NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Mid-Term Evaluation

Student: Natalie Selkirk

Clinical Instructor: David Doucet

Clinical Placement Hospital: Lakeridge Oshawa Unit: OC6

Date: May 20, 2016

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.
Progress
Evidence/Indicators Satisfac Unsatisfac
tory tory
I believe that I have successfully demonstrated
accountability and responsibility thus far. I have
attended all scheduled labs, SIMs and clinical
days. In addition to attendance, I ensure that I
arrive on time and wear the proper attire (e.g.
TFSON scrubs). Additionally, I ensure that I
complete any required assignments or prep
prior to attending any of these (e.g. pre-
clinicals, SIM preparation, lab quizzes). By
prepping for clinical, labs and SIMs I am
ensuring and demonstrating that I am
competent to complete any activities or tasks I
may be assigned to. A specific example would
be when one of my patients had a chest tube
and my instructor asked me to do some
research on chest tubes and nursing specific
care; by completing this research I
demonstrated accountability and responsibility
to my instructor. Moreover, a second example
is when I was assigned to administer
medications I ensured that I looked up what
the medication was and why it was being
given; I am accountable for administering
those medications so I need to have a full
understanding of why I am giving them, the
desired outcomes and any possible side
effects to assess for. When at clinical, I ensure
that I am thorough with my documentation; this
makes me accountable for all of my actions.
However, this is my first time using the
meditech computerized charting system so I
still need to become more efficient with my
charting; I have made this a goal for the end of
the semester. With that, I do feel that I become
much more proficient with the charting with

2. Explain the experience of chronic illness in
individuals receiving care in chronic care settings
3. Interpret critical aspects of the persons experience
of chronic illness in relation to the nursing process
each shift. I have accepted responsibility over
the course of this semester by accepting and
caring for my assigned patients. Finally, I am
accountable to this class and program by
being aware rules, regulations and objectives
that are expected of me (e.g. I always refer
back to my syllabus whenever I need
clarification).
The completion of NURS 3001 provided me
with a good basis and background of chronic
illnesses and the different ways in which
people cope and experience them. Additionally,
NURS 3001 has provided me with theories that
better allow me to explain chronic illnesses.
For example, I have used these theories to
explain chronic illnesses in my post clinical
assignments. I have been able to explain the
experiences of chronic illnesses by completing
my pre and post clinical assignments; I have
put great detail and effort into these
assignments. These assignments have
allowed me to research my patients chronic
illnesses in depth prior to caring for them. For
example, my first patient had locked in
syndrome, I was not sully aware of this chronic
illness, so by completing my pre-clinical I was
better able to understand and explain this
illness (and thus provide better care). Other
chronic illnesses that I have explained and am
more informed of now are dementia,
hypertension, GERD and various types of
cancer including leukemia, prostate cancer
and ovarian cancer. Additionally, by
participating in post conferences I am able to
explain chronic illnesses to my peers that I
have knowledge of, as well as learn about
other chronic illnesses from them. I feel as
though I have been able to explain and
understand chronic illnesses in a satisfactorily
way to this point.
Chronic illness is a complex concept that
involves multiple aspects and is a very
such as common signs and symptoms, responses to
treatment, patterns of coping, and impact on
individual and family relationships.
individualistic experience. The nursing process
involves assessment, diagnosis,
outcomes/planning, implementation and
evaluation. Completing my pre-clinical
assignments allows me to develop a good
understanding of the chronic illnesses I will be
dealing with; in this research I ensure that I
look up common signs and symptoms of each
illness. Doing this allows me to be more aware,
as well as look and ask for any of these
symptoms when I complete my head to toe
assessments for example. Moreover, pain is a
common symptom of many chronic illnesses,
therefore I always ensure to inquire about each
patients level of pain (e.g. using PQRST
approach). By looking at my patients lab
values (on meditech) each shift I am able to
assess and address any abnormal values.
Head to toe assessments and vitals help me
assess and evaluate my patients condition; I
approach my nurse or clinical instructor if I
have any concerns I cannot deal with myself. I
plan my day based on my assessments; for
example, my instructor taught me to briefly visit
both of my patients in the morning first prior to
completing any in depth assessments, this way
I can attend to the patient who may be in
worse condition first. I experienced an
example of patterns of coping last week; my
patient was coping well with his illness,
however he then received news from his
physician that is condition was progressing and
worsening and his level of coping then
diminished at this point. For this patient I was
able to recognize this change and plan and
implement empathetic caring. I established
goof rapport with one of my patients who has
ovarian cancer; this patient has only months to
live. The relationship that I established with her
allowed her to feel comfortable enough for her
to discuss her feelings on end of life with me.
She is having a hard time accepting her end of

4. Identify symptoms and common medical treatments
of selected chronic illness.
life, however she appeared to feel some level
of relief being able to voice some of her
concerns to me (she stated she is unable to
speak with her husband about this topic
because he becomes extremely upset). I
believe that I have been successful in being
able to critically interpret my patients
experiences, resulting in me effectively
planning, implementing and evaluating care.
The most common symptoms that I have
identified thus far are fatigue/weakness and
pain. Of all the patients I have been exposed
to this semester they have all had some
degree of pain and consistently report that they
feel tired or exhausted. Although, all chronic
illnesses and patients are unique, these
appear to be 2 symptoms that are consistent.
In terms of cancer I have been able to identify
that each type of cancer may have some
overlap in symptoms, however each type does
have distinguishing features. For example, my
patient who have prostate and ovarian cancer
tend to have more localized symptoms to
these specific regions (e.g. abdominal pain,
swollen genitals, etc.). Whereas the patient
who has leukemia tends to display more
generalized symptoms (e.g. fever, chills,
recurrent infections, etc.). The symptoms
associated with locked in syndrome are very
evident including complete paralysis of the
body. Medical treatments for the chronic
illnesses that I have been exposed to appear
to be very individualistic. For example the
patients with cancer heavily rely on radiation
and chemotherapy, whereas other chronic
illnesses have required varying medical
treatments such as chest tubes, central lines,
heavier reliance on physiotherapy, TPN
nutrition, etc. Overall, I believe that I have been
able to successfully identify the symptoms and
medical treatments related to each of my
patients chronic illnesses.
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.
Examples of specific assessments that I have
completed are head to toe assessments,
neurological assessments, vitals, glucose
scans, and pain assessments. On May 17th I
prepared and administered several
medications including heparin, Haldol,
prednisone, gravol, decadron, dilaudid,
lactulose, pantoloc, and more. Moreover, I
administered these medications through
various routes including, oral, IV,
subcutaneous and subcutaneous lock routes.
For example, on this same day my patient was
experiencing increased levels of pain due to
her cancer, I assessed her using the PQRST
pain scale and then administered her PRN
pain medication. I then reassessed her again
30 minutes and 1 hour later to ensure that her
pain levels had been reduced (they went from
a 6.5/10 to a 2/10 after reassessment).
Additionally, another example is that one of my
patients IV orders changed (the rate was being
decreased from 50 to 30 ml/hr), I spiked a new
bag and programmed the pump. Although I
have not had any experience with restraints in
practice I am currently more knowledgeable
about them as I prepared for and attended the
lab for this topic. My patient this past week had
an NG tube, therefore I learned how to connect
her NG tube to suction (e.g. low, intermittent),
assess and monitor the tubing (e.g. assess for
any blockages or pooling of secretions in the
tubing) and check and monitor the collection
container (e.g. check the level at the beginning
of my shift and observe the level throughout).
In my first week I had experience with a GJ
tube (this patients tube was used to drain
gastric secretions by gravity rather than used
for feeding). I do have previous experience
with G tube feeding from a previous summer
student job. Additionally, I was able to
collaborate with one of my peers and learn
more about G tubes from her post-conference

6. Identify potential consequences/complications of
select chronic illnesses and related interventions.
7. Under the supervision of a Registered Nurse,
demonstrate safe, competent, evidence-informed,
holistic nursing practice with clients with chronic
illness
a. Use a wide range of effective communication
strategies and interpersonal skills to
presentation on May 16th. I have completed
wound care on my patients GJ tube site, as
well as completed tracheostomy wound care
and dressing change. I think I have
successfully demonstrated this objective up to
this point.
The patient that I was assigned to the first
week presented with the most consequences
and complications in relation to her locked in
syndrome. Consequences related to the
locked in syndrome include the need for TPN,
a G-tube, a permanent indwelling Foley
catheter, as well as a complete lack of mobility
(contractures) or ability to speak/communicate.
My patient from May 9th and 10th was admitted
for sepsis; he developed swelling and fluid
build up in various parts of his body. This
sepsis resulted in the insertion of a chest tube
(a complication of the sepsis). One of the
patients I was assigned to on May 16th and 17th
was taking hydromorphone (dilaudid); this
intervention is required to control severe pain
in her abdomen, however she also
experiences many side effects including
sedation, dizziness and persistent nausea,
vomiting. The other patient that I was caring for
on these days was taking steroids as a part of
his cancer treatment (prednisone and
decadron). These medications have resulted in
multiple side effects for this patient including
sleep problems (he is barely sleeping), mood
changes (agitated), increased level of sweating
and some dizziness. I have been able to
successfully identify these potential
consequences and complications in my
patients.
Over the course of this semester I believe I
have successfully collaborated with all nurses I
have been paired with and demonstrated
safe/competent/evidence informed/holistic
nursing care in relation to chronic illnesses. I
have used a wide range of communication
 appropriately establish, maintain, re-establish
and terminate the nurse-client relationship
b. Demonstrate accountable, responsible and
ethical practice
c. Engage in respectful, collaborative,
therapeutic and professional relationships
i. Demonstrate therapeutic use of self
ii. Create a culturally safe environment
d. Apply nursing models and theories
e. Demonstrate health promotion and illness
prevention practices
f. Demonstrate patient advocacy
g. Predict outcomes of nursing care
h. Evaluate client response to nursing care
i. Critically appraise own practice in relation to
nurse-client/family interactions and as a
member of the health care team
strategies over the first half of this semester,
including teaching (e.g. taught one of my
patients about the importance of good nutrition
when trying to recover from an illness),
empathetic (e.g. I spoke empathetically with a
family member who was having a hard time
accepting her husbands new worsening
prognosis) and listening styles (e.g. rather than
talking myself, I allowed one of my patients to
just express her feelings to me and get
everything off her chest). I have demonstrated
interpersonal skills through my successful
establishment, maintenance and termination of
relationships with nurses, my peers, my
instructor and patients and family members.
For example, each week I am assigned to care
for a new patient and because we are only with
them for 2 days it is important that I establish
good and quick rapport, as well as successfully
terminate the relationship, as I will have a new
assignment the following week. I think being
thanked for my help by the unit nurses, as well
as patients and family members demonstrates
my success. I always ensure that I maintain
confidentiality and privacy throughout each
shift. I have successfully demonstrated
professionalism by being respectful,
collaborative and therapeutic with the unit
nurses, the patients and my peers. For
example I am respectful of my peers when
they are speaking in post conference and I
collaborate with them frequently throughout the
shift (e.g. work with one another for patient
repositioning and brief changes). I think I apply
nursing models and theories subconsciously
(e.g. the nursing process is always in the back
of my mind), however I have also written about
some in my post-clinical assignments. An
example of when I advocated for a patient was
when they expressed their high level of pain to
me, I then went and notified the nurse that a
pain medication is required. An example o a

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
time when I evaluated nursing care was when I
evaluated level of pain prior to and after the
administration of a pain medication. Each time
I enter my patients room I try and educate
them on something, even if it is something
small (e.g. I educated my one patient about the
importance of mobilization in the prevention of
pressure ulcers).
Over the course of this semester, as well as
everything other semester and placement, I
am constantly critically appraising and
evaluating my own behaviour and actions.
Anytime I receive feedback from a nurse, a
patient, my instructor or peers I take it into
consideration and alter my practice if I feel it is
required. For example, I am working with many
experienced nurses, therefore I think it is
important for me to critically appraise their
actions and utilize some of their techniques in
my own practice. For example, my instructor
taught me several techniques in relation to
medication preparation (e.g. labeling syringes,
how to effectively hold the vials, how to
effectively hold multiple pieces of equipment
when starting a new IV bag, etc.). Additionally,
I feel as though the positive feedback that I
have received from my patients and nurses is
an indication that I am effectively acting as one
of their health care team members.
I have successfully participated in professional
development over the course of this semester.
I have participated in post conferences by
sharing my information and experiences with
my peers, this allows me to share my
knowledge and encourage learning for my
peers. I have developed professionally by
increasing my knowledge about chronic
illnesses through personal research and the
completion of all assignments (e.g. lab prep,
SIM prep, clinical prep, etc.). The completion of
all the associated NURS 3001 course work has
allowed me to professionally develop as well. I
 am always reflecting on my practice, however
my formal written reflective journal is an
example of reflective practice. The completion
of this evaluation is an example of reflective
practice (e.g. I have been able to reflect on my
semester so far). I have effectively utilized
resources that I have been offered in order to
critically inquire into various illnesses,
medications, side effects and more (e.g. I have
utilized Lexicomp, The Wave, UpToDate, etc.).
I have also demonstrated professional
development by participating in morning report
with my nurses. One afternoon and nurse
approached me and asked me to give her
report because I had been working with her
newly assigned patient all morning (I was able
to provide her with critical information about
this patient).

Overall, I feel as though I am progressing well

and am where I need to be at this point in the
semester.

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

comment)
Signature of Instructor: Date:

Signature of Student: Date: