NURS 3021H Clinical Practice Focused on Chronic Disease Management

Mid-Term Evaluation Final Evaluation X

Student: Bethany Carr

Clinical Instructor: Sharon Tripp

Clinical Placement Hospital: 120 Unit: Rehab

Date: November 26, 2017

Missed Clinical Hours: 8 Missed CLC Lab Hours: 0

 NURS 3021H Clinical Practice Mid-Term Evaluation
Program Goals
Students graduating from this program will be:
1. Prepared as generalists entering a self-regulating
profession in situations of health and illness.
2. Prepared to work with people of all ages and genders
(individuals, families, groups, communities and
populations) in a variety of settings.
3. Expected to have an enhanced knowledge of the program
foci: indigenous, women's and environmental health and
aging and rural populations.
4. Prepared to learn to continuously use critical and scientific
inquiry and other ways of knowing to develop and apply
nursing knowledge in their practice.
5. Prepared to demonstrate leadership in professional nursing
practice in diverse health care contexts.
6. Prepared to 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
7. Able to establish and maintain therapeutic, caring and
culturally safe relationships with clients and health care
team members based upon relational boundaries and
respect.
8. Able to enact advocacy in their work based on the
philosophy of social justice.
9. Able to effectively utilize communications and
informational technologies to improve client outcomes.
10. Prepared to provide nursing care that includes
comprehensive, collaborative assessment, evidence-
informed interventions and outcome measures.
3000 Level Outcomes
On completion of 3000 level courses students will be
able to:
Fully understand how to practice in a self-regulating
profession.
Analyze clinical situations and reflect on individual roles of the
nurse as it impacts upon patients and the nursing profession.
Rationalize the link between health and illness.
Understand the complexity adults, of all genders, to achieve
optimal health.
Use a critical perspective in applying the foci to nursing
knowledge and practice.
Integrate critical reflective evidence-informed care using
multiple ways of knowing.
Develop and embody leadership at the point of care.
Expand awareness of leadership in nursing.
Identify strategies to develop leadership potential.
Anticipate, identify and manage risk situations.
Demonstrate awareness of resources related to risk
management.
Engages in deliberative personal centred relational practice to
assist individuals, families and communities to achieve health.
Acknowledge own potential to contribute to effective
collaborative team function.
Advocate for individuals, families, and communities
recognizing the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.
Integrates and applies critical thinking to the use of
information technology and dissemination strategies as related
to clinical outcomes.
Critically assess the individuals, family and community health
status.
Collaborate to identify priority health needs.
Identify evidence informed interventions and health outcome
evaluation in complex care situations.
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.

Each objective should be awarded one of the following ratings:

Midterm:
Satisfactory Progress (SP): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve
the objective with an average level of teaching support and guidance; or the level of performance is what the instructor would
expect of an average student at that level and point in time; and the instructor reasonably anticipates that if the student
continues at the current pace of practice and achievement, the student should be able to fully meet the objective at the end
of the course.

Needs Development(ND): The student demonstrates sufficient knowledge and ability to safely practice or achieve the
objective, but requires more than average teaching support and guidance; or the student demonstrates knowledge but needs
more practice to achieve the competency; or the level of performance is below what the instructor would expect of the
average student at that level and point in time; and the instructor reasonably anticipates that if the student focuses his/her
learning in the required area, and gains sufficient practice, the student has the potential to meet the objective at the end of
the course.

Unsatisfactory Progress (UP): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or
achieve the objective, even with constant, intensive teaching support and guidance; or the level of performance is far below
what the instructor would expect of the average student at that level and point in time; and the instructor reasonably
anticipates that if the student continues at the current pace of practice and achievement, the student is not likely to meet the
objective at the end of the course.
Final:
Satisfactory (S): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve the
objective with an average level of teaching support and guidance; or the level of performance is what the instructor would
expect of an average student at that level.

Unsatisfactory (U): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or achieve
expected objectives, even with constant or intensive teaching support and guidance; or the level of performance is far below
what the instructor would expect of the average student at that level.
 NURS 3021H Clinical Practice Evaluation
Course Objective
1. Demonstrate accountability and responsibility in the
teaching-learning relationship.
2. Explain the experience of chronic illness in individuals
receiving care in chronic care settings
Progress
Evidence/Indicators SP/S ND UP/U
I have handed in all assignments on time.
I complete all pre clinical work and medication
preperation as well as post clinical work.
I believe Sharon and I have an open line of
communication if I need something from her and
I feel comfortable approaching her if I am in need.
The same goes for if I am doing something
incorrectly, she would correct me and help me in
a respectful and meaningful way.
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Prepared post clinical and facilitated in a
professional and effective way on Schizophrenia
I believe I met this objective when I spent time
talking to a patient over two weeks. She talked
about her excitement to go home and get her hair
done and wear makeup. She also enjoys travelling
and is not use to spending so much down time in
bed. It made me realize that not all patients are
leaving to go to LTC but some are going home to
continue living their lives as they were before,
this is just a little stop on the road for them.
Another patient I talk with each week, had spent
their summer on the unit. The patient is very kind,
and often reminds me to think from the patients
prespective. I explained something I was doing
and he told me I needed to think about what the
other patient might be experiecing at the time. It
really opens my eyes when someone on the unit
is willing to help students slow down and open
their eyes to the patient experience on the unit.
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3. Interpret critical aspects of the persons experience of
chronic illness in relation to the nursing process such as
common signs and symptoms, responses to treatment,
patterns of coping, and impact on individual and family
relationships.
I have had numerous patients speaking about the
food offered on the unit, how it is decent enough
and there is variety but it doesnt compare to
being at home.
I believe I have met this objective when helping a
patient who some days can help themselves and
others needs full assistance. He often says he
can't do it, or that he is sorry. I often tell him he
doesnt need to say sorry to me, we are trying to
help him to the best of our abaility but he feels
like since he can't help sometimes he should be
sorry for it.
Each morning a patients son brings him a coffee
and sits with him at breakfast, it is nice to see
such a positive reationship and the impact it can
have on the patient. He seems much happier and
social when his son is there and gets out of bed. I
have helped him other days when he barely
replies to me and seems very lathargic. The
difference between the two moods is dramatic
but also refreshing that a family support is there
for him.
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One week I had a patient become very angry with
me because she felt weak and couldn't get up. I
explained to her that I wasnt trying to rush her
and we could take our time to complete the task.
After a few moments she apologized and it is easy
to understand that taking our anger out on
someone can be easy to do when you are
frustrated when becoming fatigued so easily.
Another patient talked to me about how
frustrating it is to have this surgery that is

4. Identify symptoms and common medical treatments of
selected chronic illness.
5. Demonstrate select nursing and collaborative interventions
related to caring for the person with chronic illness such as
specific assessments, medication administration, physical
and chemical restraints, enteral feeding & residual
volumes, NG tube insertions, wound care, patient
controlled medication administration pumps.
suppose to help her and how it isnt fair that it is
so hard after. She seemed very discouraged when
I help her with care, which then made it more
difficult for me to help since she was becoming
less willing to help. This can result in a very
negative cycle where she won't be seeing the
results she wants and won't continue to put in
the work if she isn't seeing the results.
I believe I have completed this objective by
completing weekly pre-clinical and post clinical as
well as completing my preperation to give
medications on my selected days.
Patients I have worked with have had mobility
issues due to hip fractures to AFIB and spinal
compression fractures. Patient diagnosis and
ability must be clear before attempting to help
patient.
I will conitnue to research patient diagnosis and
treatments before every shift to continue
learning, there are a variety of different reasons
are on the rehab unit and every patient is
different.
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Attending all post clinicals and having a more
indepth understanding of a few chronic illnesses.
I believe I have met this objective by completeing
a head to toe assessment on my assigned patients
each shift and charting findings such as breathing
and bowel sounds.
Completing vital signs on my two assigned
patients and other patients nurses require vital
signs for.

6. Identify potential consequences/complications of select
chronic illnesses and related interventions.
7. Under the supervision of a Registered Nurse, demonstrate
safe, competent, evidence-informed, holistic nursing
practice with clients with chronic illness
a. Use a wide range of effective communication
strategies and interpersonal skills to appropriately
establish, maintain, re-establish and terminate the
nurse-client relationship
b. Demonstrate accountable, responsible and ethical
practice
c. Engage in respectful, collaborative, therapeutic
and professional relationships
Though my patient was off unit on my two
medication days, I have assisted the nurse I am
assigned to in the process of medication
administration. I have been shown and can use
Pyxis, access a patient's eMAR, and scan patient
and medications using checks.
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Completing assessments on patients who have
edema or pain.
Completed two days of medication
administration.
I believe I have completed this objective by
looking into possible complications or reasons
why my patients are taking certain medications.
Also reviewing patients lab values to find out
possible problems is also very beneficial.
There are many complications that I have seen on
the unit the most common I have witnessed are
bed sores/pressure ulcers, constipation, hospital-
acquired pneumonia, and UTIs.
There are specific treatments for each one of
these complications but interventiosn taking
place before hand can stop the complication from
taking place or reduce the incidence.
A) I try to be confident when talking to patients,
as well as I keep an open-mind, I use active
listening and giving time for patients to finish
their thoughts if it takes a while to be
communicated. I try to use good body language
that is appropriate and eye contact.
In practice I try to maintain a positive attitude
when appropriate, as a nurse student I am a team
player and assist RPNs and RNs on the unit who
may need something done.
 i. Demonstrate therapeutic use of self
ii. Create a culturally safe environment
d. Apply nursing models and theories
e. Demonstrate health promotion and illness
prevention practices
f. Demonstrate patient advocacy
g. Predict outcomes of nursing care
h. Evaluate client response to nursing care
i. Critically appraise own practice in relation to
nurse-client/family interactions and as a member
of the health care team
B) Practice within my nursing student scope of
practice, and adhere to hospital and school
policies. Ask for assistance from nurses on the
unit when needed, and seek help from other
nursing students.
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Check with perceptor or assigned nurse if I have
any concerns with vital signs found.
C) Using verbal and nonverbal forms of
communication as mentioned above to
communicate effectively with members of the
health care team and patients.
To create a culturually safe environment I have
reflected on my own culture, views and attitudes.
I can recognize stereotypes and avoid using them
as they can be offensive and not true.
D) During post clinical each week we look up a
nursing theory or framework that applies to our
patient the given week. Reflecting on theories
learned in class and through readings helps me
have a better understanding and fit my practice
to a theory.
E) I have been helping promiting health by
helping patients get to their physio class and
encouraging patients to attend exercise classes. I
also have provided morning care and showers for
patients who need assistance.
F) I have advocated for patients by letting their
nurses know if they require pain medication, and
in one case, one patient requires gravol daily as
she gets very nauseus.
G) Monitoring patients as they receive
medications, or after they have used the
bathroom after having some discomfort. Keeping
an open communciation between myself in
patients so I may know their feelings

8. Critically appraise own practice in relation to nurse-
client/family interactions and as a member of the health
care team
9. Participate in professional development based on
reflective practice and critical inquiry
Areas of Strength Identified by Student
1. Communication skills
2. Patient assessments and charting
3. Taking opportunities to see different aspects of the hospital to gain a more hollistic view
before/during/after.
H) As stated before I tried to keep an open line of
communication between myself and patients. I
conducted pain assessments and asked questions
to determine their level of comfort or need.
I have struggled in some situations on what to say
to patients, one patient who has trouble
understanding is sometimes hard to
communicate with and it takes patience. In other
cases I am intimidated by some nurses working
on the unit, and find it hard to approach them
because I am nervous.
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I believe I have met this objective by completing
my first reflection. For my first reflection I focused
on an event that stuck out in my mind to patient
and nurse safety, which happened on my 6th shift.
I focused on problems I saw with the situation
and how I think it could have changed for better
or worse. By reflecting I was able to learn from
the past if I ever come across a similar situation.
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Completing my second reflection based on a
situation I experienced with a patient who had
not been bathed in over a week.
Areas for Future Development Identified by Student

1. More practice preforming wound dresses

2. Being more confident with my skills when offered a task

3. Using different version of Meditech then I am use to

Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment)

Clinical Practice Attendance (8 Hours Per Shift)

Thurs Fri Thurs Fri

Week 1 8 8 Week 6 8
Week 2 8 8 Week 7 8 8
Week 3 8 Week 8 8 8
Week 4 8 8 Week 9 0
Week 5 8 8 Week 10

Total number of clinical practice hours completed: 120 /128 Hours

Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory Unsatisfactory

Clinical Learning Centre

Total number of clinical simulation hours completed 3.5 / 14 Hours

Total number of lab hours completed 10 / 22 Hours

Clinical Learning Centre Outcome (completed by Course Lead): Satisfactory Unsatisfactory

Signature of Course Lead: Date:

Signature of Clinical Instructor: Date:

Signature of Student: Date: