Multi Rater Competency Assessment

2015 - 2016 - NURS 253 Practical Nursing Pre-graduate Experience MRA Mid (201508)
NURS 253 Practical Nursing Pregraduate experience (PN, 18-Jan-2016 - 07-May-2016)
Student :
Clinical Teacher/Preceptor :
Advisor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Period :
Student hours :
Required Hours :
Validated hours :

Valentina Ramirez
Debarah Bernard
Farah Jabri
Judy Martin
Villa Sheridan
Agency
No Unit
18-Jan-2016 To 07-May-2016
208
200
200

Teacher comment for validated hours:

student hrs are at the half way point -mid 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. Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies and procedures of the
practice setting.

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

Satisfactory

Satisfactory

procedures.
V.R. : I comply with regulatory standards, relevant legislation and the practice settings policies and procedures. For example, the floor I am working
on has a respiratory outbreak and I comply with infection control protocol by not leaving the floor for the entire shift.

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

Satisfactory

Satisfactory

V.R. : I act in a professional, responsible, ethical and accountable manner everytime my shift begins and I arrive on time wearing the appropriate
Humber uniform and personal identification badge.

1. 3 Use the three factor and decision making frameworks to determine strengths and limitations and

Satisfactory

Satisfactory

when to collaborate and consult with other professionals.

V.R. : I use the three factor and decision making frameworks to determine strengths and limitations and when to collaborate and consult with other
professionals when I do my best in trying to wake a patient but am unable to do so. For example, I was trying to give the evening medications to a
resident who would not arouse when I called their name or when I tapped on their hand. They only mumbled and fell back asleep. I usually did not
have trouble with waking this resident. I then called for another healthcare worker to assist me in waking the patient because their medications we're
important for them to have.

1. 4 Integrate evidence-informed practice and a theory based approach into nursing care.

Satisfactory

Satisfactory

V.R. : I integrate evidence-informed practice and a theory based approach into nursing care when I check capillary blood glucose and I am able to
establish the target ranges. For example, after checking a residents capillary blood glucose I recognized that they had a low blood glucose level. To
treat this, I gave the resident a fast acting carbohydrate; orange juice along with cookies.

1. 5 Assess practices and risk management principles and take action to ensure safety of clients,

Satisfactory

Satisfactory

self, and others.

V.R. : I assess practices and risk management principles and take action to ensure safety of clients, self, and others when a resident forgets to use
their walker. For example, I noticed a resident clinging onto the side railing on the wall. I walked up to them and asked them where their walker was.
They told me that they couldn't find it. I told the resident to stay in the same spot while I find their walker. I back tracked to where the resident came
from and I found the walker in their bathroom. I quickly brought the walker out and the resident was thankful.

1. 6 Question and clarify unclear orders or directions and when uncertain.

Satisfactory

Satisfactory

V.R. : I question and clarify unclear orders or directions and when uncertain. For example, a resident was ordered a cream to apply to their ear, when
I approached them to apply the cream they told me that nothing is wrong with the outside of their ear but it's the inside of the ear that's the problem. I
took the cream back with me to ask the nurse what I should do with the newly ordered cream. The nurse informed me that this cream could also be
applied to the inner portion of the ear as well.

1. 7 Question, clarify or challenge questionable orders, decisions or actions by others.

Satisfactory

Satisfactory

V.R. : I question, clarify or challenge questionable orders, decisions or actions by others. For example, the nurse was asked by a residents family to
give a prn dose of a narcotic every fifteen minutes. After fifteen minutes went by the family would come ask the nurse for the next dose and so on. I
asked the nurse if it was normal to give this much narcotic without stopping at a maximum dose. The RN clarified that it was okay to give it since the
patient is receiving palliative care.

1. 8 Respond in a professional manner to situations in which there is unsafe, unacceptable or

Satisfactory

Satisfactory

unprofessional behavior.
V.R. : I respond in a professional manner to situations in which there is unsafe, unacceptable or unprofessional behavior. For example, when a
resident was scheduled for their insulin injection, and I asked the resident if it was okay if I gave them their insulin, they nodded, but when I proceeded
to wipe their abdomen area with an alcohol swab they swatted at me with their hand. I took this gesture as a refusal and quickly backed away to stop
that behaviour.

1. 9 Demonstrate understanding about the role of the nurse within health care.

Satisfactory

Satisfactory

V.R. : I demonstrate understanding about the role of the nurse within healthcare when I listen to residents concerns during assessments. For
example, I was making sure a resident had applied their treatment cream for that day when they informed me that they had felt like that cream wasn't
helping and they wanted to change it for another one they had in mind. I put the residents request in the doctors book so that changes could be made
to better suit the clients needs.

Teacher comments for Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies
and procedures of the practice setting. :
Demonstrates ethical and legal regulatory practices surrounding framework of work setting.

2. Communicate using strategies and technology to effect accurate and timely information sharing including data, research, and other
information.

2. 1 Contribute to team sharing and discussions.

Satisfactory

Satisfactory

V.R. : I contribute to team sharing and discussions after I have helped with feeding a resident and the PSW requires the intake amount. I inform them
of approximately how much fluids and food the patient had and they record it.

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

Satisfactory

Satisfactory

V.R. : I document clearly, accurately, concisely in a timely manner using written and electronic methods when I have taken a capillary blood glucose
reading on a resident and directly record it in the electronic medication administration record. When the order states that the residents insulin must be
held if it falls outside specified ranges then I make sure to write a progress note with the reason to why I held the insulin.

2. 3 Use effective communication techniques when reporting relevant information and providing

Satisfactory

Satisfactory

feedback to the appropriate members of the interprofessional heath care team.

V.R. : I use effective communication techniques when reporting relevant information and providing feedback to the appropriate members of the
interprofessional healthcare team by giving information. For example, I gave a residents treatment cream to one of the PSW's. I informed them that it
was newly ordered for areas that appeared raised or reddened. I had researched from the progress notes that the main focus would primarily be near
the residents anus. I let the PSW know about this so that they could apply the cream while they were changing the patient.

2. 4 Evaluate and refine techniques used to communicate and share information with clients and the

Satisfactory

Satisfactory

interprofessional health care team.

V.R. : I evaluate and refine techniques used to communicate and share information with clients and the interproffessional health care team by
speaking a foreign language. For example, there is a resident who speaks French. I use what I know of the language to do my best to communicate
with them using French words. They once asked me in French if the phone was pressed down all the way (to hang it up), and I understood so I replied
with, "oui, ces't bon", which meant yes, it's good.

2. 5 Ensure privacy and confidentiality.

Satisfactory

Satisfactory

V.R. : I ensure privacy and confidentiality everytime I discard each residents medication pouch in the appropriate shredder box.

2. 6 Use technology to retrieve information including research and other date and to obtain and

Satisfactory

Satisfactory

forward information both within and outside the practice setting.

V.R. : I use technology to retrieve information including research and other data and to obtain and forward information both within and outside the
practice setting. For example, I took time to write down all of the residents evening medications and I used my ebooks, specifically the Mosby's drug
guide, to identify the drug action and side effects.

Teacher comments for Communicate using strategies and technology to effect accurate and timely information sharing including data,
research, and other information. :
Valentina has been a help in researching any nurse criteria questions needed for her clinical experience.

3. Engage in relational practice that is caring, compassionate and respectful.

3. 1 Establish therapeutic caring, compassionate, and culturally safe relationships with clients and
health care team members.

Satisfactory

Satisfactory

V.R. : I establish therapeutic caring, compassionate, and culturally safe relationships with clients and healthcare team members when I'm dealing
with a vulnerable residents that cannot perform certain tasks on their own. For example, I was giving a drink to a resident when they asked me to tuck
a tissue under their chin before I proceed. I placed the napkin down for them and proceeded to give them their drink. A small amount of mucous
started running from their nose, so I grabbed another tissue and asked if it was alright for me to wipe their nose. They said, "yes please". This resident
was treated with respect and after I helped them they said "thank you".

3. 2 Establish a caring environment that supports clients in meeting their needs and outcomes,

Satisfactory

Satisfactory

managing their illness, or experiencing a peaceful death.

V.R. : I establish a caring environment that supports clients in meeting their needs and outcomes, managing their illness, or experiencing a peaceful
death. For example, I was with the nurse who was about to administer a narcotic injection into a patients thigh for end of care comfort measures. Just
before the nurse was about to give the injection the patients breathing became heavy and they seemed anxious. I held the residents hand and
repeatedly told them that they will be okay. The patient was noticeably comforted by this soothing measure and the nurse was able to inject the
medication.

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

Satisfactory

Satisfactory

V.R. : I demonstrate therapeutic use of self to foster client well-being whenever a resident becomes confused. For example, I was passing by a
resident who was wondering the halls and kept on saying that they do not know where they are. I told the resident that they are in a safe place and I
pointed out their name tag next to their room to reassure them that they were in the right place. They read their name out loud and confirmed that that
must be their room.

3. 4 Utilize relational knowledge and skills, and ethical principles to support clients and to interact

Satisfactory

Satisfactory

with health care providers.

V.R. : I utilize relational knowledge and skills, and ethical principles to support clients and to interact with healthcare providers by helping the PSW
when they need help with the chair lift. For example, I was asked by a PSW if I could assist them with the chair lift. I entered the residents room and I
closed the curtain to ensure privacy. Before the resident was lifted I checked that the wheelchair was locked, the PSW made sure that the residents
hands were resting on their lap. As the chairlift went up, I held the clients legs and guided them towards the bed. Both the PSW and I worked as a
team to ensure the resident was safe and comfortable during the entire process.

3. 5 Use self-awareness to identify the effects that beliefs, values, and personal experiences have on

Satisfactory

Satisfactory

relational practice.
V.R. : I use self awareness to identify the effects that believes, values, and personal experiences have a relational practice by offering my help when
someone needs it. For example, a resident had just arrived from the hospital in the late afternoon. When I walked into their room they asked me why
it was so quiet. I realized everything in their room was still shut off (their lights and tv). This resident was not capable of getting up from bed and
turning on any of those things, so I asked them if they would like to watch some tv. They said yes, so I grabbed the remote and turned the tv on, but
the cable box was not working. I let the resident know I would inform someone from maintencance to come see what the problem was. I made sure I
connected with someone to come have a look at the tv. Shortly after the tv was fixed and the resident was pleased.

3. 6 Collaborate with clients, members of the interprofessional and health care teams; and, consult

Satisfactory

Satisfactory

appropriately.
V.R. : I collaborate with clients, members of the interprofessional and healthcare team; and, consult appropriately. For example, a resident was in
need of large towels and had come out of the room to ask me if I could get them. I let them know that I will find the person who delivers the towels. I
went to look for someone who knew where I could get towels from and the PSW said that they will be able to get them for the resident. I went back to
the residents room to tell them the PSW will bring them shortly.

3. 7 Uphold practices and systems that support the diversity of clients and of the interprofessional

Satisfactory

Satisfactory

health care team.

V.R. : By making sure I do my best to accommodate the way a resident prefers to take their medication. For example, I have a resident who likes to
take their medication whole mixed with jam while some other residents need theirs crushed in jam. Some prefer drinking their water with a straw while
others do not. I do my best to respect their wishes and customs.

3. 8 Provide effective client education.

Needs
Development

Satisfactory

V.R. : I provide effective client education when a resident refuses to take their medication and I am able to educate them to take it by providing further
information on that medication. For example, a resident had refused to take their senokot, but they had told me they have not gone to the bathroom
yet. I told them that the senokot will help with the constipation. The resident seemed more assured that this will help them and asked me to hand back
the pills for them to take.

Teacher comments for Engage in relational practice that is caring, compassionate and respectful. :
Valentina has demonstrated compassionate caring nursing style towards her clients.

Advisor comments for Engage in relational practice that is caring, compassionate and respectful. :
Valentina indicated a needs development in Sub Ability 3.8; however, student clearly demonstrates a satisfactory in this category.

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

4. 1 Evaluate and refine leadership skills to develop solutions, resolve conflict, create a positive work
environment and organizational culture, and to strengthen advocacy role.

Needs
Development

Satisfactory

V.R. : I evaluate and refined leadership skills to develop solutions, resolve conflict, create a positive work environment and organizational culture, and
to strengthen advocacy role. For example, when I was helping feed a resident I noticed they did not enjoy it and spit it out. It was important for this
resident to eat something to control their diabetes so I asked if there was another dish that the resident would enjoy more. They handed me a
sandwich instead, which the resident ate more of than the speghetti from before.

4. 2 Provide feedback to peers and accept feedback from peers and members of the

Satisfactory

Satisfactory

interprofessional health care team.

V.R. : I provide feedback to peers and accept feedback from peers and member of the interprofessional health care team. For example, one of the
nurses who was crushing medications for the residents told me that they use strawberry jam mixed in with apple sauce to prepare the powdered
medications in. They told me that the jam has a thick consistency and it sometimes sticks to the roof of some patients mouth, so they mix apple sauce
in with it to make the consistency easier for the resident to swallow. I told the nurse that this was a good idea for us to use with certain residents.

4. 3 Advocate for clients, self, others, and quality practice environment.

Needs
Development

Satisfactory

V.R. : I advocate for clients, self, others, and quality practice environment. For example, a resident had concerns over how their laundry was being
done. They told me their socks were coming back with a tighter fit. They wanted to find out if the people who did the laundry could lower the heat
setting. I told the resident I would find out from the registered nurse if those changes could be made. I let the RN know that this resident was unhappy
about how their clothing was coming back and if any changes could be made. The RN made a call to the laundry department and found out that the
machines are pre set and they do not have an option to decrease the heat. They also informed the RN that articles of clothing made from cotton are
able to withstand the heat better than other materials. I went back to the resident to inform them of the circumstances. They understood the situation
and they were thankful that I had tried my best to help them.

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

Satisfactory

Satisfactory

V.R. : I support clients rights for self determination and choice when I give the client the chance to choose whether they want their pills in their hand
or to be put in their mouth for them.

4. 5 Respond appropriately to unsafe, unacceptable, and unprofessional behaviors.

Satisfactory

Satisfactory

V.R. : I respond appropriately to unsafe, unacceptable, and unprofessional behaviours. For example, a resident was using their walker, and I was
standing near by when I heard them say that they were tired because they were on their feet all day. I approached the resident and asked them if they
would like me to pull up a chair for them to sit on. They said yes, so I quickly brought over a chair. The resident was relieved and the PSW brought
over a glass of water for them.

4. 6 Demonstrate public protection and acting in the interests of the public through collaboration and

Satisfactory

Satisfactory

consultation with other members of the interprofessional health care teams.

V.R. : I demonstrate public protection and acting in the interests of the public through collaboration and consultation with other members of the
interprofessional healthcare teams. For example, I noticed a puddle of water coming from the garbage pail. Someone else walking by may have easily
missed that, so I cleaned it up to prevent injury.

4. 7 Contribute to the creation of quality practice strategies and solutions.

Satisfactory

Satisfactory

V.R. : I contribute to the creation of quality practice strategies and solutions every time I lock both the medication cart and the patients medication
profile on the eMAR when I leave it unattended.

4. 8 Assign, supervise, teach as appropriate, and provide feedback to unregulated care providers
(UCPs) in collaboration with the interprofessional health care team.

Needs
Development

Satisfactory

V.R. : I assign, supervise, teach as appropriate, and provide feedback to unregulated care providers in collaboration with the interprofessional
healthcare team. For example, I had a resident who refused to have their nitro patch removed by me. I asked the PSW who was in charge of getting
this resident ready for bed if they could try and help me remove the patch. The PSW was able to successfully remove the patch for me while changing
the residents clothing.

Teacher comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
Valentina continuesly advocates for her elderly client's and demonstrates a diversity of putting into practice solutions to providing for their individual
care needs.

Advisor comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
Valentina indicated a needs development in Sub Ability 4.1, 4,3 and 4.8; however, student clearly demonstrates a satisfactory in these categories.

5. Integrate the nursing process into all aspects of nursing care and across diverse practice settings.

5. 1 Formulates clinical judgments that meet clients unique and changing health needs and priorities,
outcomes, and overall condition and incorporates these into evolving plans of care.

Needs
Development

Satisfactory

V.R. : I 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. When I am aware that a resident has difficulties swallowing I make sure to elevate the head of the bed
before I give them fluids. Some residents who have had strokes require thickened fluids, which I give to them slowly. I make sure they have swallowed
what is in their mouth before I pour them some more. If the resident starts to cough I stop pouring the liquid and let them catch their breath. I give rest
periods in between each sip to avoid coughing.

5. 2 Devise evidence-informed plans of care that are holistic and client-centred.

Satisfactory

Satisfactory

V.R. : I devise evidence-informed plans of care that are holistic and client-centered whenever I use an aerochamber to give a resident ther puffer.
For example, I have a resident who requires the assistance of an aerochamber to inhale the medication from a puffer. They are not able to inhale on
cammand or administer the puffer to themselves so they must be given something that allows them to breath in on their own time. The aerochamber
works perfectly for this resident and I make sure I use it each time with the puffer so that they get their full dose.

5. 3 Use clinical judgment to assess clients, prioritize needs, outcomes, and nursing interventions.

Needs
Development

Satisfactory

V.R. : I use clinical judgment to assess clients, prioritize needs, outcomes, and nursing interventions. For example, I was about to change a
residents leg dressing when they stated they were cold. I noticed they had a sweater hung on the back of their wheelchair, so I grabbed that and place
it over their upper body. I wanted to make sure the resident was comfortable before I continued my nursing care.

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

Satisfactory

Satisfactory

V.R. : I collaborate in the evaluation, refinement and modification of plans of care. For example, I was cleansing three separate areas on a residents
body that required wound care protocols to them. I noticed after asessing one of the three wounds that it no longer needed wound care protocol; as it
had healed. I informed the nurse of my assessment so that the results could be noted and the wound care protocol could be discontinued.

5. 5 Safely and competently perform treatments and use techniques, and technology autonomously

Satisfactory

Satisfactory

and in collaboration with clients and members of the interprofessional health care team.
V.R. : I safely and competently perform treatments and use techniques, and technology autonomously and in collaboration with clients and members
of the interprofessional health care team whenever I perform hand hygiene and wear gloves to dress a wound.

5. 6 Collaborate with the clients across the lifespan and with members of the interprofessional health

Satisfactory

Satisfactory

care team to create a client centered plan of care that is articulated with competence both in writing
and orally.
V.R. : I collaborate with the clients across the lifespan and with members of the inter-professional healthcare team to create a client centered plan of
care that is articulated with competence both in writing and orally. For example, a resident was ordered an expectorant by the doctor to help with their
congestion, but they felt that it made them feel worse. The resident knows themselves best. Their wish was to remove the order from their list. I made
sure to convey that message to the nurse. The message was written in the doctors book so that the changes could be made when the doctor comes
in.

5. 7 Use awareness of own knowledge and skills, the three factors of nurse, client and environment

Satisfactory

Satisfactory

and the practice decision-making framework to guide practice.

V.R. : I use awareness of own knowledge and skills, the three factors of nurse, client and environment in the practice decision-making framework to
guide to practice. For example, I was heading to a residents room to check their vital signs when I just saw them come out of the bathroom. They saw
me and asked if I was going to check their blood pressure. I replied yes; however, I knew that their blood pressure would be slightly elevated since
they were just performing an activity. I also noticed that they were slightly short of breath, so I said I would come back to check their blood pressure
because right now we may not get an accurate reading. I explained to the resident that everything may be elevated since they were just in the
bathroom. I instructed them to relax for a moment until I came back.

5. 8 Manage workload, time, and physical resources to provide effective, efficient and ethical care.

Needs
Development

Satisfactory

V.R. : I manage workload, time, and physical resources to provide effective, efficient and ethical care everytime I complete giving medications to all
residents. I make sure I park the medication cart near the residents that I will be delivering medications too. I save steps and time. I make sure I park
the cart against the wall so that it is still safe for the residents to pass by.

Teacher comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :
Valentina uses the nursing process in making decisions necessary to comply with expaectaions and collaborating with HCP team to meet quality care
needs of clients.

Advisor comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :
Valentina indicated a needs development in Sub Ability 5.1, 5.3 and 5.8; however, student clearly demonstrates a satisfactory in these categories.

6. Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and holistic health care in a
complex and changing environment.

6. 1 Collaborate with clients to determine needs, mutually agreed health outcomes, approaches to
care, and to evaluate care.

Needs
Development

Satisfactory

V.R. : I collaborate with clients to determine needs, mutually agreed health outcomes, approaches to care, and to evaluate care. For example, I was
entering a residents room when they started to scream like they were in pain. I quickly asked them what's wrong and tried to look for the source of
their pain. They stopped yelling and said its okay its just a spasm. Before continuing to give their medicine I asked them if they were sure they were
okay. The resident confirmed everything was alright.

6. 2 Contribute as a member of the interprofessional and health care teams to respond to changing
client needs and outcomes.

Needs
Development

Satisfactory

V.R. : I contribute as a member of the interprofessional and healthcare teams to respond to changing the client needs and outcomes. For example,
there was a resident who was sitting at the dining room table and began to lean forward. Another Resident called out for help since the resident was
so lethargic that their head was leaning on the table. One of the PSW's was going to bring the resident back to the room to put them back to bed. I
assisted the PSW by supporting the residents chest and keeping their upper body against the back of the wheelchair so that there would be no injury
while wheeling them to their room.

6. 3 Consult with and seek out assistance from members of the interprofessional health care team.

Satisfactory

Satisfactory

V.R. : I consult and seek out assistance from members of the into professional healthcare team. For example, there was a resident who I usually give
evening medications to. When I enter their room they normally sit up and take their medicine on their own; however, this night they lay still. I tried
waking the patient by calling out their name and tapping their hand, but they only mumbled. I knew I needed help with wakening this resident, so I
asked the PSW who normally assists this resident to help me out. The PSW tried but they were not able to do so either. They told me to call the RN at
the desk to come have a look and make sure the resident was okay.

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

Satisfactory

Satisfactory

expected client outcomes.

V.R. : I use teamwork, consensus building, and conflict resolution and leadership skills to meet expected client outcomes. For example, when a
resident was starting to have trouble taking their pills whole or crushed in jam, the family member suggested to put the crushed medication in their
pro-source with ice and water. This method was successful since the resident enjoyed this choice of drink.

6. 5 Integrate effective, collaborative, and consultative strategies to meet clients needs within a

Satisfactory

Satisfactory

changing environment.
V.R. : I integrate effective, collaborative, and consulted strategies to meet clients needs within a changing environment. For example, I was walking
by a resident who was sitting in their wheelchair when they asked if I could help them. I said sure what can I help with? The resident said that they felt
like they should be doing more than just sitting in their wheelchair, like they should be moving around (exercising). I encouraged the resident by
demonstrating a couple leg excersices that they could do in their wheel chair. I told them that by pumping their feet they will encourage the blood flow
from their feet back to the rest of their body. They we're thankful I stopped by to show them.

6. 6 Respect the unique role and competencies of all members of the interprofessional health care

Satisfactory

Satisfactory

team.
V.R. : I respect the unique role and competencies of all members of the interprofessional health care team by showing my gratitude. For example, I
had medications to give to a resident but they were sleeping and they did not respond to my voice. The PSW was walking by and noticed I needed
help. They showed me how they usually get this patient up. They gently rubbed the residents shoulder and called out their name and said, "hello". The
resident awakened and with the PSW's help we were able to get them to agree to take their medication before their bedtime. I later thanked the PSW
for helping me out.

6. 7 Collaborate as a member of the interprofessional health care team to respond to changes in

Satisfactory

Satisfactory

nursing knowledge and practice and in the health care environment.

V.R. : I collaborate as a member of the interprofessional healthcare team to respond to changes in nursing knowledge and practice and in the
healthcare environment. For example, there was a resident who told the staff that a resident in the dining room was not wearing any pants. I went to
go check on that resident in the dining room and seen that they were sitting down at a table. I was asked by the PSW to quickly grab something to
cover them up. I went to the residents room to find a robe that would cover them when they stood up. I put the robe on the resident which covered any
exposed areas. The PSW brought the resident a pair of pants and got them to stand up to put them on.

Teacher comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
Valentina has met with understanding her clients are complex and frail elderly she will utilize and collaborate well with the HCP team members to
accentuate for the individual client.

Advisor comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
Valentina indicated a needs development in Sub Ability 6.2; however, student clearly demonstrates a satisfactory in this category.

7. Engage in Quality Assurance consistent with the regulatory framework.

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

Satisfactory

Satisfactory

consultation with other members of the interprofessional and health care teams and by through
competent and safe practice.
V.R. : I act in the best interest of clients and protect clients from harm through collaboration and consultation with other members of the
interprofessional and healthcare teams and by thorough competent and safe practice. For example, a resident was laying in their bed when they
complained of pain in their arm. I took a look at their arm and only noticed a watch on the left arm, but no signs of redness or bruising. I asked them
where the pain was, but they just kept on repeating that their arm was hurting. I noticed the watch was a bit high on their arm so I lowered it down and
realized it was digging into the patient's skin and causing a tight band to form around the arm. I lowered the watch to where it was meant to sit on the
wrist. I then asked the resident if it felt better. The resident said it felt a bit better. The impressions from where the watch had been were still in the
patients arm, so I let them know that it might take a few minutes for their arm to go back to normal. I told them that if the pain does not go away in a
few minutes then they should press on the call bell. I then spoke to the PSW and made sure they would help keep an eye on the position of the watch
so that it does not cut off the circulation the the residents hand again.

7. 2 Commit to Quality Assurance practice to identify strengths and areas for professional growth and
in accordance with the regulatory framework (CNO).

Needs
Development

Satisfactory

V.R. : I commit to quality assurance practice to identify strengths and areas for professional growth and in accordance with the regulatory framework
by continuously working on getting to know the clients status and health care needs. I am professionally responsible and I demonstrate this when I
seek support or assistance when necessary.

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

Satisfactory

Satisfactory

(CNO).
V.R. : I create, implement, and evaluate a learning plan consistent with the quality assurance program (CNO). For each semester I have developed a
learning plan that will be placed in my nursing portfolio.

7. 4 Assume responsibility to seek out feedback for colleagues and peers and learning opportunities

Satisfactory

Satisfactory

that foster professional development.

V.R. : I assume responsibility to seek out feedback for colleagues and peers and learning opportunities that foster professional development. For
example, one of the residents had just come back from the hospital. The RN asked if I would like to help with collecting an MRSA swab culture, take
the vital signs and be present for the head to toe assessment. I was thankful to be present for such a moment and I was able to assist the RN by
moving the patient on their side and checking for any redness. Redness was noted on the residents heels and buttocks area. While assessing the
residents skin to the buttocks I was also able to take the rectal swab culture at the same time so that the resident would not have to experience too
much discomfort from being moved too many times.

7. 5 Consistently review nursing research and information about health care to improve competence
and to support clients.

Needs
Development

Satisfactory

V.R. : I consistently review nursing research and information about health care to improve competence and to support clients. For example, products
or medications that are sent from pharmacy come with instructions and details printed on a pamphlet inside their box. I take the time to read a lot of
these pamphlets. I get more familiar with the product or medicine and the proper ways to use them.

7. 6 Develop professional responses to health care system changes resulting from advances in

Satisfactory

Satisfactory

research, technology, and changes in societal and political forces.

V.R. : I develop professional responses to healthcare system changes resulting from advances in research, technology, and changes in societal and
political forces. For example, there is a mobile stroke unit that is able to diagnose and treat stroke victims before they get to the hospital. There is a
CT scanner inside the ambulance that will send out the results on the scan immediately for diagnosing. I think this can save many lives by saving the
time it takes to recieve the treatment. The cost of each vehicle may interfere with how many mobile stroke units are made available, since having a CT
scanner and other laboratory equipment is costly.

Teacher comments for Engage in Quality Assurance consistent with the regulatory framework. :
Valentina always seeks peer feedback.

Advisor comments for Engage in Quality Assurance consistent with the regulatory framework. :
Valentina indicated a needs development in Sub Ability 7.2 and 7.5; however, student clearly demonstrates a satisfactory in these categories.

8. Use critical thinking, problem solving and decision making skills to meet the health care needs and expected outcomes of clients.

8. 1 Use critical thinking to inform decision making in all aspects of nursing care.

Satisfactory

Satisfactory

V.R. : I use critical thinking to inform decision-making in all aspects of nursing care. For example, I was taking the radial pulse for a resident in a
wheelchair, but whenever I touched the resident on their wrist they would tense up. I made sure I told the patient what I was doing before touching
them, but they still would tense their arm which made it difficult for me to get an accurate reading. After a few attempts, I was still not pleased with the
results I got. The pulse was irregular and I had a different reading each time. I told the patient I would listen to their apical pulse using a stethoscope.
This method proved to be more successful, the heartbeat was still irregular but it was an accurate reading.

8. 2 Use clinical judgment to assess and refine assessments in collaboration with the
interprofessional health care team, formulate nursing diagnoses, plan nursing interventions, and

Needs
Development

Satisfactory

outline evaluative criteria.

V.R. : I use clinical judgment to asses and refine assessments in collaboration with the interprofessional healthcare team, formulate nursing
diagnosis, plan nursing interventions, and outlined evaluative criteria. For example, I was talking to a resident when they asked me if there was
something I could do about their dry lips. I let them know that I would take a look at what we had that could help. I went to ask the nurse if there was
vaseline for this resident. The nurse informed me that there was but it was in a larger container. The nurse had an idea that we could put some
vaseline in a small cup for the resident so that they could take it to their bedside and use it for later if they had dry lips. I brought the vaseline over to
the resident in a small cup and instructed them to bring it to their room so that they could have it in case their lips started feeling dry again.

8. 3 Evaluate and refine critical thinking, problem solving, and decision-making skills.

Satisfactory

Satisfactory

V.R. : I evaluate and refine critical thinking, problem-solving, and decision-making skills. For example, in the middle of giving medications to all of the
residents the RN noticed one of them getting more tired. The RN advised me that it was probably a better idea to give this patient their medication
now rather than later because they were awake still. I agreed that this would be best, since the patient also had a nitro patch on their upper back and
it would be easier to remove while they were still sitting in the chair.

8. 4 Integrate knowledge from variety of nursing, health, and other theory into nursing practice to
provide safe and competent care.

Needs
Development

Satisfactory

V.R. : I integrate knowledge from variety of nursing, health, and other theory into nursing practice to provide safe and competent care whenever I
ensure a resident has swallowed their medication. To prevent choking I give the resident a drink after their medications and I make sure they are in a
semi fowlers position or higher. I also make sure I stay with them until they have swallowed everything. In case, they did choke, I know I will be there
to help them.

8. 5 Prioritize effectively.

Needs
Development

Satisfactory

V.R. : I prioritize effectively by developing a routine for how I deliver the medications. For instance, I will start on one wing on the floor and give
medications to all the residents who are on that side. Once that wing is finished I move onto the next wing and so on until all the medications have
been administered to all four wings.

8. 6 Demonstrate professionalism, responsibility, and accountability.

Satisfactory

Satisfactory

V.R. : I demonstrate professionalism, responsibility, and accountability by coming back from my breaks on time. There was also a time when I was
asked to go to another floor to ask if they had a specific wound covering for a resident. Our floor had run out. I left the floor and went to the next level
up. When I spotted a nurse on that floor I introduced myself and my purpose for visiting. I was able to retrieve the correct wound covering for the
resident.

8. 7 Use critical thinking, the practice decision-making framework and the nurse-client-environment
framework to inform clinical judgments and practice.

Needs
Development

Satisfactory

V.R. : I use critical thinking, the practice decision-making framework and the nurse-client-environment framework to inform clinical judgments and
practice. For example, I was with a patient when they complained of neck pain and wanted me to massage their neck. After I massaged their neck, I
asked them if it helped at all, they informed me that it still hurt and wondered if their was something warm I could get to put on their neck. I went to the
nurse to ask if we had any heating pads that I could use for the resident. The nurse said that we didn't have any, but that we could use towels soaked
in warm water. So we returned to the resident with this alternative and left the warm towel on their neck for ten minutes. The residents pain had
decreased after using this non-pharmacological intervention.

Teacher comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
Valentina has demonstrated critical thinking when involved with giving direct care,administering medication,and performing small treatments and
dressings.These have been described in her summary answers to specific questions. Preceptor has read and does concur.

Advisor comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
Valentina indicated a needs development in Sub Ability 8.2, 8.4, 8.5 and 8.7; however, student clearly demonstrates a satisfactory in these categories.

Student Midway Summary with Strategies for Continued Growth

I will continue to provide safe patient care by reviewing information through my nursing e-books and complying with CNO side standards. I will
continue to work on getting to know each resident by getting more involved in their plans of care and reading their patient profile. I will also focus on
becoming more efficient when it comes to administering medications to the residents in a timely fashion.

Teacher Midway Summary with Strategies for Continued Growth

Valentina has progressed well within her active clinical experience thus far. She demonstrates awareness to accountability, knowledge within her
scope. She does demonstrate critical nurse thinking and applies it. questions 1.7, 3.5, 4.5, and 6.7 may need further development which would be had
through time spent in nursing.

Advisor Midway Summary with Strategies for Continued Growth

As Valentina and Deborah have identified, Valentina has clearly demonstrated a satisfactory in all abilities and sub abilities. Valentina is showing
growth and progress. As Valentina summarizes, i suggest Valentina to continue to provide safe patient care by reviewing nursing e-books and
complying with CNO standards, becoming more familiar with the patients by reviewing patient care profile and care plans, and to continue to
administer medication in safe, efficient, and timely order. Great work, Valentina.

Refer to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Grade

Needs Development

Satisfactory

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

Submitted Date: 02-Mar-2016 05:51

Unsatisfactory