NURS 3021H Clinical Practice Focused on Chronic Disease Management

Mid-Term Evaluation X Final Evaluation

Student: Marissa Brown

Clinical Instructor: Danielle Reid

Clinical Placement Hospital: PRHC Unit: A2

Date: February 16th 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. - Arrive to placement on time in
full uniform with pre-clinical
Progress Midterm Progress Final assignment complete from
report on patient
 SP  S - Made sure to ask questions to
 ND  U my peers and instructor for
 UP guidance with difficult decisions
or tasks (ie. Charting properly or
discussing an abnormal
assessment result and Student:
brainstorming interventions to
put in place)
- Responsible and accountable for
performing a full assessment on
two patients every shift and
charting in both the tick charts,
graphics and a progress note Clinical Instructor:
- When giving medications, having
the prior knowledge about what
the medication is and why the
patient is taking it

Clinical Instructor:
Marissa 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. Marissa should continue to use
these tools as an opportunity to evaluate
 and links between her patient, diagnosis
and test. Marissa gives report to both
fellow nursing students as well as the
primary nurse in a professional manner.
Marissa will continue to develop this
skill by following the SBAR format and
HEAL check while doing beside shift
report with fellow nursing students.
Marissa 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 - Patients who are on a good plan
settings of recovery but then start to
regress, may feel frustrated and
Progress Midterm Progress Final hopeless
- Other patients with not many
 SP  S visitors may get lonely – this can
 ND  U increase if they are not able to Clinical Instructor:
 UP move around on their own or
need a lift to get out of bed
- Patients who are progressing
well and meeting their goals may
feel excited to finally be able to
get home, they may also feel
worried about having to perform
ADL’s without assistance once at
home

Clinical Instructor:
Marissa has had an opportunity to work
with a number of patients all at different
stages in their recovery. She does a great
job caring and supporting each of her
patients. Marissa can identify the impact
a chronic illness has on the person and
their family. Going forward I would like
 to see Marissa 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. Marissa
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 - Experience interacting and care
nursing process such as common signs and with patients with varying
symptoms, responses to treatment, patterns of degrees of hemiparesis and other
coping, and impact on individual and family effects of stroke
relationships. - Learned and implemented
Progress Midterm Progress Final knowledge of proper body
mechanics with positioning and Clinical Instructor:
 SP  S transferring patients who are
 ND  U
recovering from a stroke – such
 UP
as propping a pillow under an
affected arm to prevent skin
breakdown
- Ensured all patients are sitting up
at a 90-degree angle for meals to
prevent aspiration and choking

Clinical Instructor:
Marissa is developing her assessment
skills to help identify and understand the
signs and symptoms of a stroke and
many other chronic illnesses. Marissa
can perform the proper assessment and
can relate her finding to the nursing
diagnoses. Marissa continues to gain
experience, knowledge and confidence in
her practice.
4. Identify symptoms and common medical Student: Student:
treatments of selected chronic illness. - Performed Canadian
Neurological Scale assessment,
Progress Midterm Progress Final GCS and PERRLA assessments on
patients with varying degrees of
 SP  S disability every shift
 ND  U - Watched a chest X-ray on a
 UP patient Clinical Instructor:
- Went to the blood bank with the
primary nurse and watched a
blood transfusion on a patient
- Watched an IV insertion on a
patient whose vein had blown
- Cared for a patient who had had
tPA for an ischemic stroke and
noticed how fast he/she was
recovering compared to patients
who were ineligible

Clinical Instructor:
Marissa completes her head to toe
assessments competently. Marissa is
developing an understanding of medical
treatment for stroke patients. Marissa
Josie can identify the importance in
symptom assessment and monitoring and
completes Neuro vitals amongst other
assessments competently. Marissa
completes pre and post clinical to assist
in developing her knowledge and
understand of these chronic illnesses.

5. Demonstrate select nursing and collaborative Student: Student:

interventions related to caring for the person - Have given meds on 2 evening
with chronic illness such as specific shifts, including PO and SUBCUT
assessments, medication administration,
 physical and chemical restraints, enteral insulin
feeding & residual volumes, NG tube insertions, - Performed a staple removal on a
wound care, patient-controlled medication pt. admitted for rehab of a hip
administration pumps. surgery
- Performed a dressing change and Clinical Instructor:
Progress Midterm Progress Final cleaning using aseptic technique
- Flushed an NG feeding tube
 SP  S - Performed Braden scale
 ND  U assessments on patients to
 UP identify risk of pressure ulcer
development

Clinical Instructor:
Marissa can competently administer
medications, while identifying nursing
responsibilities while administering
them. Marissa is eager to learn new tasks
and help others along the way. Marissa
should continue to apply the therapeutic
interventions learned in the last pre
clinical for positioning. Marissa should
continue to work on her sterile technique
in any dressing change she completes.

6. Identify potential consequences/complications Student: Student:

of select chronic illnesses and related - Patients recovering from a stroke
interventions. may experience a variety of
disabilities based on the location
Progress Midterm Progress Final and seriousness of the stroke. I
have interacted with patients
 SP  S with varying degrees such as full
 ND  U independence to full paralysis on Clinical Instructor:
 UP one side. I have also interacted
with patients with dysarthria and
aphasia and well as a patient
who is dysphagic and can only
 have thickened fluids and minced
foods
- Cared for a patient with nerve
pain from an amputation due to
diabetic foot ulcers

Clinical Instructor:
By Marissa completing her pre and post
clinical assignments she demonstrates
her understanding of the complications
of chronic illnesses and related
interventions. Marissa 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.

7. Under the supervision of a Registered Nurse, Student: Student:

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
- Arrived on time to every shift in
full uniform
- Approach every patient with an
open mind and unbiased attitude
- Apply nursing models such as the
self-care theory to every patient
on the assigned post-clinical Clinical Instructor:
assignment that is submitted to
my clinical instructor
- Applied Orem’s self-care theory
with all patients by encouraging
independence in a safe manner
 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:
Marissa is great at communicating and
seeking guidance from me. She is
respectful of all feedback and should
continue to develop her confidence in her
skills. Marissa speaks competently and
confidently with patients. Marissa seeks
out information when necessary and is
eager to assist all patients when
appropriate. Marissa is diligent in
advocating for her patients and speaks to
the nursing staff with confidence.

Progress Midterm Progress Final

 SP  S
 ND  U
 UP

8. Critically appraise own practice in relation to Student: Student:

nurse-client/family interactions and as a - Incorporated specific
member of the health care team communication skills to interact
with patients with varying
degrees of aphasia and other
deficits (ie. Keeping sentences
short and direct)
Progress Midterm Progress Final - Incorporated teaching skills to Clinical Instructor:
educate patients and their
 SP  S families about their recovery
 ND  U process and next steps
 UP - Used therapeutic communication
skills to build a relationship with
every patient I am caring for on
every shift
 Clinical Instructor:
Marissa is great at developing
relationships with both patient and
family. Marissa should continue to work
with all the interdisciplinary teams and
how their roles affect their patient’s
rehabilitation. Marissa 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 - Participated in post-conferences
where topics such as proper body
Progress Midterm Progress Final mechanics, and positioning as
well as the type of stroke and
 SP  S common symptoms were
 ND  U discussed
 UP - Identifying specific care needs Clinical Instructor:
and investigating treatments
plans for individual patients as
part of the pre and post clinical
assignments
- Completed a hand hygiene and
PPE module and apply the
learning every shift to prevent
the spread of infection and
protect myself

Clinical Instructor:
Marissa has completed all pre and post
clinical in a timely manner. She was
successful at completing her SILO
effectively. Marissa completed Hand
hygiene in a timely manner. She is
diligent in completing her charting in a
timely manner. Marissa actively
participates in post clinical discussion

This section to be filled out by the
student.
and should continue to do so. Marissa 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. I believe I can effectively manage my 1.
time to get charting and tasks
complete in a timely manner
2.
2. I believe I am good at asking
questions if I do not know 3.
something in order to learn the
most that I can from this experience Student Areas for Future
Development
3. I believe I am good at supporting my
fellow students with tasks if they
1.
need assistance
Student Areas for Future 2.
Development
3.
1. In the future I can assist with other
patients and ask nurses if they need
assistance more often
2. I think I can further develop my
progress noting skills to make them
more clear and concise
3. I can further develop my confidence
when educating patients on their
diagnosis or treatment plan
 Clinical Instructor Summative Comments:

Marissa’s confidence is exactly where it should mid semester, it will be nice to watch her progress in
confidence over this next half. Marissa does not shy away from opportunities and should continue to do
so. Marissa confidently and competently administered medications for 2 patients and was able to identify
the need to hold an insulin for a low blood sugar. I would encourage Marissa to continue to work more
with OT and PT to understand more the role they play in chronic disease management. Wonderful job
thus far!

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: _____________________