NURS 3020H

Clinical Evaluation
(Check one) Midterm __X____ Final ____________
Student Name: Marissa Rose-Morris
Clinical Instructor: Laura Reid
Missed Clinical Hours: 0

Missed Lab Hours: 0

Program Goals
Graduates are generalists entering a self-regulating profession in situations of health and illness.
Graduates are prepared to work with people of all ages and genders (individuals, families, groups, communities and
populations) in a variety of settings.
Graduates continuously use critical and scientific inquiry and other ways of knowing to develop and apply nursing
knowledge in their practice.
Graduates will demonstrate leadership in professional nursing practice in diverse health care contexts.
Graduates will 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
Graduates will establish and maintain therapeutic, caring and culturally safe relationships with clients and health care team
members based upon relational boundaries and respect.
Graduates will be able to enact advocacy in their work based on the philosophy of social justice.
Graduates will effectively utilize communications and informational technologies to improve client outcomes.
Graduates will be prepared to provide nursing care that includes comprehensive, collaborative assessment, evidenceinformed interventions and outcome measures.

Objectives
1 Explain the experience of acute illness in individuals
receiving care in acute setting

Progress
Indicators/Evidence
Week 2: My pt this week started off on bed rest. This pt was very
alert and cognitive and was hoping to go home ASAP. During the day
the pt mentioned to me that they wanted to be able to get out of
bed and off the unit so they could get a good cup of coffee. Since
they had already been seen by PT and set up for their w/c I asked the
primary nurse about changing his PIV to a NSL. The nurse agreed
that this could happen as the PIV was only TKVO for the antibiotics
that the pt received in the evening. This pt was extremely
independent so most of my care revolved around making sure that
they had what they needed, and were not in any pain.
Week 3: The pt I was caring for this week was in hospital due to a
percutaneous abscess and a laparoscopic colostomy. Along with the
ostomy, the pt also had a JP drain, foley catheter, PIV, PICC, and
dressing for a fistula on their lower abdomen. Before coming in for
surgery the pt had a hx of malnutrition and as such was put on TPN
post op until they started eating full meals. The pt found the foley
catheter uncomfortable when they were up walking. Since they
were able to walk and were cognitively aware the doctor put an
order to d/c the catheter. After removing the foley, the pts pain and
discomfort was eased. They were also much happier to walk around
without it. My care for this pt was based around making sure they
were comfortable, and assisting them in going for walks around the
unit. I also monitored the PICC and PIV sites, as well as the JP and
ostomy.
Week 4: My pt this week was 2 days post op from a R
hemicolectomy to correct an ileocolic intussusception. When I
started my shift they were on a PCA, R/L with 40 KCl, and 2L O2. The
pt was not in much pain, and barely used the PCA pump. The pt was
encouraged to get up at least 3x a day for a walk around the unit and
was happy to get out of bed. Since the pt reported little pain even
without using the PCA, the primary nurse suggested removing the
button from the pts reach and having them ring the call bell if in any

S U
X

pain so a milder analgesic could be given. The pt was happy with this
choice as they were not using the pump anyways. By my second
shift the pts PCA had been d/cd and they were on RA as their SpO2
was remaining at an acceptable percentage.
Marissa helps her patients explore their experiences by using a
caring and professional presence. She uses her critical thinking to
help formulate a care plan that will optimize the patient's outcome
ie. mobility and independence.

2 Interpret critical aspects of the persons experience

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

On the second day of week one I cared for a pt with a BKA. They had
been suffering from diabetic neuropathy and chronic foot ulcers
before the amputation. This pt seemed to be coping very well with
the amputation as they were no longer having the nerve pain in that
leg. The pt was mostly eager to get out of the hospital so they could
take care of their child at home. This pts coping was done before
they even had the surgery. As I was speaking with them they spoke
of how they had been ready for the leg to be gone for a while as it
was putting them in severe pain. This pt had been well prepared for
their surgery and understood what it would mean to have it done.
Where this pt coped very well with their experience, my pt in
week 3 did not seem to be coping with their ostomy very well. They
did not want to empty or learn to work with it on their own. When
speaking with them, they seemed very reluctant to discuss the
ostomy and what came with it. They made a mention of how their
spouse would probably help them a couple times than not want to
anymore as they are a nurse. I believe that this pts reluctance to
work with their appliance put some strain on their spousal
relationship as the spouse does not want to have to do the care that
they are capable of.
Marissa is able to implement treatments to optimize her patient's
recovery. She acknowledges her patient's experiences in their
illness and helps to empower them.

3 Identify common medical treatments and potential

consequences/complications of selected acute
illnesses

4 Demonstrate selected nursing and collaborative

interventions related to clinical pathways, perioperative care, IV medication administration, cardiac

assessment and rhythm strips, neurological
assessment, wound care, blood component therapy,
TPN and central lines, pulmonary care including
chest tubes and tracheotomy, initiating IVs, rapidly
changing conditions, and resuscitation

Each week I demonstrate my knowledge of common medical

treatments and potential complications through my preclinical
assignments. I research each pts diagnosis and surgery so I will
know what to look for in my head to toe assessments and what
would be concerning. For example, in week 4 my patient had a
hemicolectomy so I made sure to do a focused GI assessment and
monitor BMs. I also got all of my pts that were not on bedrest out
of bed as often as possible to encourage blood flow and reduce the
risk of post op DVT. For the pts that were on bedrest I encouraged in
bed exercises such as calf pumping and lifting their legs.
Marissa shows a good understand of possible post op
complications. She is able to show this by utilizing a variety of
techniques to prevent complications. Some examples of this are her
understanding of the importance of mobility and/or bed exercises
for her patients as well as performing deep breathing and coughing
exercises.
In week 2 I demonstrated my ability to properly administer
medications both oral and IV. With the supervision of my instructor I
used the ADU to dispense the medications needed and administer
them to the appropriate pt.
In weeks 2-4 I have demonstrated my ability to change dressings
using aseptic technique, apply mepores, empty JP drains, assess TPN
and PIV lines, assess PIV sites, empty ostomy and foley bags, and d/c
foley catheters with the supervision of a RN.
I have also performed full head to toe assessments on my pts each
week including neurological, cardiac, GI, urinary, respiratory and
integumentary assessments.

Marissa efficiently performs her head to toe assessments of her

patients. She documents appropriately in a clear, concise and
timely manner.

5 Under the supervision of a Registered Nurse,

demonstrate safe, competent, evidence-based,

holistic nursing practice with clients with acute
illness
1. Apply relevant nursing models, philosophical
frameworks, theories and evidence
2. Demonstrate therapeutic use of self
3. Engage with patients in an ethical and
culturally safe manner
4. Understand and anticipate emerging biopsycho-social needs of persons with acute
illness and apply this knowledge to care:
a. Plan appropriate nursing care
b. Predict outcomes of nursing care
c. Evaluate client response to nursing
care
5. Demonstrate health promotion and illness
prevention practices
a. Engage with patients and families to
identify health-related situational
challenges
b. Work with patients and families to
create reasonable and effective
solutions
6. Demonstrate patient advocacy

Week 4: the pt I was working with had stated that they were in pain
after getting back in bed after our walk. Since the pt was no longer
on the PCA pump at this time, I approached my clinical instructor
about giving some pain medication as I could not find the primary
nurse. At one point during my shift the pt apologized for talking so
much. I told them that it was ok, and that they were not talking too
much as I enjoyed speaking with them. For the rest of my shift I
made sure to take the time to speak with my pt in a way that did not
make them feel as though I was trying to leave or cut the
conversation short.
--every week I made myself available for my pt. When first entering
the pts room I introduce myself and state that I am a student nurse
so that the pt is aware of this fact. I researched their diagnosis and
surgery prior to attending clinical so that I was able to answer any
questions that they had to the best of my ability. If the pt had a
request or question that was outside of my scope of practice I found
either my clinical instructor or primary nurse to respond.
-- I update my flow charts regularly and inform the nurse of anything
that may be out of range for that pt. At the beginning of my shift I
do a full head to toe assessment of my pt, which I will repeat at least
once more during my shift. If the pt needs to have a specific vital
sign monitored I will do a full set of vitals however often is necessary
for that pt.

7. Demonstrate accountability
8. Demonstrate reliability

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

7 Participate in professional development based on

reflective practice and critical inquiry

Marissa is empathetic to the needs of her patients. She encourages

them to help maintain their independence by assisting them when
necessary ie mobility and health teaching.

--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 needs that patient has. I
have reported any patient concerns to my nurse during and
at the end of shift.
--Each week I approached my patients with care and respect. I
always spoke to my patients and asked them questions. I asked the
pt if I was ok before I did something in their room or with their
person such as a head to toe assessment.
Marissa is encouraged to collaborate with members of the health
care team and update them of her patient's concerns and health
needs.
-- Before and after each clinical week, I research the diagnosis and
surgeries of my patient so I can expand my knowledge their diagnosis
and procedures.
-- At the end of each clinical week, and before clinical on med days, I
research the medications being given to my patients. Through this I
am able to better understand a variety of drugs and their uses.
--I wrote a reflection on my care of a pt in week 4, and how the VAS
scale can be hard to use with some pts. This reflection allowed me to

review my practice when it comes to discussing pain levels with my

pt if they do not seem to fully understand the VAS scale.
Marissa recognizes her own nursing limitations and skills and seeks
the guidance and knowledge necessary to care for her patients.

Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment)
Marissa is a positive and caring nurse. She is confident in her head to toe assessments and is at ease with her interactions with her
patients. She demonstrates good critical thinking in her nursing role and seeks new knowledge necessary to ensure competency in the
care of her patients. She is developing well in her nursing role.

Signature of Instructor___________________________________________________
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Date

Signature of Student_____________________________________________________
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Date