Self Assessment

2017 - 2018 - NURS 208 Course Learning Outcomes Final (201708)

NUR 208 Practical Nursing Practice 4 (PN, 05-Sep-2017 - 31-Jan-2018)
Student : Hamzah Teli
Clinical Teacher/Preceptor : Kelly Ross
Program Coordinator : Judy Martin
Location : University Health Network/Toronto Rehab Lyndhurst
Site
Placement Setting : Agency
Unit/Office/Clinic : 7 South Musculoskeletal Program
Period : 05-Sep-2017 To 08-Dec-2017
Student hours : 126
Required Hours : 196
Validated hours : 138
Teacher comment for validated hours:
missed one 6 hour clinical day

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: Consistently practice safely,
competently, and ethically within legal and regulatory frameworks and the policies and procedures of the practice setting.

Satisfactory Satisfactory
1. 1 Comply with regulatory standards, relevant legislation and the practice setting’s policies and

procedures.

H.T. : I have completed the Humber College pre-placement requirements and done the UHL learning modules.

K.R. : Hamzah did complete the necessary requirements prior to his placement at TRI. It is important to also consider and maintain the CNO practice

standards and use these to guide your practice regardless of what setting you will practice in.

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

H.T. : I come prepared and on time to clinical. I research about my patient's diagnosis and medication to provide proper care.

Satisfactory Satisfactory
1. 3 Determine how the three factor and practice decision-making frameworks influence client care.

H.T. : The three-factor and practice decision-making frameworks influence client care by involving the client, the nurse, and the environment. The

clients on the floor are low complexity, predictable and have a low chance of negative outcomes. One patient on the floor was there for pain

management. This patient was low complexity, predictable and had a low risk of negative outcomes. The floor has the resources to care for this

patient effectively. One time on the floor where part of the care for one patient was transferred to another nurse was when the patient needed a wound

dressing change. A wound nurse had come to the floor to tend to the patients wound.

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

H.T. : I use proper technique when performing procedures. For example, making sure the pathway for my client is clear of obstacles before moving

them to avoid falls and injury.

 Satisfactory Satisfactory
1. 5 Carry out safety-based practices and risk management principles to ensure client safety and a

safe environment.

H.T. : When transferring and positioning clients I carry out safety-based practices to avoid patient falls and injury.

Satisfactory Satisfactory
1. 6 Ask questions and clarify the plan of care, unclear orders or directions, and whenever uncertain.

H.T. : I clarify medication changes and orders that are not clear or have not been transcribed properly with the primary nurse.

Satisfactory Satisfactory
1. 7 Demonstrate professional behavior by seeking assistance in situations in which there is unsafe,

unacceptable and/or unprofessional behavior.

H.T. : N/A

Satisfactory Satisfactory
1. 8 Demonstrate understanding about the role of the nurse within health care.

H.T. : I understand the role of a nurse in healthcare. Nurses are responsible to provide safe and competent care to clients. Nurses work with patients

and the healthcare team to assist patients in learning how to manage their own health.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK: Consistently
practice safely, competently, and ethically within legal and regulatory frameworks and the policies and procedures of the practice setting. :

Hamzah practices with knowledge of the main priorities on the unit, one of them being safety. This is reflected in his daily practice and his
concept maps he has presented. He prioritizes increased independence with an awareness of the clients impaired physical mobility. He
ensures transfers are safe and the clients environment is safe. He recognizes there are policies set out by UHN by completing the pre
placement modules.

2. ACCURATE AND RELEVANT COMMUNICATION: Communicate using strategies and technology to affect accurate and timely documentation,
reporting, and information sharing.

Satisfactory Satisfactory
2. 1 Participate in team sharing and discussions.

H.T. : I participate in weekly post-conference to discuss and share key moments from the week. This is one way I improve on my weaknesses

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

H.T. : I document daily progress notes accurately to provide a clear understanding of the client's state for other team members. I try implementing the

SOAPIE method of charting to provide a full picture for the healthcare team.

K.R. : This is one area in which I would have Hamzah focus more time and consideration of the expectations of the unit and the CNO. Hamzah's

charting is short and concise and could be improved by reviewing PCARE (Toronto Rehab's charting protocol) or the CNO documentation practice

standard. When documenting for individual clients, the documentation should provide a clear picture of the needs or goals of the client or group; the

nurse’s actions based on the needs assessment; and the outcomes and evaluation of those actions.

Satisfactory Satisfactory
2. 3 Report relevant information to the appropriate personnel.

H.T. : I report medication shortages to the pharmacy by feeling out the medication request form and by also calling and letting the pharmacy staff

know.

Satisfactory Satisfactory
2. 4 Use communication techniques with the client and the inter-professional health care team.
H.T. : I give recognition to patients when transferring them. I let them know what they are using the right and wrong techniques to safely transfer.

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

(PHIPA).

H.T. : I do not leave client charts unattended and open while on the floor and only consult with healthcare personnel assigned to the patient.

Satisfactory Satisfactory
2. 6 Use technology to retrieve and share information including research, evidence based data, and

other health information.

H.T. : I use computers on the floor to research about topics I do not understand. For example, I researched about proper use of medication when I

needed to provide a client with certain information.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION: Communicate using strategies and technology to affect accurate and
timely documentation, reporting, and information sharing. :

Hamzah is able to verbally communicate effectively with the group in post conference, the nurses he works with and myself. His
communication during client physical assessments can be improved by practicing with colleagues, friends and family in order to smoothly
transition between health history questions and physical exam techniques. This confidence will come with experience and knowledge of all
the appropriate assessments per system.

3. CARING RELATIONAL PRACTICE: Establish and evaluate relationships that are caring, compassionate, and respectful of clients and others.

Satisfactory Satisfactory
3. 1 Use effective communication techniques.

H.T. : Refer to 2.4

K.R. : Hamzah is able to use verbal and non-verbal communication in providing his care to clients. As mentioned above during physical assessments

smooth verbal communication of health history and physical assessment will come with increased practice.

Satisfactory Satisfactory
3. 2 Establish and evaluate therapeutic caring, compassionate, and culturally safe relationships with

clients and health care team members.

H.T. : I try to connect with the patients with similar interests that we share. I connected with one of my clients because we shared the interest in

sports. Another client of mine was being treated for injuries related to a vehicle accident. He shared his story with me and so I shared with him that I

had experienced a similar situation.

Satisfactory Satisfactory
3. 3 Demonstrate therapeutic use of self to foster client well-being.

H.T. : Refer to 3.2

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

relational practice.

H.T. : refer to 3.2

Satisfactory Satisfactory
3. 5 Collaborate with clients and members of the inter-professional health care team and consult

appropriately.
H.T. : I collaborate with PT/OT to encourage exercise and prevent certain movement. I also discuss what is best for my clients, hot or cold packs and

for how long to apply for. One of my clients was feeling soreness in their knee and after collaborating with the PT and client we decided to apply a hot

pack for 10 minutes.

Satisfactory Satisfactory
3. 6 Support the diversity of clients and the inter-professional health care team.

H.T. : Refer to 3.7

Satisfactory Satisfactory
3. 7 Display sensitivity and respect for clients’ cultural, religious, and other beliefs and values

influencing their choices and decisions.

H.T. : When interviewing a client for admission the client expressed that they required a specific meal plan. The client's choices were respected and

food services were notified.

Satisfactory Satisfactory
3. 8 Provide client education and evaluate effectiveness.

H.T. : My primary nurse and I educated a patient on how to self-inject a medication. To evaluate the effectiveness we asked the client to repeat the

procedure in front of us.

Teacher comments for CARING RELATIONAL PRACTICE: Establish and evaluate relationships that are caring, compassionate, and respectful of
clients and others. :

Hamzah begins his day by introducing himself to the clients primary nurse and then explaining his role in the clients care for the day. He is
able to give the client the time and opportunity to express their needs and explain their symptoms and strives to understand the clients
experience. He will also build trust and rapport with clients by getting to know them on a personal level.
He will consult as needed when he does not have the answers.

4. LEADERSHIP AND ADVOCACY: Use leadership skills to promote quality practice.

Satisfactory Satisfactory
4. 1 Apply appropriate conflict resolution skills in therapeutic client and other interactions.

H.T. : I respect my clients right to choose and make sure they have sufficient knowledge to make decisions. For example, one of my clients made the

decision to wait an additional day before taking a laxative to promote a bowel movement. I ensured that the client had the proper knowledge to make

an informed choice decision.

Satisfactory Satisfactory
4. 2 Evaluate and refine leadership skills to develop solutions and create a positive work

environment.

H.T. : I try the help my peers by answering any questions they have to the best of my ability before asking others for help. One of my peers needed

help with preparing for a dressing change and I helped them by telling them what materials they needed.

Satisfactory Satisfactory
4. 3 Provide feedback to peers and accept feedback from peers and members of the inter-

professional health care team.

H.T. : I am always open to feedback from my colleagues and I give feedback to my peers when I think it is appropriate. Before charting, I get

feedback from my peers and revise my notes.

Satisfactory Satisfactory
4. 4 Advocate for clients, self, others, and quality practice environment.

H.T. : I advocated for a client by telling that doctor that a patient was not taking a medication for the right reasons. The patient was not in need of this

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

H.T. : Refer to 4.1

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

H.T. : N/A

Satisfactory Satisfactory
4. 7 Collaborate and consult when implementing health care and nursing practices that are in the

best interests of the public and protect the public through collaboration and consultation.

H.T. : When admitting a patient they have to be consulted with to gather information to provide proper care. I observed my assigned nurse interview a

new client.

Satisfactory Satisfactory
4. 8 Contribute to the creation of quality practice solutions and strategies.

H.T. : I participate in the daily huddle that occurs on the floor to bring awareness to certain problems.

K.R. : By attending safety huddles and listening to the concerns of the team, Tseten participated in the process of ensuring the unit remained safe for

the staff and clients.

Teacher comments for LEADERSHIP AND ADVOCACY: Use leadership skills to promote quality practice. :

A component of client advocacy is allowing the client choice, supporting clients autonomy and speaking up on behalf of the client when
needed. Hamzah has been able to both advocate on behalf of his client and offer the clients choice in their care. He understands that client
choice should be backed by sufficient knowledge to make an informed decision and ensures he has done the appropriate teaching.

5. PLANS OF CARE: MEET CLIENTS’ NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES: Develop, evaluate, and modify mutually
agreed upon plans of care that maintain, promote, and restore health, prevent illness, support rehabilitation, and provide palliation.

Satisfactory Satisfactory
5. 1 Incorporate the clients’ unique needs and expected outcomes into holistic and client-centred

plans of

care.

H.T. : Refer to 3.7

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

competently in writing and orally.

H.T. : I develop theory-based plans of care by creating concept maps that are holistic and client-centred for each of my clients each week.

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

H.T. : When one of my clients was feeling nauseous the priority was to make sure they were not experiencing any other symptoms that could have

been related to their preexisting conditions. By doing this I can rule out other possible causes

Satisfactory Satisfactory
5. 4 Collaborate in the evaluation and modification of plans of care.

H.T. : I participate in weekly rounds where the doctors, pharmacists, occupational therapist, physiotherapists and nurses collaborate on how plans of

care can be modified to fit changing patient conditions.

 Satisfactory Satisfactory
5. 5 Safely and competently implement and evaluate nursing assessments and nursing interventions

in a manner that demonstrates knowledge and skill.

H.T. : When Administering PRN pain medications first I assess my client's pain then after administering I assess again to see the effectiveness of the

medication.

Satisfactory Satisfactory
5. 6 Use the Three-Factor and practice decision-making frameworks to guide practice.

H.T. : Refer to 1.3

Satisfactory Satisfactory
5. 7 Prioritize nursing care and nursing interventions in order to manage workload, time, and physical

resources.

H.T. : I make sure that my clients are ready for their appointments and PT sessions by getting them dressed in proper clothing/shoes and making

sure they have the pain medication to avoid limitations when moving.

Teacher comments for PLANS OF CARE: MEET CLIENTS’ NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES: Develop, evaluate, and
modify mutually agreed upon plans of care that maintain, promote, and restore health, prevent illness, support rehabilitation, and provide palliation. :

Hamzah arrives early to use the clients kardex and chart prior to the start of his shift to research the clients admitting diagnosis and past
medical history. He determines what the clients needs will be and if there are appointments so that he can plan his day. When asked about
his plan he is able to share this with myself, the nurse and the client. He consults and collaborates with his primary nurse as needed
throughout the shift so they have updated information on the clients status.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM: Work effectively as a member of the inter- professional health
care team to develop and carry out holistic plans of care recognizing age-specific changes.

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

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

H.T. : I consult with OT's, PT's and the client to see how much activity can be tolerated by the patient to make sure they achieve the mutually agreed

expected outcomes.

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

needs and expected outcomes of clients.

H.T. : I consult with the primary nurse in some cases when I notice that the client is meeting goals and should be taken off priority transfer

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

H.T. : When a medication was not refilled on time I consulted with the pharmacy to have the medication delivered as soon as possible.

Satisfactory Satisfactory
6. 4 Use teamwork, consensus building, and conflict resolution skills to meet expected client

outcomes.

H.T. : I working as a team with occupational therapists and physiotherapist by following directions on exercises, transfers, and treatment to meet

expected client outcomes.

Satisfactory Satisfactory
6. 5 Use effective, collaborative, and consultative strategies to meet client’s needs within a changing

environment.
H.T. : When a new client arrives on the floor, they go through an admission which involves a consultation with them regarding how they prefer there

care. I have done this interview with my assigned nurse.

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

H.T. : Refer to 6.1

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM: Work effectively as a member of the inter-
professional health care team to develop and carry out holistic plans of care recognizing age-specific changes. :

Agree with the above comments. Hamzah has collaborated with the nurses and allied health team in order to establish best practices for
his individual client as well as their therapy goals.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE: Provide safe, competent care by using reflective practice and Quality
Assurance practices.

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

consultation with members of the inter-professional health care team and through competent and safe

practice.

H.T. : Refer to 5.4

Satisfactory Satisfactory
7. 2 Engage in ongoing reflective practice to identify strengths, areas for improvement; and, integrate

feedback into practice.

H.T. : I am always open to criticism from my teacher and other nurses. I always take feedback and try to implement it to try and improve my

weaknesses.

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

(CNO).

H.T. : I have made a learning plan for the future and will try to accomplish my goals by the midterm of next semester. my goals are to improve my

assessment and documentation skills.

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

integrate these into practice.

H.T. : I try to find patients on the floor that have a dressing change or staple removal so I can learn from observing and practicing these skills.

Satisfactory Satisfactory
7. 5 Use nursing research to foster professional development and implement nursing care plans.

H.T. : I develop weekly nursing care plans by researching my patient's diagnosis to provide client specific care.

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

H.T. : Refer to 1.4 and 2.6

Satisfactory Satisfactory
7. 7 Apply knowledge of changes to the health care system, technology, and in society as these

affect nursing practice.

H.T. : On the floor, there was a change in how they deal with health care professionals when they get the flu. To avoid the chance of nurses coming

into work because of losing a sick day the management made it so they no longer lose a sick day.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE: Provide safe, competent care by using reflective
practice and Quality Assurance practices. :

Hamzah is able to take constructive feedback well, When asked a question or given a suggestion on how to improve his practice he will
make the necessary changes.
Hamzah will seek out learning opportunities with his peers who are performing new skills (i.e. dressing changes or IV priming). He
participates in weekly K4Y submissions and reflects on his clinical experiences in post conference.

8. CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING: Use critical thinking, problem solving, and decision making skills to meet the
health care needs and expected outcomes of clients.

Satisfactory Satisfactory
8. 1 Use critical thinking and problem-solving skills to inform decision-making in all aspects of nursing

care.

H.T. : By assessing one of my clients I noted them having symptoms of constipation. Rather than starting them on PRN laxatives, we tried to solve

the problem by using natural methods like increasing fibre/fluids in their diet, increasing physical activity as allowed.

Satisfactory Satisfactory
8. 2 Use critical thinking, problem-solving and decision-making skills to assess clients and to

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

H.T. : Refer to 8.1

Satisfactory Satisfactory
8. 3 Evaluate critical thinking, problem-solving, and decision-making skills and design a plan to

improve

these.

H.T. : Assessment is an important part of problem-solving. You need to have all the information to treat the problem. I have made a learning plan

regarding my assessment skills.

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

provide safe and competent care.

H.T. : I implement what I learn in class when practicing on the rehab floor. For example, I try to connect the client's diagnosis with what medication

they are taking from what I learn in Pharmacology. When one client has a history of HTN I recognize which medications they are taking to treat the

condition. This helps me make concepts maps regarding my specific clients.

Satisfactory Satisfactory
8. 5 Prioritize effectively.

H.T. : Refer to 5.3

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

H.T. : Before leaving the floor I make sure I have done appropriately documented and my assigned nurse knows the status of my client. By doing this

I make sure the primary nurse is aware of the

Satisfactory Satisfactory
8. 7 Use the practice decision-making and the nurse-client-environment frameworks to inform and

guide practice.
H.T. : Refer to 1.3

Teacher comments for CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING: Use critical thinking, problem solving, and decision
making skills to meet the health care needs and expected outcomes of clients. :

Hamzah demonstrates his critical thinking through his daily medication review when he connects his clients medical diagnoses to
medications. He is able to report how medications will impact clients and the desired results of medications he is given whether they are
standing order medications or PRN. When he requires assistance he will seek out the primary nurse or myself to review his findings and
plan. He has been able to effectively and efficiently organize his day to care for two clients while supporting his colleague and his primary
nurse with other tasks as needed.

Student Final Summary with Strategies for Continued Growth

Nursing is a lifelong process and you can learn something new every day. Always be self-aware of your skills so you know where you can improve.

Teacher Final Summary with Strategies for Continued Growth

It was great to have you within the clinical group. You brought the desire to learn and grown while supporting your colleagues to do the same!
I encourage Hamzah to ensure that his documentation in comprehensive enough to allow other providers to have a sense of relevant subjective and
objective assessment data, plan of action related to any abnormal findings and the results. At times Hamzahs charting can be brief. This is a form of
communication to nurses coming in on other shifts as well as other health care professionals. Clear, comprehensive and accurate documentation is
an integral part of safe and effective nursing practice. Documentation provides a record of the judgment and critical thinking used in professional
practice, and provides an account of the nurse’s unique contribution to health care.

Student's References

http://www.cno.org/globalassets/docs/prac

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