NURSING 4021 Clinical Evaluation (Midterm and Final)
NURS 4021 Clinical Evaluation Midterm ____ Final ___X__ Pass____ Fail_____
Student: Melissa Friskney
Faculty Advisor: Ann MacLeod
Nature of Clinical Practice (Check all that apply)
The setting is:
_____Hospital/Inpatient Unit
_____Hospital/Ambulatory or Day Program
_____Hospital/Critical or Emergency care
_____Community/Community Health
__X___Community/Home Care
_____Community/Long Term Care
_____Industry/Occupational Health
_____Other _________________
Preceptor: Laura Kelly
Clinical Practice Site: VON
Practice hours completed 300
The population is primarily:
__X___Adults with medically-related health needs
_____Adults with surgery-related health needs
_____Children or adults with mental health needs
_____Intrapartum families/mothers and newborns (not NICU)
_____Older adults requiring support
_____Healthy adults
_____Families/Neonates requiring critical care
_____Adults requiring intensive or critical care
_____Persons requiring emergency care
_____Children with medically or surgically related health needs
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NURSING 4021 Clinical Evaluation (Midterm and Final)

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, evidence-informed interventions and outcome measures.

Before completing the evaluation form, students and preceptors should review the objectives and sub-objectives. While students
and preceptors should comment on each of the seven course objectives, it is not necessary to write comments about each sub-
objective. It is better to provide specific and detailed comments about a few sub-objectives than to write broadly about many.

Each objective should be awarded one of the following ratings:

Midterm:
Satisfactory Progress (SP): The student demonstrates sufficient knowledge, and skill and ability to safely practice or
achieve a competency with an average level of teaching support and guidance; or the level of performance is what the
instructor would expect of an average student at that level and point in time; and the instructor reasonably anticipates
that if the student continues at the current pace of practice and achievement, the student should be able to fully meet the
objective at the end of the course.

Needs Development(ND): The student demonstrates sufficient knowledge and ability to safely practice or achieve a
competency, but requires more than average teaching support and guidance; or the student demonstrates knowledge but
needs more practice to achieve the competency; or the level of performance is below what the instructor would expect of
the average student at that level and point in time; and the instructor reasonably anticipates that if the student focuses

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NURSING 4021 Clinical Evaluation (Midterm and Final)

his/her learning in the required area, and gains sufficient practice, the student has the potential to meet the objective at
the end of the course.

Unsatisfactory Progress (UP): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice
or achieve a competency, even with constant, intensive teaching support and guidance; or the level of performance is far
below what the instructor would expect of the average student at that level and point in time; and the instructor
reasonably anticipates that if the student continues at the current pace of practice and achievement, the student is not
likely to meet the objective at the end of the course.

Final:
Satisfactory (S): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve a
competency with an average level of teaching support and guidance; or the level of performance is what the instructor
would expect of an average student at that level.

Unsatisfactory: The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or achieve
expected competencies, even with constant or intensive teaching support and guidance; or the level of performance is far
below what the instructor would expect of the average student at that level.

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NURSING 4021 Clinical Evaluation (Midterm and Final)

Objectives Progress
Indicators/Evidence SP/ N UP/
S D U
1 Demonstrate professional conduct in accordance with College of Nurses of Comment on professional conduct:
Ontario standards for nursing practice and ethics: ● Accepted responsibility for actively
● Critically appraise own practice in relation to nurse-client/family engaging in NCLEX preparation by
interactions and as a member of the health care team successfully completing all activities of my
● Demonstrate accountability and acceptance of responsibility for one’s learning plan and completing all HESI
own actions and decisions activities.
● Demonstrate professional presence and model professional behaviour ● Demonstrated professional presence and
befitting a BScN student modeling professional behavior by
● Display self-awareness, initiative, and confidence to engage in care arriving at placement on time, in uniform,
within a NURS 4021 student’s scope of practice with the proper tools required for the day.
● Demonstrate effective and collaborative problem-solving strategies, I made sure I introduce myself to my
including conflict resolution clients and thanked them for having me
● Select appropriate professional development activities as a result of in their home.
personal reflection and critical inquiry ● I participated in professional development
● by attending a lunch-and-learn on wound
care products and another one on ostomy
care.
● When I was in clients’ homes I maintained
a professional manner by being respectful
and keeping in mind that I was a guest.
● I engaged in care within my scope of
practice such as wound care, symptom
management and patient teaching.
Melissa was able to maintain nurse/patient
relationships with all patients.
She was accountable for her actions and
was able to present herself in a professional
manner.
2 Demonstrate the student’s primary duty to the person requiring nursing Comment on safety, general competency, and
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NURSING 4021 Clinical Evaluation (Midterm and Final)

care—safe, competent, ethical nursing practice: ethics:

● Recognize individual competence within scope of practice ● During this clinical placement I always
● Seek support and assistance whenever necessary made sure I stayed within my scope of
● Assess patient care situations for risks to safety practice to ensure client safety. For
● Intervene, as needed, to ensure safety of the person requiring nursing example, I did not perform PICC care for
care, and where indicated, the safety of nurses and colleagues clients who required it because it is
outside my scope.
● I was supported by my preceptor and she
assisted me when I needed it. For
example, when doing a VAC dressing
change for the first time she guided me
and answered questions I had during the
process.
● I ensured my clients’ safety as well as my
own by wearing gloves, practicing proper
hand hygiene, disinfecting instruments
between each use and practicing clean
technique when providing wound care.
● I maintained client privacy and
confidentiality by always charting my
findings and only discussing my client’s
concerns within their circle of care, i.e.
preceptor, care coordinator and family
doctor.
Melissa always asked for help/clarification if
unsure of anything.
Melissa practiced care within her scope of
practice.
Melissa maintained confidentiality of
patients at all times.
She ensured patient safety by asking for
help when needed, answering/teaching
patients in relation to care needs, hand
hygiene and proper cleaning of tools needed
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NURSING 4021 Clinical Evaluation (Midterm and Final)
3 Demonstrate safe, competent and ethical nursing practice in the area of
relational practice:
● Engage in critical self-reflection
o Identify and mitigate barriers to personal and professional
development
o Prioritize specific aspects of personal development in order to
engage in person-centered, relational practice
● Engage in therapeutic, caring, and culturally safe relationships
o Effectively use self to initiate, maintain and terminate
relationships
o Demonstrate the intentionality of nursing by listening,
questioning and responding:
▪ displaying sensitivity and empathy
▪ relating with curiosity
▪ relating to complexity and uncertainty
▪ relating to vulnerability
o Create mutuality and reciprocity in relationships with persons
requiring nursing care
● Advocate for persons requiring nursing care, working collegially and in
concert with other health professionals
for care.
Comment on relational practice:
● During this placement I have engaged in
critical self-reflection by completing my
weekly journal entries each week and
frequently discussing with my preceptor
the care I am providing and our clients’
situations. I also take time to reflect on
the care I provide each day in the car on
the way to the next visit and at home
after clinical.
● I have engaged in therapeutic, caring and
culturally safe relationships this term
building relationships with my clients
(especially the clients I see on a regular
basis). Over the term I have been able to
get to know my clients better allowing us
to build and maintain a trusting
therapeutic relationship. I do this by
listening to their concerns, including them
in their care, being professional and
respecting their home. For example, I
have noticed patients have opened up to
me by sharing things about their life and
voicing their concerns about their health.
I have really enjoyed getting to know my
clients and liked being in the home. I feel
like community nursing has really opened
my eyes to the social determinants of
health and demonstrated to me how
clients are so much more than their
disease.
● I have advocated for my clients
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NURSING 4021 Clinical Evaluation (Midterm and Final)
4 Demonstrate safe, competent and ethical nursing practice in the area of
clinical decision-making:
● Demonstrate critical inquiry, scientific inquiry, and clinical reasoning:
● Informed by the discipline of nursing, use diverse sources of
knowledge and ways of knowing in the practice of nursing
o Integrate nursing knowledge with knowledge from the basic
sciences, health sciences, humanities, research, and ethics in
clinical decision-making
o Evaluate how models, theories, and frameworks from the
discipline of nursing inform the practice of nursing in the
current clinical setting
● Compare and contrast personal approaches to critical inquiry and
clinical reasoning with those of expert nurses
● Create new strategies for critical inquiry and developing expertise in
response to increasing complexity of patient care requirements
throughout this placement by listening to
their concerns and working with them to
have these concerns heard by writing
notes for them to take to their doctor,
completing charting properly and
updating the case coordinators on each
client’s condition.
Melissa has shown care and compassion
throughout the semester. She has listened
to patients who need someone to talk to,
she has answered their questions, helped
with concerns/anxiousness, reassured and
created relationships with patients in order
for them to gain their confidence and trust
in her.
Comment on clinical decision-making:
● I have integrated nursing knowledge with
the knowledge from basic sciences, health
sciences, humanities, research, and ethics
in clinical decision-making by applying the
knowledge I have learned from previous
classes--such as from my chronic care
class--to help teach my clients about their
chronic diseases such as diabetes.
● A theory from the discipline of nursing
that I have used to inform my practice is
the Hildegard E. Peplau Theory of
Interpersonal Relations. This theory
explores how nursing is therapeutic
because it is a healing art in which the
nurse assists an individual who is sick.
Peplau believes that nursing is an
interpersonal process since it involves the
interaction between two individuals with
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NURSING 4021 Clinical Evaluation (Midterm and Final)

a common goal. For this to work both the

nurse and pt need to respect each other
and both learn and grow because of the
interaction (retrieved from
http://www.nursing-theory.org/nursing-
theorists/Hildegard-E-Peplau.php). As a
nursing student, I try my best to form
therapeutic relationships with my
patients and work with them to achieve
their health goals. In order to do this, my
patient and I must first form trust with
each other. This can be done by
demonstrating to the client that I am
knowledgeable and competent. In this
particular clinical placement, I have found
the existing relationships my preceptor
has with our clients has allowed me to
easily form trusting relationships with the
clients. For example, one client who we
see several times a week for packing
wound dressing changes normally does
not allow students to perform his care but
has allowed me to perform it after
observing my preceptor perform the care
multiple times. By creating a trusting
relationship, showing my interest in his
care and observing my preceptor I am
able to be more a part of his care and
work with the client and his family along
with his healing journey.
● During this placement I was able to
compare and contrast my approaches to
care to my preceptors and develop skills,

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NURSING 4021 Clinical Evaluation (Midterm and Final)
5 Under the supervision of the preceptor, but with minimal guidance,
demonstrate safe, competent and ethical nursing practice in the area of
planning, implementing and evaluating nursing care:
● Use a deliberative, critical nursing process to recognize, gather and
analyze relevant data from multiple sources in order to develop and
implement a plan of care
● Engage in collaborative interactions with the nursing and health care
team, with the person requiring care as the center of the team
● Integrate own knowledge with client and family knowledge and
preferences, and factors within the health care setting, to plan and
implement care
● Utilize the best available evidence to inform nursing actions
o Identify gaps in current knowledge
o Seek and evaluate evidence to support nursing actions
o With minimal guidance, identify and enact appropriate nursing
care
tips and tricks from her. For example, she
taught me to start a vinegar soak as soon
as possible and then set up the rest of the
supplies I need to decrease patient
discomfort since the patient was lying on
their side. Each day at clinical I felt I
learned a lot from my preceptor from the
way she interacted with the patients to
the way she provided safe and effective
care.
Melissa demonstrated critical thinking by
offering suggestions for changes in
treatments for wound care when current
treatment plan ineffective. She was also
able to demonstrate with patients needed
to be seeing a dr and provide appropriate
documentation to go with patients to
appointments.
Comment on nursing care planning:
● I collaborate with other health care
providers and the person requiring
nursing care by writing notes to doctors,
updating the client’s date and completing
accurate charting.
● I engaged in collaborative interactions
with the nursing and health care team by
working with my preceptor to provide our
clients with the best possible care.
Together we work well as a team, for
example, even though I preform most of
the care she helps me by passing me
supplies or getting the new charting
sheets ready. I have also been able to
watch how she interacts with other team
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NURSING 4021 Clinical Evaluation (Midterm and Final)
● Collaborate with other health care providers and the person requiring
nursing to assess outcomes of nursing and health care using evidence-
informed approaches
● During week nine a nursing intervention I
● With minimal guidance I am able to
members and helps them by picking up
visits and calling other nurses when they
want to run ideas by her. By observing
this I have seen what a good team
member looks like.
planned, implemented and evaluated at
clinical was assessing a client for
compression therapy. Although the
intervention was planned for us because
we were assigned the visit we collected
the proper supplies and planned the visit
to our day. When we arrived at the visit I
implemented the ABPI test by using the
Doppler and bp cuff to check the client's
numbers. Then we determined her
numbers were okay and implemented
compression therapy by applying Coban
light on her legs bilaterally. A note was
then written to her family doctor
updating them on how we had started
compression therapy. The evaluation
process for this particular intervention
will be done during her next few visits to
see if the compression therapy is working
to decrease the swelling in her legs. We
were able to incorporate client input and
values by going to their home to perform
the test and asking the client how the
compression felt and answering any
questions they had regarding the process.
identify and enact appropriate nursing
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NURSING 4021 Clinical Evaluation (Midterm and Final)
6 Demonstrate enhanced knowledge of nursing and health related to
indigenous populations, women's and environmental health, mental health,
and aging and rural populations
● Demonstrate leadership in providing nursing care to these special
populations based on the student’s knowledge and experience
o Identify gaps in care delivery
o Challenge status quo approaches to caring for marginalized
populations
o Recognize the unique pathophysiology of disease states and
implications for care of special populations, including those
with prolonged lengths of stay and older adults
o Consistent with student role, recommend and initiate changes
in practice
care on my own. For example, I am the
primary care provider during most visits
completing all the required care and
charting. When doing wound care, I
identify the proper supplies required by
reading the chart and collecting the
supplies from the box. I then organize my
supplies and begin the dressing change. If
I am unsure of anything I ask my
preceptor and she provides me with the
support I require to ensure I am providing
my clients with the best possible care I
can.
Melissa was able to write progress reports to
the dr’s when needed for appointments.
She was able to perform appropriate care
for patients with minimal guidance.
Comment on care of special populations:
● Working in the community has been a
very eye-opening experience that I have
really enjoyed. This clinical placement
was my first time not doing hospital
nursing and it helped me shatter the
many stereotypes that are around
community nursing. Often times people
think that nurses in the community do not
work as hard or their job is easier then
nurses in the hospital because they are
not dealing with “complex” patients. This
placement has shown me how far from
the truth this really is. Community nursing
is a complex field of nursing that requires
a nurse who is independent,
knowledgeable and confident in their
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NURSING 4021 Clinical Evaluation (Midterm and Final)

practice. Every day in the community is

different and you don’t know what to
expect. One day you could be walking into
a very clean home and other days your
patient could be drunk or smoking while
you perform their dressing change.
Community nursing has taught me to be
adaptive and make the most of what you
have. For example, if the previous nurse
who saw the patient forgot to order
supplies and the client has run out then
all you have to work with is what you
bring with you. Another challenge with
community nursing is the client is not
always home and it is their choice if they
want you to come visit them. As a result,
some clients may cancel several visits in a
row and as a result their dressing won’t
be changed within the recommended
period of time and as a result the wound
takes longer to heal. However, the
biggest thing I have learned from this
placement is how the social determinants
of health truly impact the client. For
example, those who do not have the
means to buy healthy foods are at higher
risk for infection and their wounds take
longer to heal because their body does
not have the proper nutrition it requires.
So many of the clients we see are thankful
that we are coming to their house to
provide them with care because they
want to stay home. Community nursing is

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NURSING 4021 Clinical Evaluation (Midterm and Final)
7 Independently perform care of patients, within the (NURS 4021) BScN
student scope of practice
● By midterm, the student should be able to manage a full and
reasonable patient assignment in the preceptor’s practice setting,
with coaching from preceptor
o Demonstrate increasing ability to safely set priorities and
manage time in the face of competing demands
o Safely and accurately complete patient assessments
o Demonstrate increasing level of independent clinical decision-
making, with support from preceptor
o Safely and accurately enact nursing interventions
o Evaluate nursing care outcomes and adjust plan as needed
with minimal guidance
o Collaborate with team members with minimal preceptor
guidance
● By end of term the student should be able to manage a full and
reasonable patient assignment in the preceptor’s practice setting,
helping to decrease the length of stay at
hospitals and decreasing the number of
older adults in LTC, however, community
nursing is not well funded, and the nurses
make less than they would in the hospital.
I think this is an issue because in order to
encourage health at home, the
government needs to provide competitive
wages to community nurses to decrease
turn over and allow patients to have
continuity in terms of who is providing
care.
Melissa got to see the impact of social
determinants of health while at her
placement with VON. She also got to see
patients who are chronic vs short stay with
all ages of the population.
Comment on managing care:
● By the end of the term I was able to
manage a full patient assignment with
minimal coaching from my preceptor;
only requiring assistance when I had a
question and needed clarification. During
this placement I have been able to
independently and safely provide care for
a number of different clients and
demonstrated the following nursing skills:
vital signs, complete health history,
nursing admission, nursing discharge,
cardio-respiratory monitoring, skin
assessments, Glucometer testing, falls
prevention, IV management, started an
IV, medication administration, home
oxygen, insertion of catheters, wound
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NURSING 4021 Clinical Evaluation (Midterm and Final)

with minimal coaching from preceptor care/dressing changes, VAC dressing

o Independently and safely set priorities and manage time, changes, packing dressing changes,
safely carry out required assessments and nursing ostomy care, medication administration,
interventions, consult with team members, demonstrate drain care, g-tube care TPN, trache care,
leadership at the point of care in relation to clinical decision- charting, compression therapy, super-
making, anticipate changes in patient condition and intervene pubic catheter insertion, patient teaching,
appropriately; seek assistance when necessary with no charting and writing notes to doctors. I
direction from preceptor, who acts as supervisor have also assessed client’s appetite, fluid
● A fourth year nursing student is able to carry out the following nursing intake, bowel movements, safety (such as
activities: falls), how they are coping and pain level.
o Assessment Melissa was able to see and perform a wide
▪ Vital signs (Temperature/Pulse/ Respirations, arterial variety of skills during this placement. She
B/P, Sa02) was able to see catheter care, ostomy care,
▪ Biopsychosocial cardio-resp, wounds, vitals, assessments,
● Health history hand hygiene, she was able to watch
● Functional (elderly) cvad/tpn, iv and iv medications, health
● Nursing admission, pregnant woman, post- teaching, trach care, drains, documentation
partum woman, newborn/HEADSS, well child and gain nurse-patient relationships.
▪ Head-to-toe
▪ Pre/post-operative,
▪ Glucometer testing
▪ Focused: mental status/cognition, cardiovascular
(normal heart sounds, bradycardia, tachy-cardia, NSR,
Afib), neck vessels, peripheral vascular system (edema),
respiratory (breath sounds), abdominal (bowel sounds),
neurological (Glasgow Coma Scale, motor, sensory,
cranial nerve), breast, testicular exam, pain
o Hygiene Care
▪ Bed-making
● Unoccupied
● Occupied
▪ Bathing
● Complete

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NURSING 4021 Clinical Evaluation (Midterm and Final)

● Partial/supported
o Promoting Activity/Mobility
▪ Falls Prevention (Morse Falls Scale)
▪ Restraint Assessment
▪ Body Mechanics/Transfers
● Assessing body alignment and posture
● Positioning/turning person in bed
● Use of positioning devices
● Positioning a person on a bedpan
● Transfer with transfer belt
● Assisting a person to walk
● Using assistive devices for walking
o Administering Parenteral Therapy
▪ Intravenous Therapy
● Initiation of peripheral IV
● Managing IV infusion/pumps
● Administering TPN
▪ CVAD (may do only if taught and practiced in lab, and
under direct supervision of an RN, and as consistent
with agency policy)
▪ Blood Component Therapy (student may do if
consistent with agency policy)
▪ Initiation/management
o Promoting Safety/Controlling Infection
▪ Standard precautions
▪ Handwashing
▪ Use of protective barriers
▪ Donning a surgical mask
▪ Donning an N95 mask
▪ Donning sterile gloves
▪ Gowning
▪ Removing equipment
▪ Care of equipment and disposal of waste

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NURSING 4021 Clinical Evaluation (Midterm and Final)

o Nutrition/Elimination
▪ Safe oral feeding-person with dysphagia
▪ Enteral feeding
▪ Insertion and care of indwelling catheter
▪ Collecting a urine/stool sample
▪ Care of condom drainage
▪ Care of ostomy
▪ Monitoring and recording intake/output
● Maintaining Oxygenation
▪ Pulse oximetry
▪ Nasal prongs
▪ Inhalers/nebulizers
▪ Home oxygen
▪ Pulmonary care
● Suctioning
● Tracheostomy
o Dressing change
o Cannula change
● Chest tube
o Post-operative Care
▪ Assessment
▪ Use of clinical pathways
▪ Applying anti-embolic stockings
▪ Post-operative exercises
▪ Post-operative teaching
▪ Staple, Suture removal
▪ Packing removal
o Medication administration
▪ Oral medications
▪ IV medications above the drip
▪ IM, S/C, intradermal administration
▪ PCA
o Wounds

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NURSING 4021 Clinical Evaluation (Midterm and Final)

▪ Care of wounds/sutures/drains
▪ Pressure ulcers
● Braden scale
▪ Chronic wounds
▪ Dressing changes
▪ Wound care products
▪ Drains: JP, Penrose, Hemovac
o Post-mortem care
o Reporting and Recording
▪ Giving report
▪ Charting
▪ Transcribing orders
o Medication administration
▪ Topical, oral, parenteral (s/c, IM, above the drip IV)
administration
▪ Basic knowledge of the medications prescribed
● Classification
● Purpose
● Possible side effects
● Adverse effects
● Interactions with other drugs
● Appropriate dose/route
● Implications for nursing care
o Health Teaching
▪ Identify client/family learning needs
▪ Collaborate with team to develop plan to meet client’s
learning needs
▪ Implement aspects of plan within scope of practice as a
learner
o Psychosocial/Relational Practice
▪ Recognize and acknowledge client distress as it arises
▪ Demonstrate empathy, active listening, sensitive
questioning

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NURSING 4021 Clinical Evaluation (Midterm and Final)

▪ Apply principles of motivational interviewing

▪ Offer support
▪ Engage in problem-solving as required, in collaboration
with others as needed
o Team Communication
▪ Discuss any findings related to the patient assessment
with preceptor, staff nurse, physician, team member
▪ Seek assistance/ask questions before doing procedures
for the first time, or for anything about which is
uncertain
▪ Report to team leader/staff nurse when leaving the
floor and arrange for coverage of patients
o Nursing and Collaborative Therapeutic Interventions
▪ Determine which interventions are required, what
resources, including support and supervision are
required, and schedule interventions in consultation
with the client
▪ Complete interventions as appropriate and within
scope of learner practice
o Documentation
▪ Document vital signs and assessments in the
appropriate areas of the chart for assigned patients,
accurately and concisely, ASAP after assessment
▪ Use institution’s system of documentation for nursing
process and patient progress

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NURSING 4021 Clinical Evaluation (Midterm and Final)

Student and Preceptor Comments

Faculty Advisor Comments (All areas marked as unsatisfactory must have a comment)

Signature of Preceptor_____________________________________________________ Date______________________________

Signature of Advisor_____________________________________________________ Date _____________________________

Signature of Student_____________________________________________________ Date ______________________________

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