Self Assessment

2016 - 2016 - NURS 151 Practical Nursing Practice 2 Final (201508)

NURS 151 Practical Nursing Practice 2 (PN, 12-Jan-2016 - 07-May-2016)
Student : Tiange Cui
Clinical Teacher/Preceptor : Michelle Lambakis
Program Coordinator : Wendy Chow
Location : Westbury Long Term Care
Placement Setting : Agency
Unit/Office/Clinic : LTC
Description : This course is designed for building up nursing
intervention through lab learning and clinic
practice.Students can benefit from the experience to
have a better understanding on the knowledge and
apply it in a real and comprehensive situation. Also,
students can learn how to collaborate with other staffs
to perform a proper care for clients.
Period : 12-Jan-2016 To 07-May-2016
Student hours : 168
Required Hours : 168
Validated hours : 162
Teacher comment for validated hours:
Ayah has completed 162 hours of clinical time. This number DOES NOT include SIM Lab time or Evolve Online Self Directed Learning time.

(We missed 6 hours of clinical time on Good Friday, as students are not permitted to work on a statutory holiday)

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.

T.C. : Getting on time with the assigned paper. Dress as the policy. Keep the accountability and the information privacy.

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

T.C. : As I was getting familiar with the patient, sometimes I would skip some introduction. In week 7, I got the advice form you help me realise the

issue. I reflect my own behaviours and try to keep the profession all the time.

Satisfactory Satisfactory
1. 3 Determine strengths and limitations and when to consult and seek assistance from other

professionals.

T.C. : I am always willing to ask for help if I am unsure how can I react. Also, I would seek for assistance if I feel that I can't maintain safety for clients,

especially during transfer. Meanwhile, I would willing to help such as transfer or other issues that need a teamwork.

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

T.C. : Review the client's information before the care, update the care plan with the condition change, apply the knowledge based on the textbook

and the other relevant sources to ensure a nursing care; However, as we talked in weekly assessment, I still need development.
 Satisfactory Satisfactory
1. 5 Ensure client safety and a safe environment.

T.C. : Be aware of the hazard environment, such as nuclear pathway, high bed, inadequate light and so on. Also, the mental health, response and

communicate with client, report if observe any abuse in the facility.

Satisfactory Satisfactory
1. 6 Ask relevant questions to clarify understanding of the plan of care and whenever uncertain.

T.C. : When assigning with a patient, always ask the other team workers to inform the patient's condition if there is any unclear information on the

care plan. As for communicating with the patient, always feel okay to ask for clarifying if don't understand. In addition, as a student nurse, questioning

the instructor is always an effective and important way that I have to keep in mind.

Satisfactory Satisfactory
1. 7 Identify ethical and unsafe situations and seek appropriate assistance to resolve these.

T.C. : In the facility that I work, a client who understand little English, which makes us sometimes misunderstand each other and she always want to

do some work that might unsafe to her. In this case, I would check her file to know her background and ask for interpreter or PCP who speak same

language as her. If I can't find assistance, I would use body language to explain to her to make sure that she can understand the situation and keep

safety.

Satisfactory Satisfactory
1. 8 Demonstrate understanding about the role of the student nurse.

T.C. : As a student nurse, besides the centre care for the client, follow the policy and always ask the instructor to inform the unclear components.

Also, be accountability to keep patient's information and privacy.

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

During the clinical experience Tina has demonstrated competent and safe practice in a professional, legal and ethical framework. Tina has
learned to prepare a Daily Organizational Care Plan after receiving her client assignment and morning report so that she can provide
competent and safe practice to her clients in a timely and effective manner. By the end of the clinical experience Tina was able to
independently provide full care, doing both medication administration and ADL's for a three client case load with competence in a nursing
home facility.

Through her care, Tina demonstrated an ability to identify her strengths and limitations to determine the need to consult and seek
assistance from either the clinical instructor or other members of the health care team. Also, she asks relevant questions to clarify her
understanding and these are both very important attributes in a developing nurse.

2. ACCURATE AND RELEVANT COMMUNICATION

Satisfactory Satisfactory
2. 1 Participate in team sharing and discussions.

T.C. : As a nursing student, sharing and discussing are important ways to learn. I am willing to communicate with people and express my ideas.

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

T.C. : I only did documentation once when I knew that the client's blood sugar was low so I gave him a cup of orange juice and a package of jam. At

that time, I describe the client's condition, assessment, interventions, and evaluation; However, I still need more practice.

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

T.C. : As for patients, if they have some issue, I will inform to my instructor or the facility members depends on the situation. For example, the first

day of the placement, a dementia patient asked help for the bathroom. At the time, I had no knowledge about the patient so I asked her to wait and I

will find the PSW to assist her.

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

T.C. : One of my assign client who has dementia, I have to repeat my behavior to him all the time to ask for collaborating. Also, he need practice on

walking, so I also communicated to the program staff.

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

(PHIPA)

T.C. : Every time when I enter the room for any hygiene care, I would ensure the privacy of the room. Also, I never shared my clients' information to

people who are not the health team members.

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

T.C. : When I read over my patient's health history, if there is ant unclear, I will use textbooks or check my instructor to ensure my understanding.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Tina had the opportunity to use the Point Click Care documentation and eMAR program while working at the Westbury. She is competent
in her documentation of care using both written and computer documentation procedures. She is able to document clearly and accurately,
in a timely manner. Tina has demonstrated the ability to effectively communicate with the Clinical Instructor, her peers and fellow staff
members of the multi-disciplinary team at The Westbury, in order to provide safe and effective care to her clients. Throughout the semester
I have appreciated Tina's initiative to be in charge of her own learning, by keeping the Clinical Instructor informed of her learning needs
and progress goals. Because of this, I believe Tina was able to achieve optimal experience and competence with many aspect of nursing
care.

Tina has maintained the privacy and confidentiality of the client's at The Westbury, according to PHIPA.

3. CARING RELATIONAL PRACTICE

Satisfactory Satisfactory
3. 1 Utilize effective communication techniques.

T.C. : For non-English speakers, I will ask for interpreter or body language to perform a better and appropriate care. As for some clients who has

dementia, I would use strategies from textbooks such as attention client to maintain a therapeutic communication.

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

and health care team members.

T.C. : I tried to learn the clients, facility's members to know and respect each view, and properly express my idea if I feel something wrong. For

instance, as I knew that student can do lifting, the time if PSW asked me, I would say I would be really willing to help while it's against policy, so I can

ask other facility members to help and it would be appreciated if they are okay to let me just observe.

Satisfactory Satisfactory
3. 3 Apply knowledge of therapeutic use of self and identify its effect on client well-being.

T.C. : Once I noticed scars on the client's shoulder, I assess his conditions. During the assessment, I realise that they are old scars, while when the

client told me it is not a big deal, I ask his understanding on well-being and educate him as well.

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

relational practice.

T.C. : I felt that I have to build up more sense on this part to perform a better care for clients.
 Satisfactory Satisfactory
3. 5 Interact with clients and members of the inter-professional health care team; and, consult

appropriately.

T.C. : I always try to be aware of this, the only thing I think that I need improvement is the communication in the morning that I have to report my care

plan to the head nurse effectively to ensure that she can give me enough space to allow me to perform cars on my own.

Satisfactory Satisfactory
3. 6 Apply knowledge of practices and systems that support the diversity of clients and the inter-

professional health care team.

T.C. : For example, on my floor there is a couple, the husband is dementia and the wife speaks a little English, which makes us feel aggressive when

to talk to her. I am the one have to feed them, so I will learn if the colleagues who speak the same language; If not, I will show my patience and

respect by eye contact, try to follow her with clarifying, and ask for help if I feel over-controlled

Satisfactory Satisfactory
3. 7 Apply knowledge of clients cultural, religious, and other beliefs and values as these influence

clients choices and decisions.

T.C. : Because of my clients who all have dementia, I didn't have that much practice with their culture effects.

Satisfactory Satisfactory
3. 8 Provide effective client education.

T.C. : One time a client who refuse to take anything for her breakfast, I asked the reason and explain the importance of the breakfast, while she still

refused. Then I ask her to finish drinks at least because they can hydrate the body and maintain electrolytes balance

Teacher comments for CARING RELATIONAL PRACTICE :

It has been great to see Tina's confidence grow in regards to this clinical competence. She has grown from someone who was somewhat
shy and hesitant to begin care for her client, into a competent nurse professional who can provide care to her clients independently using
therapeutic communication techniques so that she could truly get to know her client.

Overall Tina provides care to her clients that is therapeutic, compassionate and culturally safe.

4. LEADERSHIP AND ADVOCACY

Satisfactory Satisfactory
4. 1 Recognize conflicts and strategies for resolution.

T.C. : For clients who speak different languages, it is easy to trigger conflict. I would try to find an interpreter to overcome the barrier or use body

language to help the communication. Meanwhile, I would prepare for failure and give them right to refuse the care or insist their own behaviour.

Satisfactory Satisfactory
4. 2 Demonstrate leadership skills that foster group work and a positive learning environment.

T.C. : I will talk to the PCP and ask them to assist my care, while I still need more practice on this part, especially the time management.

Satisfactory Satisfactory
4. 3 Identify opportunities to improve health care service and nursing interventions by advocating for

client, self, others, and quality practice.

T.C. : I will review the patient's condition to note the part that I have to pay attention, and I will use the textbook and other materials to improve my

skills. It is the chance to develop the quality. Also, through the feedback from the instructor and peers, I will reflect my own to fix the problem.

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

professional health care team.

T.C. : Review the patient's condition to note the part that I have to pay attention, and use the textbook and other materials to improve my skills. It is

the chance to develop the quality. Also, through the feedback from the instructor and peers, I will reflect my own to fix the problem.

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

T.C. : Every time when I performed the health care, I asked for patients' permissions and provide more options to let them decide, such as feeding

process.

Satisfactory Satisfactory
4. 6 Respond appropriately to unsafe, unacceptable, and unprofessional behaviours.

T.C. : When I knew that students are not allowed to lift patients, one time a PCP asked me to help, I explained this to her and told her that I will bring

other to help her and it would be nice if she can still allow me to watch, and she understood and let me observe.

Satisfactory Satisfactory
4. 7 Consult and collaborate when carrying out health care and nursing practices that are in the best

interests of the public and protect the public through collaboration and consultation.

T.C. : Even though one of my clients was encouraged to participate a social program. while when I checked to the nurse she said it was not a

concern and she will leave this first, so I didn't really got practice. The only thing I did is when the patients' families came, I would talk to them and

communicate to them to see if I can give max help to the patient through the family support, and some education if necessary.

Teacher comments for LEADERSHIP AND ADVOCACY :

Tina respects the rights of others and she participates in a collaborative manner with peers and staff. She seeks assistance from the
appropriate members of the multidisciplinary team and the clinical instructor if she is unsure and then will perform the task independently.
She has a very good understanding of when to advocate for her patient to provide the best possible care.

5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES

Satisfactory Satisfactory
5. 1 Incorporate the unique needs and expected outcomes into individual clients plans of care.

T.C. : Still need to stick on the NADA to be more familiar with the Nursing diagnosis, and then I can create proper interventions based on it.

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

competently in writing and orally.

T.C. : Got more familiar to the e-Mar, while I would expect to have more practice on the documentation such as narrative chart and the SBAR

method.

Satisfactory Satisfactory
5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.

T.C. : This is the thinking process for the concept map. Based on the knowledge, we come up with the primary problem and give the intervention. The

thing that I need more developed is priority identification. The way I think might help the skill is try to collect all the data and apply critical thinking to

understand the meaning of the data.

Satisfactory Satisfactory
5. 4 Provide information that contributes to the evaluation and refinement of plans of care.

T.C. : If I have my plan, I will evaluate the patient to see how it was going. For instance, when I know that my patient got insulin injection, I will ask if

there is any dizziness and to ensure their maintain the stable.

 Satisfactory Satisfactory
5. 5 Safely and competently carry out nursing assessments and nursing interventions that are theory-

based and within skill abilities.

T.C. : Perform nursing assessments as the checklist from the last semester, with that data, the intervention would be create based on my own ability

to make sure that can be implemented safely and competently.

Satisfactory Satisfactory
5. 6 Carry out nursing care that reflects the practice decision-making framework.

T.C. : For example, I found my patient experienced a dry cough which didn't happen earlier. Consider he has COPD, I realised that my patient was

sliding down, which made him lower than before, then I informed this to the PCP and they help me to adjust the position. However, I still need more

practice.

Satisfactory Satisfactory
5. 7 Complete nursing care responsibilities and nursing interventions in an organized and timely

manner.

T.C. : Now I can finish at least two client's morning care on my own without any issues ( only need help for transfer), while I know that I still need

practicing to get to the next level.

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

Tina has successfully completed 2 Concept Maps pertaining to two different residents she worked with. I encourage Tina to continue to
work on the data collection necessary to complete a Care Plan as well as her ability to interpret the data collected in order to determine
actual and potential risk factors and nursing diagnosis. This will be very helpful to understand what motivates nursing actions and
interventions, necessary for effective client care. I say this because, one day very soon it will be your responsibility to determine these
nursing actions. Keep up the good work!

Tina has been working on developing her Daily Organizational Care Plan and has demonstrated very good organization and prioritization of
care while working with a three client case load in a nursing home setting. Tina has learned how to take vital signs on her residents and
perform head to toe assessments, provide full ADL care to each of her residents. Tina has also had the opportunity to do medications
administration, including blood glucose monitoring, insulin administration and subcutaneous injection. Tina was able to perform the
required nursing assessments, data interpretation and critical thinking necessary to competently and safely carry out each of these
nursing skills.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

Satisfactory Satisfactory
6. 1 Work with clients and members of the inter-professional health care team to assess clients,

determine health needs, and to achieve mutually agreed expected outcomes.

T.C. : I talked to walking program's staff about the client's condition and need, and I will assist the staff to help my client exercise.

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.

T.C. : Once one of my clients who complained pain on his left shoulder, so I talked this situation to people who were going to do physical therapy to

help with his stiffness, and we decided to delay the massage to tomorrow if his pain would decrease.

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

T.C. : One of my clients who has dementia and needs exercise for walking, so I will ask for assistance from walking program staffs.

Satisfactory Satisfactory
6. 4 Use teamwork, consensus building, and conflict resolution skills.
T.C. : One time the exercise program visited to help patients move, the PCP wanted all our students to join while the programer refused it. We firstly

asked the nurse in charge(instructor wasn't there) and knew that it is free, so we again asked for the permission, we told her that we totally

understand her while feel it would be a good experience for our study. Even though she still on her side, while we had a peace and good

conversation. We prepared for failure.

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

changing environment.

T.C. : Through the communication, an inter-professional team works to estimate the risk of the change to help the patient maintain or adapt.

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

T.C. : Introduce myself before the shift start and ask them if there is any consideration to show my respect. Also, I would willing to learn to use a

different way to perform a good care.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

During the clinical experience Tina demonstrated teamwork and collaborative and consultative strategies to meet the client's care needs.
Tina has demonstrated very good collaboration with the other members of the healthcare team at The Westbury, so that mutually agreed
and expected outcomes were achieved for each client. Over the semester Tina has come to understand the importance of communicating
with her team members in regards to her client's status and changes so that safe care is provided.

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.

T.C. : Monitor the patient's ADL and if there is anything I will inform to the nurses. Also, I worked with the inter-professional team. I asked the nurses

what they did for the patient and how it worked.

Satisfactory Satisfactory
7. 2 Participate in self-reflection to identify strengths, areas for improvement.

T.C. : Use K4Y effectively. Reflect through peer feedbacks. They are significant for me to be aware of my own strengths and limits.

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

(CNO).

T.C. : Follow the CNO standards and maintain a dynamic care for clients

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

integrate these into practice.

T.C. : Ask instructors, peers, and facility members if I have any questions. I registered peer tutoring for more help. Through all these work, I will

develop myself and perform a better care next time.

Satisfactory Satisfactory
7. 5 Utilize nursing, health and other theory and literature to improve nursing practice.

T.C. : Apply the knowledge trough the theory class, to identify my patient's needs and properly response, maintain the environment, client safety and

patient centred care.

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

T.C. : Regarding on the knowledge, it supports analysing and thinking. With a good theory understanding, I can use the data as my evidence to

inform my thinking and react the situation properly.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Throughout the clinical experience Tina has demonstrated the ability to participate in self-reflection in order to identify strengths and areas
of improvement. This is especially evident as Tina worked on the development of her Daily Organizational Care Plan throughout the
semester in order to competently and efficiently provide care to a three-client case load. These tasks included timely medication
administration, timely computer documentation when needed as well as preparing clients for breakfast in the morning by completing their
ADLs.

Tina has completed her self evaluation and obtained peer feedback based on this clinical experience and previous learning plan. Tina has
identified three new learning goals for the next clinical experience.

8. USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY

Satisfactory Satisfactory
8. 1 Utilize problem-solving skills to inform decision making in all aspects of nursing care.

T.C. : Through the data collection, action, and response, it can evaluate and support the priority and identification. I need to keep working on this skill.

Satisfactory Satisfactory
8. 2 Use problem-solving and decision-making skills to assess clients and to determine nursing

diagnoses, expected outcomes, nursing interventions, and evaluative criteria.

T.C. : Need more practice through concept map.

Satisfactory Satisfactory
8. 3 Use self-reflection to design a plan to improve problem-solving and decision-making skills.

T.C. : Self-reflection is a way to rethink. For example, when I saw a patient cough which didn't happen before, I will ask what I did before I start the

assessment.

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

provide safe and competent care.

T.C. : Identify the situation, own ability to know the action and response. I would always check the precaution of clients and get call bell beside me

just in case that I need extra help to ensure the safety for clients.

Satisfactory Satisfactory
8. 5 Use prioritization strategies for client care.

T.C. : As we talked in weekly assessment, medication is always the priority than other care such as feeding. Even though that we have one-hour

adjustable time, it is easy to forget if we always put it later.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

T.C. : Follow the CNO and RPNO and college policy and facility policy. Always double check before the action, triple check for medication. Keep the

privacy for the patients.

Satisfactory Satisfactory
8. 7 Recognize strengths and limitations and seek appropriate assistance and support.
T.C. : Strengths: Responsibility to the care, prepared research, and teamwork attitude.

Limitation: time management, documentations, and prioritization.

In order to fix my own limitations, I use K4Y effectively to track my behaviour and reflect my actions, talk to instructor and fellow staffs to generate

more ideas into my own cares.

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

Throughout the clinical experience Tina has been learning what it means to to use competent critical thinking, problem solving and
decision making skills within the scope of her practice as a nursing student. It is evident that she recognizes her own strengths and
limitations and therefore seeks appropriate assistance and support when needed, either from the Clinical Instructor or the staff members at
The Westbury. Through Tina's ability to use these skills very well, she was able to competently prioritize care for her client's and learned to
care for her client's in a very organized and efficient manner.

I encourage Tina to continue to learn different medications and what necessary nursing assessments are required in order to administer
that medication and continue to build her critical thinking skills so that she is in charge of her client's care. This is an on-going learning
process!

9. SIM number of hours

9. 1 SIM number of hours

T.C. : 6

M.L. : 6

Teacher comments for SIM number of hours :

6 hours has been completed.

Student Final Summary with Strategies for Continued Growth

Sincerely appreciate the great experience and development that you help me to meet. With your kind and support, I was able to work until now. Even
though I know that I still have a long way to building up my nursing profession, it was a such a great honour for me to meet people like you who can
help me start from the very first place that I knew nothing and needed a lot of help. As for the continued growth, besides the strengths that I have
mentioned earlier which I still need to keep working on, I will review the content for GI tube and other stuff that I didn't get sufficient practice in the
clinic. Also, I will consider more about my communication to perform a better teamwork and care in the future.

Teacher Final Summary with Strategies for Continued Growth

Tina it has been a pleasure to get to know you over the semester and watch you apply your nursing knowledge to clinical practice. You truly have
accomplished a lot this past semester and I am so proud of your progress. Working with the residents at the Westbury has been a great learning
opportunity in which you have gained much knowledge and skill that will be of great value to you in your future learning. You practice your care very
effectively and efficiently and I know that you are well on your way to handling a bigger client case load next semester! I admire your genuine care and
friendliness with your clients. Keep up the good work! I am so excited for the progress you have made and the progress you will continue to make!
Good luck as you continue your learning next semester!

Student's References

CNO, Ebersole and Hess' Gerontological Nursing and Healthy Aging, Canadian EditionWHO

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