusion, blood transfusion, etc.
i. Hygiene, skin care
ii. Nutrition, elimination, intake/output
iii. Ambulation/transfers
e. Nursing and Collaborative Therapeutic
Interventions
i. Determine which interventions are
required, what resources, including
support and supervision are
required, and schedule interventions
in consultation with the client
ii. Complete interventions as
appropriate and within scope of
learner practice
f. Relationships
i. Work with the staff to learn and
deliver excellent patient care
ii. Maintain a professional manner in
dress, behaviour and conversation
iii. Assist others with patient care as
time and scope of practice permit
iv. Welcome all opportunities to learn
and practice new skills
g. Evaluation and Documentation
i. Document vital signs and
assessments in the appropriate
areas of the chart for assigned
patients, accurately and concisely,
ASAP after assessment
ii. Use institution’s system of
documentation for nursing process
and patient progress

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iii. Reflect on own performance

independently during and after each
shift
iv. Reflect on and seek clarification of
any feedback from the instructor,
who may receive feedback from the
staff.

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Student and Preceptor Comments

Student: Overall, I think I have progressed significantly since the start of this placement. I am now more comfortable on the unit
and can provide most care independently for a full patient assignment. I will continue to ask for help and supervision when
necessary for new skills, higher acuity patients and for bloodwork/venipuncture and IV insertions. For the final month of this
placement, my goals are to: 1) Continue to practice and perfect my assessment skills, with emphasis on respiratory assessment
and the assessment of wounds; 2) Work with other healthcare team members to not only build professional relationships, but to
also get help and volunteer myself to help with new skills and skills I need practice with; 3) Focus on practicing venipuncture and
IV insertions; 4) Continue to improve my knowledge of different surgeries and medications by researching them.

Preceptor: I am happy with how Alicia is doing. I can see that she has gained more confidence and is comfortably delivering care
to a full patient assignment. She just needs to continue what she’s doing and continue to work on the areas that she thinks she
needs more practice with and don’t hesitate to ask questions and clarifications. Always take initiative to every learning
opportunity on the unit.

Faculty Advisor Comments (All areas marked as unsatisfactory must have a comment)

Signature of Preceptor_____________________________________________________ Date______________________________

Signature of Student_____________________________________________________ Date ______________________________

Signature of Advisor_____________________________________________________ Date _____________________________

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