NURSING 4020/21/22 FINAL Clinical Evaluation
NURS 4020 Final Clinical Evaluation: Pass__X__ Fail_____
Student: Melissa Friskney
Faculty Advisor: Sarah Harvey
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: Anna Blanco
Clinical Practice Site: Baycrest
Practice hours completed _____________
The population is primarily:
_____Adults with medically-related health needs
_____Adults with surgery-related health needs
_____Children or adults with mental health needs
_____Intrapartum families/mothers and newborns (not NICU)
___X_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 FINAL Clinical Evaluation

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

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

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

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

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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Objectives
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
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
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
Progress
Indicators/Evidence S U
• Throughout this placement I have demonstrated professional X
behavior by always showing up on time to my shifts with the
supplies I require such as my identification badge and pen.
• When working with other team members, patients and their
families I always identify myself by stating my name and
explaining my role as a student. I also make sure to ask if they
have any questions and explain to them the care I am providing.
• I have participated in professional development by attending a
case study with my preceptor, completing my online training and
reading previous clinical skills day presentations to get myself
more familiarized with certain procedures and tasks.
• During this placement I have gained confidence in myself as a
care provider. At the beginning of the term I felt nervous and
uncomfortable on this new unit. But, as time has gone by I am
more comfortable and not afraid to ask other staff members for
guidance or assistance instead of just my preceptor. This has
allowed me to take on more of a team approach when caring for
my clients. As well, I feel more comfortable doing tasks on my
own such as injections and dressing changes.
• By working with other professionals, I am able to provide my
clients with better care. For example, I had a new patient who
had not received their blood pressure medications yet. The
pharmacist was going to order the medications for him but
because I communicated with him that the patient had a low
blood pressure we decided, as a team, that it would be best to
hold the medication and monitor the patient. I also work with
OT/PT by taking clients to the gym when it is their scheduled
time or walking patients to the dining room as per
physiotherapies request.
• Throughout my placement I have used effective strategies to X
maintain patient privacy by always ensuring the door to their
room is closed or their curtain is drawn when performing care.
For example, when performing an ECG I only expose the parts of
the patient that need to be exposed and cover the rest up with
their blanket. This allows the patient to feel more comfortable
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autonomy
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
b. uses principles of supportive counselling and
motivational interviewing to help clients set goals,
identify problems, find solutions
during this procedure.
• Throughout this placement I have used effective strategies to
maintain patient autonomy by giving my clients choices. For
example, when getting a client ready for bed I ask them if they
would like to wear a hospital gown or their own sleep wear to
bed. I also respect a client’s choice to refuse a medication. I
ensure I provide them with all the knowledge I have about the
medication, but I do not make it mandatory that they take it and
respect their decision.
• I advocate for my patients by communicating with other
members of their health care team about their condition. For
example, when caring for a patient I have had for a while I
noticed she was more confused than normal. I charted my
findings and communicated with the doctor by leaving them a
note in their book. As a result, the doctor ordered a urine
analysis and ended up changing the times for certain
medications to be administered because it turned out the
medications were interacting with proteins at meal time.
• I maintain client privacy and confidentiality by always shredding
my worksheet at the end of the shift and only discussing my
client’s concerns within their circle of care.
• I engage in critical self-reflection by completing my weekly X
journal and submitting it to my facility advisor each week. I also
take time to reflect on the care I provide while on the floor and
seek guidance form my preceptor. For example, when doing a
dressing change on a client’s toe I reviewed the procedure steps
with my clinical instructor before preforming the skills.
• I can effectively initiate, maintain and terminate relationships
with clients I care for. For example, many of the patients on this
floor are here for extended periods of time and I have been able
to initiate a therapeutic relationship with them when I initially
care for them. I have been able to maintain these relationships
by saying hi to them on the unit, assisting them with preparing
their meals and providing them with assistance when required. I
am also able to terminate these relationships at the end of their
stay by saying goodbye and wishing them luck as they are
discharged home.
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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
i. Chooses appropriate models for specific client
situations and clinical settings
b. Continuously demonstrates critical inquiry, scientific inquiry, and
clinical reasoning as evidenced by:
a. Using new understanding to identify problems, propose
solutions, find evidence for and against proposed
• I take time to listen to my patients and really get to know them.
For example, I spent a short period of time talking to my one
patient who is a holocaust survivor and she told me all about her
experience in the concentration camps. I demonstrated
attentive listening and sensitive questioning during this
experience because I listened to my client’s experience and
asked questions but did not push information out of her.
• Throughout my placement I have demonstrated empathy by
listening to my patient’s concerns and assisting them with
anything they need. For example, I often help my patient’s work
their electronics and teach them how to connect to the internet.
Although this is a simple task it helps form a relationship with
my patients and shows them I care.
• I work with other health care professionals to facilitate
appropriate, timely care by ensuring my clients have their pain
medications before therapy to optimize their comfort. This
allows the client to get the most out of their sessions. I also
answer the call bell and assist patients when their primary nurse
is busy. This allows the patient to receive the care they need in a
timely manner. I also work as a team by communicating with the
doctors, and other health care professionals to update them on
their patient’s condition. As a result, all members of the care
team are aware of the client’s status and concerns.
• During this placement I use knowledge learned from other X
courses and apply it to the care I am giving. For example, when
cleaning wounds and dressing them, I use the proper clean
technique, which demonstrates safe practice and ensures both
the safety of myself and the patient.
• When providing care to my patients I apply theories such as the
Orem’s Self Care Deficit Nursing Theory. This theory provides a
method to determine the self-care deficits and define the roles
of the patient or nurse to meet the self-care demands. Many
patients I care for require some assistance with their activities of
daily living. Often times clients are able to recognize that they
require assistance and will ask for help. As their provider I am
also able to recognize this and provide them with assistance for
tasks such as toileting, showering and dressing. I try my best to
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solutions, and evaluate proposed solutions
b. Challenging the status quo
c. Performing focused reflection, connecting new
experiences to existing knowledge, thinking creatively,
using nursing judgment
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
let the client do as much as they can on their own and only assist
when needed. I was able to recognize what the client cannot do
on their own and provide assistance with self-care tasks. It was
important to help them perform these tasks because it meant
meeting a self-care deficit that the patient did not need to worry
about and could focus on improving their health instead of a
basic requirement of elimination.
• During this placement I am continuously using my nursing
judgement when caring for patients. For example, when a
client’s blood pressure is low I try to think of the reasons why it
could be low and put some nursing interventions into place
before reassessing the problem. By using my nursing judgement,
I am also able to identify when something is a problem that the
doctor needs to be aware of right away or if the problem can be
easily fixed by providing the client with water because they are
dehydrated.
• I recognize, gather and analyze data from multiple sources to X
develop a plan of care. For example, when performing an
admission assessment, I review the patient’s chart, the OT/PT
initial assessment, and talk to the patient and to their family
members or private caregiver. This allows me to get the full
picture of the client to help develop the most accurate plan of
care.
• I document and communicate assessment data, plan of care,
interventions and patient responses or outcomes by ensuring I
complete the vital signs, stool chart and personal care flow sheet
documentation during each shift. I also make sure I write a
progress note when something out of the ordinary occurs or I
feel other staff should be made aware of something. Finally, I fill
out the card-ex for each of my patients to ensure important
information is past on during shift change.
• I expand my nursing knowledge by researching and doing
readings at placement and at home to learn more about the
conditions/procedures my clients have to gain a better
understanding. For example, one of my clients had low
hemoglobin and required a blood transfusion. Before beginning
the transfusion, I took time to research the procedure by reading
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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
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
the facilities policy and a step-by-step clinical skills handout on
how to properly preform a blood transfusion. This allowed me to
have a better understanding and answer any questions the client
had about the procedure.
• I am able to identify gaps in my own knowledge and seek out
ways to fill those gaps. For example, during down time I practice
procedures with my preceptor such as how to do blood work. I
also ask my preceptor and other members of the health care
team questions when I am unsure of how to do a skill or feel I do
not have the knowledge to answer a client’s question.
• I often collaborate with providers to assess the outcomes of
care. For example I attended multidisciplinary rounds and I also
participate in floor rounds with the MD and pharmacist. This
allows me to develop an understanding of all the client’s care
and goals, as well as see the approaches different health care
providers want to take to achieve the client’s goals.
• During my placement at Baycrest, a hospital that specializes in X
the care of older adults, I have been able to enhance my
knowledge of caring for this population and explore their health-
related issues. This placement has demonstrated to me the
many gaps to delivery of care such as language barriers, as many
clients speak little English. This can be challenging when asking
questions such as “are you in pain?” or “did you have a bowel
movement?” because often clients will smile and nod even
though they do not understand the question. To overcome this
barrier I have learned how to say bowel movement in Italian (a
language several clients speak) and try to communicate with
clients using simple words that they are more likely to
understand.
• Clients want to return back home after their hospital stay but
several clients will be discharged with a new or worse mobility
impairment. This makes it harder for them to get upstairs, move
around their house and puts them at risk for falls. As a result, it
is often recommended that they get special equipment installed
in their bathrooms, move their bedroom to the main floor or
have assistance come in to help them with activities of daily
living. However, several clients that require care do not qualify
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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
xi. Appropriate dose/route
xii. Implications for nursing care
for it because they have family that can take care of them. This
leads to caregiver burn out or clients trying to do things on their
own because they do not want to be a burden to their family.
This leads to falls, more injuries and even emergency room visits.
This is a hard gap to overcome but throughout my time at
Baycrest I have watched the staff advocate for the client’s and
family’s needs to ensure they are going home to a safe
environment.
• I am able to manage 2/3 of the preceptor’s usual assignment X
independently, with minimal supervision by my preceptor.
However, she is there to support me and assists me when I
require it.
• Nursing activities I have carried out at this placement include:
performing medication passes, assisting clients with ADLs, vital
signs, dressing changes, oxygen titration, IV bag change,
injections, new admission assessment, discharges, MRSA swabs,
ECGs, blood transfusion, ambulating and transferring patients,
team lead role, report, charting, multidisciplinary rounds, bed
making, head-to-toe assessments, pain assessments, progress
notes and bladder scans.
• I have demonstrated a basic knowledge of medications
prescribed by understanding the classification, purpose, possible
side effects, interactions, dose and route. I share this
information with my clients so they have an understanding of
why they are taking certain medications. When I am unsure
what a medication is for I take the time to research it in the drug
guide book.
• I have demonstrated health teaching by working with clients and
their families to ensure they are transferring properly. I also
encourage them to push off of the bed instead of holding on to
the walker to stand up and remind them to put their breaks on
for their wheel chairs when transferring. By reminding the client
and assisting them it helps them learn the proper technique and
eventually they develop the skills to safely transfer on their own.
• As discussed previously, I collaborate with the team to meet the
client’s goals by attending rounds, communicating with doctors,
giving pain medications before therapy to ensure the client can
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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 and arrange for
coverage of patients
d. Basic Nursing Care/Activities of Daily Living
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
participate fully and properly documenting to share information
with the team.
• I show relational practice during placement by listening to my
clients concerns and communicating about them with others. I
like to take time to talk to my clients and find out about their
family, their career and their lifestyle. This allows me to form a
relationship with them and develop a better understanding of
what their baseline was and the things in life that are important
to them.
• Team communication is very important on this unit because
each client works with several health care professionals. When
caring for clients I ensure I share abnormal findings related to
the patient with my preceptor, nurses, physician and other team
members. For example, one of my clients only drained 50ml of
urine for an 8-hour shift and had noticeable distention. I notified
my preceptor and we worked together to perform a bladder
scan, notify the on-call doctor and then follow orders by
irrigating the Foley. By working as a team, we were able to catch
this problem and help our client.
• I also make sure I always document all findings on meditech and
include important information on the Kardex.
• Every shift I assist my clients with basic nursing care and
activities of daily living by helping them to the bathroom,
emptying their catheters, providing showers and peri care,
ambulating them to meals, setting up their trays, helping them
get dressed and undressed, etc. I try my best to allow clients to
do what they can on their own and assist them as little as
possible to promote independence.
• During my clinical placement I demonstrate knowledge of
nursing and collaborative therapeutic interventions by ensuring I
administer medications at the right time, the right dose, by the
right route to the right patient for the right reason. I make sure I
assess my client’s pain and provide proper interventions when
needed such as PRN pain medications.
• Throughout this placement I demonstrate and maintain
professional relationships by dressing appropriately,
communicating in a professional manner with staff, clients,
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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
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.
families and volunteers and showing up to clinical on time ready
to learn. I take advantage of new learning opportunities by
asking other health care providers if I can observe or participate
in the care they are providing. For example, I assist and observed
a blood transfusion. This helped me develop a better
understanding of the process and the possible adverse effects
that could occur.
• During each shift I properly document all my assessment findings
in medi tech by ensuring I fill out the vital signs, stool chart,
personal care flow sheet and patient care notes sections. I also
leave notes for doctors, complete the report tool and provide
constant updates on each of my patients to my preceptor.
• I take time to reflect on my own practice by submitting my
weekly journals, asking for feedback from my preceptor, talking
with my preceptor about tasks I performed and how I can
improve and finally, personally, reflecting on the care I have
provided and thinking about what I did well and how I can
improve to ensure I am providing my clients with the best
possible care.
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