NURS 3021H Clinical Practice Focused on Chronic Disease Management

Mid-Term Evaluation Final Evaluation

Student: Riley Murphy

Clinical Instructor: Danielle Reid

Clinical Placement Hospital: PRHC Unit: A-2

Date: February 15 2019

Missed Clinical Hours: 0 Missed CLC Lab Hours: 0

 NURS 3021H Clinical Practice 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.
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 consistently demonstrates sufficient knowledge, and skill and ability to safely practice
or achieve the objective 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 the
objective, but requires more 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 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 consistently demonstrate sufficient knowledge, or skill, or ability to safely
practice or achieve the objective, 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 consistently demonstrates sufficient knowledge, and skill and ability to safely practice or achieve
the objective 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 (U): The student does not consistently demonstrate sufficient knowledge, or skill, or ability to safely practice or
achieve expected objectives, 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.
 NURS 3021H Clinical Practice Evaluation

Progress
Course Objective Evidence/Indicators Evidence/Indicators
MIDTERM FINAL
1. Demonstrate accountability and responsibility in Student:
the teaching-learning relationship. ⁃ I attend clinical on time and
prepared for my shift. This facilitates
Progress Midterm Progress Final a better learning environment for
myself, and allows my clinical
 SP  S instructor to feel confident that I am
 ND  U prepared for my day.
 UP ⁃ I ask my clinical instructor questions
when I am unsure of what I am
doing. This ensures that I complete
the task I am unsure about properly,
Student:
and allows me to develop the proper
technique and skills required to
complete that skill through the
teachings of my clinical instructor.
⁃ I always ask my clinical instructor to
review my progress notes before I
chart them. This allows her to
Clinical Instructor:
continuously teach me how to
properly document, and allows her
to view my progress over time.
⁃ I notify my clinical instructor (and the
primary nurse) when an abnormality
occurs in my patient. This allows us
to investigate the abnormality, and it
provides a teaching and learning
opportunity.

Clinical Instructor:
Riley always comes to clinical prepared for clinical. She
arrives on time and eager to start her shift. She completes both
 preclinical and post clinical in a timely manner. Riley should
continue to use these tools as an opportunity to evaluate and
links between her patient, diagnosis and test. Riley gives
report to both fellow nursing students as well as the primary
nurse in a professional manner. Riley will continue to develop
this skill by following the SBAR format and HEAL check
while doing beside shift report with fellow nursing students.
Riley recognizes her scope of practice and seeks out guidance
when necessary.
2. Explain the experience of chronic illness in Student: Student:
individuals receiving care in chronic care ⁃ On my unit, patients are (mostly) all
settings working towards regaining enough
strength and autonomy to be
Progress Midterm Progress Final discharged from the unit. Besides
their physical deficits, many of them
 SP  S are otherwise free of illness. I can
 ND  U imagine it must be very lonely and Clinical Instructor:
 UP boring being stuck in the hospital
during recovery. These patients are
usually very aware of their
surroundings, and there is not much
to do in the hospital. Additionally,
they attend physiotherapy every day,
which can be tiring and discouraging
sometimes. I can imagine how easy it
would be for someone to become
depressed from rehabilitating in a
chronic care setting in the hospital.
One of my patients was actually
starting to experience some
symptoms of depression
approximately 4 weeks post-
admission from a stroke. Many of
these patients are just trying to get
home, and when their bodies won’t
physically allow them to carry out
ADL’s, they aren’t able to go home
 right away. I can imagine that this
would be frustrating. Patients
receiving care in a chronic care
setting may also experience some
feeling of anxiety. When they are in
the hospital, they have the multi-
disciplinary team to take care of
them, but when they are discharged
home (if that is where they are
going), they no longer have constant
assistance and encouragement from
the health care staff. They may feel
anxious related to this.

Clinical Instructor:
Riley has had an opportunity to work with a number of
patients all at different stages in their recovery. Riley can
identify the impact a chronic illness has on the person and
their family. Going forward I would like to see Riley explore
more what limitations her patient has that are stopping them
from going home and what community resources are out there
to assist stroke patients get home and continue their
rehabilitation. Riley encourages a healthy work environment
by applying hand hygiene, and PPE when appropriate.
3. Interpret critical aspects of the person’s Student: Student:
experience of chronic illness in relation to the ⁃ Signs and Symptoms: feelings of
nursing process such as common signs and discouragement, depression, and
symptoms, responses to treatment, patterns of frustration, occurring when their
coping, and impact on individual and family body is no longer physically able to
relationships. do the activities they used to be able
Progress Midterm Progress Final to do. Feelings of uselessness and
worthlessness since they feel they Clinical Instructor:
 SP  S are no longer able to fulfill their
 ND  U
previous role to the same extent
 UP
they would be before the chronic
illness.
⁃ Responses to treatment: treatment
 options we as health care providers
(HCPs) provide (which we believe
medically are the best option for
these patients) are not always what
the patients believe are best for
them. For example, when they are
not seeing the results they would like
to be seeing through physio, they
may get discouraged and may want
to give up. Sometimes they don’t
even want to go to physio because of
the physical toll it takes on the body.
Often times after my patients come
back from physio, they take a nap
because they are so tired.
⁃ Patterns of coping: Initially, there
may be feeling of shock after the
diagnosis occurs. I can imagine many
post-stroke patients may feel
shocked after receiving the diagnosis
since they understand the
seriousness of a stroke and might
know the potential outcomes. After
the initial period of shock is over and
they have had some time to think,
they may have feelings of optimism
and hopefulness. They might have
some ideas of how they plan on
rehabilitating, or how they might
modify their lifestyle to adapt to
their condition. After continuous
rehabilitation, they might start to
feel discouraged and frustrated if
they are not adapting as fast as they
thought they would be.
⁃ Impact: individuals may not be able
 to do the activities that they used to.
For example, one of my patients said
she really enjoyed baking, and she’s
not sure how she’s going to be able
to do that anymore, as she is now
hemiplegic and has no sensation in
her left arm/leg. A chronic illness,
such as a stroke, changes family
dynamics and roles. The patient who
experiences a stroke who used to be
the family’s source of emotional
support may now need to switch
roles, and another family may need
to step in to fill this role during this
time of recovery and rehabilitation.
They may not be able to physically
do as many things either, such as
cleaning or laundry. Someone else (a
family member or a friend) may need
to step in and fill this role.

Clinical Instructor:
Riley is developing her assessment skills to help identify and
understand the signs and symptoms of a stroke and many
other chronic illnesses. Riley can perform the proper
assessment and can relate her finding to the nursing
diagnoses. Riley continues to gain experience, knowledge and
confidence in her practice.
4. Identify symptoms and common medical Student: Student:
treatments of selected chronic illness. Selected chronic illness: stroke.
Symptoms:
Progress Midterm Progress Final ⁃ Hemiplegia – paralysis of one side of
the body
 SP  S ⁃ Facial droop – when one side of the
 ND  U face remains lower than the other
 UP side due to damage of the facial Clinical Instructor:
nerves.
⁃ Aphasia – the impairment to speak
or understand speech.
⁃ Apraxia – the patient has difficulty
performing motor skills, and
difficulty when prompting.
⁃ Loss of bladder and bowel control
⁃ Impairment in vision
⁃ Impairment in ambulation and
carrying out ADLs
⁃ Confusion and/or memory loss
Common Treatments:
- tPA (tissue plasminogen activator) –
administered into the blood stream
for specific candidates less than 4.5
after the first symptoms of the
ischemic stroke. Breaks up blood
clots in the brain to restore blood
flow and prevent further ischemia
and necrosis.
- Mechanical embolectomy –
physically removing the embolus
- Carotid endarterectomy – the
removal of atherosclerotic plaques
from the carotid arteries to restore
blood flow to brain.
- Stent – when an artery is
mechanically held open to promote
adequate blood flow.
- Clipping or coiling of the aneurysm
blood vessel to stop the bleeding
- Physiotherapy – to regain strength to
as close as possible to pre-stroke
level and to learn new ways to carry
out ADLs.
- Lifestyle modifications – in order to
be able to carry out some of the

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.
Progress Midterm Progress Final
 SP  S
 ND  U
same activities as pre-stroke or new
activities. Promotes a better quality
of life.
- Structural modifications in the home
– to promote an accessible
environment for the patient in their
own home
- Bladder retraining to regain control
over bladder and when urination
occurs
- A modified diet – if the patient is
experiencing any deficits in chewing
or swallowing food, they may be put
on a specific diet for their needs
Clinical Instructor:
Riley completes her head to toe assessments competently. She
is developing an understanding of medical treatment for
stroke patients. Riley can identify the importance in symptom
assessment and monitoring and completes Neuro vitals
amongst other assessments competently. Riley completes pre
and post clinical to assist in developing her knowledge and
understand of these chronic illnesses.
Student: Student:
- Canadian Neurological Scale – used
on post-stroke patients to monitor
their progress over time. Assess their
level of consciousness, orientation,
pupil size and reactivity, and
assesses for weakness of the limbs.
- Nasogastric tubes – two of my Clinical Instructor:
patients had nasogastric tubes. One
was due to palliation and one was
due to the inability to adequately
chew and swallow post-stroke. I was
able to remove an NG tube from my
 UP palliative patient.
- Bladder Scanning – I have assisted in
bladder scanning. A patient may
have loss of control over their
bladder post-stroke, and may be
retaining urine. A bladder scan is
done to determine whether or not
an in and out catheterization is
required.
- Swabs for MRSA and VRE – done as
per hospital protocol. Performed
when patient is admitted, or when
patient is transferred from unit or
unit. This helps to control the spread
of infection and to detect any
infections early on.
- Subcutaneous lock – I initiated a
subcutaneous lock on a palliative
patient. This is a good port for pain
medication to be administered for
palliative patients, as they receive
high strength pain medication
(narcotics) fairly often.

Clinical Instructor:
Riley can competently initiate a sub cutaneous lock. Riley
should continue to apply the therapeutic interventions learned
in the last pre clinical for positioning. Riley should continue
to take advantage of every opportunity to expand her skill set.
Riley completes Neuro vitals thoroughly and in a timely
manner.
6. Identify potential consequences/complications Student: Student:
of select chronic illnesses and related Consequences/complications of illness:
interventions. - Decreased quality of life related to
deficits (can no longer participate in
Progress Midterm Progress Final pre-stroke activities). Intervene by
suggesting alterations in these
 SP  S activities so that they are accessible
 ND  U to the patient. Suggest new activities Clinical Instructor:
 UP that the patient can try instead.
- Some patients may never walk again
and are bound to a wheelchair. They
are also at risk for skin breakdown
and pressure ulcers from sitting in a
chair for so long, and due to the
decreased sensation they may
experience. Intervene by reminding
the patient to periodically readjust
themselves to alleviate some of the
weight off of affected areas. Remind
patients and families of patients who
are incontinent that their brief needs
to be changed often in order to avoid
skin breakdown due to moisture.
- Some patients may experience
confusion and memory loss. If they
lived alone pre-stroke, they might
now have to move in with family or
an assisted-living facility so that it
can be ensured they are well-taken
care of.
- Difficulty in
dressing/cooking/cleaning. Assist
patient in learning how to dress with
their deficits, as well as do some
cooking and cleaning. Meal services
and cleaning services may need to be
set up for someone who lives alone,
but otherwise other family members
will need to assist the patient,
depending on their degree of
deficits.

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 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
Clinical Instructor:
By Riley completing her pre and post clinical assignments she
demonstrates her understanding of the complications of
chronic illnesses and related interventions. Riley can identify
interventions and can distinguish the difference of how Acute
stroke/Rehab care may differ from disease management in
acute medical patients. She can identify a complication
developed from a stroke and can apply the interventions
taught to assist in the rehabilitation as well as the
effects/impact it has on the person.
Student: Student:
A – I always walk in the patient’s room
and introduce myself and state that I am
a student nurse. Throughout the day, I
establish whether or not my patient
would enjoy talking with me, or if they
would rather I did my assessments and
let them be. I act accordingly as to not Clinical Instructor:
bother my patient. I end the shift by
stating that I am leaving, but if they
need anything, the nurse will be around
all night. I encourage them to use their
call bell, and state when I will be in next.
The next day, I re-introduce myself just
in case my patient does not remember
me. At the end of the shift, I let them
know that I am leaving, and tell them
when I will be returning.
B – I always remain within my scope of
practice as a third year nursing student
of Trent. If I am ever asked to do
something new, I find my clinical
instructor who walks me through the
task and will provide supervision. I let
my covering nurse know when I am
going for breaks and when I will return.
C – I use the therapeutic use of self by
 providing humour when I am practicing.
Progress Midterm Progress Final I enjoy making my patients laugh in
hopes that I can brighten their day. I am
 SP  S culturally safe by never assuming what a
 ND  U patient’s needs and wants are. I always
 UP listen to my patient’s wishes, and try not
to make assumptions about them based
on what I have read from their
chart/heard from staff. I work with my
patients to complete their goals for the
day, instead of “doing for”, which is easy
to do as a nurse. I always remain
professional with my patients by
maintain a therapeutic relationship.
D – Being on a stroke rehabilitation unit,
I find myself using the self-care model
often. This promotes independence and
that the patient provides as much care
to themselves as possible in that
moment in time. This facilitates progress
in rehabilitation, and potentially a faster
discharge.
E – I always encourage my patients to
wash their hands after using the
bathroom. Additionally, I remind
patients and families of patients who are
on contact/droplet precautions to wear
the proper PPE and keep patient items in
the patient’s room. I perform hand
hygiene frequently and at the five
moments of hand hygiene. I always don
and doff the proper PPE when caring for
a patient on isolation precautions.
F – One of my patients had lost a blanket
in her transfer from one unit to ours. I
advocated for her by calling the other

8. Critically appraise own practice in relation to
nurse-client/family interactions and as a
member of the health care team
unit to find the blanket, and when they
did not get back to me, I walked up to
the unit to collect the blanket myself.
Additionally, one of my patients did not
receive his full breakfast one day. I
advocated for him by reporting this to
the clerk, who called the kitchen, and we
were able to provide him with some
more food.
G – I can predict that my patients will
feel better after getting dressed and
showering at the beginning of their day,
which is why I encourage that.
H – I am constantly evaluating my
patients throughout my shift. I
consistently check in on them and ask if
they need anything. If they seem lonely,
I will sit and chat with them for a bit,
time permitted. If they seem sleepy, I
encourage periods of rest. I always
encourage that my patients get up,
bathed, and dressed for the day and into
chairs/wheel chairs. Usually this makes
them feel better physically and mentally.
Clinical Instructor:
Riley speaks competently and confidently with patients and
family. Riley engaged with a patent that suffers with dementia
and walked him around the unit chatting to calm/ease his
anxieties. Riley seeks out information when necessary and is
eager to assist all patients when appropriate. Riley is diligent
in advocating for her patients and speaks to the nursing staff
with confidence.
Student: Student:
- When a family is visiting a patient on
 the unit, I always ask both the
patient and the family if they need
anything before I leave the room.
This ensures that I am taking care of
Progress Midterm Progress Final my patient’s needs, and also the
needs of their family. I believe that Clinical Instructor:
 SP  S this is providing holistic care.
 ND  U - I consistently update my primary
 UP nurses on the status of their
patients. This is to maintain
adequate communication, which
facilitates better patient care.
- I answer call bells when I am able to
and others are not. This facilitates a
supportive work environment with
team-work as the focus. It also helps
to improve patient care, and their
experience in the hospital.
- When the patient’s family is visiting,
I like to gather information from
them that my patients may not be
able to express to me. This helps me
to include the family in the patient’s
care, and also helps me in knowing
how the patient would like to be
cared for in instances where they are
not able to verbalize this with me.
- I talk my patients through what I am
doing when I am performing a
procedure on them, or performing a
head to toe assessment. Patients like
to know what is happening to them
and what I am doing with them. I
always communicate the vital signs
to the patient so they know how
they are progressing over time. I
 believe that this facilitates a trusting
relation between myself and my
patient.
- When appropriate, I provide as much
privacy to my patients as possible.
This includes waiting outside the
door for them to be done in the
bathroom in order to ensure privacy
(if possible). It is easy for nurses to
forget about providing privacy to our
patients as the care we provide is
part of our normal routine. Patients
may not be used to someone
standing in the bathroom with them
and this may make them feel
uncomfortable. It is important to me
that I provide privacy to my patients
to ensure that they are comfortable.

Clinical Instructor:
Riley is great at developing relationships with both patient
and family. She has had opportunity to assist in OT therapies
by walking patents around the unit as part of their therapy.
Riley should continue to work with all the interdisciplinary
teams and how their roles affect their patient’s rehabilitation.
Riley interacts with the nursing staff and peers in a respectful
and helpful manner.
9. Participate in professional development based Student: Student:
on reflective practice and critical inquiry - Each week after clinical, I send my
clinical instructor a quick e-mail
Progress Midterm Progress Final summarizing what I have done that
week and how I felt about doing it.
 SP  S - Each week, I fill out a post-clinical.
 ND  U This allows me to look back on my
 UP patients and their conditions, and Clinical Instructor:
helps me to understand why the

This section to be filled out by the
student.
interventions they had were done,
and why they are taking the
medications that they take.
- After clinical shifts, my colleagues
and I discuss our day. We talk about
what we found interesting, difficult,
fun, sad, etc. It allows us all to get a
glimpse into what we all did that
day, even if we weren’t right there to
experience it.
- Attended an in-service about proper
readjusting and transferring of
patients who have experienced a
stroke.
- Attended an in-service about bed-
side shift reporting and proper
transfer of accountability.
Clinical Instructor:
Riley has completed all pre and post clinical in a timely
manner. She was successful at completing her SILO
effectively. Riley completely Hand hygiene in a timely
manner. Riley is diligent in completing her charting in a
timely manner. Riley actively participates in post clinical
discussion and should continue to do so. Riley is diligent in
seeking clarification for the unknown and will actively
participate in critical thinking a solution/answer.
Student Areas of Strength Student Areas of Strength
1. Time management 1.
2. Quality of progress notes 2.
3. Communication with primary 3.
nurse
 Student Areas for Future
Student Areas for Future Development
Development
1.
1. Properly reporting off to
receiving staff 2.

2. Completing and filling out the 3.

Canadian Neurological Scale

3. Finding time to connect with my

patients instead of solely
providing care.

Clinical Instructor Summative Comments:

Riley’s confidence is developing very well this semester. She is a caring nurse who will look outside the box to provide
support and comfort to her patient. Going forward Riley should continue to work on her time management as well as her
progress notes. Great Job!

Clinical Practice Attendance (8 Hours Per Shift)

 Thurs Fri Thurs Fri
Week 1 Week 6
Week 2 Week 7
Week 3 Week 8
Week 4 Week 9
Week 5 Week 10

Total number of clinical practice hours absent: __________

Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory Unsatisfactory

Clinical Learning Centre

Total number of clinical simulations completed /4

Total number of labs completed / 11

Clinical Learning Centre Outcome (completed by Course Lead): Satisfactory Unsatisfactory

Signature of Course Lead: __________________________________Date: _____________________

Signature of Clinical Instructor: __________________________________Date: _________________

Signature of Student: ______________________________________Date: _____________________