4th Year Theme: Integration of Professional Self into the Health Care System

Connecting Theory and Practice across NSE417, NSE418, NSE407, NUR 820/823/824/825/826
NSE 417 Student Self-Evaluation: Fall 2016
With Faculty Evaluative Comments
Mid-Term ____
Student Name:

Rosette Lenon

Preceptor Name:

Marina Lam

Final _X_

Faculty Advisor Name: Patricia Hynes

Clinical Practice Setting: Pediatrics (Michael Garron Hospital)

For Office Use Only:

Faculty:
End of term Review ___________
Mid term Review ____________

Student:
_______

Self Review with Preceptors signature

Preceptor:

Mid term Feedback ________

End of Term Feedback ________

Record of All Required Hours: _______

Accountability
Students are accountable to
the public and responsible for
ensuring that their practice
and conduct meets legislative
requirements.

I demonstrated accountability by advocating on behalf of the client. I

was assigned a newborn admitted into the unit and I watched the
mother attempt to breastfeed the child and tried to help the mother with
breastfeeding by educating her on how to hold the baby while feeding,
and how to use tactile stimulation to keep the child from sucking. I
recognize that I did everything in my knowledge to help the family, and
then sought for my preceptors guidance in teaching the mother to
breastfeed. She also contacted the lactation consultant to assess her
feeding, in order to educate the mother better before she leaves the
hospital. I was able to advocate for the patient by connecting them to
resources that meet their needs, and also was able to recognize when I
have a gap in my breadth of knowledge.

I continue to maintain accountability by refraining from performing

activities such as independently administering narcotics to children.
When I am required to administer narcotics, I always have my
preceptor in the room when I am drawing up the medication, and also
have another nurse sign off to double-check the medication. I also
refrain from administering IV morphine and communicate this to my
preceptor accordingly. I let my preceptor know that I am not allowed to
administer such medications, and work together to provide care to the
patient.
Faculty Evaluative Comments
Pass Fail

Continued Competence
Students must assume
responsibility for their ongoing
professional development in
the practice setting
(progressive improvement in
knowledge, skills and
judgment).

I am able to demonstrate this standard by implementing a part of my

learning plan. For discharge teaching, I continued my competence by
developing a concept map on discharge teaching that includes
information about what asthma is, the signs and symptoms to watch out
for, what parents can do during an emergency situation, how to
administer medications, and what allergens to avoid. I also included
extra information on exercised-induced asthma, and how to
communicate with the childs school about their childs asthma. By
developing my knowledge on discharge teaching, I felt that I had a
better grasp on asthma management for the pediatric population. I also
feel more confident in providing health education to families regarding
asthma. I consulted with my preceptor as she is an asthma educator, to
ensure that the information that I provided are relevant and accurate.
I was able to continue my competence by investing time, effort and
other resources to improve my knowledge on what occurs during a
code pink on the unit. There was a situation in my unit where I took
part in a code pink on a child with RSV, as the child was apneic and

needed intubation. I felt that it was overwhelming as everyone knew

their role and were very organized on their tasks and the order of a
code pink. However, I felt that I lacked the knowledge on what the
process is like and the role of the nurses. After this experience, I
researched on the nurses role in a code pink to identify what type of
medications, and interventions are expected. By doing so, I will be
more confident in taking part in this emergent situation.

Faculty Evaluative Comments

Pass

Fail

Ethics
Students must understand,
uphold and promote the values
and beliefs described in the
ethical framework (1999). For
example, identification of
ethical issues in the practice
setting and identifying
strategies, in consultation with
the health care team, to
resolve ethical issues.

An ethical issue occurred in placement when a newborn was admitted

for hypoglycemia. Initially, she was very calm and was able to
advocate for her own child. Later throughout the night, she is seen
crying and refusing to be in the room alone. I came into the room, and
asked her what was wrong. She stated that she feels very sad and
depressed being alone in the room. She states that she would like to go
home. I felt unsure on the correct words to say, and told her to call her
husband to stay in the hospital with her to support her, and continued to
console her by stating that nurses are here to support her as well. My
preceptor communicated to her that she needs to stay as her childs
condition is not well enough to be sent home and that she needs to
learn how to care for her child before being discharged. In this
situation, I identified my personal values as I initially felt that she was
not ready or responsible for her childs condition. It was shocking to
experience a mother who was refusing to stay in the hospital and I felt
that she was not mentally prepared to learn how to care for the child. I
reflected on this thought and recognized that my thinking process is
inappropriate as I should not be jumping into conclusion or judging
their behaviours. I also recognized that I did not truly explore her
personal experience and situation that may have led up to his
behaviour. I was able to recognize my personal values and ensure that
it did not conflict with my care and communication with the families. I
continued to be respectful towards her throughout my shift. From this
situation, I reflected on my personal values and recognized that it is
unacceptable to enact in my professional practice.
Faculty Evaluative Comments
Pass
Fail

Knowledge
Students possess through basic
education and continuing
learning knowledge relevant to
their professional practice.
For example, being informed
about nursing and its
relationship to the health care
system. Students demonstrate
the ability to provide

In my placement, I was assigned a child diagnosed with NAS, which is

neonatal abstinence syndrome. This was my first time encountering a
child with this diagnosis and was able to find time to research on the
interventions regarding NAS. I was also informed by my preceptor
about how we use the NAS score to assess withdrawal symptoms. NAS
score assesses their status such as high pitched crying, sleep, muscle
tone, myoclonic jerks, temperature etc. which can be documented
through the eChart. The rationale for administering small dosages of
morphine PO is to gradually wean off the child daily to prevent severe
withdrawal symptoms. I was also able to recognize the collaborative

theoretical and evidence based

rationale for all decisions in
the practice setting.

effort of nurses assessing, and physicians titrating the drugs from the
nurses assessments. I was able to know to rationale behind the dosages
of morphine, and why it was decreased the next day.
Being in the circumcision clinic, I became informed about the roles and
objectives of nurses. I was able to help with assessing the weight of the
newborn upon admission. More importantly, I was assisting with the
circumcision procedure by placing the child on the surgery table, and
promote comfort by using sugar water and a sucker throughout the
whole procedure. I also had the opportunity to provide education to a
family about what to expect when they return home, and how to care
for the penis. I educated the family on the normal and abnormals signs
and symptoms post-procedure. From this experience, I was able to
understand the role of a nurse and its relationship to the health care
team in that situation.

Faculty Evaluative Comments

Knowledge Application
Students continually improve
their application of
professional knowledge.
Ensures practice is based in
theory, evidence and meets all
standards and guidelines

Pass

Fail

In my nursing practice, I was able to manage three patients effectively

which had multiple interventions. During this shift, I was responsible
for a newborn jaundice patient that required continuous monitoring, a
CBC to be completed by the nurse, and reminding the family to feed
and supplement with formula. My second patient was also a newborn
that had an NG tube, and required monitoring to meet the total fluid
intake each other. The infant also had three medications to administer
via IV push throughout the shift. My third patient was a tonsillectomy
post-op and required to be monitored as he has obstructive sleep apnea.
I was responsible for managing pain, and also ensuring that the IV site
in intact and running well throughout the shift. I was able to meet the
needs of all three clients by prioritizing my workload and planning
ahead to manage multiple interventions.

I was able to effectively use best-practice guidelines to address the

clients needs by conducting a lung assessment and recognizing
wheezing and crackles on all lobes. I consulted with my preceptor to
see if there was Ventolin via nebulizer available that promotes airway
entry in order to prevent further exacerbation of their symptoms. I was
able to apply my knowledge on airway management in children to
recognize that it is an abnormal finding, and their PRN medication will
help in alleviating the symptoms.
Faculty Evaluative Comments
Pass
Fail

Leadership
Students demonstrate
leadership by providing,
facilitating and promoting the
best possible care service to
the public.

I demonstrated leadership by acting as a role model and mentor to

students that were shadowing the unit for the day. I noticed that they
were interested in how the newborn assessments were done. My
preceptor allowed me to educate them based on my knowledge as I felt
experienced in this skill. I was able to guide them step by step on how
to find the apical pulse, and to count for a full minute. I also instructed
them that newborn respirations are often counted more efficiently if
their hand is on the abdomen. I let one of the students take an axilla
temperature, and to also listen to the apical pulse to engage them into
the learning. From this experience, I was demonstrating leadership by
sharing my current knowledge.

Throughout my whole nursing practice in the pediatric placement, I

role-model professional values of a family-centered care. I was able to
communicate with families and incorporate them into my plan of care.
An example is enacting this is when I allow the mother to take part in
the plan of care by either letting them calm their child using sugar
water during a blood work procedure, or simply letting them give an
oral medication to their child. By doing so, I am allowing the parents to
continue to show support to their child. Another important aspect of
family centred care is sharing information. An example of this when I
was assigned a post-op T&A, I always made sure to communicate with
the family the plan of care and managing pain. I let her know that if the
child experiences pain, vomiting, bleeding from nose or mouth, or not
drinking well, to let me know in order to intervene accordingly.

Faculty Evaluative Comments

Pass

Fail

Relationships
Students establish and
maintain respectful,
collaborative, therapeutic and
professional relationships.

In caring for children, I was able to develop a therapeutic relationship

with the family in order to ensure that the childs personal needs are
met. A child was admitted on the unit for constipation, and the mother
and grandmother was in the room. Instead of just doing my nursing
tasks, I had a conversation with the grandmother and mother about the
childs history leading up to constipation. From this, I was able to have
a better understanding of the childs school environment and also the
stress it puts in the family. They told me that the child goes over a
month without a bowel movement. The grandmother also expressed her
feelings in the childs situation as she feels very stressed and worried
about his condition. I reassured the family that it is concerning, and that
is why they are admitted at the hospital. I told them that the health care
team has the same goal of reducing constipation in the child. By
developing a therapeutic relationship, I felt that it was enjoyable to
collaborate with the family, and also ensure that the child remains that
main focus of this relationship
Faculty Evaluative Comments
Pass
Fail

Areas for Growth and Development

An area for growth is to become more proficient in calculating medications. At a point of the semester, I
was having difficulty calculating medications using a vial in a powered form. I felt that it was due to
anxiety, and my lack of experience of using a powered vial. It was difficult to read the instructions on the
label and find the one relevant to the administration. I have been practising and feel that I am more
competent in drawing up medications. I plan on continuing to engage myself in reviewing medication
administration questions to ensure that I provide the correct dose to the correct patient.
An area of development in my practice is to promote collaboration within the health care team. In my
clinical placement, I felt that I did not communicate my care to the physician or another health care
provider. This was due to my focus being strictly clinical skills, and anxiety due to internalizing that they
are the authority. Knowing that this is my gap, I would like to actively seek an opportunity to
communicate about abnormal findings, and become autonomous in consulting and contacting a
physician. In the future, I plan to integrate a portion of my future learning plan into inter-professional
collaboration.

Clinical Hours to date: 152 (+ 8 hours orientation, + 8 LAB + 3 HESI) = 171

Midterm Written Work

Letter Grade for LP1 _______

Midterm Practice

PASS

FAIL

Final Written Work

Letter Grade for LP1 _______ LP2 ______ RA _______

Final Practice

PASS

FAIL

FOR FACULTY USE ONLY

OVERALL STATUS IN NSE 417: PASS _____ FAIL _____
Comments:

Student Signature: ________________________ Date: ______________________________

Faculty Advisor Signature: ________________ Date: ______________________________