NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Mid-Term Evaluation

Student: Dakota Horton

Clinical Instructor: Sarah Jackman

Clinical Placement Hospital: Complex continuing care Unit: C2

Date: Feb 6, 2017

Missed Clinical Hours: 0 Missed CLC Lab Hours: 0

 NURS 3021H Clinical Practice Mid-Term Evaluation
Program Goals
Students graduating from this program will be:
1. Prepared as generalists entering a self-regulating
profession in situations of health and illness.
2. Prepared to work with people of all ages and genders
(individuals, families, groups, communities and
populations) in a variety of settings.
3. Expected to have an enhanced knowledge of the program
foci: indigenous, women's and environmental health and
aging and rural populations.
4. Prepared to learn to continuously use critical and scientific
inquiry and other ways of knowing to develop and apply
nursing knowledge in their practice.
5. Prepared to demonstrate leadership in professional nursing
practice in diverse health care contexts.
6. Prepared to contribute to a culture of safety by
demonstrating safety in their own practice, and by
identifying, and mitigating risk for patients and other
health care providers
7. Able to establish and maintain therapeutic, caring and
culturally safe relationships with clients and health care
team members based upon relational boundaries and
respect.
8. Able to enact advocacy in their work based on the
philosophy of social justice.
9. Able to effectively utilize communications and informational
technologies to improve client outcomes.
10. Prepared to provide nursing care that includes
comprehensive, collaborative assessment, evidence-
informed interventions and outcome measures.
3000 Level Outcomes
On completion of 3000 level courses students will be
able to:
Fully understand how to practice in a self-regulating
profession.
Analyze clinical situations and reflect on individual roles of the
nurse as it impacts upon patients and the nursing profession.
Rationalize the link between health and illness.
Understand the complexity adults, of all genders, to achieve
optimal health.
Use a critical perspective in applying the foci to nursing
knowledge and practice.
Integrate critical reflective evidence-informed care using
multiple ways of knowing.
Develop and embody leadership at the point of care.
Expand awareness of leadership in nursing.
Identify strategies to develop leadership potential.
Anticipate, identify and manage risk situations.
Demonstrate awareness of resources related to risk
management.
Engages in deliberative personal centred relational practice to
assist individuals, families and communities to achieve health.
Acknowledge own potential to contribute to effective
collaborative team function.
Advocate for individuals, families, and communities
recognizing the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.
Integrates and applies critical thinking to the use of
information technology and dissemination strategies as related
to clinical outcomes.
Critically assess the individuals, family and community health
status.
Collaborate to identify priority health needs.
Identify evidence informed interventions and health outcome
evaluation in complex care situations.
 NURS 3021H Clinical Practice Mid-Term Evaluation
Course Objective
1. Demonstrate accountability and responsibility in the
teaching-learning relationship.
2. Explain the experience of chronic illness in individuals
receiving care in chronic care settings
Progress
Evidence/Indicators Satisfac Unsatisfac
tory tory
- Throughout my clinical placement I
have shown up ontime, well rested
and ready to work. I am eager for any
opportunities that the nurses on the
floor deligate my way
- I use time management skills to
finish my tasks in a timely manner
- By completing tasks deligated to me
by nurses, I prove that i am
competent enough to provide them
with help and demonstrating my
accountability
-When there is extra time on the
floor, I try to take advantage of this
by chatting with some of the clients.
While doing this I gain insight towards
what it might be like to live with a
chronic illness in this setting.
- I have noticed many of the clients
are lonely, socially isolated or just
want some company. Being in a
hospital setting can be hard without
family or friends around you. This is
why it is important that we take time
out of our day to make these clients
feel supported and not alone, even if
it is just chatting about their history
or family.
- Although these patient may have
had these illnesses for quite some
time, i noticed that many of them
have a negative attitutde towards

3. Interpret critical aspects of the persons experience of
chronic illness in relation to the nursing process such as
common signs and symptoms, responses to treatment,
patterns of coping, and impact on individual and family
relationships.
4. Identify symptoms and common medical treatments of
selected chronic illness.
their care. They are tired and
exhausted. They know the drill to
their treatments and care plan but
have lost some motivation and may
need extra encouragement.
- I worked with a patient one week
that displayed a decreased ability to
cope. When i would wake him up in
the morning he would state " please
leave me alone here to sleep". I took
note of this and gave the patient
extra time to sleep in the morning
before i bothere him, and let him
dictate when he wanted to get
washed up.
- While attempting to insert a
catheter, the patient i was working on
continuingly stated "please stop it
hurts" abiding to the patients wishes i
did not continue. I realize his
response to the treatment was very
negative and we gave him a break.
- Another patient that i interacted
with on the floor has increasing
memory deficits. I can tell that this
impacts his relationship with his wife
because I saw her tearing up in the
hallway after her visit. I could tel that
this had put strain on their
relationship and may be very difficult
to cope with
-I have had the opportunity of caring
for a few patients with a diabetes
mellitus diagnosis. I have noticed that
in the mornings they are often very
tired and groggy if their blood sugar
is too low. I have been able to shadow
nurses taking blood sugars and noted

5. Demonstrate select nursing and collaborative interventions
related to caring for the person with chronic illness such as
specific assessments, medication administration, physical
and chemical restraints, enteral feeding & residual
volumes, NG tube insertions, wound care, patient
controlled medication administration pumps.
6. Identify potential consequences/complications of select
chronic illnesses and related interventions.
the difference in alertness and energy
throughout patients with varying
blood glucose levels.
- I have cared for patients with COPD
diagnosis. These patients often have
a hoarse cough and require O2
therapy. Regularly they experience
SOB and need to be repositioned to
sitting up straight
- Completed a head-toe assessment
on every shift for patients with
varying diagnosis
- Drew up 0.5mg heparin and gave
the SubCut needle
-Cared for a patient with a belt
restraint in bed and in his chair. I
worked with the locks on the restraint
to safely complete my bed bath
- Assisted with total feed of a patient
who was blind
- I have had the opportunity to work
with many patients with
osteoarthritis. As this chronic illness
can lead to great amounts of pain, i
have noticed that these patients
often get out of bed less, walk around
less and usually are bed or chair
ridden or only get up to get on a
commode.
- Many patients on the floor have
memory or mental deficits. While
chatting with patients sometimes
they are forgetful and fail to
remember important aspects of their
life. I have noticed how this can affect
the patient by bringing negative
thoughts or feelings of
 disappointment or discouragement.
- After working with multiple patients
with diabetes, It was brought to my
attention how important it is to
monitor blood sugars. The patients
meals have to be planned accordingly
to medication, medication has to be
planned according to blood glucose
levels. It is a never ending cycle and
if it gets off track it can have great
impacts on these patients.
7. Under the supervision of a Registered Nurse, demonstrate - Many patients on the unit have
safe, competent, evidence-informed, holistic nursing different isolation precautions. I
practice with clients with chronic illness recognize that this is a hassle for
a. Use a wide range of effective communication nurses and often causes them to
strategies and interpersonal skills to appropriately enter the room significantly less
establish, maintain, re-establish and terminate the amount of times. Because of this, i
nurse-client relationship try to take my free time to visit these
b. Demonstrate accountable, responsible and ethical patients. One patient said "well, i got
practice nothing else to do in here except wait
c. Engage in respectful, collaborative, therapeutic and for my nurse to come visit me". This
professional relationships statement really stuck with me. Some
i. Demonstrate therapeutic use of self of these patients dont have visitors
ii. Create a culturally safe environment everyday or every week. This can
d. Apply nursing models and theories lead to social isolation. I try to
e. Demonstrate health promotion and illness engage in light conversation with
prevention practices these patients to make them feel less
f. Demonstrate patient advocacy alone or left out, and ultmately build
g. Predict outcomes of nursing care a therapeutic nurse-client
h. Evaluate client response to nursing care relationship.
i. Critically appraise own practice in relation to nurse- -I have noticed that a lot of the
client/family interactions and as a member of the clients on this floor have decreased
health care team motivation to get out of bed. I always
try to promote them to get moving,
reposition, sit up in a chair if they are
feeling up to it. This can help revent
medical complications like ulcers,
DVT etc.

8. Critically appraise own practice in relation to nurse-
client/family interactions and as a member of the health
care team
9. Participate in professional development based on reflective
practice and critical inquiry
- I was able to advocate for one of my
patients last week after he expressed
concern with waking up at 7am. He
wanted to be able to sleep in and i let
this happen. I took his vital routinely
and then gave him time to nap while i
got other things done and returned at
a later time to complete his bed bath.
His primary nurse approved of this
and let me do it the following shift
aswell
-After each shift, i go over it in my
head and decide what went well and
what did not. After chatting with
patients, I think about how i could
have said something more clear or in
a better way, or ways that i could
approach subjects better to allow a
better nurse-client relationship
-As a meber of the health care team, i
try to be as knowledgable as possible
so i can accurately answer clients or
family members questions. i do this
by familarizing myself with the floor
and asking questions when i don't
know something.
After each shift i personally reflect on
everything i may of done well and
everything that i could have done
better. I go over the shift in my head
and give myself constructive criticism
on what i need to work on
-After this reflection, I make goals for
myself for the next shift. Whether it is
do vital signs on an extra patient in
the morning, complete the bed bath
more time efficiently etc.
- After each shift, i complete a post
 clinical assignment. This is where i
reflect on diagnoses, lab values and
assessments that i do and explain the
rationale. This helps remind me why i
am doing what i am doing and
motivates me to want to learn more.

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

comment)

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