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 : Sarah Mann
Clinical Teacher/Preceptor : Shahrzad (Sheri) Janani
Program Coordinator : Judy Martin
Location : Humber River Regional - Wilson
Placement Setting : Agency
Unit/Office/Clinic : 13W Oncology Inpatient
Period : 06-Sep-2016 To 09-Dec-2016
Student hours : 196
Required Hours : 196
Validated hours : 184
Teacher comment for validated hours:
Student missed 12 hours of clinical due to sickness. Doctor's note was provided.

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.

S.M. : I comply with regulatory standards, relevant legislation and the practice settings policies and procedures by following the dress code set by

Humber River. I adhere to the policies and procedures Humber River hospital has in place for patient care (Medication administration for diabetes

(double checks), Safety Checks, and bowel routine etc). I follow the regulatory standards set forth by the CNO (confidentiality and privacy,

professional standards etc)

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

S.M. : I act in a responsible, ethical and accountable manner by taking part in morning report at the beginning of the shift to transfer the accountability

of the patient as well as at the end of my shift. I take responsibility for my actions when I have made a mistake ex. My patient had an IV and at the

time I did not know about the little blue caps to put on the end port which are used to keep the port sterile.The nurse I was working with advised me of

the error I made and I took full responsibility for not using the correct procedure. Together we gathered new equipment and set up new lines. I now

carry blue caps with me to have them on hand when I need them.

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

S.M. : I use the 3 factor frame work to apply safe, compassionate, competent and ethical care. I assess the client to see the condition they are in (is it

within my scope of practice to provide care for this individual, are they stable and have predictable conditions), the nurse (am I the right HCP to

provide the care, am I knowledgeable in the procedure I am about to perform, Can it be done safely for the patient and myself) and the Environment

(are their clear and identified procedures, policies, medical directives, protocols, plans of care, care pathways and assessment tools). Ex. I had a

patient who recently had a tumour removed from her neck. I was able assess and come to conclusion that she was in stable and predictable

condition. Patient was able to function well on her own. The care I needed to provide was within her ADLs and would not change her current

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

S.M. : I use evidence informed practice and a theory-based approach to care. When Administering Tinzaparin (a low molecular weight heparin, used

to treat blood clots) it is important to know the patient INR, PT, PTT ratio levels (international normalized ratio, used to determine how fast a patient

blood clots to stop bleeding). I make sure to check the levels of my patients on this medication. If patients level is to low they are at risk for bleeding or

haemorrhage if the patient falls an injuries them self. Normal levels should be 0.8 - 1.2 someone on heparin should be between 2 -3.

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

safe environment.

S.M. : I ensure client safety and a safe environment by lowering the bed back to the lowest setting, making sure the call bell is within the patients

reach and I make sure they know how to use it. I tidy the room making sure nothing is in the way that might obstruct the client or harm them (ex.

tables, chairs). I make sure to lock the patient wheel chair and buckle them in to make sure the remain safe and free of harm. I make sure to explain a

procedure before performing it and making sure the patient understands what needs to be done. I always obtain consent to preform the procedure.

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

S.M. : I ask relevant questions to clarify understanding of the plan of care and whenever uncertain. Example my patient was on IV antibiotics, she

had some allergies, I made sure she was not allergic to the medication to be administered and I also clarified with the nurse the mL per hour the IV

was to be administered over and why that was a therapeutic rate.

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

unacceptable and/or unprofessional behavior.

S.M. : I am able to demonstrate professional behavior by seeking assistance in situations in which there is unsafe, unacceptable and/or

unprofessional behavior. Ex. an agency nurse came on the unit to help out and we shared a patient who has DM. The plan of care in the patients

MAR said blood sugars BID. The nurse did not want to check the patients BS at lunch because she had check it for breakfast and the plan said BID

so she assumed she didn't have to check it again until dinner time. however the patient was to receive insulin for lunch time. I addressed the situation

with her and said I cannot give insulin if I do not know the patient BS levels. She still didn't want to take the BS so I went to my clinical teacher and

addressed it with her and we advised another nurse working on the unit. We all went together to speak with the nurse and she then took the patient

blood sugar.

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

S.M. : I demonstrate understanding about the role of the student nurse by being accountable, following procedures, policies and regulations set forth

by Humber, CNO, and Humber River. I work in a safe manner for my patients and myself. I do not preform procedure that I am not allowed to do as a

student nurse example blood glucose monitoring and phone orders from the doctors.

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

Throughout the term, Sarah was able to provide safe, ethical practice for her patients. She did not assume any tasks that she was not
competent to complete. She respects patients privacy and confidentiality according to the Personal Health Information Protection Act
(PHIPA). Throughout the term, Sarahs practice was based on CNO standards.

2. ACCURATE AND RELEVANT COMMUNICATION

Satisfactory Satisfactory
2. 1 Participate in team sharing and discussions.
S.M. : I participate in team sharing and discussions at the end of every clinical day. I was able to share a presentation on COPD and give insight

about the disease and how to care for that type of patient.

Satisfactory Satisfactory
2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.

S.M. : I document clearly, accurately, concisely in a timely manner using electronic methods. I have become more proficient and timely about

entering information (vitals, am care, and patient checks etc) into the computer. I have been able to write DAR notes on patients. ex. my patient

refused heparin and I wrote a note about why she decided to refuse it, the action I took such as checking the INR, PT, PTT levels and document that

the medication was not given. I also had a patient who experience vomiting after a diagnostic test. I was able to ask her a few questions about how

she was feeling, if she had ate, was she feeling nauseated etc. I assess the emesis and document colour, amount, smell. Informed the nurse and

advised in the note that I will continue to monitor. Patient was feeling much better 20 minutes after incident.

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

S.M. : I report relevant information to the appropriate personnel. When the agency nurse did not want to take the patients BS I advised my clinical

teacher and another nurse on the unit that I was working with. We all addressed the situation together. If she still did not want to check the BS I wold

have gone to the charge nurse.

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

S.M. : I utilize communication techniques with the client and inter-professional health care team. I have been able to learn how to communicate with

patients that are not able to use verbal forms of speech because of language barriers. I use more hand gestures and communicate with a family

member that is able to interpret, when possible.

Within my own team I have been able to communicate patient issues that I felt needed a second opinion such as an IV line that seemed to not be

situated corrected in the patient and their hand was beginning to swell. I was able to talk with the charge nurse who advised that the IV line did need

to be taken out and positioned in a new place on the opposite arm.

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

(PHIPA).

S.M. : When performing procedures I make sure to provide privacy. I keep my patients identity confidential and do not speak about them outside of

the workplace.

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

S.M. : I use technology to retrieve information including research, data and other information. When I need to know lab data for my patient I go onto

the computer at Humber River and search the values that I need to know. I have also be able to use the IHumber compatibility for IV medication

online (compared NS and hydromorphone). I research medications using my drug book and look online when I am not able to find one in the book.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Sarah communicated effectively with the health care team in order to provide quality care for her patients. She has improved on
documentation skills.

3. CARING RELATIONAL PRACTICE

Satisfactory Satisfactory
3. 1 Use effective communication techniques.
S.M. : I am able to use effective communication techniques such as using general leads, open and closed ended questions, restating etc. I have

been able to work with a patient who has a language barrier and try to communicate using symbols or physical gestures and using a family interpreter.

ex. I had an Italian patient who as not able to speak English very well and I had to try and restate what I thought he was trying to say, "do you want

me to lift the head of the bed up?" he was able to then nod his head to tell me if that's what he meant.

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

health care team members.

S.M. : I demonstrate therapeutic caring, compassionate, and culturally safe relationships with clients and health care team members. ex. a patient of

mine was talking with me about how some nurses had been treating her. I told her that I would be there for her when she needed me to be and that I

was only the push of a button away. She was having a difficult time because she was not able to get up to the bathroom without help and she was

wearing a brief and did not like the feeling of being wet after peeing. I told her that I would feel the same way and that any time she needed me to

changer her I would be there to do so.

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

S.M. : I demonstrate therapeutic use of self to foster client well-being by advocating for my patient and including my patient in their decisions in plan

of care. ex. my patient was going for an MRI so I told her she could take her lax-a-day before she went in hopes that she would have a BM before the

procedure or she could have it after she came back that way she did not have a BM while having the MRI done and then remain uncomfortable until

she could be changed.

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

relational practice.

S.M. : I have seen how personal experiences can have effects on nurse and patient. for example I saw a patient that felt like their voice was not being

heard by the nurse. They started to get agitated and emotional. If the nurse had of used a different approach and just listened to the patient the

outcome could have been different. I have learned from this experience to take my time with my patients and listen to what they have to say.

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

appropriately.

S.M. : I was able to collaborate care for a patient experiencing some difficulty coping with her illness. She was reluctant to get out of bed and try to

perform ADLs on her own. I spoke with the social support worker on the unit and we were able to come up with a plan of care together with the patient

to help her address her fears of falling again and work on getting her strong enough to perform ADLs on her own.

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

S.M. : At Humber River there is a large diverse population of client and HCP that are of different culture then myself. I am respectful to culture, beliefs

and values and will continue to do so.

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

influencing their choices and decisions.

S.M. : I have worked with patients that are a different religion from my own and I have notice spiritual items at there beside. I ask them about their

values and belief and make sure to be respectful.

Satisfactory Satisfactory
3. 8 Provide effective client education.
S.M. : A patient of mine had a broken wrist from falling at home. I took it upon my self to each her about the important of proper nutrition to promote

healing such as coming foods high in protein, calcium, vit D&C etc. I did this because she was not eating vary well and I wanted to make sure she was

going to consume the right foods to promote proper healing.

Teacher comments for CARING RELATIONAL PRACTICE :

Throughout the term, Sarah provided care while displaying sensitivity and respect for clients differences and their unique needs. She
demonstrated caring in her practice. Sarah maintained a therapeutic relationship with patients and their families. She has established
relationships that are caring, compassionate, and respectful of clients and others. She was able to provide patient education when
necessary.

4. LEADERSHIP AND ADVOCACY

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

S.M. : I am able to apply appropriate conflict resolution skills in therapeutic client and other interactions. I had a conflict between patient and their son.

The son was getting upset about his mothers condition and it did not understand why she was hesitant to participate in the plan of care to help her get

better. I talked with the son to see his point of view and then I talked with my patient. She advised me that she was scare to get up and walk around

because the last time she did she fell and broke her arm. I then talked with the son and said he needed to keep a positive attitude and keep a positive

environment to encourage her to get up and about. If she has someone motivating her she may be less hesitant.

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

environment.

S.M. : I seek out opportunities for learning experiences for my fellow class mates such as blood transfusions, PIC line Flush etc. I was able to make

sure everyone was able to take part in the prep and care of a patient after death. I told the nurse that all of us are interested in knowing what to do and

to please let us know when she was ready.

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

professional health care team.

S.M. : I took part in peer feedback for a fellow student. She was able to demonstrate proper medication research and administration of PO and SQ

injection. She was timely, accurate and concise on her care but she needed to work on time management in terms of putting in her documentation. I

was able to get advise on my skills fro her as well and she advised me I need to work on time management to take my breaks.

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

S.M. : A patient of mine was going for an MRI and she was to have lax-a-day and tinzaparin before she went. The agency nurse was adamant that

the patient take the medication before she left the unit. I check the patients INR and it was at 1.0. I felt like the patient did not even need to take the

medication because her clotting time was within normal limits. I gave the patient the option and information she would need to make the decision and

she decided to refuse the medication while being put onto the stretcher to be transferred. With the lax-a-day I gave her the option to have the

medication when she returned to the unit so that way she would remain clean and dry for her procedure and she like the idea. The agency nurse

didn't seem to happy but I believe I advocated for my client and made the best decision for her at the time.

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

S.M. : I had a patient that wanted to get better and she advised me she wanted to do her own AM care as well as make a new bed for herself

because it was good exercise for her recovery. Since she had no restrictions I supported her choice.

Satisfactory Satisfactory
4. 6 Respond appropriately to unsafe, unacceptable, and unprofessional behaviours.
S.M. : A nurse on the unit was acting in an safe manner toward the client. He went to change the patient who had an IV. He disconnected the IV and

left it running without putting a cap on to prevent contamination. I should have told him that it was not the way he should be providing care. I know for

next time it is important to make sure I tell him.

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.

S.M. : I was able to work with the social support worker on the unit to develop a plan of care to help get a patient mentally prepared to get up out of

bed. She was having a hard to wanting to participate in doing physical activity to strengthen muscles. She had recently broken her arm falling and was

scared it would happen again. We decided together that we need to support her emotionally to build her confidence as well as assist her to the

washroom when she calls upon us.

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

S.M. : I was able to do a presentation on COPD that provided inside on the disease as well as solution and strategies to apply when caring for an

individual with COPD. Respiratory status is extremely important with these individuals. You must make sure they are on 2L of oxygen at all times or

there 02 sat will drop below 92 % and that is not good. I advised how important doing respiratory therapy will help the individual. Doing spirometer,

lifestyle changes are important such as quit smoking or avoid being around it, Medications include Inhaled bronchodilators, corticosteroids,

Vaccinations, Antibiotics

Teacher comments for LEADERSHIP AND ADVOCACY :

Throughout the term, Sarah was receptive to feedback and tried to makes changes as suggested. Sarah demonstrated leadership through
her assistance to other students. Sarah submitted all assignments on time and received a satisfactory grade for each.

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.

S.M. : I am able to Incorporate the clients unique needs and expected outcomes into holistic and client-centred plans of care. I do this by making

sure my client who is having difficulty walking, due to muscle weakness/ muscle spasms, is able to get to and from the bathroom with minimal

assistance or with the using assistive devices. the development is gradual and at the patients tolerance. In a week or two I would expect to see

improvements in muscle strength and the ability to use the assistive device on their own with practice. I only had this patient last week and if they are

there again this week I would expect to see these results.

Satisfactory Satisfactory
5. 2 Develop theory-based plans of care that are holistic and client centered and are articulated

competently in writing and orally.

S.M. : Every week I develop theory-based plans of care that are holistic and client centered and are articulated competently in writing and orally via

concept map. Example My concept map on my breast cancer and COPD patient.

Also on a weekly basis I review my patient information and decide what is most important in their plan of care to watch for throughout the day. This

week one of my patients was experiencing a great deal of pain post op from removal of a tumor in her neck. Pain management was important so that

she was able to still get up and walk around to gain strength back in her legs especially when OT came to work with her. it was also important to

asses the site for signs of infection and making sure it was healing.

Satisfactory Satisfactory
5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.
S.M. : I use knowledge, skills and judgment to assess clients, prioritize needs and outcomes. This past week I had a patient that was able to get up

and void and patient who was diabetic. My patient had voided and breakfast had just arrived..I prioritized my care making sure my patient with DM

had inulin first, then making sure to keep the other patient clean and dry to avoid skin breakdown.

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

S.M. : I have worked with an OT to develop a plan of care to help get one of my patient up to the washroom that way she is doing physical activity to

strengthen muscles. she is afraid she fall again because she broke her arm the last time she fell. We decided together that we need to support her

emotionally to build her confidence as well as assist her to the washroom when she calls upon us. Modifying her current plan of care to keep her dry

and free of posture to prevent skin breakdown.

Satisfactory Satisfactory
5. 5 Safely and competently implement and evaluate nursing assessments and nursing interventions

in a manner that demonstrates knowledge and skill.

S.M. : Safely and competently implement and evaluate nursing assessments and nursing interventions in a manner that demonstrates knowledge

and skill. Ex. my patient was having a hard time swallowing pills, I took the time to research if they could be crushed to make it easier for the patient to

swallow and they could so the next time I administered the patients medication I crushed the pills for him.

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

S.M. : I use the Three-Factor and practice decision-making frameworks to guide practice. I assess the client to see the condition they are in (is it

within my scope of practice to provide care for this individual, are they stable and have predictable conditions), the nurse (am I the right HCP to

provide the care, am I knowledgeable in the procedure I am about to perform, Can it be done safely for the patient and myself) and the Environment

(are their clear and identified procedures, policies, medical directives, protocols, plans of care, care pathways and assessment tools)

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

resources.

S.M. : I am able to prioritize nursing care and nursing interventions in order to manage workload, time, and physical resources.I haver been able to

work with three patients and I have been able to do my vitals, head to toe assessment and am care before 12:00 as well as plan time around that for

documentation.

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

Throughout the term, Sarah used knowledge, skill, and judgment to assess clients, prioritize needs and outcomes. Sarah always
researched the relevant diagnosis and medications. She demonstrated eagerness to learn new skills. She has made improvements on
knowledge, knowledge application, as well as time management in order to manage workload for 3 patients

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.

S.M. : I was able to discuss with the OT the plan of care for a patient that needed to be rehabilitation in doing her ADL so she could go home. We

decided the first step was to help get her up and to the washroom to be able to void. She is scared that she will brake her arm again. We also decided

that a social worker would be someone important that the patient needed to talk to in order to help with her fears.

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.

S.M. : I participate in report and transfer of accountability every morning and discuss the plan of care for the day for my clients and address the needs

of the client. Then throughout the day we reconvene and discuss what has happened so far and what they next plan of care will be for the afternoon.

Satisfactory Satisfactory
6. 3 Seek out assistance and consult with members of the inter-professional health care team.

S.M. : I seek out assistance and consult with members of the inter-professional health care team. ex. the agency nurse I was working with did not

want to take my patients BS but the patient was to have insulin administered at lunch. She did not want to because the MAR advised BS to be done

BID and not TID so she felt she didn't need to do it. I consulted with another nurse and my clinical teacher on the unit and both advised that the BS

needed to be done and finally the agency nurse got the patients BS.

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

outcomes.

S.M. : I am able to use teamwork, consensus building, and conflict resolution skills to meet expected client outcomes. ex. I had a client who had a

general state of confusion because of his alcohol abuse. He was very irritable, combative and aggressive at times. He has bed restraints (all 4 side

rails up, bed alarms). He was trying to get out of bed and had stripped himself naked. I did not know that he had a geriatric chair used to keep him

calm and restraint so he couldn't hurt himself. A fellow nursing student had him the previous week and discussed with me about putting him in the

chair and we worked together to sort out the problem. we put the client in the chair and we were able to calm him down.

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

environment.

S.M. : I am able to use effective, collaborative, and consultative strategies to meet clients needs within a changing environment. Example is when

the OT and social worker to get my client to optimal functioning to be able to return home (the lady with the broken arm who was afraid to get out of

bed because she was scared she would break it again)

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

S.M. : I Interact with members of the health care team respecting their unique role and competencies. I have worked with nurses who are RN and

ones who are RPN and I treat them with respect. It does not matter their title I trust my co workers and use them as a port to gain more knowledge

within my field.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Sarah sought assistance when needed and collaborated with both clients and members of the interprofessional health care team to assess
clients, determine health needs, and achieve mutually agreed expected outcomes.

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.

S.M. : I acted in my patients best interest to protect them from harm by consulting with the OT and Social workers to figure out a plan of care that will

help my patient get back to optimal functioning.

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

feedback into practice.

S.M. : I am able to engage in ongoing reflective practice to identify strengths, areas for improvement; and, integrate feedback into practice. We

partnered up to look at the areas we are strong in and areas we are weak in. I will take there feedback and apply it to the rest of the semester. I know I

am strong in documentation and assessments but I would like to work more on time management to make sure I can take my breaks.

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

(CNO).

S.M. : I participate weekly on knowledge for you which is designed to foster CNO Quality Assurance Program.

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

integrate these into practice.

S.M. : Each week I make sure to find out something new they are going to do on the unit that I have never seen before. We had a patient pass away

on the unit and I wanted to know what needed to be done for the care after death. I asked the nurse if she would let all the students come to watch as

well and let us know when she was going to start. I also sought out the opportunity to watch an IV line insertion.

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

S.M. : I use nursing research to foster professional development. When I am on the unit and I am not sure of how a certain drug works ex.

pantoprazole. I look up the MOA and make sure to know adverse effects to watch for with he patient. By doing your own research you gain knowledge

and competence. The nursing profession is all based on self regulation so I would like to work more on gaining more knowledge my doing more

research.

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

S.M. : I Use a theory-based approach and evidence-informed practice. example is when I had to prime the tubing for my patient on IV medications. I

used the textbook approach (what we learned in lab) and applied it in clinical. I was advised but the nurse that they use a blue cap on the end of the

tubing to prevent infection when it is not being used. She advised it was better then using the port close to the end (evidence informed) They next time

I will use the blue cap on the end port while my patient is not using the IV.

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

affect nursing practice.

S.M. : I am able to recognize the challenges within my unit currently I believe they have two many patients to one nurse 5 or 6 - 1. yes the patients

are a little more independent but I feel the care provided is not up to the standards it needs to be because the nurses are more worried about

administering all the medication they need to then creating a plan of care that will allow the patient to get back to optimal functioning. The technology

on the unit is the best yet. The nurses are able to bring the med carts right into the room, the scan check at the patients bed side allows for less error.

The nurse carry around little phone that if the patient pushes the call bell it comes straight to the phone which allows for quicker time responses.

However the phone also show the amount of time spent with the individual patient and that is monitored by the managers. It allows then to question

the time you may spend with one patient and why it took you so long before you were able to get back to another patient this can be a challenge.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Sarah has been constantly interested in learning and improving her nursing knowledge and skills. Sarahs decisions and clinical
judgments has more of a theoretical and evidence-based rational since mid-term. Sarah always sought learning opportunities and feedback
to enhance professional development.

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.

S.M. : I utilize problem-solving skills to inform decision making in all aspects of nursing care. I had a patient who was extremely confused due many

years of alcohol abuse. He was extremely combative and didn't want to listen or stay in his bed. I was able to get him up into a chair and keep him

buckled up to stop him from wondering off and being aggressive. There was an order in place to keep him restrained when needed.

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.

S.M. : During clinical I use the information I have gathered as well as the plan of care set out by the doctors to make sure I have meet expected

outcomes. I decided what goals goals and interventions are specific to my client. I evaluate the interventions and make sure they are working, if they

are not I make sure to change the intervention to meet one that will work. ex. with my confused patient I was not able to keep him in bed so I put him

up in his chair and I was able to keep him happy before bed.

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

improve

these.

S.M. : I am able to evaluate critical thinking, problem-solving, and decision-making skills and design a plan to improve these. I do this by researching

my patients condition and reviewing what areas are to be focused on for each individual patients condition. This allows me to become more effective

in a situation that may become a crisis.

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

provide safe and competent care.

S.M. : I make sure to used my text books, videos, evidence informed practice to provide safe and competent care for my patients. Their safely is most

important.

Satisfactory Satisfactory
8. 5 Prioritize effectively.

S.M. : I am able to recognize the priorities that are important to my client. ex. I had a patient who was incontinent and had many wet briefs and

another who has DM and needed insulin before she ate her breakfast. As much as keeping a patient free of moisture is important in preventing skin

breakdown I was more important to make sure my patient with DM had insulting administered first before breakfast.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

S.M. : Every week I participate in transfer of accountability with the nurses and I demonstrate professionalism when doing so, never talking bad about

clients and making sure to be respectful.

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

guide practice.

S.M. : I use the practice decision-making and the nurse-client-environment frameworks to inform and guide my practice safely, compassionately,

competently and ethically. I assess the client to see the condition they are in (is it within my scope of practice to provide care for this individual, are

they stable and have predictable conditions), the nurse (am I the right HCP to provide the care, am I knowledgeable in the procedure I am about to

perform, Can it be done safely for the patient and myself) and the Environment (are their clear and identified procedures, policies, medical directives,

protocols, plans of care, care pathways and assessment tools)

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

Since midterm, Sarah has improved on her judgment and critical thinking skills. Her critical thinking skills were demonstrated though her
patients care. concept maps as well as doing case scenarios in the post-conferences. She applied the knowledge gained through literature
by using her critical thinking skills.

Student Final Summary with Strategies for Continued Growth

I have continued to grow over this last clinical semester. I am able to provide competent, ethical and safe care. Do a thorough head to toe assessment
as well as document in a accurate and timely manner. I was able to provide care for up to three patients at one time. I learned about how to set up
IVs, do blood transfusions and end of life care.

During pregrad I plan on learning and growing more about post partum which is where I will be place. I want to take a neonate resuscitation course
and learn how to provide care to mother and baby.

Teacher Final Summary with Strategies for Continued Growth

Sarah demonstrated professionalism and accountability in her practice throughout the semester. She Missed one clinical day due to sickness. She
notified the instructor in advance and provided a doctor's note. She was able to provide safe, competent care by using reflective practice. She has
been consistently reading, looking up new ordered medication, medical history and diagnosis information, and otherwise getting herself ready to
perform new skills. Sarah has demonstrated the leadership standard by role-modeling positive relationships with others. She has always maintained a
therapeutic relationship with patients and their family members.

Program Coordinator comment

Well done!

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