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 :
Clinical Teacher/Preceptor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Period :
Student hours :
Required Hours :
Validated hours :

Janine Ervie Garcia

Marlene Sutherland
Wendy Chow
William Osler Health Centre/Brampton Civic Hospital
Agency
N3 ACE
12-Jan-2016 To 07-May-2016
168
168
156

Teacher comment for validated hours:

Janine was absent on April 12 due to illness this clinical term.
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

1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies and

Satisfactory

Satisfactory

procedures.
J.E.G. : I have delivered a safe nursing care for my patients by complying with policies and procedures set by my clinical placement establishment as
well as by performing procedures according to CNO standards. For example, I do not help patient with getting out of bed by myself unless I have
conducted a fall risk assessment or a therapist have set a mobility instructions for the patient.

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

Satisfactory

Satisfactory

J.E.G. : I always take full responsibility for my patients and accountable for all my actions while in the clinical setting. For example, now that I am
able to administer PO, inhalation and SC medications to my patients, I make sure that they are given on time and I do not miss any medications by
checking my patient's MAR frequently and also to look for any new orders (CNO, 2008).

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

Satisfactory

Satisfactory

professionals.
J.E.G. : By performing self-evaluation, I am able to determine my strengths and limitations in terms of delivering care for my patients. I never hesitate
on asking the primary nurse or my clinical instructor for help if I am unsure of anything. For example, I ask my clinical instructor to provide guidance
when I am administering SC medications.

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

Satisfactory

Satisfactory

J.E.G. : If need to go in an isolation room, I make sure I wear all the necessary PPE depending on the type of isolation as well as perform hand
hygiene especially before and after I enter the room because evidence informed practice suggest that performing these precautions will decrease the
risk of spreading infection.

1. 5 Ensure client safety and a safe environment.

Satisfactory

Satisfactory

J.E.G. : I always assure client safety and provide a safe environment. For example, when transferring patient from bed to the wheelchair, I make
sure the wheelchair is locked so it will not slip away when patient is attempting to sit on it and patient's foot will not get caught in between the blankets
or hanging cords such as the call bell cord.

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

Satisfactory

Satisfactory

J.E.G. : I ask the primary nurse or my clinical instructor if I do not understand or have a question regarding my patient's plan of care or if the care
needs to be re-assessed. For example, my patient who had Hepatic Encephalopathy was on soft-restraint when I came in the morning because she
was confused and was pulling out her tubes but after assessment of my patient, I determined that she is alert, oriented and far from confused
therefore I informed the primary nurse of my assessments and my patient was then taken off from soft-restraints (Potter et al., 2014).

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

Satisfactory

Satisfactory

J.E.G. : I will be able to identify ethical and unsafe situations and act accordingly based on my learning and I I will seek assistance from the primary
nurse, my clinical instructor and the health care team when necessary to find a resolution to the situation.

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

Satisfactory

Satisfactory

J.E.G. : After completing 10 placement days, I have come to understand the role of the student nurse. It is to provide not only basic nursing care for
my patients but providing holistic nursing care consisting of getting them better or at least making them feel better as well as addressing each of their
concerns.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
Janine has practiced safely, competently and ethically, complying with the policies and procedures of WOHS and CNO. She has
incorporated the policies that guide safe patient care in the area of medication administration, mobility and nutritional guidelines such as
dietary restrictions for patients with swallow limitations. She has mobilized patients during activity; following the guidelines laid out by
physiotherapist and nursing staff to ensure patient is ambulated and transferred safely. She has followed IPAC standards for hand hygiene
and isolation regulations. She has ensured patient equipment is used safely, being mindful of breaks, position of bed and chairs; and
ensuring patients are able to reach the call bell system.
Student has acted in an accountable manner in preparing for clinical by researching all relevant patient related information to ensure they
are providing safe nursing care that reflects the care need for individual patient. Has researched patient specific medical diagnosis in
order to understand the nursing care needs required
She is able to determine strengths and weakness by practicing self-reflection and incorporating guidance provided during feedback on
how she could improve her practice, incorporating this feedback in her practice to achieve beneficial methods of conduct in the practical
setting.
Used theory-based approach to practice by implementing the theoretical content gleaned during her first and second semester of learning
in the academic setting. This has been evident in her knowledge base as she has been able to discuss patient care need with instructor
appropriately.
She has been able to ask relevant questions to clarify and guide actions and task appropriately and safely, example if she needed to clarify
her understanding of medical diagnosis and medication usage, clarify medical terminology and clarify information found in patient chart,
Kardex and MARs
Has demonstrated understanding of the role of the student nurse by applying academic learning appropriately in the clinical setting,
working as a part of the care team at all times and working well with peers to provide safe nursing care.

2. ACCURATE AND RELEVANT COMMUNICATION

2. 1 Participate in team sharing and discussions.

Satisfactory

Satisfactory

J.E.G. : If there is any interesting or unusual situation that happened during the placement day or even uncommon diagnosis of my patients, I make
sure I share it during our post-conference to extend the knowledge to my peers, get some feedback and learn more from it.

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

Satisfactory

Satisfactory

J.E.G. : Before documenting, I make sure all the necessary information for my documentation is ready and on-hand so I can document accurately
and concisely. I also assure that documentations are done in a timely manner by planning and organizing my day as well as double checking if all the
required documentation are completed.

2. 3 Report relevant information to the appropriate personnel.

Satisfactory

Satisfactory

J.E.G. : If there are any concerns regarding my patients, I report the primary nurse or my clinical instructor so appropriate interventions can be
planned and carried out. For example, my patient's BP was significantly high so I reported the information to the primary nurse and anti-hypertensive
medication was administered.

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

Satisfactory

Satisfactory

J.E.G. : When I conduct assessments of my patients, I actively listen to their words and even beyond words by observing their gestures and body
language because sometimes they may say one thing but mean the opposite. I make sure I use open-ended questions to allow my patients to speak
their mind and express themselves further. With the inter-professional health care team, I show respect by using the right tone of voice and
acknowledging their presence and sometimes ask questions regarding my patient.

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

Satisfactory

Satisfactory

(PHIPA)
J.E.G. : I abide by the privacy and confidentiality according to PHIPA by keeping patient information only within the healthcare team and those
directly involved with my patient's care (CNO, 2009).

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

Satisfactory

Satisfactory

J.E.G. : I utilize the technology at WOHS to gather information regarding my patient through the electronic medical records. For example, I had a
patient with Hepatic Encephalopathy so I looked at her diagnostic and laboratory data to find out more about her current situation and determine if she
is getting better and also to determine other necessary interventions needed to be carried out to further assess her condition and to help her get better
if she was not making progress.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Janine has been able to participate in team sharing and discussion by building on her confidence in speaking to the healthcare team. She
has been able to communicate with nursing staff during shift report to collected and provide necessary information on plan for patients
care. She has documented appropriately in the EMR, patient MAR and communicated patient related information to staff nurse, charge
nurse and clinical instructor appropriately to ensure all involved is aware of plan for patient care and any changes to plan of care
accordingly.
Has been able to build on confidence to utilize communication techniques with the client and also involved family members in discussion
as appropriate, for example to translate and instruct patient when language barrier is present. Janine has been able to communicate with
inter-professionals such as physiotherapist and occupational therapist in efforts to plan and deliver appropriate nursing care for patients.
She has maintained privacy and confidentiality when discussing patient care needs and ensuring all conversations regarding patient is
done with confidentiality in mind.
Has been able to utilize the electronic documentation system to document and research patient care related information such as lab
values, patient history, results of test and procedures and notations from healthcare staff such as nurses and physicians that is found in
the patients EMR
Janine has grown a great deal in her communication skills during the clinical as indicated by the comment made above. She is much more
comfortable communicating with those around her as she gained greater experience in the clinical setting.

3. CARING RELATIONAL PRACTICE

3. 1 Utilize effective communication techniques.

Satisfactory

Satisfactory

J.E.G. : My patients are all elderly so I take their age into consideration whenever communicating with them and using communication techniques
such as allowing extra time for them to respond as well as not hesitating to repeat myself I determine that my patient did not understand what I said. I
also make sure I clarify things with my patient and not assume anything.

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

Satisfactory

Satisfactory

and health care team members.

J.E.G. : I always try to build rapport with my patients and the healthcare team as well as establish positive nurse client therapeutic relationships. I
made sure I address my patients and the healthcare team the way they wanted to be addressed. Furthermore, I allow time and do not disturb my
patients who are praying and hold actions until after my patient has finished praying.

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

Satisfactory

Satisfactory

J.E.G. : For example, since I am able to administer medications to my patients, I am able to help aid their pain especially those not relieved by
positioning or diversion techniques.

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

Satisfactory

Satisfactory

relational practice.
J.E.G. : I had a patient with diabetic foot ulcer who required a below knee amputation but because of their beliefs, they refused the operation. From
my point of view, I believe that if it means saving one's life, whatever it is, it must be done but I also believe that it is important to respect patients
decision especially decisions that would contradict their beliefs so I treat my patient the same as I treat any other patient.

3. 5 Interact with clients and members of the inter-professional health care team; and, consult

Satisfactory

Satisfactory

appropriately.
J.E.G. : I take advantage of every opportunity I get to communicate with the inter-professional health care team including the PT, OT and dietitians to
discuss progress of my patients and necessary adjustments required to achieve an improved health status of my patients.

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

Satisfactory

Satisfactory

professional health care team.

J.E.G. : WOHS acknowledges the diversity of clients and inter-professional health care team by providing menus that take religion into consideration.
For example, they provide Halal menu and vegetarian menu to consider Muslims and Hindus respectively.

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

Satisfactory

Satisfactory

clients choices and decisions.

J.E.G. : My Hindu patient who had a diabetic foot ulcer and required a below knee amputation declined the operation due to his belief that the body
must be preserved as a whole.

3. 8 Provide effective client education.

Satisfactory

Satisfactory

J.E.G. : For my patient who had a diagnosis of CHF and had +1 edema on both of her lower extremities, I provided health education on how to
reduce the edema keeping her feet elevated although never elevate above heart level, reducing salt intake and performing ROM.

Teacher comments for CARING RELATIONAL PRACTICE :

Janine has utilized effective communication techniques when interacting with staff, patients, allied healthcare professionals, each other
and instructor.
Has demonstrated therapeutic caring and culturally safe nursing care by being mindful of the cultural needs of patient population such as
dietary restrictions and privacy needs for prayer and meditation.
Has used self-awareness to identify the effects that beliefs, values and personal experience has on relational practices such as being
mindful of how ones individual experiences may related to the experience of clients and their families for example understating how illness
and mindset of health influence individual patient behaviors
She has consulted with staff, OT and physio appropriately when she needed directions, clarifications and additional information that would
benefit the nursing care being provided.
Has applied knowledge of practices and systems that support the diversity of the client population of the ACE unit. These clients are
elderly and require a great deal of care, they have varied cultural backgrounds and student has been mindful of this when providing
nursing care. Has also been mindful of patients religious beliefs that influence choice again such as diet needs and giving patients the
opportunity to have time to pray during the day.
Is mindful of cultural diversity and cafe needs for patients with varied cultural beliefs, respecting their care needs as appropriate.

4. LEADERSHIP AND ADVOCACY

4. 1 Recognize conflicts and strategies for resolution.

Satisfactory

Satisfactory

J.E.G. : I will be able to recognize conflicts based on my learning and I have sufficient knowledge on conflict resolution that will help me resolve
different conflicts that would arise in the future.

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

Satisfactory

Satisfactory

J.E.G. : If there is any interesting or unusual situation that happened during the placement day or even uncommon diagnosis of my patients, I make
sure I share it during our post-conference to extend the knowledge to my peers, get some feedback and learn more from it.

4. 3 Identify opportunities to improve health care service and nursing interventions by advocating for
client, self, others, and quality practice.

Satisfactory

Satisfactory

J.E.G. : For my patient who had Hepatic Encephalopathy was on soft-restraint when I came in the morning because she was confused and was
pulling out her tubes but after assessment of my patient, I determined that she is alert, oriented and far from confused therefore I informed the primary
nurse of my assessments and my patient was then taken off from soft-restraints (Potter et al., 2014).

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

Satisfactory

Satisfactory

professional health care team.

J.E.G. : I provide feedback to my peers regularly when I notice them doing a good job or I believe they can do better and I ask them to evaluate my
skills too in performing interventions for my patients whenever they are around to assist or just witness.

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

Satisfactory

Satisfactory

J.E.G. : Every morning I give my patients freedom to choose how they want their hygiene care to be carried out, whether they want it on the bed or in
the washroom, if they are allowed, while promoting patient independence as much as I can.

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

Satisfactory

Satisfactory

J.E.G. : Once I have determined there are unsafe, unacceptable and unprofessional behaviors during clinical, I will act professionally and seek help
from appropriate health care staff to help me manage the situation.

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

Satisfactory

Satisfactory

interests of the public and protect the public through collaboration and consultation.
J.E.G. : I communicate and consult with the PT, OT and Dietitian in order to provide the best quality of care possible for my patient and also to set a
common goal for my patient to achieve a better health status.

Teacher comments for LEADERSHIP AND ADVOCACY :

Janine has been able to understand the theory supporting conflict resolution and has been able to demonstrate leadership skills. This has
been evident as student has taken part in discussions with nursing team regarding patient care needs, clarifying plan of care as necessary.
Engaging in discussion with peers regarding best approach to plan of care for their individuals patients. They have worked very well
together to foster an environment conducive to learning.
She have advocated for patients by informing appropriate individuals regarding changes in patients plan of care for example when patient
is having difficulty with voiding or having too many bowel movements that required changes in their care interventions. Janine has been
able to engage in activities that encourages providing feedback to her peers and wither receiving feedback as well. They have been able to
assess each others skills and capabilities and give each other directions accordingly on how thy might improve their basic nursing skills.
She has consulted and collaborated with staff members, instructor and peers in efforts to provide beneficial nursing care to her patients,
supporting client choice at all times by providing client with the information they require to make decisions concerning their care.
Janine has shown growth and development in her leaderships skills. She was very quiet at the start of the semester but has been able to
build her knowledge regarding leadership qualities and demonstrated them appropriately over the course of the clinical practicum.

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

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

Satisfactory

Satisfactory

J.E.G. : One of my patient had CHF and COPD. After helping her eat breakfast in the morning, she developed wheezing and I determined she
needed her inhalation medications but I have never administered it before so I looked for my clinical instructor to provide supervision while I
administer the medication but I found out she was busy with another student so I took the initiative to ask the primary nurse to supervise me instead
because the need for the inhalation medication arose and was needed to be administered as soon as possible to help my patient breathe easily.

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

Satisfactory

Satisfactory

competently in writing and orally.

J.E.G. : By constructing a concept care map for my patients, I am able to determine their nursing needs, I am able to set a goal, develop a plan,
implement interventions and evaluate if the goals are met. For example, I constructed a concept care map for my patient with Type 2 Diabetic Mellitus.

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

Satisfactory

Satisfactory

J.E.G. : When I am assessing patient's level of pain and I determine that my patient is in an intolerable pain and can only be relieved using
pharmacological intervention, I make sure that I check the MAR for any scheduled or PRN pain medications so I can administer it to my patient right
away and alleviate their pain.

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

Satisfactory

Satisfactory

J.E.G. : My patient who had Hepatic Encephalopathy was on soft-restraint when I came in the morning because she was confused and was pulling
out her tubes but after assessment of my patient, I determined that she is alert, oriented and far from confused therefore I informed the primary nurse
of my assessments and my patient was then taken off from soft-restraints (Potter et al., 2014).

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

Satisfactory

Satisfactory

based and within skill abilities.

J.E.G. : There was an order for my patient who developed pneumonia and was on recuperating period to wean off oxygen so I would check her
respiration and oxygen saturation and report it to the primary nurse so we can decide to decrease her oxygen flow as her respiration and oxygen
saturation gets better.

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

Satisfactory

Satisfactory

J.E.G. : As an example, my patient's BP was significantly high so I reported the vital signs to the primary nurse and I then administered a diuretic and
anti-hypertensive medication as per order to decrease my patient's BP. I made sure I evaluated if the medication has taken effect after 30 minutes.

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

Satisfactory

Satisfactory

manner.
J.E.G. : Now that I am able to administer PO, inhalation and SC medications to my patients, I make sure that they are given on time and I do not miss
any medications by checking my patient's MAR frequently and also to look for any new orders (CNO, 2008). I also make sure I assess my patients
post-medication administration. For example, upon giving pain medication, I re-assess my patient after an hour to determine if the medication has
taken effect and my patient has improved level of pain.

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

Janine has ensured she is meeting the unique care needs for her patients she has cared for clients with Renal Disease, Cardiac disorders,
Diabetes, Hypertension, COPD Pneumonia etc. and has always ensured she knew their unique care needs for these etiologies as they
related to the specific patients.
During the time caring for these patients she has been able to provide holistic nursing care again that is specific to the individual patients
diagnosis and care needs.
She has been able to utilize knowledge of the disease process for example understanding the diseases process of Renal insufficiency ,
Hypertension etc. and what to expect for nursing care, monitoring intake and output, assessing lab values and monitoring blood pressure.
In the case of her diabetic patient, monitoring blood sugars; for clients with respiratory ailments, understating to monitor respiratory rate
and oxygen saturation levels. She has been able to safely carry out nursing care based on the fact that she has researched the patients
conditions and as such, understood the care needs required, utilizing theory based assessment and nursing interventions.
She has been able to carry out nursing care that reflects the decision making process such as holding diabetic medications when the
patients blood sugars levels are too low, holding patient B/P meds when their blood pressure is too low, holding bowel routine
medications after assessing the client's bowel movement activity; holding medications for patients going to Hemo Dialysis. Has also been
able to assess patient for activity, having them limit activities based on their energy levels if they are fatigued.
Janine has been able to provide nursing care in an organized manner for this latter half of the clinical. She is able to plan her day utilizing
a work plan and is able to complete hygiene care needs, perform treatments, administer medications and document the nursing care
provided in a timely manner.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

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

Satisfactory

Satisfactory

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

J.E.G. : Whenever the opportunity arises, I communicate and consult with the PT, OT and Dietitian in order to provide the best quality of care
possible for my patient and also to set a common goal for my patient to achieve a better health status. For example, one of my patient was assessed
by the PT for her level of ambulation and determined that she needed a one person assist when getting out of bed but is aiming for full independence
prior to discharge.

6. 2 Contribute as a member of the inter-professional health care team to respond to the changing

Satisfactory

Satisfactory

needs and expected outcomes of clients.

J.E.G. : As an example, my patient needed to be weaned off from oxygen so I would check her vital signs regularly taking note of her respiration rate
and oxygen saturation to determine if her oxygen flow could be slowly lowered down.

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

Satisfactory

Satisfactory

J.E.G. : One of my patient was needed to be seen by the Physiotherapist and Occupational Therapist so when the Physiotherapist came to assess
my patient for improved ambulation, I discussed with them the progress of my patient in regards to ambulation also any further nursing care needed to
hasten my patient's recovery.

6. 4 Use teamwork, consensus building, and conflict resolution skills.

Satisfactory

Satisfactory

J.E.G. : If there are any circumstances that needs a collaborative work to resolve, I will utilize teamwork, consensus building and conflict resolution
skills to overcome the issue.

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

Satisfactory

Satisfactory

J.E.G. : Based on research that when people are hospitalized, especially the elderly, there is a high risk for them to develop blood clots because of
restricted movements and lack of exercise while confined in the hospital so they are given prophylactic anti-coagulants. I would consult with the
primary nurse as well as check the blood results on whether to administer the prophylactic anti-coagulant if my patient is already receiving another
anti-coagulant. Also I would monitor my patient for signs of bleeding if I do administer the both the anti-coagulants.

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

Satisfactory

Satisfactory

J.E.G. : When the wound care nurse came to perform dressing and a possible debridement on my patient with diabetic foot ulcer, we had a
discussion about the need for debridement and how to continue with the dressing. I also assisted him in performing wound dressing while he
explained to me how the need for amputation is vital to prevent development of osteomyelitis.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

During her time on the ACE unit, Janine has arrived at the stage in her learning where she can comfortably work with allied staff and staff
members in a way that meets the expected outcomes of the patient. She has been able to provide basic nursing care, provide nutritional
care, ambulate patients, send and receive patient to test and procedures while working with the health care team members in a
collaborative effort.
She has been able to seek assistance as needed when providing care to patient, for example if she needed assistance in bathing and
ambulating patients. Provide hygiene care needs when patient was incontinent of urine or stool and skin care; and also if she needed
direction for administration of medications and treatments. She has interacted with members of the healthcare team in these instances
appropriately.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

7. 1 Act in the best interests of clients and protect clients from harm through collaboration and

Satisfactory

Satisfactory

consultation with members of the inter-professional health care team and through competent and safe
practice.
J.E.G. : Physiotherapist came to assess my patient for level of ambulation and by having the physiotherapist assess my patient, I was confident in
assisting my patient in getting out of bed but also making sure I test my patient's leg strength prior to transfer.

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

Satisfactory

Satisfactory

J.E.G. : I always perform self-reflection on how I deliver care to my patients and I practice to improve on skills I am not yet confident in performing.
For example, for administering SC medications, I made sure I practiced manipulating with the syringe and practice to point the needle away from me
and the patient after administering SC medication even if safety device has been initiated.

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

Satisfactory

Satisfactory

(CNO).
J.E.G. : I develop concept care map for my patients to determine their nursing needs and be able to set a goal, construct a plan, implement the
interventions and finally evaluate if my interventions has achieved the planned goal.

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

Satisfactory

Satisfactory

integrate these into practice.

J.E.G. : The wound care nurse came to perform dressing on my patient with diabetic foot ulcer. I asked about the kind of dressing ordered for my
patient and he stated to use Inadine which is a brand of non-adherent surgical dressing containing the disinfectant povidone-iodine but there was
none available in the ward because apparently not many use them but he insisted that it would be the best for my patient's kind of wound so he
placed an order for Inadine. For my future dressing, I would look for Inadine to use for my patient if povidone-iodine is required.

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

Satisfactory

Satisfactory

J.E.G. : I do this constantly searching the best care possible for my patient. For example, my patient was a fall risk therefore I utilized theory and
literature to plan and implement ways on how my patient will not fall such as keeping the bed at its lowest, making sure call bell is within reach and
answered promptly when patient calls as well as other necessary belongings are placed on a reachable side table.

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

Satisfactory

Satisfactory

J.E.G. : When administering medications, I make sure I utilize the CNO's 8 rights of medication administration because it has been proven to reduce
the potential of medication error if followed precisely (CNO, 2008).

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Janine has been able to protect patients from harm as she ensured she had the correct instruction for providing safe nursing care at all
times. She would ensure she knew the patients diet, activity tolerance, nursing care needs and researched medications as necessary prior
to administering them.
She has been able to self-reflect on her performance, taking the time to practice and change methods of conduct when she needed to
improve a skill or learn a different method to accomplishing task. She has practiced how to administer s.c. injections, administering
inhalation treatments, ambulating patient in a different way to achieve safe transfer.
She seeks out learning opportunities by assisting the nursing staff in providing care for patients other than the one she is assigned to,
offering her a broader learning opportunity as she cares for other patients with varied health challenges and health needs. She has been
able to utilize literature and theory from her academic studies such as books, online courses, simulation practice labs and medication
administration drug books.

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

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

Satisfactory

Satisfactory

J.E.G. : My diabetic patient had a blood glucose level of 3.7 mmol/L prior to having his lunch and with that information, I recognized that my patient
was hypoglycemic therefore I informed the primary nurse as soon as possible so that hypoglycemic protocol could be initiated for him and
complications arising from hypoglycemia could be prevented.

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

Satisfactory

Satisfactory

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

J.E.G. : By constructing a concept care map for my patients, I am able to determine their nursing needs, I am able to set a goal, develop a plan,
implement interventions and evaluate if the goals are met. For example, for my diabetic patient I developed a nursing care plan consisting of:
Nursing diagnosis: Fatigue RT decreased metabolic energy production and altered body chemistry of insufficient insulin AEB lack of energy and
inability to maintain usual routines
Expected outcomes: Patient will verbalize increase in energy level and will improve participation with ADLs
Nursing interventions: Discuss with patient the need for activity, plan schedule with patient, identify activities that lead to fatigue, alternate activity with
periods of rest and uninterrupted sleep, monitor VS before and after activity, do not rush patient when providing nursing care and increase patient
participation in ADLs as tolerated
Evaluation: Patient displayed improved ability in participating with ADLs

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

Satisfactory

Satisfactory

J.E.G. : With medications, I am always cautious and utilize self-reflection on whether I am done the administration right. For example, prior to
administering warfarin (Coumadin) to my patients, I make sure I check the blood work especially the INR level to give me a basis on whether to
continue with the administration or hold the dose and inform the primary nurse regarding the situation so proper actions could be taken.

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

Satisfactory

Satisfactory

provide safe and competent care.

J.E.G. : When administering medications, I make sure I utilize the CNO's 8 rights of medication administration because it has been proven to reduce
the potential of medication error if followed precisely (CNO, 2008).

8. 5 Use prioritization strategies for client care.

Satisfactory

Satisfactory

J.E.G. : For my diabetic patients who require blood glucose monitoring prior to every meal, I make sure that blood glucose level is obtained 30
minutes prior to their meal so I would be able to administer insulin or hypoglycemic oral medication if necessary.

8. 6 Demonstrate professionalism and accountability.

Satisfactory

Satisfactory

J.E.G. : I am always professional and accountable for my actions. For example, I take full responsibility for my patients when administering
medications. I make sure I know the medication indication and other related factors regarding the medication I am giving. I also make sure that they
are given on time and I do not miss any medications by checking my patient's MAR frequently and also to look for any new orders (CNO, 2008).

8. 7 Recognize strengths and limitations and seek appropriate assistance and support.

Satisfactory

Satisfactory

J.E.G. : By performing self-evaluation, I am able to determine my strengths and weaknesses and if I know I need guidance or I need to consult
anything with the primary nurse or my clinical instructor, I do not hesitate and do not delay it if it means better outcome for my patient or just to
increase my understanding of my patient's condition.

Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY :
Janine is able to utilize problem solving skills for example, able to think through care needs for patient when there is an unplanned change
in schedule or medications changes are made. Able to assess patient for pain medication usage and if they have not had the required
amounts of urine output for the shift.
Is able to utilize knowledge such as pathology when discussing lab values for patient with elevated potassium, low hemoglobin due to
Chronic Kidney Disease. Also able to assess patient with hyper/hypo glycemia, administer or hold sc and oral diabetic medications
accordingly based on findings. Able to assess patients with COPD, asthma and pneumonia and understand the respiratory assessment
finding as it pertains to lung auscultations. Also able to understand the use of puffers and inhalation treatments to treat these disorders.
She is able to understand the assessment process for patients with edema to limbs and assess for pitting edema specifically. Able to
assess normal and abnormal vital signs and report finding appropriately to nursing staff and to instructor. Demonstrating professionalism
and accountability at all times during the clinical experience. Janine has cared for patients with Foley catheters and understood the
nursing care required for such interventions.

9. SIM number of hours

9. 1 SIM number of hours

J.E.G. : 6

M.S. : 6

Teacher comments for SIM number of hours :

Janne has utilized the SIM lab as a means to aid in her development and learning of theoretical content that guides her ability to critically
think through care need for patients.

Student Final Summary with Strategies for Continued Growth

I will continue to conduct research to better understand my patient's illnesses and link it with their lifestyle and past medical history because most of
the complaints that my patients come in with are related to previous illnesses. I will also familiarize myself to medications commonly administered so I
can save time and I will be able to administer medications in a timely manner especially if I have more than one patient to care for. Furthermore, I will
continue to communicate with the health care team and will advocate for my patient if any issues needs to be addressed.

Teacher Final Summary with Strategies for Continued Growth

Janine has meet the criteria required for a satisfactory pass this clinical. She has managed in her role as a student, administering medications and
treatments for patient in her care. She has given medications via PO, Inhalation, rectally and S.C safely with good techniques at the beginners level.
Janine is encouraged to continue to be attentive to her academic studies by continuing her learning in areas such as anatomy and physiology,
pathophysiology and medication usage in treatment of disease. She will benefit from these studies as she continues the PN course for the next
semester. She is to continue using her textbooks and other literature/resources for learning as she continues in the PN nursing program.

Student's References
College of Nurses of Ontario (2008). Practice Standards: Medication, Revised 2008. Toronto, ON: College of Nurses of Ontario.
College of Nurses of Ontario (2009). Practice Standards: Confidentiality and PrivacyPersonal Health Information. Toronto, ON: College of Nurses of
Ontario.
Potter, P., Perry, A., Ross-Kerr, J., Wood, M., Astle, B., Duggleby, W. (2014). Canadian Fundamentals of Nursing, 5th Edition [VitalSource Bookshelf
version]. Retrieved from https://pageburstls.elsevier.com/books/978-1-926648-53-8

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

Student Comment
I have gained so much experience during this clinical rotation. I will retain the knowledge as well as continue to learn, explore and practice best
quality of care for my future patients.