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 __x__
Student Name:

Rosette Lenon

Preceptor Name:

Marina L.

Final _____

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.

For a hypoglycemic patient, they required point-of-care testing with a

blood glucose meter. From orientation, I was aware that as a pregraduate student, this out of my scope of responsibilities and I
informed my preceptor about this restriction. Rather than performing
the procedure, I was able to watch her perform and interpret the results,
and intervention with my preceptor. I demonstrated accountability by
refraining from performing activities that I know that I am not
competent in. While I am not allowed to perform a glucose-check, I
interpreted the results with preceptor because that is a required
competency in nursing practice. I also watched her perform it because I
am aware that in the future of my nursing career, it is a skill that I will
learn through the agencys training.
During my second shift, I was unable to effectively hear a clear apical
pulse in a pediatric patient due to the lack of experience and skill. I
demonstrated accountability by seeking for my preceptors assistance
immediately and asked her for tips in the proper auscultation method in
taking an apical pulse in pediatric patients. From this, I also learnt that
apical pulses are taken for all pediatric patients. From seeking
assistance, it filled the gap in knowledge and ensured that my practice
meets the appropriate guidelines in providing accurate and safe care.

Faculty Evaluative Comments

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

Pass

Fail

A nurse demonstrates continuing practice by investing time, effort and

other resources to improve knowledge, skills and judgement. A
situation where I invested time and sought resources is when I noticed
a large number of newborns being admitted for jaundice in the
pediatric unit for phototherapy. I had the basic idea on how bilirubin is
a by-product of the breakdown of red blood cells, but I did not know
how it affected newborns. My preceptor filled in this gap by addressing
common reasons such as lack of nutritional intake (due to supply of
breastmilk) leading to poor output of bilirubin, or blood incompatibility
between mother and child. She also mentioned that phototherapy aids
in speeding up metabolism to secrete the excess bilirubin. To further
develop my knowledge, I researched jaundice in newborns after my
placement. I researched on its etiology, risk factors, signs and
symptoms, as well as common nursing interventions. The unit also had
charts that I reviewed regarding levels of bilirubin to determine their
risk, expected intervention, and when to notify MD. By investing time
to gain knowledge of the disease, I feel more equipped to care for the
newborns diagnosed with jaundice and perform the full scope of a

nurse, and ultimately promote inter-professional collaboration.

I am demonstrating continuing competence by developing a learning
plan on asthma management that focuses on pharmacological and nonpharmacological interventions, as well as discharge teaching. I will be
creating charts, and reference notes for myself to apply into practice. I
plan to spend my time developing and applying my knowledge to my
practice in order to become competent in caring for pediatric patients
with asthma.

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.

The unit had a situation where the newborn has an infiltration and
required an IV to be re-inserted, and the RN explained the issue and
plan to the mother. The father became upset at an RN because we did
not ask for his permission, as he was out of the hospital, regarding the
emergent nursing intervention. One of the issues that I often encounter
that clash with my personal values are when the father often hold the
power and authority to make decisions regarding the childs care,
meaning that the mother of the child would sometimes not be form
their own opinion due to their culture where men hold power. My
personal values would not tolerate this behaviour, as I believe that
gender should not equate who makes decisions. I believe that it should
be a collaborative decision between the parents regarding a childs
care. Despite my personal values, I reflected on my thoughts and
recognized this ethical issue to ensure that it does not interfere with my
professional practice, and will not show a negative behaviour towards
the family. I simply just recognized the issue, and continued to promote
a respectful therapeutic relationship towards the family.
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
theoretical and evidence based
rationale for all decisions in
the practice setting.

When administering salbutamol on a pediatric patient, it is not simply

knowing how to administer the medication; I needed to possess the
knowledge to know the reason for the medication, pre and post
assessments, method of delivery to the pediatric patient and also know
the adverse effects. In order to provide the medication, I knew that
asthma causes the constriction of the bronchioles, and salbutamol is a
bronchodilator which promotes airway entry into the lungs. I also
performed a pre-assessment to hear a decreased air entry in the lower
bases, and wheezing in the left and right upper lobes. For my postassessment, I use the knowledge of the purpose of the medication and
determine that the expected outcome would be decreased wheezing and
better air entry into the lungs. The method of administering the
medication is through a spacer, and I had the knowledge to know that
this promotes better inhalation of the medication since it can be
difficult to synchronize pushing the puffer and inhaling for a two year
old child. I was able to effectively aid in administering the medication

by knowing the rationales for the intervention.

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

Prior to starting placement, I did research on how taking vital signs are
different within the pediatric population. From the guidelines of Sick
Kids, I was able to know that apical pulse is taken for a full minute,
respirations taken for a full minute, and that temperature and blood
pressure are often done last because children perceive it as an invasive
procedure. Many guidelines also state that allowing the child to play
with the tool before taking it will ease the child from the procedure.
There was patient that had Downs Syndrome who was admitted. He
was very afraid with the thermometer and pulse oximetry. By reading
the guidelines and tips in taking vital signs of a pediatric patient, I took
respirations and the pulse first. I let him play with the thermometer and
helped him put it on the axilla, and also demonstrated that the pulse
oximetry was not painful by putting it on my finger first, then putting it
on his finger. By doing so, the patient become comfortable and less
anxious about the situation. I was also able to effectively take vital
signs in a pediatric patient.
When administering a subcutaneous injection, I refrained from
performing it first because I recognized my lack of knowledge in
performing it on a pediatric patient, as well as lack of prior experience.
My preceptor tested my knowledge on performing the injection on a
newborn. I learned that subcutaneous injections are often injected into
the thigh, with the skin pinched at a 90 degree angle because the
prepared enoxaparin had a small needle. After placement, I researched
on this. I had the opportunity of having the same patient with a
different preceptor. I informed her that I was comfortable enough in
administering a subcutaneous injection. With the same method that I
learned, I was able to successfully administer enoxaparin to the child
and applied my knowledge accordingly.

Faculty Evaluative Comments

Pass

Fail

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

Personally, I feel that this is an area of improvement as I feel that I

need to demonstrate leadership. In a situation where I felt that I
advocated for a patient was when their child had dry skin, and they
were ready for discharge. The mother was looking for a nurse, and I
asked her what she needed. She was looking for the doctor regarding
the dry skin and whether it needs a prescribed cream. To advocate for
her inquiry, I looked at her charts for any orders on the cream and
could not find anything. I was aware that the MD was in the unit, so I
searched for her and inquired her about any prescribed order for dry
skin on the newborn. She stated that it did not need any special
intervention. By advocating for the clients questions, she was able to
go home with all needs met.
I also demonstrate my own professional values regarding integrity. I
had the opportunity to prepare enoxaparin. While the substitute
preceptor for the day stepped out of the room, I remained true to
performing the three checks of medication administration. By doing
this, I noticed a medication error as the prepared enoxaparin was only
0.3 mL with multiple air bubbles, and I was intended to administer 0.5
mL as per order. I informed the RN, and she was able to call pharmacy
to correct the error. By maintaining integrity in the safety aspect of
medication administration, I was able to catch errors and promote
patient safety.

Faculty Evaluative Comments

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

Pass

Fail

In promoting a nurse-client relationship, I am able to focus on familycentered care. I developed a therapeutic relationship towards the
mother who has a child that has been through multiple complication
post-cardiac surgery, and is recovering from a post-op infection. They
have been in and out of the hospital since the beginning of September. I
showed respect and empathy by recognizing the strength of not only
the child, but also the mother and father for being able to handle the
stress. Whenever there is a PO medication, I would give the medication
to the mother to give to the child to promote collaboration into the care.
I felt that we had a good nurse-client relationship as she felt
comfortable with me, and trusted my skills to care for her child.
In terms of professional relationships, I role-model positive collegial
relationship between me and my preceptor as I treat her with respect
and trust her teaching methods. I acknowledge her skills and expertise,

and I have been learning about pediatric nursing by sharing knowledge

with each other. This has allowed me fill my gaps and gain a lot of
knowledge regarding caring for children.

Faculty Evaluative Comments

Pass

Fail

Areas for Growth and Development

Accountability
An area for growth and development is to demonstrate sharing nursing knowledge and expertise to meet
the clients needs. I plan to demonstrate sharing knowledge by being accountable for my patients status
and report to the following nurse. This is often done through verbal reports of significant findings, and
also a paper-chart documentation on the Kardex binder. In the future, I plan to become accountable with
my patients by providing report.
Continuing Competence:
To improve my skills of continuing competence, I plan to implement an aspect of my learning plan in
asthma management and be able to effectively administer medication with the knowledge of its purpose,
adverse effects, expected outcomes and how to incorporate the child and family into the care using my
pharmacological chart.
Ethics
To develop my ability to demonstrate ethics, I want to become more conscious of the separation of my
personal and professional values. Before my shift, I want to encompass my professional values of
nursing such as maintaining integrity and promoting dignity to patient care at all times despite my
personal beliefs. Preserving dignity could include promoting privacy when needed, and accounting for
their values, customs and spiritual beliefs. When encountering a new patient, I plan to check their charts
for cultural/spiritual preferences more thoroughly and implement it into my care.
Knowledge
I believe that I still have a gap in knowledge of caring for newborns, as I feel that I have had no
experience in caring for this population. To understand the knowledge required to meet the needs of this
population, I plan to continue reviewing newborn assessments, and the common diagnosis and nursing
interventions. Another aspect in pediatrics is the shift of professional practice to a family-centered care
approach. In my learning plan, I indicated the need to recognize how to develop a family-centered care
approach in order to apply it into the practice setting.
Knowledge Application
An area of growth and development is caring for PICC lines. While I learnt this skill in second year, I
want to address this gap by reviewing best-practice guidelines in caring for PICC lines (when to change
dressings, how to administer medication, locking and flushing). I plan on reading RNAOs best practice
guidelines Care & maintenance to reduce vascular access complications regarding PICC line care. I will
also search for policies regarding the nursing students role in PICC line care, and other specific hospital
guidelines in order to apply them in my practice.
Leadership
As mentioned, I feel that this is a gap in my care. I want to be able to demonstrate leadership by

collaborating with clients and the health care team to provide professional practice that respects the
rights of the client. I want to be able to promote inter-professional collaboration by independently report
significant changes or inquiry about an order to a physician and collaborate the plan of care. When
reporting to a physician, I will utilize an SBAR (Situation, Background, Assessment, Recommendation)
approach when providing report to ensure communication is clear. With this approach, I will be able to
promote leadership in the clinical care setting by advocating for a clients care.
Relationships
In order to develop my ability to promote a therapeutic relationship, I hope to be able to become more
independent with my patient assignments, and then be able to ensure that the family and childs need are
met. To do this, I want to encompass a relationship that is trustworthy, respectful, and use my power as a
nursing student accordingly to meet their needs. I plan to spend more time communicating with my
patients, and asking them throughout the shift if they have any questions or needs that I can fulfill.
In professional relationships, I hope to become more comfortable with the unit and promote interprofessional collaboration, especially within the pediatrician. As I become more competent and
knowledgeable about the daily tasks, I hope to promote interprofessional collaboration by sharing my
knowledge with other health care professionals to determine the best quality of care to the patient. I also
would like to maintain collegial relationships with other RNs in the unit by continuing to seek guidance
with respect to their expertise in pediatrics and nursing in general.
Clinical Hours to date: 64 hours ( + 8 hours orientation, +8 LAB +3 HESI) = 83 hours
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: ______________________________