NURS 253 STUDENT SELF-ASSESSMENT

EVALUATION OF PERFORMANCE OCCURS AT WEEK 4 and/or ongoing (if required), WEEK 7 (Midterm), Week 11 AND WEEK 15 (Final)
NOTE: Students who are experiencing difficulties that could result in an unsatisfactory in Week 7 or Week 15 will be expected to do a self-evaluation and receive
a preceptor and faculty evaluation in Week 4 and/or week 11, and as required.

PLEASE CIRCLE

S = SATISFACTORY

COMPETENT AND SAFE PRACTICE WITHIN A LEGAL

AND ETHICAL FRAMEWORK
1. Model safe, competent, and ethical practice in
compliance with legal and regulatory frameworks
and the policies and procedures of the practice
setting.
i.
ii.
iii.

iv.
v.
vi.
vii.
viii.

ix.

Comply with regulatory standards, relevant legislation

and the practice settings policies and procedures.
Act in a professional, responsible, ethical and
accountable manner.
Use the three factor and decision making frameworks
to determine strengths and limitations and when to
collaborate and consult with other professionals.
Integrate evidence-informed practice and a theory
based approach into nursing care.
Assess practices and risk management principles and
take action to ensure safety of clients, self, and others.
Question and clarify unclear orders or directions and
when uncertain.
Question, clarify or challenge questionable orders,
decisions or actions by others.
Respond in a professional manner to situations in
which there is unsafe, unacceptable or unprofessional
behavior.
Demonstrate understanding about the role of the nurse
within health care.

Week 4

ND = NEEDS DEVELOPMENT
S

ND

Student signature and date

Week 7 S ND U

Student signature and date

Week 11 S ND U

Comments

Preceptor signature and date

Comments

Preceptor signature and date

Comments

Student signature and date

Week 14

U = UNSATISFACTORY

Preceptor signature and date

Comments

Demonstrated competent and safe practice in a hospital setting. Organized

plans for each patient received from report and provided full patient care in a
timely manner. Asked for clarification regarding medication administration
depending on patients condition. ex. Administration of blood pressure
medication when patients systole bp is lower than 100. Asked for preceptors
assessment when a new wound or rash was presented during skin
examination.

Student signature and date

Week 4

ND

Preceptor signature and date

Comments

ACCURATE AND RELEVANT COMMUNICATION

6. Communicate using strategies and technology to
effect accurate and timely information sharing
including data, research, and other information.
i.
ii.
iii.

iv.

v.
vi.

Contribute to team sharing and discussions.

Document clearly, accurately, concisely in a timely
manner using written and electronic methods.
Use effective communication techniques when
reporting relevant information and providing feedback
to the appropriate members of the interprofessional
heath care team.
Evaluate and refine techniques used to communicate
and share information with clients and the
interprofessional health care team.
Ensure privacy and confidentiality.
Use technology to retrieve information including
research and other date and to obtain and forward
information both within and outside the practice setting.

Student signature and date

Week 7

ND

Student signature and date

Week 11 S ND U

Student signature and date

Preceptor signature and date

Comments

Preceptor signature and date

Comments

Preceptor signature and date

Week 14

Comments

Provided patient report to team leader and informed and consulted with team
leader regarding vital signs, diet, skin integrity, mental status, etc. Provided
relevant information during the huddle with the unit manager and reported on
assigned patients conditions and progressions. Utilized therapeutic
communication techniques with patients and ensured privacy and
confidentiality. Utilized medtech to access assigned patients reports, vital
signs, lab results, progression notes, eMAR in order to prioritize and practice
safe and effective care.

Student signature and date

CARING RELATIONAL PRACTICE

Week 4

ND

Preceptor signature and date

Comments

7. Engage in relational practice that is caring,

compassionate and respectful.
i.

ii.

iii.
iv.

Establish therapeutic caring, compassionate, and

culturally safe relationships with clients and health care
team members.
Establish a caring environment that supports clients in
meeting their needs and outcomes, managing their
illness, or experiencing a peaceful death
Demonstrate therapeutic use of self to foster client
well-being.
Utilize relational knowledge and skills, and ethical
principles to support clients and to interact with health

Student signature and date

Week 7

ND

Preceptor signature and date

Comments

Student signature and date

Week 11

ND

Preceptor signature and date

U

Student signature and date

Comments

Preceptor signature and date

c
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Week 14

Comments

Provided safe and compassionate environment for clients. Developed therapeutic

nurse-client relationships with assigned clients. Continued to maintain positive
therapeutic relationship with patients and the health care team. Demonstrated
respectful behaviour and cooperation to patients and family members. Supported
the diversity of clients and of the health care team. Continued to teach clients the
purpose of each procedure prior to it being done. Explained the importance of ROM
exercises. Provided discharge instructions to clients and when appropriate family
members.

Student signature and date

Week 4

ND

Preceptor signature and date

Comments

LEADERSHIP AND ADVOCACY

8. Act as a leader and an advocate to empower
clients, self, the interprofessional health care team
and to further the profession.
i.

Evaluate and refine leadership skills to develop

solutions, resolve conflict, create a positive work

Student signature and date

Preceptor signature and date

ii.

iii.
iv.
v.
vi.

vii.
viii.

environment and organizational culture, and to

strengthen advocacy role.
Provide feedback to peers and accept feedback from
peers and members of the interprofessional health care
team.
Advocate for clients, self, others, and quality practice
environment.
Support clients rights for self-determination and
choice.
Respond appropriately to unsafe, unacceptable, and
unprofessional behaviors.
Demonstrate public protection and acting in the
interests of the public through collaboration and
consultation with other members of the
interprofessional health care teams.
Contribute to the creation of quality practice strategies
and solutions.
Assign, supervise, teach as appropriate, and provide
feedback to unregulated care providers (UCPs) in
collaboration with the interprofessional health care
team.

Week 7

ND

Comments

Student signature and date

Week 11 S ND U

Comments

Preceptor signature and date

Student signature and date

Week 14 S
U

Comments

Preceptor signature and date

Continued to advocate for clients while respecting clients' choice, and

cultural beliefs. Understood the importance of autonomous care and
encouraged independence. Provided safe environment for clients and
continued to contribute to quality nursing care. Worked with PSW's and
volunteers and provided professional and appropriate leadership skills to
work in collaboration.

Student signature and date

Preceptor signature and date

PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY

AGREED EXPECTED OUTCOMES

Week 4

ND

Comments

9. Integrate the nursing process into all aspects of

nursing care and across diverse practice settings.
i.

ii.
iii.
iv.
v.

vi.

vii.

viii.

Formulate clinical judgments that meet clients unique and

changing health needs and priorities, outcomes, and overall
condition and incorporate these into evolving plans of care.
Devise evidence-informed plans of care that are holistic and
client centered.
Use clinical judgment to assess clients, prioritize needs,
outcomes, and nursing interventions.
Collaborate in the evaluation, refinement and modification of
plans of care.
Safely and competently perform treatments and use
techniques, and technology autonomously and in
collaboration with clients and members of the
interprofessional health care team.
Collaborate with the clients across the lifespan and with
members of the interprofessional health care team to create
a client centered plan of care that is articulated with
competence both in writing and orally.
Use awareness of own knowledge and skills, the three
factors of nurse, client and environment and the practice
decision-making framework to guide practice.
Manage workload, time, and physical resources to provide
effective, efficient and ethical care.

Student signature and date

Preceptor signature and date
Week 7 S ND U
Comments

Student signature and date

Week 11 S ND U

Preceptor signature and date

Comments

Student signature and date

Week 14 S U

Preceptor signature and date

Comments

Developed daily organizational care plan to prioritize care while working

five client case load during day shift and eight client case load during
night shift, working collaboratively with preceptor. Continued to monitor
patients with confusion and decreased LOC ensured patient safety and
protected them from harm. Performed routine check Q1H during night
shift. Performed Q2H turning for patients unable to reposition
independently to prevent pressure ulcers. Reoriented confused patients
to prevent injuries including falls and self-harm.

Student signature and date

Preceptor signature and date

COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH

CARE TEAMS

Week 4

ND

Comments

1. Collaborate and consult with clients and the

interprofessional health care team to provide
comprehensive and holistic health care in a complex
and changing environment.

i.

ii.
iii.
iv.
v.
vi.
vii.

Collaborate with clients and members of the

interprofessional health care team to determine needs,
mutually agreed health outcomes, approaches to care, and
to evaluate care.
Contribute as a member of the interprofessional and health
care teams to respond to changing client needs and
outcomes.
Consult with and seek out assistance from members of the
interprofessional health care team.
Use teamwork, consensus building, and conflict resolution
and leadership skills to meet expected client outcomes.
Integrate effective, collaborative, and consultative strategies
to meet clients needs within a changing environment.
Respect the unique role and competencies of all members
of the interprofessional health care team.
Collaborate as a member of the interprofessional health
care team to respond to changes in nursing knowledge and
practice and in the health care environment.

Student signature and date

Week 7 S

ND

Preceptor signature and date

Comments

Student signature and date

Week 11 S ND U

Comments

Preceptor signature and date

Student signature and date

Week 14 S
U

Comments

Preceptor signature and date

Continued to work as a member of 6WEST on Geriatric Medicine at

Humber River Regional Hospital and contributed to the health care team.
Worked in collaboration with other members including nurses, team
leaders, physiotherapists, respiratory therapists, dieticians to promote
and maintain optimal outcome of clients. Consulted with team leaders
when any changes were noted in client's conditions, and continued to
monitor and took necessary action including performing suction, bladder
scan, bladder irrigation, and contacting the physician.

Student signature and date

Preceptor signature and date

Week 4

ND

Comments

QUALITY ASSURANCE: CONTINUE AND IMPROVE

COMPETENCE
10. Engage in Quality Assurance consistent with the
regulatory framework.
i.

ii.

iii.
iv.

v.

vi.

Act in the best interests of clients and protect clients

from harm through collaboration and consultation with
other members of the interprofessional and health care
teams and by through competent and safe practice.
Commit to Quality Assurance practice to identify
strengths and areas for professional growth and in
accordance with the regulatory framework (CNO).
Create, implement, and evaluate a learning plan
consistent with the Quality Assurance program (CNO).
Assume responsibility to seek out feedback for
colleagues and peers and learning opportunities that
foster professional development.
Consistently review nursing research and information
about health care to improve competence and to
support clients
Develop professional responses to health care system
changes resulting from advances in research,
technology, and changes in societal and political
forces.

Student signature and date

Week 7 S ND U

Preceptor signature and date

Comments

Student signature and date

Week 11 S ND U

Comments

Preceptor signature and date

Student signature and date

Week 14 S U

Comments

Preceptor signature and date

Created self-reflection in order to identify own strengths and areas of

improvement. Created learning plans to continue to develop new skills and
improve competence. Evaluated own practice to ensure safe and quality
nursing care. Sought out for feedback from other nurses to continue to learn
and develop professional nursing skills.

Student signature and date

Preceptor signature and date

USE CRITICAL THINKING, PROBLEM-SOLVING and

DECISION-MAKING EFFECTIVELY

Week 4

ND

Comments

11. Use critical thinking, problem solving and decision

making skills to meet the health care needs and
expected outcomes of clients.
i.
ii.

iii.
iv.

v.
vi.
vii.

Use critical thinking to inform decision making in all

aspects of nursing care.
Use clinical judgment to assess and refine
assessments in collaboration with the interprofessional
health care team, formulate nursing diagnoses, plan
nursing interventions, and outline evaluative criteria.
Evaluate and refine critical thinking, problem solving,
and decision-making skills.
Integrate knowledge from variety of nursing, health,
and other theory into nursing practice to provide safe
and competent care.
Prioritize effectively.
Demonstrate professionalism, responsibility, and
accountability.
Use critical thinking, the practice decision-making
framework and the nurse-client-environment framework
to inform clinical judgments and practice.

Student signature and date

Week 7 S ND U

Preceptor signature and date

Comments

Student signature and date

Week 11 S ND U

Comments

Preceptor signature and date

Student signature and date

Week 14 S U

Comments

Preceptor signature and date

Continued to develop daily organization care plan and learned to

prioritize nursing care for a five-client case load on geriatric floor.
Continued to study nursing theories in order to develop and improve
critical thinking skills. Utilized problem solving skills obtained from
classroom in a hospital setting. Competently made clinical judgements
and consulted with preceptor regarding assigned clients' conditions
and expected outcomes.

Student signature and date

Preceptor signature and date

Add pages if needed for additional comments