NURS

2021H Clinical Course Evaluation

Mid-Term Evaluation


Student: Nicole Warren (0492022)
Clinical Instructor: Anne Falconer
Placement: Mental Health @ PRHC
Missed Clinical Hours: 0
Missed Lab Hours: 0

MIDTERM EVALUATION

Nicole, you have the makings of a fine psychiatric nurse. If this is not your chosen field then be blessed with the knowledge
that your patients will be in the presence of a person who is sensitive and intuitive to their needs.
Keep on with communication and therapeutic relationships.
You are doing well.
Anne

FINAL EVALUATION
Nicole, I am extremely pleased with your effort and dedication to learning more about mental health , its manifestation, treatment and
outcomes.
You have told me your personal story of a friend committing suicide and your personal journey to become a nurse so that others may benefit
from your knowledge and skills.
You are on a mission to be the best you can be in order to help others. This is evidenced by your skill at communication and interpersonal
relationships. You are dedicated to improving in all areas of therapeutic approaches and care.
You have a firm working knowledge of mental illness, the impact it has on people and community. I also believe that you realize the barriers to
wellness that exist in our community and in our stigma towards mental illness.
You had the opportunity to administer a long acting intramuscular injection. The nurse reports that you followed protocol.
Your attendance and punctuality are excellent. You are a good role model to you co peers, patients and staff.

Keep your mind and heart open to the endless possibilities that exist for your future.
Sincerely,
Anne Falconer
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NURS 2021H Clinical Course Mid-Term Evaluation

Progress
Course Objective
1. Demonstrate competency in navigating the
complexities of family nursing.

Evidence/Indicators
Satisfactory Unsatisfactory
- I will acknowledge that in the mental health unit x

there is not a whole lot of interaction between
patients, families, and myself. For the most part
patients families are not around, or the patient
will leave with the family if they visit. However, if I
were to meet the family, I would be interested in
watching the interaction between the patient and
family to understand how their relationship
worked. This would tell me the sort of support
that individual from the unit would have at home,
and how to proceed with which community
resources would be most appropriate. For
instance, an individual who is estranged from their
family or is homeless will need access to resources
of food and shelter, where as someone who has a
non-supportive family may more so need a
support line or therapy session to get that support
elsewhere
- Can now walk up to a client, introduce self and
being a conversation that navigates through the
individuals life history in order to find pertinent
information regarding the individual and their
illness, and can do so unobtrusively within the
context of general conversation, and not by
putting the client on the spot
- Have become aware that the life history of the
person typically has a great influence on their
actions and their illness, and being aware of their
family situation makes it easier to understand who
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2. Integrate knowledge from previous courses to

support diverse populations.

they are as a person and the amount and type of

support they need from myself and the unit to
support the fostering of stronger mental health
- I have previously taken several neuro courses,
x
SafeTalk courses and written several papers on
mental health topics and it has been enjoyable
finally employing this learning, I have a substantial
body of knowledge regarding various diagnoses
and treatments and find it easier them some of
my colleagues due to know how to initiate and
maintain a conversation with individuals in the
unit because I understand the illness and its
properties
- I know not to say I understand, as this often
makes people feel as though you are reducing the
impact of what their lived experience means to
them, I always try to say Im doing my best to
understand, but I have never experienced what
you are going through and then offer whatever
help you feel pertinent beyond that
- When referring to charts listing medications, I
am gaining a better understanding of the use of
the drug for that client as I take more
pharmacology courses that discuss the
pharmacokinetics and pharmacodynamics
- The family nursing course I have taken has
brought to my attention that therapeutic
communication is often done as means to an end
where the conversation is controlled by the nurse
for the sole purpose of obtaining pertinent
information that they deem relevant, however
within mental health I have tried to challenge this
typical use of therapeutic communication and
instead listen to hear what the client has to say
and then pursue a conversation that is directed by

3. Critically appraise relational inquiry processes

and skills to develop meaningful
relationships with health care providers and
family members.

what information they bring to the table

- I have also become quite aware of the difference
between listening to a conversation and waiting
for the chance to speak in reply, as to listening to
the conversation to fully and completely hear
what another person is trying to say to you, as
such this skill also learned in my family nursing
course has become invaluable in developing more
genuine conversations between myself and the
client, and me learning to listen as attentively as
possible as often they just need someone to talk
to, and not someone to problem solve all their
troubles

- I have shadowed a few of the nurses (both RN
x
and RPN) within the unit, and have posed
questions to them regarding various topics that I
have heard in class and want to explore further
- I utilize the conference time with my colleagues
and clinical instructor to ask questions I have
thought of, pose questions to everyone to hear
their perspective on topics, and listen to others
concerns and ideas to understand how others
understand various situations and individuals and
how they would choose/chose to act in various
contexts
- There was also a situation in the nursing student
with a staffed individual who made a few
comments regarding my group of nursing
students. Immediately, everyone perceived that
he was serious and took what he said personally,
however once we spent time with the individual
later everyone came to realize that he was
someone who loved kidding around. By not
allowing yourself to engage in comments directed

4. Collaboratively formulate a plan of care based

on knowledge of family nursing,
related theories and scholarly literature.

at you, or not making assumptions about the

individual and maintaining those assumptions
based on your first in encounter with someone, it
is easier to develop a relationship with them going
forward to better understand their personality,
the context of the comment, and what is going on
in their life that may have resulted the comment.
By being able to do this, youre better able to
work with all individuals, and when you do
encounter a few difficult ones you wont take it as
personally and perhaps will still be able to work
with them.
- Whenever I am in doubt I always bring my
questions back to my clinical instructor, as well as
to my various seminar groups, and lab leaders so
as to form my own well-rounded opinion of
different situations I have encountered, to reflect
on what I did, and to hear others perspectives of
better courses of action in the future, for instance
discussing hallucinations and delusions and the
point at which you are playing into the delusion
vs. accepting that that is the clients reality and
working with them acknowledging their situation
but not fueling the delusion any further
- From the Self-Care requisites theory, patient
x
assessment is done by taking their personal
information, life history, family history, which
would provide a basis to identify the needs of the
patient. The goal of the patient assessment is to
develop communication that allows for effective
interaction with the patient. This can then allow
for the nurse to develop a plan for a course of
action relevant to the needs of the patient.
Evaluation would be completed after a period of
time to ensure the plan was applicable, effective,

5. Develop, implement and evaluate the

effectiveness of health-promoting,
evidence-based practice, reflecting principles
of family nursing as relational

and served its purpose to help the patients

needs.
- In mental health the self-care requisite theory
seem very relevant to individuals experiencing
mental illness. This takes into account the
individuals ability to engage in activity/rest, social
interaction, and prevention of hazards and
promotion of normalcy. Deviations from the
ability to self-care include inability to adhere to
medical regimes, awareness of potential problem
associated with that regime, lifestyles that arent
conducive to self-care, etc.
- Plan for safety, plan for sense of well-being,
competence, self-esteem, sense of trust, provide
for physical needs (walk, hygiene encouragement,
promote, health-teach, medication compliance,
nutrition, adequate diet and intake, exercise, full
set of vitals, ensuring BP is appropriate for
medication administration of anti-hypertensives )
- After working with a few clients over a series of
several weeks I have began to see the progression
of the treatment of mental illnesses, and how
initially implementing a medication regime is and
essential part initially, then increasing interacting
with the patient to develop an understanding of
their circumstances, working with them towards
future goals of what they want to accomplish,
where they will go, where they see themselves
once they are out, providing them with access to
job resources, various groups, and then readying
them for discharge with further access to
outpatient groups and so on
- I am always questioning various topics, situations x
and use of medications/restraints to fully
understand whether they are used based on what

practise.

has been historically accepted or have significant

evidence supporting them
- I also have been doing research further on
different harm-reducing strategies, i.e.
methadone, to see if how it is utilized is
appropriate and harm-reducing or if a lot of the
use of methadone is driven by revenue and profit
generation
- I have been developing opinions on the line
between respecting autonomy and imposing on
peoples right regarding the use of medications,
especially when a patient is non-compliant with
their medication regime, does not want to live in
our world in a lucid state, etc.
- In one situation the RN instructed a patient
requesting medication PRN for their anxiety to
instead practice their deep breathing techniques,
and that she would return in fifteen minutes to
assess again for the need of medication. As she
said, breathing was something an individual would
always have available to them, whereas
medication wasnt and if they could learn to
appropriately control their breathing if situations
where they werent able to medicate then they
were more likely to be able to better cope with
the situation.
- I have taken the opportunity in a few
conversations with clients to ask them their
opinion of the mental health unit, to see if it
reflects my initial reaction when I was exposed to
it, and what they would like to see changed to
create a better environment while they work with
learning about their mental illness and how to
respond to it. The evaluations I received from the
clients were interesting and brought to light areas
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6. Demonstrate increasing competence and

confidence in the application of
psychomotor skills in practice settings.

that need to be better constructed to more

appropriately help people respond to their
illnesses. For instance, one individual said that the
complete lack of privacy in the rooms, as there
isnt even curtains to draw around the bed is
disconcerting, and another said he smokes out of
habit when he is stressed, however the hospital is
a locked unit and does not permit smoking, so the
patient who is dealing with a mental illness, and
experiencing high levels of stress at the same
time, is also required to go through nicotine
withdrawal, or required to attempt to use a patch,
which can induce irritability, and so on
- Going forward I would probably look into what
could be done to implement a little more privacy
into the rooms, and if a patient is insistent on a
practice (despite having been educated on the
risks) it is still their right to do as they wish with
their body, as we have been taught about
autonomy incessantly, and if they have something
that is an avenue for stress-relief we may have to
look into being able to better accommodate
peoples quirks so that we are not creating more
complications while attempting to treat their
illness
- I am very aware of myself (body language,
x
language, choice of words) in the unit, I try and
maintain an open posture towards everyone to be
approachable, and I feel as though I am getting
better at this as when I sit in the lounge I find
patients will initiate conversation with me, or ask
me to engage in an activity with them. I find that
having been aware of myself has made me my
most successful tool in working in mental health.
By having this constant scrutiny of myself going

on, and appearing approachable in the patients

perspective the following interaction is more
therapeutic then when I try and engage with them
purposely. Essentially it a tactic of allowing them
to come to you, and its most successful when you
appear easy-going and welcoming.
- The third clinical shift myself and a partner were
instructed to take a full set of vitals on five
patients, using the manual BP cuff, the first
patient I was disorganized, didnt know how to
properly approach and proceed with my first
patient, however with an intervention with Anne
before the second patient I was better able to
approach the next patients and by the fifth I was
accurately taking the BP, TPR, etc., discussing BM,
and doing so without feeling stressed or pressured
- Im very vigilantly while on the floor about where
my body position is in comparison to the patients
I always try to situate myself so my back is
protected and be aware so I am approached
unknowingly. In the courtyard and unit I will use
window reflections and listening to footsteps to
constantly orient myself to where I am in regards
to the patient. I try to do it so its not apparent
that I am doing it so the patients arent upset by
my vigilance. I also use the morning conference
regarding the patients to pinpoint who I should be
concerned about and who I can let my guard
down around a little more so an interaction with
them wouldnt be stiff. For instance a patient
came and sat beside me on the bench who has
been previously aggressive, as well as
inappropriate towards women, so when
conversation dwindled and I was watching what
others were doing in the courtyard, instead of
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7. Demonstrate accountability and

professionalism that is consistent with a nurse
entering a self-regulating profession.

jumping at any sound cue that came from him, I

casually watched him through window reflections
so I wasnt blatantly staring at him the whole
time.
- I can know take vitals competently and
confidently with either the automatic or manual
machines, I am no longer awkward to ask personal
questions (i.e. regarding bowel movements)
- I am learning how to best engage clients into
conversation, and how to pick up individuals
quirks that give me indication of their openness to
talking, whether they are trying to lead me on or
manipulate me, and how to consciously appraise
what you want to say before you say it
- I have administered my first injection, and it
went well. I was fairly confident after discussing
the procedure with my clinical instructor, as well
as from what I have practiced in lab. The injection
seemed to go well as the individual did not flinch,
or react to anything I did throughout the entire
procedure.
- I always have my name tag on, maintain hand
x
hygiene, knock on a door before entering a room,
and always introduce myself
- I explain any procedure I wish to do with the
patient ahead of time, ask permission, and do my
best to respect their autonomy
- I have declined the chance to administer insulin
as we have not completed a lab yet regarding drug
administration, despite having wanted very much
so to engage in that situation
- I have never shown up late for any clinical, I have
always been dressed appropriately, and have
come to each shift appropriately rested and
engaged and excited for the twelve hour shift

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8. Select appropriate community support

services for families needing referral to
enhance coping with diverse transitional
experiences.

- In my clinical placement I have yet to deal with a

family in need of community support, the mental
xhealth unit consists of many residents who are
homeless or estranged from their families, so
what is done is they are asked if theyd like to
participate in group therapy and activities while in
the unit and then are encouraged to participate in
ongoing group therapy and workshops after
release. However, their participation cant be
forced, so it is their right to do what they see they
need themselves.
- I would try to reinforce the idea that there is
help available 24/7 if an individual experiences a
crisis though, and hand them various pamphlets
relating to their individual needs
- There are many resources available that a person
can turn to if they are in the community and
having a crisis, and I have listed a few as follows:
- Canadian Mental Health Association

- Peterborough Youth Services

- Four County Crisis Community Mental Health
Crisis Response Program : 705 745 6484

- Call Telehealth for medical advice, Telehealth
Ontario is a free, confidential service you can call
to get health advice or information. A Registered
Nurse will take your call 24 hours a day, seven
days a week.
For mental health services in Ontario, call 1-866-
531-2600 (toll-free).

- Connex Ontario provides information about
mental health services and supports in

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communities across Ontario. The information line

is free, confidential, and anonymous. Or search
the MHSIO database online. Call 1-866-531-2600
24 hours and day, seven days a week

- Safe Beds is where some areas of the Ontario
have safe beds which are meant for assist people
in crisis in address their immediate physical and
mental health needs. Call 1-866-531-2600 24
hours and day, seven days a week for more
information

- Peterborough County-City Health Unit
10 Hospital Drive Peterborough, Ontario K9J 8M1
Phone: (705) 743-1000
- I have now had a first hand experience at the
Brock Mission which provides a place to stay for
men, and provides a free dinner time meal to the
community every weekday night, it is another
resource that I have now have observed
personally and will be able to enlighten people I
meet about should I feel that it would be
something beneficial to them

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

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