NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Mid-Term Evaluation
Student: Marissa Rose-Morris
Clinical Instructor: Melissa Farrow
Clinical Placement Hospital: PRHC
Missed Clinical Hours: 0

Unit: C2

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, evidenceinformed 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. Explain the experience of chronic illness in individuals
receiving care in acute settings

Progress
Evidence/Indicators
Wk 6: I cared for an elderly male patient with
MRSA and a forefoot amputation. The patient
was upset with the lack of pain management. I
listened to his complaints and then discussed
with my clinical instructor to understand why
he could not have narcotics. I asked the patient
about his pain and actively listened so I could
understand his frustrations.
Wk 3: My patient was diagnosed with
freidreich's ataxia. With this Dx the patient has
loss of motor control but their mind is not
affected. For this patient I made sure to ask him
yes or no questions so he was still involved in
his care.
Wk 5: My patient was an elderly female in
hospital after a revision to her knee implant.
She was mostly independent and only needed
help with some washing as she could reach
everything.
~ Pre and post clinical assignments
are submitted in a timely fashion;
showing evidence of research and
increased knowledge gained
~ Marissa is linking together
diagnosis and nursing interventions
to care required for each patient she
cares for and the rational for this
requirement
~ Marissa is very thoughtful and
thorough in the care she provides
~ She is caring for 2 patients each
clinical shift independently, and

Satisfac
tory

Unsatisfac
tory

2. Interpret critical aspects of the persons experience of

chronic illness in relation to common signs and symptoms,
responses to treatment, patterns of coping, and impact on
individual and family relationships.

3. Identify symptoms and common medical treatments of

completing tasks in a timely fashion

-Every week before clinical I make
sure to do do my assigned preclinical
and look up and dx or hx that I do not
know so as to have a better
understanding of my patients
condition.
-Each week I perform a head to toe
assessment on my pts, including lung
sounds, bowel sounds, and skin
integrity. If any of the areas are not
normal, it is noted and reported to
the nurse. With patients that have a
g-tube, the bowel sounds are
important to make sure the tube is
not blocked.
-Wk 3: My patient was on a variety of
Rx all but one of which I was able to
apply to his diagnosis. The drug that I
was unable to find the use for, I asked
my clinical instructor about and was
then informed of its usage. By
understanding the medications I was
able to know the effects they had on
the body and potential side effects.
~ assessments of patients
completed in a timely fashion
~ Marissa is developing assessment
skills and concentrating on details;
her assessment forms show evidence
of this
~ Marissa's charting has continued to
improve and is completed on time to
leave the unit
~ Progress notes are progressing to
the third year level, and is requiring
less and less adjustments
Freidreichs ataxia

selected chronic illness and disease process in individuals

receiving medical, rehabilitation or long term care.

Neurodegenerative disease
Knowing the pathophysiology
allowed me to understand that
the patient was mentally aware
even if he was unable to control
his physical movements.
Because the patient was nonverbal I asked yes or no
questions so they could nod an
answer.
Cared for bowel incontinence,
foley catheter in place
Pt also had dysphagia due to
this Dx so I assessed
respiratory and was cautious
when feeding.

COPD
Progressive lung disease
Pathophysiology told me to look
for wheezing and other
abnormal breath sounds as a
sign of an exacerbation. Also to
look for increased RR and
cough
Kept patient from lying flat on
their back to improve breathing
Forefoot amputation
Pt was on floor for rehab
Worked with OT in an air-cast to
improve mobility and get used
to walking without forefoot
Pt. was required to do as much
care for themselves as possible,
during morning care I offered
cues and help when the pt. was
in too much pain to finish care
on their own.

~ Great medication passes, well

prepared and knowledgeable of
medications, ensured the 3 checks
and 5 rights. She did wonderful
considering her first time using an
ADU
~ Marissa is independent in caring
for feeding pumps, tubes and
hydration flushes
4. Demonstrate selected nursing and collaborative
interventions related to palliative approach, clinical
pathways, health promotion and self-management,
functional assessment, nutritional assessment,
musculoskeletal assessment, respiratory assessment,
head/neck/eyes/ears assessment, wound care and end of
life care.

Wk 6: My patient had two wounds on

his lower leg. He spends most of his
time in bed which puts him at higher
risk for pressure ulcers and other bed
sores. Risk is lowered by frequent
turning and an air bed to relieve
pressure. The wound was treated with
silvercell and covered with a mepore
dressing.
Wk 5 (?): This week one of the pt on
the floor passed away before our
shift. At the end of this shift we
preformed end of life care for this pt.
We looked over the body and
recorded and belongings. The brief on
the pt was clean so was left on and a
new gown was placed on the pt. The
body was checked for the correct
paperwork and tagged. We then
transferred the pt to a body bag and
onto the table. We made sure the
hallways were as clear of
unnecessary people as possible
before moving to the morgue.
Wk 6: I went with a patient to get a
cat scan. While there the technicians
explained the process and what was
being shown on the scan.

5. Identify potential consequences/complications of chronic

disease process and related interventions.

~ Marissa is continuing to hone in on

assessment skills, she seeks
clarifications and second checks as
her confidence is increasing
~ I feel Marissa is starting to put
together the clinical pieces and is
collaborating a variety of nursing
models and theories, and utilizing the
knowledge she has gained thus far in
the program
~ We had an opportunity as a group
to explore end of life care and post
mordem care in week 4; this was
managed professionally and with
great respect. There was a comment
in regards to Trillium Gift of Life from
the charge nurse and her disbelief in
the program; she is not enforcing the
required contact with TGOL. This
upset and caused a discussion at
post conference that day.
~ We invited Shelley the Respiratory
Therapist department lead to 2 of our
post conferences. The first she
reviewed oxygen therapy, and the
second she reviewed tracheostomies.
She shared wonderful clinical
examples, uses and applications of
each device. An increased knowledge
and comfort was gained from these
experiences.
Wk 6: cared for patient that had a
forefront amputation due to lack of
circulation. Since interventions were
not put in place early the patient was
left with needing an amputation. This
also led to the patient having
extreme pain in his feet, both

6. Under the supervision of a Registered Nurse, demonstrate

safe, competent, evidence-based, holistic nursing practice
with clients with chronic illness
a. Apply nursing models and theories
Self management
Motivational interviewing
Addictions
Palliative approach

phantom and not.

Wk 5: cared for a patient with IDDM,
he also had acute renal failure. The
renal failure could be associated with
his IDDM if his numbers were
uncontrolled as this affects the
kidneys. I was able to think critically
about what interventions could have
been instated earlier in life to help
prevent the renal failure.
Wk 2: Increased my understanding of
pt. living with degenerative
neurological disorders. Researched
interventions that may be used to
slow the progress of the disease.
~ Marissa reports abnormal findings/
assessments and behaviors to nurse
and instructor
~ able to predict outcomes and
foresee consequences (increase
secretions of trach requiring suction,
advocating for her patients in regards
to pain medications, and personal
care)
~ continuing to comprehends risks
related to patients and adjusts
practice accordingly ( HOB elevated
with feeding tubes, side rails, risks
related to tracheostomy tubes, lift
polices)
Wk 1-6: researched pt. Dx, looked
into medications and possible side
effects. Increased my understanding
of
conditions
and
possible
complications of these conditions.
Wk 5: Spent time listening to patient
talk about family and how they were
looking forward to going home. We

b. Demonstrate therapeutic use of self

c. Engage with patients in an ethical and culturally
sensitive manner
d. Demonstrate health promotion and illness prevention
practices
e. Demonstrate patient advocacy
f. Predict outcomes of nursing care
g. Evaluate client response to nursing care

7. Critically appraise own practice in relation to nurseclient/family interactions and as a member of the health
care team

spoke of how often her family came

into visit, and that they were not
coming in that day.
Wk 6: My patient did not want care
done until later in the morning as he
was tired. When I came back after
breakfast he allowed me to complete
his care. I asked him if he wanted to
sit up or not and he decided to go
back to sleep. When I went in to
check on him throughout the day we
had small conversations before he
would go back to sleep.
~ Professional behavior on the unit
~ applies multiple nursing models in
practice and addresses them in post
clinical assignments
~ good time management skills, as
Marissa's confidence increases, as
does her ability to manage a heavier
patient load
~ Marissa has experienced both
verbal and nonverbal patients and
has managed the challenges of
communication
and
therapeutic
relationship development well
~ helpful around the unit, always
willing to assist team members and
staf
Wk 1-6: attended report at the
beginning of each shift. Understood
the concerns of the nurses in regards
to my patients. Also helped me to
understand my approach to care for
each patient.
- I have introduced myself to my
patients nurse each week, and
inquired about any specific

8. Participate in professional development based on reflective

practice and critical inquiry

needs that patient has. I have

reported any patient concerns
to my nurse during and at the
end of shift.
Wk 6: I spoke with a patients family
while they were visiting, as I had to
take the pts blood pressure. We
discussed how the patient wanted to
go home and was tired of the
hospital.
~ professional uniform and attire
~ introduces self to staf and
patients; does well reporting of to
peers and staf before breaks
-Wrote a reflection on my experience
on the unit. Through this reflection I
was able to better understand the
level of care I was giving and what
was given on the unit. From here I
was able to improve my skills to
increase the quality of care I was
giving.
Wk 2: researched medication use
and side effects before administering
on shift. For the medications I was
unsure of, I inquired about why they
were used from my peers and clinical
instructor.
Wk 2: This was my first experience
giving medications. I learned how to
use the ADU, and how to give
medications via a g-tube.
~ Evidence is sufficient in Marissa's
post clinical assignments that she
reflects on each patient she has and
the day spent with them providing
care
~ Marissa's reflection on coping with

patients behavior was brief and did

not include research or much format.
I have given her feedback and she
will seek guidance if required for the
next reflection. I have ofered to
show her examples of other
reflections to gain a firmer grasp on
the format required.

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

comment)
Marissa is a delightful addition to our C2 group, and wonderful to instruct. She started
the semester as the only student that has not completed an acute placement; however
she is not lacking in any way for that lack of experience. The first 2 weeks were a good
orientation to the hospital and floor routine, and she has done very well in this placement.
I look forward to mentoring her growth in the second half of the term!

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