Self Assessment

2016 - 2016 - NURS 151 Practical Nursing Practice 2 Final (201508)

NURS 151 Practical Nursing Practice 2 (PN, 12-Jan-2016 - 07-May-2016)
Student : Maria Guineva Galvey
Clinical Teacher/Preceptor : Zaynab Panchbhaya
Program Coordinator : Wendy Chow
Location : William Osler Health Centre/Brampton Civic Hospital
Placement Setting : Agency
Unit/Office/Clinic : N3 ACE
Period : 12-Jan-2016 To 07-May-2016
Student hours : 156
Required Hours : 168
Validated hours : 156
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

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

procedures.

M.G.G. : I make certain to follow regulatory standards, hospital and the school's policies and procedures by attending to my clinical practice every

Friday 30 minutes prior to my shift, wearing the appropriate blue uniform/scrubs with the proper white shoes, and no nail polish. I apply proper hand

wash before and after an interaction with a patient to ensure my client's safety and my safety as well. Whenever a client that is in an isolation is

assigned to me, I ensure to follow proper PPE as well as the proper donning and doffing of the equipments.

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

M.G.G. : I practice in a responsible and ethical manner by attending to my clinical practice every Friday, 30 minutes prior to my shift. I make sure to

do my research about the medications my patient have to be able to do the proper assessments and apply the right nursing considerations to be

aware of. I only practice nursing skills that is within my limits as a student nurse such as not performing IV insertion and administering IV meds. I

make certain to respect and build rapport with my group mates, my primary nurse and most of all my client.

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

professionals.

M.G.G. : Before coming into my clinical practice, I would often review and study my client's medical diagnosis, medical history and medications. In

this way, I will be able to know my nursing priorities and signs&symptoms to be aware of. For example, I know when I will be able to do a bed bath on

my own or not. When time comes that my client is independent and would only require assistance, I would usually do their bath on my own. If my

patient is in total care, I would ask someone from my group and even my instructor's help to assist me.

Satisfactory Satisfactory
1. 4 Use evidence informed practice and a theory-based approach to care.
M.G.G. : I ensure to make use of an evidence practice and a theory based approach when providing care to my assigned clients. I show this by

reviewing system assessments that is taught and demonstrated in Jarvis' Physical assessment book, performing nursing skills that are appropriate for

my client's care (i.e, change of colostomy bag) that is demonstrated in Mosby's Nursing videos and being aware of the mechanism of action and the

do's and don'ts of a medication from Mosby's Drug Guide book. I include the pathophysiology, nursing interventions and signs and symptoms of a

diagnosis by referring to our Theory class and notes because I know that information about a specific medical diagnosis needs a factual and reliable

source to have a better understanding and to do the optimal plan of care for my client.

Satisfactory Satisfactory
1. 5 Ensure client safety and a safe environment.

M.G.G. : I establish a safe environment for my client and ensuring their safety by positioning their bed in the lowest position, side rails up and putting

their personal belongings within reach to avoid falls and injury. In addition to that, I would also put the call bell beside them and would always tell my

client, before leaving their room, to press the call light whenever they need help or whenever they feel any pain while I am not with them. I ensure to

visit my client around the clock during my shift.

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

M.G.G. : Whenever I am unsure of something or anything regarding medications, nursing skill to be performed and care that the patient is receiving, I

make sure that I ask and clarify my understanding. For example, I asked my instructor about the order of my client's meds to be crushed; however

she's on an enteric coated aspirin (ECASA), that is very well known not to be crushed because of its enteric coat (Lilley, Harrington, Snyder, Swart &

Savoca,2011), before crushing and/or administering the said medication.

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

M.G.G. : Whenever I feel that the situation is unsafe not just for myself but mostly for my client, I would seek assistance and report it to my primary

nurse and clinical instructor to be addressed. For example, when my primary nurse asked me to sit my client beside his bed to wait for his dinner but I

am well aware that my client is not able to sit on his own due to confusion and lethargy. I have addressed this to my clinical instructor because I

believe that the action is unsafe for the client and would put him at risk for fall and injury as well.

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

M.G.G. : I see to it that the the procedure and nursing skills that I will be performing is just within the scope and role of a student nurse. I would inform

my primary nurse that I will be the one to do vital signs, administer medications but without IV meds and assist in ADLs. I ensure to make reports

regarding of my client's vital signs, meds that were already administered and performed ADLs to my primary nurse prior to charting in MediTech.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :

Maria was present and prompt for all clinical dates. Maria ensured she complied by the guidelines stated in the handbook. She was prompt,
in uniform and prepared to the best of her abilities. Maria submitted assignments in a timely manner and completed K4Y on time. Maria
took responsibility for her own actions and asked questions accordingly. She understands her role and responsibility as a student nurse
with respect to practice limitations, documentation and reporting. When able, Maria used theory to guide her learning. She ensured a save
environment for her patients by ensuring the bed was always in the lowest position, call bell was within reach and the patient had their
belongings within reach. When Maria provided care she used evidence-based researched to provide the care (i.e. when changing a
colostomy bag, following the rights and routes of medication administration, changing dressings, etc).

2. ACCURATE AND RELEVANT COMMUNICATION

Satisfactory Satisfactory
2. 1 Participate in team sharing and discussions.
M.G.G. : I participate in team sharing and discussions by answering questions of my group mates regarding a task or charting;however, I would only

answer something that I am sure of the answer or the information to give and would seek assistance if I am not sure of the answer. I also demonstrate

my participation during post conference by answering raised questions and suggesting health care professionals to be collaborated with to ensure

optimal care for my client and give my rationale about it.

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

M.G.G. : Because of our practice in charting every Friday in MediTech, I can competently document my client's findings on the right category in

MediTech in a timely manner. For example, I am able to chart my head to toe assessment into MediTech by each system in the right category without

mistakes. I also know where to find the laboratory values in MediTech that would be needed prior to administering medications.

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

M.G.G. : I make sure to report the set of vital signs that I got, as well as any relevant information and findings my primary nurse and my clinical

instructor. For instance, I had the chance to change a colostomy bag in one of my clients. I had assessed the skin and stoma, after the colostomy bag

changing, I ensure to report the appearance of the skin and stoma to my primary nurse because I know that it would be relevant for my primary nurse

to know.

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

M.G.G. : I make use of communication techniques well with my client and inter-professional health care team, as well as to my group mates. I ensure

to report my findings (i.e, vital signs, patient's concerns) to my instructor and primary nurse (day or afternoon shift) in order to communicate and

collaborate about my client's care. For my clients, I would inform them the nursing skill that I will be performing, asking for a consent and I would walk

them through and during the procedure of care.

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

(PHIPA)

M.G.G. : I make certain that I do not leave my client's MAR or Kardex in any places in the hospital but the COW and the nursing station. This is to

ensure that my client's health records will not be viewed by any unauthorized people around the hospital, even my client's relatives. Moreover, when

doing a concept map that is to be submitted, I make sure not to include my client's name in it. Lastly, I am providing privacy to my client by simply

closing the door or curtain when doing bed bath.

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

M.G.G. : I often use technology to retrieve information as well as to do my research. Using Meditech is one example of retrieving information through

the use of technology. I would often check the lab values of client especially if there are medications that are in need of it. Moreover, most of our

books are already in Evolve and I would often use this as a reference in medications and nursing interventions for my plan of care.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Maria has done an exceptional job at communication throughout this clinical. Maria worked well with others and actively participated in
group discussions, sharing her experiences and thoughts. She understands the importance of communication and documentation. She
documents accurately and thoroughly, with minimal assistance. She communicates well with staff and patients, often demonstrating great
patience when the patient does not understand. Maria ensures all of her findings, particularly things out of norm (i.e. vital, blood work
results, patients current attitude, etc) is documented and shared with the appropriate persons. She is cognizant of her surroundings and
the importance of maintaining patient privacy and confidentiality (i.e. not sharing information about patients in front of other, discussing
patients in the elevators or hallways). She used technology to find research to support her care and research medications.

3. CARING RELATIONAL PRACTICE

 Satisfactory Satisfactory
3. 1 Utilize effective communication techniques.

M.G.G. : Effective communication techniques such as verbal -- open and close ended questions, and non-verbal -- thumps up or down, smiling and

grimace, is what I would usually enforced using during clinical. I demonstrate this by combining my words with minimal gestures to have a better

understanding. For example, I had a patient who were moaning before I even went into her room. Because of the continuous moaning that I have

observed, I instantly asked my client if she is in pain and asked the location. But, my client cannot tell where the pain is and would only say that it is on

her back, because of the information that I have prior on having her, I turned my back on her and let her point on my back where she feels the pain. In

this way, my client can tell me where exactly she is feeling the pain.

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

and health care team members.

M.G.G. : I demonstrate therapeutic and compassionate care by listening to my patient's stories (i.e, reminiscing and story telling) as this will help

them to regain respect and worth of themselves. (Touhy, 2012) Giving attention and actively listening to my patient would also build rapport and

relationship between us and that would make them more cooperative in their care. Together with good communication and active listening, I also

make sure to provide therapeutic care and culturally safe care to my clients by making sure that my client. For example, one of my clients allowed me

to do his bed bath but doesn't want me to do his perineal care, I didn't insisted but rather asked him if he can be able to do it by himself and explain

the importance of perineal care.

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

M.G.G. : Interactions with my assigned patients must be conducted in a way that's fair to all other patients that were assigned and will be assigned to

me. I examine my own feelings and biases toward my patient's attitudes, behaviour, gender, race and even their medical diagnosis. For example,

some weeks, I have patients who's on isolation and some weeks are not. I make sure that the patient who's on isolation would get the same care and

assistance to those who is not in isolation. As patient that are in isolation, nurses who will be providing care needs to use PPE every time entering the

room. Using PPE while providing care or doing ADLs is difficult than not wearing any of it; however, I still ensure that I will be bathing my client and

would change their bed linens as I would have done with other non-isolated patient.

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

relational practice.

M.G.G. : Self- awareness as defined in Canadian fundamentals of nursing as being aware of our own biases and choices. I tend to reflect on my

feelings, culture biases and thoughts prior, during and after giving care. In this way it would impede and hinder me from providing care to my clients.

For example, mostly of the clients that are assigned to me are males, I usually ready myself prior to coming into clinical to be comfortable because I

am well aware that I will be giving or assisting them for their baths.

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

appropriately.

M.G.G. : I make sure to communicate and report to my primary nurse and clinical instructor regarding of my client's care as wells as other health care

team and even the family members. For instance, when I was administering medication to my client, a doctor was on her rounds and ask some

reports about the client I had. I make sure to inform the doctor the right and accurate information needed for the client's plan of care. In addition to

that, I had a patient whom her granddaughter and daughter was on her side during my medication administration. I make sure to communicate with

the family as well as the client about the medications and the reason why she had to take it.

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

professional health care team.

M.G.G. : I, myself is an immigrant here in Canada and I am well aware that I have to respect each and everyone, whatever ethnicity they are in. I

apply practices and support the diversity of clients by accepting and not being picky with whatever client I have in my shift. Moreover, I also show

respect to my primary nurse even we are not in the same race.

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

clients choices and decisions.

M.G.G. : I have demonstrated this when I had to do a bed bath with my client but refused when it is time for his perineal care. I have recognized that

the patient didn't want me to be touching and cleaning his perineal and what I did was asked him if he can do it, and gave him the towel for cleaning.

His bed bath was completed as well as his perineal care because I have noticed and addressed his concern.

Satisfactory Satisfactory
3. 8 Provide effective client education.

M.G.G. : I ensure that I effectively do a health teaching to my client about their care or even the medications that I am administering. For example,

one my clients had a nicotine patch but would still smoke outside the hospital and would even go out to smoke without notice. I have told my client

about the purpose of the nicotine patch and the rationale why he had to stop smoking. Another is when I am administering medications to my client. I

would give the PO meds one at a time and tell him/her what the medication is for. In this case, I am not just educating my client but also involving

them into their care.

Teacher comments for CARING RELATIONAL PRACTICE :

Maria has been a caring professional. She has always respected the culture of others and has an appreciation of how that can effect ones
choice. When providing care Maria is aware of her own values and beliefs and makes sure they do not interfere with the care she is
providing. As she had the opportunity to work with patients with different cultural backgrounds, experiencing difference diagnosis, Maria
was able to appreciate how difference patients required different methods of care. For example: An aphasic patient who was still able to
communicate using physical signs, or a patient who was only able to communicate with her eyes, etc. She treated every patient with
respect, despite the level of care they required (independent versus total care). In addition, she provided effective patient education during
feeding, medications and their diagnosis.

4. LEADERSHIP AND ADVOCACY

Satisfactory Satisfactory
4. 1 Recognize conflicts and strategies for resolution.

M.G.G. : I do my best to recognize conflicts in regards with my clients care. I would try to critically think to find a resolution and seek assistance. For

example, I asked my instructor about the order of my client's meds to be crushed; however she's on an enteric coated aspirin (ECASA), that is very

well known not to be crushed because of its enteric coat (Lilley, Harrington, Snyder, Swart & Savoca,2011), before crushing and/or administering the

said medication. My clinical instructor have asked me to inform my primary nurse about it, so that the primary nurse can report it to the pharmacy and

be changed as soon as possible.

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

M.G.G. : When I am able to, I lend a hand to my peers who needs help or assistance regarding of bath, meds, transferring and charting in Meditech.

For example, one of my peers have asked me to assist him in preparing his medications that are to be administered through G-tube. We worked

together as preparing the medication to avoid mistakes to decrease potential occlusion or further complications with patient whose on G-tube.

Moreover, I have also helped one my peers as she said that she haven't had an experience on how to administer puffers, I told her the possible

patient teaching upon administering such as shake the canister, holding of breath for 5 seconds, wait for 2 minutes before administering another puff

and rinsing of patient's mouth. I let her do the patient teaching and administration, but I stay with her until puffer meds are done as a backup, if ever.

Satisfactory Satisfactory
4. 3 Identify opportunities to improve health care service and nursing interventions by advocating for

client, self, others, and quality practice.

M.G.G. : I try my best to recognize opportunities to provide care for patients in the best way that they can received by improving nursing interventions

and identifying any changes in the patient's condition and status. For example, when I went to my patient's room, she had taken off her nasal prongs

and as I assess her O2 Sat, it was too low in room air. I fixed her nasal prongs and educate my patient the rationale why she need to use nasal

prongs. I would usually visit her to check if she still have her nasal prongs. Because of the prolonged use of nasal prongs with 3L of oxygen, I am

aware that my patient's nasal mucosa would show dryness, irritation and pain. I have assessed her nose and noticed the dryness and patient reported

of pain in her nose. I have address this concern by telling it to my primary nurse and she have resolve the dryness and reduced the pain by

administering humidifier together with the 3L oxygen. As this was done, patient will not be irritated and would not pull out the nasal prongs causing to

an expected outcome of higher O2 Sat.

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

professional health care team.

M.G.G. : I have provided and received feedback from my clinical group and clinical instructor. I make sure to review and acknowledge the feedbacks

that I am receiving from other people because it will help me to improve my skills and abilities. As an example, I would usually received a feedback

every week through k4Y from my clinical instructor, and noticed that I need to improve my time management skills and to advocate for my patient. I

have reflected to her feedback and try possible solutions to improve my weaknesses. lastly, in regards of feedback from inter-professional healthcare

team, I would also consult and include my primary nurse's input to the care that I will be providing to my client.

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

M.G.G. : I ensure that I support my patient's self-determination and choice by asking for their consent before providing any care or nursing skills to

them. In this way I am respecting my patient's autonomy that is included in the ethical principles in nursing (pharmacology class). For example, I had a

patient who is independent and I have asked him if he needs assistance with his bath but says no, I have accepted his decision and rather asked if I

can change the linen of his bed for him but still declines. I tried offering my help but didn't insisted as he declines.

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

M.G.G. : I had noticed one nurse in the unit wearing long artificial nail polish while on her duty and providing care to her clients. The said nail polish is

against the regulatory standards because it would increase transmission of bacteria and viruses. Because I am aware of that, I still comply to the

regulatory standard and didn't imitate the said conflict. Moreover, I also noticed that some nurses would usually arrive 5-10 minutes late to their time

in. We as (student) nurses should arrive 15-30 minutes earlier to our shift time to do bedside reporting and a

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

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

M.G.G. : Whenever I am unsure about the plan of care for my patient, I make sure to ask my primary nurse to confirm or clear something for me. For

example, I would usually ask my primary nurse for any food or liquid restrictions and how the patient is to be fed to ensure that I am not putting my

patient at risk for choke or any complications.

Teacher comments for LEADERSHIP AND ADVOCACY :

Maria has demonstrated exceptional leadership skills. She advocates for clients when she feels she needs too (i.e. with medications,
nutrition, wound care, etc). Maria supports the choices a client makes when she is positive they have enough information to make an
informed decision. When caring for patients who require isolation, Maria protects herself, others and the public by ensuring she complies
by donning and doffng the correct PPE. Maria is always supportive of her peers. She provides assistance when they require it, without
being told too. Maria also provides feedback to others in a non-judgemental way. She accepts feedback graciously, and attempts to make
changes to her practice accordingly.

5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES
 Satisfactory Satisfactory
5. 1 Incorporate the unique needs and expected outcomes into individual clients plans of care.

M.G.G. : I make certain that I provide care to my patients depending on their needs and I would prioritize assessments and nursing skills to be done

that are in most need for the patient to obtain optimal health and comfort. I don't provide the same care to my patient that have the same diagnosis, as

it was mentioned in Canadian Fundamentals of Potter and Perry, every patient has their own unique needs and interests, that is why I have to see my

patient's kardex to have a better understanding of their status. As an example, I had two patient, different weeks, with the same admitting diagnosis;

however, both of them have different needs to be addresses. I ensure to provide a specific care that would deal their need to obtain comfort and

optimal health.

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

competently in writing and orally.

M.G.G. : I demonstrate this by making concept maps every week that is based on my patient's medical diagnosis, status (i.e, lethargic, amputations,

confusion, etc.), needs and abilities. I ensure to include nursing interventions that are theory based such as increasing patient's engagement in

mobility and exercises to prevent constipation or position patient in a fowler's position to help them breathe in ease, such things are included in my

plan of care as it was taught in theory classes and NURS 104.

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

M.G.G. : Prior to coming to clinical, I would do my best to be knowledgeable of my patient's diagnosis and current medications to set my nursing

priorities, assessments and plan of care; however, because of the patient's unique needs and changing environment, I would still come to my clinical

setting early enough and check on my patient's Kardex and nursing notes to see if I should be focusing on any restrictions, allergies or new orders

and medications. As I start taking vital signs, head to toe assessment on my client, I would usually observe how they interact, cooperate and involve

themselves in their therapeutic regimen and start to work out other interventions or health teaching that is needed. For example, a client who had a

nicotine patch but would still go out and have a smoke, I have address this to him and provide a rationale about the nicotine patch and the importance

of quitting smoking. As I have assessed, the patient would cooperatively involve himself in his therapeutic regimen; however because of his

independence, it I feel that he needs the rationale why have nicotine patch, why he needs to stop smoking and the purpose of his 3 puffers.

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

M.G.G. : I make certain to report my patient's vital signs, LOC or concerns to my primary nurse and clinical instructor, especially if I find it doubtful

and unusual. In this way, we can try to resolve and deal with it as early as possible to decrease the risk for mistakes and injury to the patient's care.

For example, addressing my primary nurse about the Colace liquid gel to be changed into a liquid form as my patient is in a crushed meds form.

Moreover, reported to my primary to be aware and cautious about the maximum dosage the patient can have for her pain reliever as I have already

administer 650 mg as PRN meds and 2000 mg for the scheduled meds (morning and afternoon) and the patient is still be getting another 1000 mg for

her night meds. The maximum amount for acetaminophen is 4000 mg.

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

based and within skill abilities.

M.G.G. : I ensure to carry out a safe and competent care, nursing assessments and intervention that are theory-based and within my skill abilities to

my clients every week. I do this by researching and reviewing the night before my patient's information and medications using credible source such as

Canadian Fundamentals (Potter & Perry), Physical Assessment (Jarvis), Mosby's Drug Guide book and other credible online resources for a better

understanding. Whenever my I have things that I don't understand or don't make sense why my client is having a medication, I would usually come in

the hospital earlier than usual to have a look of my patient's Kardex and some nursing notes. If I still couldn't make the connections, I speak honestly

to my clinical teacher that I don't know about why the patient is having the medication and she would explain it to me.

Satisfactory Satisfactory
5. 6 Carry out nursing care that reflects the practice decision-making framework.
M.G.G. : I practice decision-making to provide nursing care to my patients based on their unique needs. For example, when I was taking vital signs, I

noticed that my patient O2 Sat is 85%, I didn't hesitated to administer 2L of O2 to prevent hypoxia and I make sure to monitor her O2 Sat after that, so

that I can see if the 2L that I have administered is enough to provide O2 in her body.. I am fully aware that we can administer maximum of 2L of

oxygen, and I also have read in her Kardex the order to administer oxygen if the patient O2 in below 92%.

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

manner.

M.G.G. : I usually complete nursing care to my patient in an organized and timely manner. I demonstrated this by taking a set of vital signs in the

morning, together with a head to toe assessment and chart everything in the meditech. after charting, I will prepare the meds of my patients to follow

the said schedule on his/her MAR.

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

Maria has worked exceptionally well at following a care plan and meeting the patients needs. Maria is aware that all patients are different
and they have different needs. She ensures her care is patient specific. She completes accurate and thorough head to toe assessments.
Her assessments are often specific to the patient and their clinical diagnosis. Maria is aware of her limitations as a student nurse and only
implements nursing interventions which she knows and understands how too. When there are any changes to the patient, she reports this
to the primary nurse or myself so the care plan can be changed accordingly. She has improved over the term in completing nursing
responsibilities and interventions in a time manner.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

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

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

M.G.G. : I ensure to involve my client in their therapeutic regimen such as when taking a set of vital signs, I would tell them and inform them about

their it and as well as to be reported to my primary nurse. One patient I had was in a prolonged nasal prongs used and being administered of 3L of

oxygen. with the said situation, our expected outcome is to increase her O2 sat with the help of oxygen administration; however, with the prolonged

use of nasal prongs can cause, dryness of nasal mucosa, irritation and sensation of pain. With that said, my patient had self reported of the pain on

her nose due to dryness of nasal mucosa. I listened to her concern to determine her needs and reported it to my primary nurse. We, my client, primary

nurse and myself have worked together by the self reported pain of my client, assessment of the nose and listening to her concern by me and

addressed it by reporting to my primary nurse and resolve it by putting a humidifier. Because we have all work together, we can still achieve our

expected outcome of increased O2 Sat.

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.

M.G.G. : I contribute as a member of the inter-professional health care team by taking a set of vital signs (morning and afternoon), do a head to toe

assessment and administer medications to my assigned clients within my scope of practice and limitations. For example, noticing the needs of

medications that are not supposed to be crushed, but are crushed based on the patient's needs. I would address this to my primary nurse and clinical

instructor so that it can be change into a liquid form, if possible.

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

M.G.G. : whenever I am unsure or doubtful of a certain situation, I would ask my clinical instructor or primary nurse to clear things out. For example,

addressing the fact that enteric coated meds are not be crushed, Colace that is in liquid-gel form are also not be crushed; however the patient is only

taking meds that are in crushed forms. I have consulted this to my clinical instructor and tell her my reasons and rationale about it first and seek for

approval on what to do. As for my primary nurse, I would inform her the step I had took and explained to her the reason and asked for assistance to

change the patient's meds (if possible) to a medication that doesn't have complications on being crushed.
 Satisfactory Satisfactory
6. 4 Use teamwork, consensus building, and conflict resolution skills.

M.G.G. : Mostly when opportunities arise and when one of our group mates are given the chance to perform nursing skills such as wound dressing

change and foley catheter insertion, the whole group would be working as team and everyone is willing to lend a hand, especially if the the nursing

skill to be performed requires a sterile work field. For example, when one of my peers is already wearing sterile gloves, I lend a hand on opening

things such as gauze, catheter, etc., to avoid breaking the sterility process. Moreover, if ever we had an incident of missing some important equipment

for the care that is being provided, I would voluntarily go to the stock room and look for and get the equipments that is needed to be used.

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

changing environment.

M.G.G. : Every week as a new client is being assigned to me, I would make sure to make reports and inform my primary nurse and clinical instructor

of my client's vitals signs and any significant findings. In this way, I can include their input into my plan of care and be able to be flexible enough to

change and adapt to my client's needs and environment. For example, consulting my teacher of any medications that I couldn't do connections with

my clients medical diagnosis or PMH. In addition to that, asking the reason behind why my client is not on a medication or plan of care that could help

him/her situation. Moreover, during post conference, I would suggest some professional in the health care team that could meet the client's needs to

achieve his/her optimal health and comfort.

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

M.G.G. : The member of health care team that I usually have an interaction is my primary nurse; with that said, I show respect their role and

competencies by reporting to the after VS, assessment, ADLs and meds administration are done and prior to charting so they are aware of the

nursing practice that I have performed to my assigned client. I also lend a hand to my primary nurse if ever they ask for one and let them lead the

teamwork by not impeding or telling what to do in the situation we are in.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Maria collaborated well with members of the healthcare team throughout the semester. She actively contributed as a member of the
healthcare team by caring out all nursing interventions within her limits. Maria has good team work skills. She worked will with her peers
and with other members. She assisted other nurses as they required assistance. She has knowledge of and appreciates the various
members of the healthcare team. Although, she was not able to collaborate directly with them, Maria was able to discuss which members of
the healthcare team she would consult in her patients care and why.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

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.

M.G.G. : I try my best to provide safe and competent care to my clients but I am well aware that there are certain things about my client's condition

are to be consulted and collaborated with healthcare team professional to achieve their optimal health. In this way, I participate in our post conference

regarding the healthcare professionals to be consulted in the best interest and needs of my assigned client and provide rationale about it. For

example, asking for to collaborate with a dietitian for my client who doesn't want to eat anything, lethargic and have stage 2 pressure ulcer. I have

suggested a dietitian to ask if my patient can have more calories in her diet to increase energy and protein to promote healing.

Satisfactory Satisfactory
7. 2 Participate in self-reflection to identify strengths, areas for improvement.
M.G.G. : I participate in self-reflection to identify my strengths and ares of improvement by reviewing my weekly k4Y and figuring out possible ways ti

improve it. For example is my time management. At the first couple of weeks of clinical, I was taking my time to its extent when providing care, taking

VS and even head to toe assessment. Nevertheless, as my clinical instructor have brought it up in my k4Y, I started to put things that can be done

together to show time management.

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

(CNO).

M.G.G. : I have done a clinical summary about my strengths and weaknesses as I have reflected on my practice and also obtain my group mate and

clinical instructor's input to help me determine my strengths and areas for improvement and learning needs. I would developed my learning goals,

based on my weaknesses, and include research, learning activities and practices that are necessary to achieve my goals. For example, on week of

this semester, I have included in my areas to be developed is my time management, I have tried to carry out practices to improve it and as my clinical

practice ends, my clinical teacher have recognized my improvement in that area.

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

integrate these into practice.

M.G.G. : As opportunities arise during our shift such as wound dressing with orders to follow, insertion of foley catheter, Changing of colostomy bag,

nebulizer administration and G-tube meds administration, I would make sure to be in the same room while performing those nursing skills and

observe, in this way I will learn and see possible mistakes that are encountered and would try to figure out on how to avoid committing mistakes as

much as possible to obtain optimal health and comfort for the patient. For example, I have watched one my peers administer medication through

nebulizer, As weeks passed by, I was assigned to a patient with medication on nebulizer, because of the opportunity I had watching my peer doing it, I

have successfully administer my clients medications through nebulizer.

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

M.G.G. : I include notes and knowledge from anatomy, physiology, NURS 103, 150, 104, 101, 151 and lastly pharmacology into my plan of care. For

example, I am able to perform a head to toe assessment and vital signs without mistake because of the practice in NURS 104, 101 and 151. I also

ensure to watch videos in Mosby's Nursing Videos that would demonstrate nursing skills such as colostomy bag change, wound dressing, etc., that

will be relevant to my patient's plan of care.

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

M.G.G. : As I have mentioned earlier (question 7.5), I include notes and knowledge from our courses in our program practical nursing when providing

care to my clients; however, it also taught in NURS 150 that every patient has its own needs and interest. In this case, I should be flexible enough to

adapt to the changing environment of the my client. For example, I had a patient with right side hemiparesis.. In theory, physiology and anatomy, I

would have an idea that the patient would have a left side weakness and decreased in mobility even vision acuity; however, when I got the chance to

meet my client, he is independent, mobile and have good vision acuity and I had to change the nursing priorities that I had set for him. In addition to

that, we are taught that 4 side rails up are considered as a restraint but in our clinical practice, we would usually put all the side rails up to ensure the

patient's safety especially if the patient is at high risk of falls.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Throughout the term Maria has demonstrated ongoing competence. She participated in in-services and sought opportunities which came
up with her peers (i.e. administering medications via nebulizers, inserting a foley catheter, watching complex wound care, etc). Maria
reflects well on her practice and progress both verbally and written. Her learning plan was accurate and she honestly highlighted her areas
of strengths and weaknesses. All of the care that Maria provided was supported by theory she had previously acquired.

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

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

M.G.G. : I make use of my problem-solving skills and decision making by administering 2L of oxygen to a patient whose O2 sat are 85% in RA.In this

way, hypoxia and other complications are to be decreased in existence. I know that the we are able to administer 2L of oxygen and as it was also

written on my client's Kardex. I make sure to let my primary nurse know about the action I carry out. The sooner a problem is identified and solutions

are made, the better for all involved.

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

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

M.G.G. : While working on my patient, she self reported that she is having pain in her nose because of her nasal prongs. I have assessed her nasal

mucosa and notice the start of dryness due to prolonged use of nasal prongs that is in 3L of oxygen as well. I report the significant findings to my

primary nurse to avoid the patient being irritated of the nasal prongs and to decreased the possibility of her taking it off her nose. We ended up by

providing humidifier (water) together with the oxygen to provide hydration to her nose and to decreased sensation of pain. In this way we have solved

and address the problem and change or improve our nursing intervention and could still have the expected outcome of higher O2 sat for the client.

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

M.G.G. : Because of our weekly basis k4Y, I would get feedback from my clinical teacher in any areas that I should improve and reflect on. I would try

to think and act on some possible ways to improve those areas that needs development such as time management, patient advocacy and concept

maps on the first couple of weeks. As weeks passed by, I feel that I have improve myself in these areas by managing my time properly in clinical

doing VS, assessment and ADLs, voicing out and speaking to my primary nurse about any concerns that is unusual and doubtful for my patient's care

and by making a concept map thats is detailed and client-centred.

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

provide safe and competent care.

M.G.G. : I include notes and knowledge from anatomy, physiology, NURS 103, 150, 104, 101, 151 and lastly pharmacology when providing care. For

example, I also ensure to watch videos in Mosby's Nursing Videos that would demonstrate nursing skills such as colostomy bag change, wound

dressing, etc., that will be relevant to my patient's plan of care. Moreover, I have the knowledge on how to educate patient using puffers on how to

administer it as I have learned it in our Pharmacology class such as holding their breath for 5 seconds after administering the puffer, rinsing mouth

and waiting for two minutes before having another dose.

Satisfactory Satisfactory
8. 5 Use prioritization strategies for client care.

M.G.G. : before coming into clinical, i would have an idea of my nursing priorities for my patient according to their admitting diagnosis and PMH;

however, I am also aware that the nursing priorities that I have set has the chance of being changed because of the patient's physical condition. For

instance, when I was about to take a set of vital signs to my patient, I heard her moaning. As I went in, I quickly introduce myself and ask her the

reason behind her moaning. I assessed her pain first prior to her vitals signs. I usually do a head to toe assessment after taking a set of vital signs, but

because I know that my patient is in pain, that first, could affect the result of her vital signs, the findings of my assessment and mostly her cooperation

on the assessment, I quickly looked into her PRN meds and administer it.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.
M.G.G. : I demonstrate professionalism by coming into the hospital 30 minutes prior to my shift, wearing my clean scrubs and proper white shoes. In

addition to that, my personal issues and school load are left at home and I don't burden myself with it as I come to my clinical because I know that it

will impede the way I will be providing care and interacting with my patient if I am distracted.

I exhibit accountability as a student nurse by evaluating my strengths and weaknesses and reflecting on the feedback that I have received and try to

look for possible strategies to improve my weakness. Moreover, I practice nursing skills that are only within my limit and scope of practice, and would

seek assistance if I have doubt and confusion about the care that is to be provided.

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

M.G.G. : I am aware of my own strengths and limitations. I know when to help my other group mates if ever they need help for they patient or any

question about something; however, if I am unsure of the answer, I would tell them honestly that I don't know and we can ask our clinical teacher or

primary nurse to clear things up. For example, one of my peers have asked me to assist him in giving meds on a G-tube and helped him through it.

But, when she asked me to help him fill the feeding bag, I told him that we need to ask someone to assist us on doing it and be aware if we need

order or if ever there is a specific order for his patient.

Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY :

Throughout the semester, Maria has been professional and demonstrated accountability for her own learning. Maria is aware of her
strengths and weaknesses. She asks for help when needed, and develops learning plans as she requires them. She has drawn on
knowledge acquired from other courses and previous life experiences. Maria ensures her practice is guided by theory, and demonstrates
professionalism when practicing as a student nurse. With every patient, Maria prioritizes their care (i.e. continuing a assessment versus
addressing pain). As Maria continues to practice, it is evident her confidence is increasing.

9. SIM number of hours

9. 1 SIM number of hours

M.G.G. : 6

Z.P. : 6

Teacher comments for SIM number of hours :

Student Final Summary with Strategies for Continued Growth

**I am short of 12 hours in my clinical hours due to Good Friday, week 10, March 25, 2016.**

Altogether, I have exhibit professionalism of being a student nurse by complying to regulatory standards both the hospital and the college and have
demonstrated that I can practice nursing skill within my scope of practice and limitations.I ensure privacy and confidentiality by only speaking of the
patients' needs and concerns on the unit with the relevant personnel only. Moreover, I am fully aware of my own strengths and when to seek for
assistance when providing care. I would still continue to reflect and review the feedback that was given to me by my peers and clinical instructor by
practicing certain areas and referring to our notes from our previous courses. I am capable of communicating and interacting with my clients using
therapeutic communication strategies as well as to other health care team members such as my primary nurse. I ensure to ask for consent and inform
my client of the nursing skill that I will be providing. In regards of my primary nurse, I make sure to report to her of the set of VS prior to charting;
however, I still need to improve my communication skills and different strategies in communication when caring to patient. I am not only collaborating
with my primary nurse or clinical instructor but also with my peers. I seek out assistance and help accordingly and I am very much willing to lend a
hand to them also. I make certain that the assigned clients to will be receiving nursing care that is specific and would address their unique needs. I will
try my best to be as flexible as possible to adapt my client's changing environment and unique needs. I will continue to practice and be aware of
different scenarios that would enhance my prioritization of nursing assessments to be done. I will also continue to provide nursing care that is theory-
based; however, are also evidence-formed to meet client's needs. I have established a good foundation and an idea of managing my time when on
unit and providing care to clients. I am able to suggest different members of the healthcare team to collaborate to achieve my client's optimal health,
however, I will continue to do my research about different members of healthcare team, so I will be able to look and ask assistance to the right
personnel. I have always been professional and accountable for my actions in our clinical practice towards the nursing care, assessments and
administration of medication that I am providing. Whenever I have doubt, I seek out assistance to decrease errors in my care. All in all, I will continue
to practice and review significant informations that will strengthen my nursing skills and improve my weaknesses, so that I will be competent enough
when providing and interacting with my clients.

Teacher Final Summary with Strategies for Continued Growth

As the semester progressed Maria became a more competent and confident student nurse. She continued to adhere to the guidelines set by Humber
College and the practice facility. She demonstrated professionalism with her patients, her peers, and other staff. She competently completed head to
assessments and documented her findings into Meditech. She advocated for her patients and demonstrated leadership by supporting her peers.
Maria accepted feedback provided to her and made changes to her practice whenever she was able too. Maria administered medications through a
variety of routes (PO, SC injections, inhalation, nebulizers, and Peg-Tube). When administering medications, Maria was always prepared and was
able to make the connections between the medication and the patient's diagnosis and past medical history. To maintain her success, in the upcoming
semester, Maria needs to continue to practice her head to toe assessments skills. This will maintain her competence and help hone her skills. She
should explore other resources (i.e. peer-reviewed journals, videos, and text-books) to broaden her knowledge base, deepen her understanding of
concepts, and ensure her practice is evidence-based. Maria should maintain familiarity with the CNO practice standards to ensure her practice is up to
par. She should also ensure she seizes new opportunities and continue to challenge herself, as this will further increase her confidence and
competence enabling her to provide better patient care. Furthermore, it is important for Maria to engage in on-going self reflection to recognize her
strengths and weakness, and seek assistance accordingly.

It has been a pleasure having Maria as a student nurse for this clinical rotation. I wish her the best of luck in the upcoming year.

**Was absent for 12 hrs due to Good Friday**

Student's References

Goodridge, D., Lewis, S. M., Goldsworthy, S., & Barry, M. (2014). Medical-surgical nursing in canada: Assessment and management of clinical
problems (3rd Canadian ed.). Toronto: Elsevier Canada.
Jarvis, C., Browne, A. J., MacDonald-Jenkins, J., Luctkar-Flude, M., & Camera, I. M. (2014). Physical examination & health assessment (Second
Canadian ed.). Toronto, ON, Canada: Elsevier Canada.
Lilley, L. L., Harrington, S., Snyder, J. S., Swart, B., & Savoca, D. (2011). Pharmacology for canadian health care practice (2nd Canadian ed.).
Toronto: Elsevier Canada.
Mosby's Nursing Videos
Potter, P. A., & Kerr, J. C. (2014). Canadian fundamentals of nursing (5th ed.). Toronto: Elsevier Mosby Canada.
Touhy, T. A., Jett, K. F., Boscart, V., & McCleary, L. (current ed.). Ebersole and Hess Gerontological Nursing and Healthy Aging (current ed.).
Toronto: Elsevier.
Skidmore-Roth, L. (2015). Mosby's drug guide for nursing students (11th, updat with new drugs for 2016. ed.). St. Louis: Elsevier Mosby

Grade Satisfactory Unsatisfactory

Referred to Clinical Excellence Committee (CEC)

Program Coordinator Feedback
The Program Coordinator has reviewed the evaluation Yes No

Student Sign Off

I met with my Clinical Teacher/Preceptor and discussed my evaluation Yes No

In general this evaluation accurately reflects my performance Yes No

Student Comment

I have already talked to my clinical instructor about this.