“—smuRsinG (clinical Evaluation Jan 2018 ¢ ¢ NURS 4021 Clinical Evaluation Midterm X__ Final Pass Fail Student: Sarah Ross. Preceptor: Amy Ferguson Faculty Advisor: _ Wendy Fucile____ Clinical Practice Site: PRHC Unit: B4__ Nature of Clinical Practice (Check all that apply} Practice hours completed 120, The setting is: ‘The population is primarily: _X__Hospital/inpatient Unit _X_Adults with medically-related health needs Hospital/Ambulatory or Day Program Adults with surgery-related health needs Hospital/Critical or Emergency care ‘Childron or adults with mental health needs Community/Cammunity Health Intraparturn families/mothers and newborns (not NICU) Community/Home Care __X_Older adults requiring support ‘CommunityfLong Term Care Healthy adults Industry/Oceupational Health Families/Neonates requiring critical care Other Adults requiring intensive or critical care __Persons requiring emergency care Children with medically or surgically related health needsONG «(gi Clinical Evaluation Jan 2018 @ ¢ E Progam Goals Graduates are generalists entering a seleregulating profession in situations of heeth and less. "Graduates are prepared to-werk with pee ple ef all ages and gendor (ind Graduates continuously use duals, families, groups, eommunities andl popula itical and scientific Inquiry and other waysef knowing tadevelop and apply nuisingknavdledgeInthelrpractice. Graduates will demonsteate leadership in prafessional nursing practice in diverse health care contexts "Graduates wil contrinute to a eulture of selety by demonstrating safety hm thelr oun practice, and by Wentfying, andl mitigating sk far patients and cther health cave providers "Graduates will establish and maintain therape 16 and culturally safe respect, ‘are team mambers bas : upon relational boundaries end bbe able tw enaet advacacy in their were based on the philosophy of social justice lectively utilize communications ond iAforma ional techrwlogies to livprove client out Graduates will be prepared ta provide nursing care that includes comprehensive, callaboralive #5se5smei evidence informed interventions and oulcame 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 camments 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 {he Instructor reasonably anticipates that if the student focusesASING (Clinical Evaluation Jan 2018 q « 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 dees 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. 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 perfermance 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 ta 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.SING YQ. Clinical Evaluation Jan 2018 | Objectives [Progress Undicators/Evidence uP Demonstrate professional conduct in accordance with College of Nurses of Ontario standards for nursing practice and et Critically appraise own practice in relation to nurse-client/family interactions and as a member of the health care team Demonstrate accountability and acceptance of responsibility for one’s ‘own actions and decisions ‘Bemonstrate professional presence and model professional behaviour befitting a BScN student Display self-awareness, initiative, and confidence to engage In care within a NURS 021 student's scope of practice Demonstrate effective and collaborative problem-solving strategies, including conflict resolution Select appropriate professional development activities as a result of personal reflection and critical inquiry (Comment on professionof conduct) have demanstrated professfonal cenduct thus far during my placement at Peterborough Regianal Health Centre (PRHC] Unit: Ba through my daily Interactions and communications with the staff'and -clents.an the unit. | arrive early each shift in proper Uniform with everything Iwill need farthe day. This -eraure | allow myself enaugh time to get prepared ‘for nny shift by preparing my client sheet, getting report and going thraugh the Kardex’s for each of my patient's, | speakto all staff, clients and family members on the flaor with respect and ina professional manner at all times. | have shown respensibility through completing all tasks for each patient on my shift and reporting anything that | haven't dene or forgotten to my preceptor as well as the next nurse coming on shift. | have shown accountability through checking with my preceptor before | complate any task, a8 well as asking for assistance in areas | a nat feel confident in, For example, | vill notify my preceptor when lam giving medications and what they are (ie, routine or PRN}. have shown confidence through increasing my worklaad and independence throughout my time on the floor. | started with shadowing my precentor with patients and am nawconfident caring for my own three patients independently. | effectively collaborate with my preceptor and other staff members through asking for their assistance and help with clarifying shings when needed, as well as working with the other disciplines on the fipar such as physio and social work, | have continued to selectASING Wf. linical Evaluation Jan 2018 ( « appropriate professional development activities and | T conduct personal reflection through completing the HES! modules outlined in my tearning Plan and. vw i ng rei a submitting my weekly reflections on time Demonstrate the student's primary duty to the person requiring nursing iomment on sofety, genesol competency, and care—sate, competent, ethical nursing practice: ethics} © Recognize individual competence within scope of practice © Seek support and assistance whenever necessary + Assess patient care situations for risks to safety 4, | MME TY HEESHOCRIC Rlotaiee hey) doo * Intervene, a5 needed, to ensure safety of the person requiring mursing feet camforiable completing a task slone yetar am care, and where indicated, the safety of nurses and colleagues Unsure of the process. have had my preceptor demonstrate tasks such as giving medications through NG tubes; administering Iv medications and tracheostomy care where t would abserve first before then trying it on my own, As well, any medications | am unsure of | look up te knows what they ate far, their actions and adverse effects. Similarly, for every IV medicatlon that ! administer | ensure look it upon the PRHC IV manual to make sure | have the correct infusion rates and times. | have been able to assess patient care situations far risks to safety through inquiring how each patient moves befare ambulating, asking for assistance when they requiring more than ane person to walk and having my pretentor or ather staff member present when using a mechanical lft. Fhave intervened when necessary such as praviding walkers arid veheelchairs to newly admitted patients Who need them as well as grip Socks for each | patient, | ensure all bed and chair alarms are for the designated patients before leaving the room as well as always sobering the exits as aur floor has wanderers. Ihave been able to recognize my individual competence within my scape of practice through v Demonstrate safe, competent and ethical nursing practice in the area o| (Conament on relational practice@ relational practice: | + _ Engage in critical self-reflection | have engaged In eiitkal self-reflection throughoutSING {Clinical Evaluation Jan 2018 ( identify and mitigate barriers to personal and professional the semester so far through completing weekly development journal reflections of my practice, as well as taking Prioritize specific aspects of personal development in order to and listening to my preceptor’s feedback. As welll engage in person-centered, relational practice have organized a learning plan and study guice to help me in my learning needs and preparedness for the NCLEX, This includes completing HES! modules and reading scholarly articles weekly. | have engaged in therapeutic, caring and culturally safe relationships throughout placement. | have maintained solid relationships and rapport with my + Engage in therapeutic, caring, and culturally safe relationships © Effectively use self to initiate, maintain and terminate relationships © Demonstrate the intentionality af nursing by listening, questioning and responding | "displaying sensitivity and empathy patients as Ihave mostly had the same patients each * relating with curiosity shift. This has made it easter to knaw their needs, + felating to complexity and uncertainty complexities and baselines. it allows me to better © relating to vulnerability work with my patients and understand their goals. © Create mutuality and recipracity in relationships with persons | Simiorly,| have effectively terminated relationships Teuubine nuTsInEERra through being apart of multiple discharges. | have ; 2 jn. | advocated f yugh refer + Advacate for persans requiring nursing care, working collegially and in| *¢¥0csted for my [patients through referring them tascifferent disciplines Ithink are necessary, such as concert with ether health professionals | dieticians, CACC and physia. As well, Ladvocate for my patients through getting doctors to order = eis adh oh cae oti “i _medications and review patient medication lists 4 Demanstrate safe, competent and ethical nursing practice In the area of Ti€omment.en cltaicol decision-making} clinical decision-making: © Demonstrate critical inquiry, scientific inquiry, and clinical reasoning: Through placement | have integrated knowledge | + Informed by the discipline of nursing, use diverse sources of have gained from all of my previous placements and knowledge and ways of knowing in the practice of nursing receptors. Luckily | was placed on this unit for my Acute placement sernester; therefore it gave me ‘© Integrate nursing knowledge with knowledge from the basic background knewledge of the floor and where stiences, health sciences, humanities, research, and ethics in things vere1 have taken the knowledge gained dlinical decision-making from labs ard previous placements such 2s head to © Evaluate how models, theorles, and frameworks fram the toc assessments, checking vitals, pouring and discipline of nursing inform the practice of nursing in the administering medications and providing current clinical setting therapeutic cornmunication to my patients. Through * Compare and contrast personal approaches to critical Inquiry and shadowing my preceptor | have inquired how to clinical reasoning with those of expert nurses ‘organize my days and tasks in order to get © Create new strategies for critical inquiry and develaping expertise In| *#2?¥thing done Ineed to, As well |have gained a i ; better understanding of hove theories and response ta increasing complexity of patient care requirements SranGNIG TAG lay AfoLs Ertaal Aalaetiinns or abe 3 franewe rks play @ role in r uGASING ¢ . Clinical Evaluation Jan 2018 ( 5 | Underthe supervision of the preceptor, but with minimal guidance, demonstrate safe, competent and ethical nursing practice in the area of plonning, implementing and evoluating 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, ta plan and implement care * Utilize the best available evidence to inform nursing actions 9. Identify gaps in current knowledge © Seek and evaluate evidence to support nursing actions © With minimal guidance, identify and enact appropriate nursing care © Collaborate with other health care providers and the person requiring, nursing to assess outcomes of nursing and health care using evidence | Informed approaches woample, being 2 part of discharge planning you have to ensure that each patient haswhat they need to be successful within the community. This includes setting up fallow-ups, sending scripts and providing educatian to patients and families ebout the recovery processes, | have been able to effectively start to fully be able to organize miy time during my shifts through using all of my current knowledge to ‘work within my scope af practice to give my patients the best treatment | cane {Comment an narsing care ptanning) ‘Throughout placement | have demonstrated planning, implementing and evaluating nursing care through gathering information of my patients from multiple sources, l receive renort from the pres nurse at the beginning of each shift aswell as go through each patients Kardex to get the pertinent inforrnation I will need such 35 code status, diagnosis, health histories, allergies and treatmerit plans, | have been apart of rounds during day shifts (during the week) where all of the disciplines come Together to go over the treatment plans tor every patient on the floor and what is needed for them to be able ta be discharged. Here we give everyone report of our patients and our opinions of what they may need in order ta be successful, | have also been able to independently complete the admission process for patients coming onto the floor, This Includes doing full head to toe assessments as well as inquiring about their home life, diet, motility and other medical needs, As well, itallows me the opportunity to see if they may need a consult from other areas too. | have collaborated with many ather health care professionals, especially when | need guidance. | have utilized my preceptor and ether staff members for instruction on procedures and | how ta navigate the meditech. [have asa been ableJASING (|. Clinical Evaluation Jan 2018 ¢ ( va - to identify client needs such as the need of prn medications with minimal guidance, Demonstrate enhanced knowledge of nursing and health velated t@ indigenous [Comment on care of special populations) populations, women's and environmental heaith, mental health, ond aging | Ghd cutalbobudanions Throughout placement and dealing with the older 2 Demonstiate leadeiship In providing nurshigicareto these spaglal aged papulation within our cormmunity t have been populations based on the student's knowledge and experience able to recognize their cifferentheatthvniceds, Old ar adults tend to have memary problems such a > Identify gaps in care delivery i dementia and eontusion-causing thera to forget © Challenge status quo approaches to caring for marginalized | nee they are and peapie the people they know populations This has allewed me to recognize the patients who © Recognize the unique pathophysiology of disease states and | may need wander bracelets and reorienting them to Implications for care of special populations, including those where they are and why. As well marw elder adults with prolonged lengths of stay and older adults have mobility issues, which hasalso allowed me to © Consistent with student role, recommend and initiate changes | recognize when individuals need assistance or inpractice | walkers/tuheelchairs and bed alarms sa they do not hurt themselves, Many of the alder population alsa have DNR’s which are important to knaw when working with a patient wha has one. In patients who have been here fara prolonged stay | ensure they are regularly moved and changed to prevent pressure ulcers as well as administer anticoagulants ta prevent blood clats from immobility. Older adutt usually have family members invalved in there care which requires educating them on treatments and interventions to help with their family members. As a student | have been able to do this in practice through interacting with families and patients and , addressing concerns they may have. 7 | Independently perform care of patients, within the (NURS 4024) BScN student | (Comment an managing care) scope of practice * By midterm, the student should be able to manage a full and pL TiIs pobnt bi ihe sernester, Ihave been able to reasonable patient assignment in the preceptor's practice setting, with | ™anage 3 out of 4 of my preceptor's patient doathifa fram precediar assignments with coaching and guidance from my © Demonstrate increasing abllty to safely set priorities anit prerepiat: | ave incensed iif rhonda as ae 7 each shift far where [feel comfartable in. This has tpanare time bo tne:fece Sf competing quam included taking on more patien's, doing report and © Safely and accuratels85ing € Clinical Evaluation Jan 2018 ¢ Demonstrate increasing level of independent clinical decision making, with support from preceptor © Safely and accurately enact nursing interventions © Evaluate nursing care outcomes and adjust plan as needed with minimal guidance © Collaborate with team members with minimal preceptor guidance 8y ond of term the student should be able to manage a full and reasonable patient assignment in the preceptor’s practice setting, with minimal coaching from preceptor © Independently and safely set priorities and manage time, safely carry out required assessments and nursing interventions, consult with team members, demonstrate leadership at the paint of care in relation to clinical decisian-making, anticipate changes in patient condition and intervene apprapriately; seek assistance when necessary with no direction from preceptor, ‘who acts as supervisor A fourth year nursing student is able ta carry out the following nursing, activities © Assessment "Vital signs (Temperature/Pulse/ Respirations, arterial BYP, Sas) Biopsychosocial © Health history ‘© Functional {elderly} ‘© Nursing admission, pregnant woman, pos! partum woman, newborn/HEADSS, wellehild = Head-to-toe * Pre/post-operative, * Glucometer testing * Focused: mental status/cognition, cardiovascular (normal heart sounds, bradycardia, tachy-cardla, NSN, Afib), neck vessels, peripheral vascular system (o\e1n9), respiratory (breath sounds}, abdominal (bowel yours), ° | administering medications independently. Each shift | complete all assessments for my patients and report al vital signs and anything abnormal to my preceptor. | have preformed tasks such as: glucometer testing and insulin administration, bed making and bathing, Morse Falls Scales, assisting patients with walking, managing N's and administering medications through them, proper PPE application, hacking up tube feedings and administering medications through NG/G tubes, Foley care and removal, waund care, attempts at starting IV's, maintaining oxygen through applying nasal prongs/masks and monitoring patients for any. changes in O2 stats, deep suction and tracheostomy care, administering medications through IV, injections and orally, giving report and documenting all tasks preformed during my shift, | have | Increased my centidence this far through completing many tasks and inquiring more learning for areas 1 ‘am unsure of. | feel that this placement is giving me ood experience to becomea navice-practicing nurse and look forward to more learning experiences,vasinG {clinical Evaluation Jan 2018 ( neurolagical (Glasgow Coma Scale, motor, sensory, | cranial nerve), breast, testicular exam, pain | 2 Hygiene Care * Bed-making * Unoccupied * Occupied = Bathing * Complete © Partial/supported © Promoting Activity/bobility «= Falls Prevention (Marse Falls Scale} +) Rostraint Assessment * Body Mechanics/Transfers «Assessing body alignment and posture « Positicning/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 * CAD (may do only if tought ond practiced in lob, and under direct supervision of an &N, and as consistent with ogency paticy) + Blood Component Therapy (seudent may do If consistent with agency policy) * Initiation/management © Promoting Safety/Cantrolling Infection + Standard precautions * Handwashing z_ Clinical Evaluation Jan 2018 + Use of protective harriers = Donning a surgical mask = Donning an NSS mask * Donning sterile gloves + Gowning © Removing equipment = Care af equipment and disposal of waste o Nuteition/Elimination © Safe oral feeding-person with dysphagia + Enteral feeding Insertion and care of indwelling catheter Collecting a urine/stoo! sartyple Care af candam drainage Care of astomy ® Monitoring and reco ding, intake/output + Maintaining Gxygenation + Pulse oximetry = Nasal prongs = Inhalers/nebulizers Home oxyeen Pulmonary care « Suctioning «Tracheostomy ‘o Dressing change © Cannula change © Chest tube > Past-operative Care + Assessment = Use of elinical pathways = Applying ant-embolic stockings # post-operative exercises # Post-operative teaching + Staple, Suture removal _Packing removal __-UksING( . clinieal Evaluation Jan 2018 ¢ ‘© Medication administration = Oral medications © medications obove the drip IM, S/C, intradermal administration * PCA © Wounds Care of wounds/sutures/drains = Pressure uleers * Braden scale * Chronic wounds "Dressing changes = Wound care products * Brains: JP, Penrase, Hemovac Post-mortem care Reporting and Recording = Giving report = Charting = Transcribing orders Medication administration = Topical, aral, parenteral (2/¢, IM, above the drip [¥) administration * Basic knowledge of the medications prescribed + Classification + Purpase * Possible side effects | + Adverse effects » Interactions with other drugs + Appropriate dase/route + Implications for nursing care © Health Teaching «Identify client/family learning needs "Collaborate with team to develop plan ta meet client's learning needsarsine (Clinical Evaluation Jan 2018 ¢ * Implement aspects of plan within scope of practice as a learner © Psychosocial/Relational Practice * Recognize and acknowledge client distress asit arises = Demonstrate empathy, active listening, sensitive questioning = Apply principles of mi + offersuppert = Engoge in prablem-solving as required, incallaboration with others as needed © Team Communication * Diseuss any findings related to the patient assessment with preceptor, staff nurse, physician, team member = Seek assistancefask 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 9. Nursing and Collaborative Therapeutic Interventions. * Determine which interventions are required, what resources, including suppart and supervision are required, and schedule interventions in consultation with the client * Complete interventions as appropriate and within scope of learner practice 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 af documentation for r process and patient progress ational interviewing sing, Student and Preceptor CommentsARSING( Clinical Evaluation Jan 2018 ¢ f Able Po wolepenclens ee eae 3-4 on nights woth mun Supervisicy), Sarah aboka ee ee oe Sarah to pre te Crotiabte, Ske Uo checomi ortabte a Strolent Turan here on 6 “fap up the gos ok Sarah | Faculty Advisor Comments (All areas marked as unsatisfactory must have a comment) Signature of Preceptor. Date, yA bo 27 50/8 Signature of Advisor Z Pts iS pate £210 OQ Lo 8 Signature of Student. a Date