L4 Clinical Intensive I

Summative Clinical Evaluation Template

Student Name: Courtney Wolf Clinical Site: Presbyterian Pediatrics

Scoring:
E = Exceeds expectation: Consistently appropriately independent, and shows initiative
S = Satisfactory: Meets expectations and competencies
U = Unsatisfactory: Unsafe, consistently needs guidance, unable to perform independently, unable to demonstrate
appropriate clinical judgment
Scoring: E = Exceeds Expectations S = Satisfactory U = Unsatisfactory

Course Student Instructor

Objective
Competency E S U E S U
Course Integrate nursing practice concepts into their professional X X
Objective 1 nursing practice.
Course Integrate diverse patient values into plan of care for patients X X
Objective 2 with acute illness.
2.1 Integrate patient’s values, beliefs and attitudes into the X X
patient plan of care
I have had a Native American patient in the hospital with pneumonia. I noticed her and her mother were
very stoic and traditional in their mannerisms. I respected these values to the best of my ability and did
not think differently of them because they were reserved and made limited eye contact and conversation.
When the patient had many family members over, I respected their space and respected their cultural
belief of strong ties to family.
2.2 Using effective communication, integrate patient’s expressed X X
values, beliefs, and attitudes in nursing care
While talking to my hematology patient, his mother expressed that she was concerned about his low
blood pressure while receiving his chemotherapy. To address this problem, I reassured the mother that I
would go straight to the doctor with her question. I promised the mother I would make sure the doctor
would address the problem personally with her. I made sure to value her concerns and communicate
effectively with both the patient’s family and doctor. Additionally, I have had a young patient who met all
of her requirements and was just patiently awaiting discharge instructions to go home. When she asked
me, I went straight to the doctor and asked if he could put the order in.
2.3 Integrate the use of resources to meet health care needs for X X
diverse patient populations
While caring for a 7-week old patient newly diagnosed with an extremely rare form of anemia (black
diamondfan), the nurse and I printed off some educational information sheets from a reliable source on
the internet to help teach the family about the syndrome and what to expect with the condition.
Additionally, I helped provide meal tickets to the family members of a young girl who lived on the
reservation and did not have very much money.
Course Interpret and analyze factors and system contributions that X X
Objective 3 impact the quality and safety of nursing practice.
3.1 Analyze factors present in clinical settings that promote or X X
hinder a culture of safety and caring.
While on the unit, I have noticed many practices that promote safety noticed a few factors that hinder it
as well. For example, the nurses are all really great at charting all of the essential information and
performing hand hygiene. However, I have noticed a few nurses do not always put on all the required PPE
when performing nursing care. I have also noticed sometimes nurses leave medications unattended out on
a desk after pulling them. Furthermore, I have also noticed many great system contributions that all
hospitals should utilize, including the medication administration scanning and the Vocera phones all
healthcare providers use to communicate interprofessionally.

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3.2 Anticipate, identify, and eliminate potentially harmful X X
situations in an acute care setting with minimal guidance.
While previously I only successfully identified potentially harmful situations (lack of ppe for example), and
did not act on them, now I do my best to eliminate them when I see them occurring. For example, while
my nurse was changing a central line dressing, she broke sterile field. I went and got her a new sterile kit
and gloves. Additionally, I got very good at making sure I performed my Q2 hourly safety checks while
documenting in the chart what safety measures I was starting or maintaining.
3.3 Interpret and evaluate system contributions and staff response X X
to clinical errors and near misses in an acute care setting, with
minimal guidance.
While calculating a dose of morphine for a withdrawal baby, I noticed my nurse accidentally calculate the
wrong dose because the dose was different from yesterday as doctors were weaning her off the opioid.
However, the nurse and I that did the double check with her and caught the mistake before anything was
pulled from the pyxis. Furthermore, I noticed that it wasn’t very safe to bring drawn up unlabeled
medications into the patient’s room as it could be confusing knowing which medication is which. I learned
to label all of my medications in order to prevent this confusion and possible med errors.
3.4 Implement evidence‐based procedures to reduce harm, X X
promote safety, and improve care in an acute care setting with
minimal guidance.

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 Before beginning my day at the NICU, my nurse and I completed the standardized safety equipment check
at every patient room. We checked to ensure the suction was on and working properly and made sure the
oxygen and ambu-bag was on and running. This was an evidence-based procedure that is implemented at
Pres to be prepared in emergent situations. Additionally, the Q2 hr safety checks I implemented are a
proven evidence based protocol that show increased patient safety outcomes.
3.5 Design methods to introduce best and/or evidence based X X
practice within an acute care setting.
Before performing a heel stick on a baby in the NICU, I determined the best way to do it was to ensure I
had all my equipment and supplies ready, open, and at the bedside before beginning. This ensured I will
able to get a clean poke, a good blood glucose reading, and be able to collect a vial’s worth of blood for
labs all in an effective, timely, and clean manner. Additionally, I found the most accurate way of drawing
up crushed medications. Instead of putting the crushed med in a med cup and mixing it with saline, I
found it is more efficient and accurate to put the crushed med straight into the syringe and drawing up
the saline in there. This minimizes medication lost in the transfer.
Course Integrate an evidence‐based approach in the delivery and X X
Objective 4 evaluation of nursing care to acutely ill patients across the
lifespan.
4.1 Incorporate patient/family preferences and values into an X X
evidenced‐based plan of care for participants with acute
health problems.
While at the NICU, a mother of a newborn only wanted to breastfeed her baby. However, she ran into
problems when her milk hadn’t come in yet and she had to be around every 3 hours to feed the baby.
During my shift, the mom was at home in Rio Rancho and said she was going to come back to feed the
baby. However, the mom did not come back to feed the baby. Instead of going against her wishes and
feeding the baby formula, the nurse and I called her to made sure she came back to the hospital
immediately to breastfeed her baby.
4.2 Apply evidence based approaches to care for participants with X X
acute health problems.
My nurse in the NICU taught me about a recent study that has developed the best protocol for weaning
off drug-addicted babies off of morphine. This is the protocol the doctor used when writing her dosing and
what we followed when delivering her morphine. The baby tolerated it well.
4.3 Modify care based on evidence based protocols/pathways X X
when providing care for participants with acute health
problems.
When my 16-year old cancer patient was receiving chemo, his blood pressure significantly dropped, down
to 88/55. The nurse and I followed the evidence-based protocol, which called for us to stop his transfusion
immediately and notify the provider.
Course Evaluate the use of policies and procedures within the acute X X
Objective 5 care setting
5.1 Demonstrate clinical competency with the acute care patient X X
in lab and practice settings.
In the clinical setting, I performed thorough assessments on my patients. I was the first one to find
diminished lung sounds in my patient with pneumonia. I safely delivered all of my medications following
the seven rights of med administration and 3 medication double checks. I however, still feel like I am
developing in this category as I still sometimes get nervous around patients. I recently spilled Lasix all over
a patient’s bed. Overall, I hope to grow in both my confidence and clinical skills.
5.2 Use effective communication style with appropriate team X X
members in care of patients with acute illness.

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 My patient with pneumonia was on antibiotics, however one
of the antibiotic IV bags was not in the pxyis. I had to use SBAR
and call the pharmacist and ask if he could send it over. I also
communicated with the pulmonologist, X-ray technician, and
doctor throughout my shift to ensure interprofessional
collaboration for the best health outcomes.
5.3 Identify how healthcare policy, finance, and regulatory X X
environments relates to the care of patients with acute illness.
Although I am still developing in identifying how healthcare policy affects patients, I have noticed how Medicare has allowed for
most pediatric patients to receive healthcare when needed. Additionally, I have observed how nurses in the NICU implement
safety checks on suction and oxygen before starting their shift. Lastly, I have seen regulatory bodies, such as CYFD, step in and
intervene for the sake of a child’s safety.

5.4 Demonstrate ethical practice in the delivery of care to patients X X

with acute illness.
. Throughout the shift, I noticed some nurse leave their patient’s medication out at the nurse’s station for
hours before delivering it. This medication could potentially get lost or stolen. Furthermore, in the PICU, I
noticed my patient’s potassium level was elevated at 5.3. When I told my nurse about this, she brushed it
off as nothing, while in reality, this could cause devastating effects on the patient.
Course Effectively collaborate with the healthcare team in the delivery X X
Objective 6 of patient care.
6.1 Begin to integrate the collaborative role of the nurse X X
effectively within the inter‐professional team.

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 I feel more confident accessing patient information through EPIC now. I feel as though I consistently access
and document all physical assessment, lab values, medications, diagnoses, goals, past medical history, ect.
I also performed more of the nursing role when delivering medications, working the pumps, performing
patient education, and speaking with the doctor/pharmacist for the patient. I also collaborated with the
pharmacist when performing a toe stick to measure Coumadin levels on my pediatric patient.
6.2 Engage effectively in shared decision making to provide quality X X
patient care.
In all of my clinical days thus far, I have participated in daily rounds with the doctors, nurses, case
managers, social workers, respiratory therapists, and other students. Together, patients concerns are
discussed and solutions are thought of collectively to provide the best quality patient care. Shared decision
making is also made when discussing interventions with my nurse or with Manijeh.
6.3 Create supportive relationships with team members to X X
leverage diverse skills.
Many times, I worked with my fellow classmates to perform tasks collectively and more efficiently. For
example, Kylee and I helped changed a short bowel syndrome patient, helped her patient ambulate to the
restroom, and deliver medications together.
6.4 Demonstrate ability to function as team member or leader. X X
Offering advice and expertise is a leadership behavior I have noted on at Pres. Now, when my fellow
nursing students are struggling or have questions, I feel confident I am able to also offer up my advice and
expertise that I have acquired through clinical. I know that everyone has their strengths and weaknesses
and that it is essential to pull from everyone’s expertise.
Course Integrate use of appropriate technology for the delivery of X X
Objective 7 nursing care to acutely ill patients.
7.1 Document planning, implementation and evaluation of nursing X X
care of patients with acute illness using available technology.
Using EPIC I was able to document full assessments meds, I/O’s, safety checks, lines/drains/airways, and
all other important data. Also through EPIC I was able to follow the nursing plan of care and see
medications in the MAR to understand my patient’s illnesses and be informed on how to treat them. I also
have found the other resources on EPIC, such as the medication reference or the nursing diagnosis
applications, to be quite helpful in caring for my patients and their safety.
7.2 Incorporate health care resources in sharing health X X
information with patients with acute illness.
Offering more resources for my patients is something I strive do be better at. For example, for the new
teenage parents in the NICU I had, I wish I had offered them parenting and other resources in order to
help them adjust to being new parents with a new baby. I did share educational sheets to the family who’s
daughter was just diagnosed with black diamondfan anemia as well as provide meal coupons for a family
who did not have a lot of money.
7.3 Safely operate appropriate technology in the delivery of care X X
to acutely ill patients.
I successfully performed my first heel stick and blood glucose on a baby using the glucometer. I was sure
to clean the baby’s foot with alcohol, correctly set up the glucometer, wipe away the first drop of blood,
and flex the foot to get the blood out of the body. Additionally, I safely put on a baby on a 23 mL of oxygen
by putting his nasal cannula on correctly. Lastly, I helped the pharmacist perform a toe stick on a baby and
also now feel confident using both kangaroo and normal pumps.
Met Course Clinical Expectations X X
Demonstrated mastery of previous competencies X X
Student Comments:

Overall, I had such an amazing growing experience at Presbyterian. I believe I grew the most in terms
of two skills: medication administration and communication skills. I now feel very confident
administering medications, everything from PO to IV, on all types of pumps. This is something I am
very excited to know how to do because I practically came in with no experience with this.
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Additionally, I feel as though my communication skills with my patients, everything from
motivational interviewing to discharging patients, is something I have greatly improved on as well. I
look forward to growing more in handling larger patient loads and gaining more confidence in my
nursing skills. Thank you so much to all the nurses, especially Manijeh, who taught me so much on
PCU, PICU, and NICU. I have had an incredible experience at Pres.

Faculty feedback: Courtney,

You have improved and grown so much in all areas and different skills
throughout this rotation. You go above and beyond to ensure safe
care for your patients. From administering po meds to administering
blood, you have done a great job! You have excellent communication
skills with our pediatric patients. I really enjoyed having you in my
group. Best of luck to you!

Student signature: Courtney Wolf

Instructor/Preceptor signature: Manijeh Sharifi