Comprehensive Nursing Practice

Critical Care

GTNI
NU
202
Clinical Reflective Journal
Fall 2019
Evaluation Tool

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Student Name:_Aly Gomaa__________________________________
NU 202 Clinical Evaluation Tool

Course Objective 1
Use the nursing process to promote wellness, human flourishing and adaptation for individuals and families
with complex physical and psychological needs by applying safe, culturally sensitive therapeutic nursing
interventions (CII)

1. Assessment:

Assess the adult patients physiological and psychosocial integrity; the safety of the care environment and
holistic needs.

Competencies:
1. Integrates data obtained from patient and family with complex health needs based on physical,
psychosocial and environmental assessments using electronic resources, as appropriate (PSII)
2. Evaluates potential and actual hazards in the patient care environment intervening as appropriate (CIII)
3. Integrates normal and abnormal lab and diagnostic test findings with emergent patient symptoms (CIII)
Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make
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Feedback:
Week 2 Student: Today I was in ICU department, in General El Hurghada Hospital. I was deal with the patient
has HTN, Diabetes and Atherosclerosis IN neck arteries , initial name M.A, 55 years old, male and admission
date 22/9/2019.

1- I did complete assessment to the patient, according my assessment the patient had 1- Decreased
cardiac output, as my patient had high Blood pressure 180/110 mmHg and had HDL. C 63.5 (high)
because the patient had atherosclerosis this condition where the arteries become narrowed and
hardened due to buildup of plaque around the artery wall, the disease disrupt the flow of blood
around the body , this disease can come result on high level of cholesterol, smoking and high levels
of sugar in the blood what are the risk factors in your patient condition?. Also my patient has
weakness in carotid pulse, weak pedal pulse, according to respiratory didn’t use accessory muscle
and use abdominal breathing those result on the effect of the disease. Also was has past medical
history of stroke and after brain scan found brain ischemic. My patient was receive O2 2l/hr because
was had difficult of breathing and become comfortable after it also take farcolin( Generic Name?) this
medication is bronchodilator used to control and prevent reversible airway obstruction, side effect
restlessness, headache, insomnia, nausea, vomiting It has a significant side effect which is
Tachycardia !!! . Also was has high level of sugar in the blood so was take insulin every 6 hours. Also
was receive omeprazole this therapeutic anti-ulcer agent, pharmacologic proton-pump inhibitor. This
maintenance of healing in erosive esophagitis, duodenal ulcers, side effect dizziness, fatigue, chest
pain and constipation. Was take Lasix this diuretics used for hypertension side effect blurred vision,
dizziness, headache, excessive urination and dry mouth. Also the patient was receive ATOR this
lipid-lowering agent, primary management of hypercholestelomia and mixed dyslipidemia. Side effect
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 confusion, chest pain, rashes and increase liver enzyme. The patient HR 79bpm (normal). RR 16
b/m (normal), spo2 96 %( normal). T was 36, 5 c was normal. Blood glucose 72 mg/dl (normal). K 4,8
normal, Na 134 is low, Ca 0,83 what is your nursing observations that you need to consider?

2- The patient had impaired physical mobility as my patient, had muscle weakness. Activity restriction
because his weakness, also was had catheter this also restricted his mobility. After I entered to the
patient urine output was 1100ml, I removed it and after one hour excrete 100m this should be related
to the CO issue in the first cluster l. wasn’t oriented and GCS was 13 and had sluggish pupil and size
2mm. limited ROM, Oxford muscle 4 in upper limbs and 3 in lower limbs. So I achieved safety after I
entered for avoid and hazard happen also did the environment suitable around the patient and
maintained bed clean and side rails up, also did identification first. Fall risk assessment was 13 is low
risk not it is high risk because 13 or more are liable for fall. Braden risk assessment is 14 is
moderate risk. Also the patient had difficult in swallowing as eat soft food as the patient was had past
medical history about stroke. Also the patient had disturbance sleeping.

3- The patient high risk for infection as the patient had PVC in heft hand and this invasive procedure.
Also from hospitalization period as the patient was in another hospital and transport to this hospital
for 3 days. As the patient was receive ceftriaxone this anti-effective, treatment of skin structure
infection. Side effect high dose do seizure, rash, diarrhea and pain. The patient WBC 4, 4 is normal,
RBC 5, 13 normal. What is your nursing consideration to maintains safe antibiotic administration

4- High risk for Impaired skin integrity nursing dx should be mentioned in the coming section not here
as the patient may still a long time without moving as he didn’t able to do it, had pale skin, oral care
assessment was 15, what else is causing the risk for the disruption of skin integrity? Aging?
Diabetes? Friction and shearing? so I start to change position and start do care for him, also for
avoid happen bed sores. This should be in the implementation part!

5- Anxiety as my patient was stress from it and was sad because another person feed him, move him
and everything he depend on another person’s, also he was sad because of his illness do him didn’t
able to do his work, has stress from hospital and because he didn’t see his sons most of the time.
Also his brother was sad because he need him in a good condition, so I was support him and deal
with them a good way did them trusted me. This is more to be self-care deficit

6- The patient also high risk for fall as he had problem in his eye as he had cataract, sluggish pupil, this
affect to the patient as my fall from the bed so I was raise side rails, or happen injury to from another
things so I was had close observation to the patient. What else is posing him as risk of falling?
Week 2 Faculty:
You have provided a priority assessment for both physical and psychological assessment. Indeed, you need
to emphasis more about your assessment for safety and medications.
Week 3 Student: Today in psychiatric simulation lab I was a primary nurse. I was deal with substance abuser
patient. Initial name us E.O, female, 35 years old (in which developmental stage), admitted to ER, She has
Heroin overdose.

1- According my assessment, first nursing diagnosis is pain as the patient, she admitted because over
dose of heroin and receive 2 dose of naloxone (why??). Is the patient has severe abdominal pain and
facial expression is Grimacing due to pain, feel discomfort and shout say I have severe pain also was
has muscle ??and joint pain, I did distracting technique for him and did pain assessment (describe ,
called the doctor and doctor prescribed for it Acetaminophen 300 mg, this is pain relief refiling. The

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 patient was has nausea and vomiting so was take Metoclopramide 10 mg IV every 6 hours. The
withdrawal symptoms of opioid appear to the patient after take naloxone is opioid antagonist, as the
patient was has sweating, restlessness, Runny nose, vomiting, abdominal cramp, dilated pupil, tearing
and agitation. The patient was receive 200ml/hr of normal saline as fluid and electrolyte balance. Past
medical history, patient has been admitted twice before for heroin over dose and for 5 years ago did
back surgery and was take morphine, she became addicted and moved to heroin 2 years ago. Also she
has drug rehabilitation 3 times prior in the last 3 years which indicate ineffective coping. RR WAS 16
b/m normal. BP was 140/100 mmHg, CRT less than 3 second. Labs are pending for BAL, Urine
toxicology, magnesium and phosphorus.

2- Second nursing diagnosis is Anxiety as the patient has restlessness, agitation because she in
withdrawal symptoms of Opioid, she has 3 children and currently is going through divorce with her
husband (psychosocial disturbances due to addiction) . She was cry and say I didn’t able do care to my
children, say no anyone care for me, say I feel alone, also she missed her work and she was say I want
go out from this hospital. I and my colleague were support her all the time and say to her this is
withdrawal symptoms and will disappear after several days of taking the medication also was anxiety
from the pain. We called the doctor and doctor prescribes for her Diazepam 5mg PO is anti-anxiety.

3- Third nursing diagnosis is Ineffective coping as the patient didn’t able to cope with the withdrawal
symptoms, also because she missed her work, didn’t able to care for her children, currently is going
through divorce with her husband, so I and my colleague start to assess her psychological condition, as
tried support her, say to her that withdrawal symptoms (the pt. was in which stage of addiction) will
disappear after several days after taking the medication, didn’t able to cope with hospital period and say
I will go out. Also she was has agitation, restlessness also the effect of the pain.

4- The patient high risk for injury because of withdrawal symptoms appear to him, feel alone went leave
the bed and go out also the pain effect do him uncomfortable. So we achieved safety for avoid any
hazard happen and environment available for him. Also achieved identification for avoid any error such
as medication error. Try to support her and tell her the coming will be better after taking the medication
and will return to normal life again.
Week 3 Faculty: your assessment was organized and comprehensive as assess the adult patients physiological
and psychosocial integrity; the safety of the care environment and holistic needs.
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2. Analysis/Nursing Diagnosis:

Analyzes assessment data to select nursing diagnoses to meet patient and family needs

Competencies:
1. Organizes data to determine actual, high risk, wellness and/or potential complication nursing diagnoses
(CIII)
2. Constructs nursing diagnoses for the complex patient (PSIII)
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Feedback:
Week 2 Student: 1st Decreased cardiac output r/t Alteration in Blood Pressure

2nd Impaired physical mobility r/t musculoskeletal impairment and imposed restrictions of movement.

3rd High risk for infection r/t hospitalization period and invasive procedure

4th high risk for impaired skin integrity r/t immobilization

5th Anxiety r/t ineffective coping and powerlessness

6th high risk for fall r/t eye cataract and impaired physical mobility
Week 2 Faculty:
You have formulated priority nursing diagnosis based on your patient needs.
Week 3 Student: 1st acute Pain r/t withdrawal symptoms of opioid

2nd Anxiety r/t increased sensitivity to pain and helplessness

3rd Ineffective coping r/t confusion from withdrawal symptoms and inadequate support

4th High risk for injury r/t withdrawal symptoms and feeling of uncomfortable.
Week 3 Faculty: I agree with you for selecting the appropriate NDs but for priority the risk for injury need to be
with high priority after acute pain as it concerned with safety
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Week 9 Faculty:
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NU 202/Comprehensive nursing practice/clinical evaluation tool/ 2019

3. Plan:
Develops a plan of care to promote adaptation for individuals and families with complex needs considering the
influences of the macrosystem and work unit.

Competencies:
1. Evaluates priorities of nursing diagnoses for complex patients and families (CIII)
2. Collaborates with the patient, family and health care team to formulate relevant outcomes for complex
patients based on patient and family values (AII)
3. Correlates nursing theory to practice by identifying the physiological/psychosocial/ pathological bases
which link patient data with the stated nursing diagnoses in the care of complex patients (CII)
4. Proposes relevant, culturally-sensitive, individualized nursing interventions based on evidence-based
practice to achieve expected outcomes in the plan of care for complex patients and families(CII)

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Feedback:
Week 2 Student: 1st The patient Blood Pressure will return to normal range, have present pedal pulse, normal
carotid pulse and normal HDL.C after receiving his medication as Ator, Lasix and omeprazole through treatment
plan, through long time (2 Weeks). The patient will show signs of adequate cardiac output evidence by BP= 120-
140/ 60-90 mm hg after 1-2 hours.

2nd The patient will maintain normal muscle strength as has normal Oxford muscle, normal ROM, after resolving
the problem of the disease and removing catheter through long treatment plan (2 weeks) This is not realistic, but
at least you can say . The patient will show gradual active participation during ROM activity after 10-20 minutes
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of demonstration.

3rd The patient will be free from any infection as evidence by clean woundTemperature ,normal , normal WBC
during my shift through 4 hours.
Week 2 Faculty:
Your EOC needs to be realistic, measurable, time framed and have its evaluation criteria of achievement.
Week 3 Student: 1st The patient pain will relief after taking medication (acetaminophen as pain reliving) and
follow distracting technique through 15 minutes

2nd The patient will be free from anxiety after support her and give her information about withdrawal symptoms
through 45 minutes and taking antianxiety medication

3rd The patient will able to cope with this after pain reliving, support, take information about withdrawal symptoms
and feel care from the others through 1 hours
Week 3 Faculty: I agree with you 1 st 2 EOCs but for the 3rd one is long- term, so you need to revise the time
fram for your for the last one
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4. Implementation:
Implements nursing care that meets the comprehensive physiological and psychosocial patient/family needs
within a safe, effective care environment

Competencies:
1. Operationalizes safe work practices, initiating requests for assistance when needed to maintain a safe,
effective care environment (PSII)
2. Provides prioritized, holistic patient-centered nursing care to complex patients and families (PSII)
3. Completes nursing care of the complex patient in a timely manner coordinating with the health care
team (PSII)
4. Integrates effective use of technology and standardized practices that support safe nursing care of
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 complex patients, reduces reliance on memory and minimizes interruptions (PSII)
5. Prioritizes nursing responsibilities when administering and/or monitoring effects of medications and IV
therapy for the complex patient (CII)
6. Administers medications safely following hospital and program policy to the complex patient (PSII)

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Feedback:
Week 2 Student: For first nursing diagnosis
1- Check Vital Signs including BP, lab tests for know what the normal and what is abnormal to manage
disease process.
2- Record urine output because the renal system is counterbalance low BP by retaining water
3- Do ECG for compromise cardiac output
4- Give low cholesterol diet for manage Atherosclerosis
5- Medication such as Lasix (diuretics), Ator (lipid- lowering agent) what else? Positioning? What is the fluid
balance required?

For second nursing diagnosis

1- Assess physical activity for manage it
2- Encourage for ROM
3- Give the patient appropriate nutrition for improve muscle strength
4- Maintain safety environment for avoid any complication may happen
5- Determine patient daily routine for activity what else? mattress? Elastic stocking? Change the positioning?
Clexane /Heparin as DVT prophylaxis?

For third nursing diagnosis

1- Assess the presence of infection how and why?
2- Monitor WBC for know was find infection or not why?
3- Maintain clean PVC clean and free from any contaminated for avoid any complication happen how?
4- Monitor appearance of urine this will indicate if find infection how and why?
5- Encourage him to cover mouth and nose during coughing or sneezing

Week 2 Faculty:
Ali, you have provided your patient with acceptable intervention within the clinical placement, yet your writng
does not reflect what you have already done. Indeed, you did not provide any analysis to your interventions and
why you selected them. You need to read more about the nursing care plan from Lewis or Medical surgical
textbooks to enrich your knowledge on the appropriate nursing care plan to your patient.
Week 3 Student: For first nursing diagnosis
1- Pain assessment for know about severity of pain and coping of patient with it
2- Distracting technique, such as look at me, try to forget the pain, turn you attention away from it, listen to
anything and position do you feel comfortable
3- Take medication as doctor prescribed acetaminophen as pain reliving 300 mg
4- Provide information as this pain result on withdrawal symptoms
5- Support him for express feeling this do the patient more comfortable.

For second nursing diagnosis

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  Assess level of anxiety
1- Maintain calm, non-threating environment for the patient became relax and decrease stress
2- Support her and tell her that withdrawal symptoms will disappear after several days after taking the
medication
3- Motivate her as tell her after this will be able introduce a good care to her children and will able to return
to her job
4- Doing touch technique and eye to eye contact this gain patient trust and say everything want say it
5- Called the doctor and doctor prescribed diazepam 5mg PO the anti-anxiety medication

For third nursing diagnosis

1- Explain to the patient about withdrawal symptoms, when and why will disappear this do the patient able to
cope with it also cope with environment
2- Relief pain first this will do the patient comfortable, able to speak and able to cope
3- Encourage good facial expression when you speak with the patient this do the patient gain trust and good
self- esteem
4- Find a way to bring her friends and her children to stay with her this do her more relax
5- Provide suitable environment for the patient to accept treatment and able to cope with it.
Week 3 Faculty: ok Aly is accepted for the intervention related the 1 st 2 NDs, but the last one is not enough to
help your pt. you need to read more deeper about ineffective coping problem with affected person to enrich your
knowledge and be able to help your pt. appropriately.
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5. Evaluation:
Evaluates the level of achievement of expected outcomes and the patient’s and family’s response (s) to
nursing interventions.

Competencies:
1. Evaluates the complex patient’s response to nursing interventions comparing expected outcomes with
actual outcomes (CII)
2. Revises the expected outcomes and nursing interventions based on the complex patient and/or family’s
response (CII)
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Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make
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Feedback:
Week 2 Student: For first outcome unmet because it need long term plan through following medication and
health teaching that gave to him will be met after it.so what is your action plan or your follow up plan? Reflect

For second outcome unmet because the activity will return to normal after resolve disease process and this also
need long term plan and after resolving it will be met so what is your action plan or your follow up plan? Reflect

For third outcome met as no found any signs of infection also normal WBC and normal Temperature.
Week 2 Faculty:
Because you have not formulated your EOC within the SMART criteria, you have the outcome as UNMET as
your EOC was not realistic. Indeed, what was your impact on your patient since 2 out of 3 nursing outcomes are
unmet?
Week 3 Student: 1st Met as patient pain relieved after distracting technique and took the medication

2nd Met as the patient anxiety relived after session of support, introduce appropriate care and took the medication

3rd Met as the patient was able to cope after doing calm environment and more explanation about withdrawal
symptoms.
Week 3 Faculty: the last evaluation need to reevaluated again as it is long term problem and can not achieved
during the simulation lab as it need long term intervention and follow up.
Week 4 Student:
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Course Objective 2
Promote a spirit of inquiry and innovative thinking in the pursuit of learning among peers and colleagues in
the development of a caring, professional identity (AII)
Competencies:
1. Formulates a plan of action based on self-reflection in the development of a professional identity
seeking guidance, as needed (AII)
2. Assumes responsibility for meeting clinical requirements on time following program policies, procedures
and clinical protocols (AII)
3. Shares appropriate patient research in clinical conference(AI)
4. Exhibits professional comportment demonstrating attention to appearance, demeanor, respect for self
and others (AI)
5. Respects professional boundaries (AII)

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Feedback:
Week 2 Student:

first I will explain thing happen to me through Kim’s model, when I deal with my patient and do assessment and
care for him, I saw one of the student nurse from El Hurghada nursing school bring medication and give it to one
of the patients, I asked him do you know this medication he answer me no but the nurse told to do it, I told him
didn’t give any medication without know about it for avoid any complication happen, also for avoid problem
happen to you, and he didn’t do documentation. Also didn’t follow six right and three checks. So I did research
after going to the institute and I was found from article that the nurse is responsible about medication
administration if any error happen the patient will suffer from it also the nurse will responsible about this error and
the nurse punished, also found following ten rights not six rights (Right patient, route, dose, time, drug,
knowledge, right to refuse, right questions or challenges, right advice, right response and outcome)
so the nurse be aware about it. So if happen this situation again, I will give more advice to the nurse to follow 3
checks and ten rights also know about the medication that give it, according to myself I will not give any
medication I don’t know about it, do search and know it first. (Edwards, et al. 2015). So Ali, what did you learn
from this situation? Is this new to you?

I was prepared very well before going to ICU as read about stroke, myocardial infraction but after I took this
case I came and read more about it. Also I did action plan before going to it was about CO3 Documentation I
could achieve it but found some defect such as didn’t do it in timely because another thing do me busy about it.
CO5 about ethical, legal regulatory guidelines and professional standard of nursing practice and I could achieve
it as I was read about principles of ethics from ethics handout so this helped me when I work with the patient also
page of ethics that found in clinical package. I did search about information of atherosclerosis and shared it with
my clinical instructor,
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 I was follow steps when I do any procedure for avoid any error happen such as when I empty the urine bag,
first wear gloves, do disinfect empty it in urinal for know about the amount, check color and observe the bag
every hour for know about amount and if any abnormality also observe catheter if found any complication. I was
follow GTNI uniform policy and prepared my equipment. I was deal a respect way with my patient and everyone
in the area including my colleagues, nurses and my clinical instructor. Also respect professional boundaries as I
didn’t ask the patient about things not from my role ask about it also I was take permission before I touch him or
when I do any procedure.
Week 2 Faculty:
You were showing preparedness to the clinical placmenet by being on time and adhering to uniform policy.
However, what did you learn from your KIM’s Model? It is very superficial and does not enrich your knowledge.
Thus, you need to select a new topic to reflect upon via using PICO format.
Week 3 Student: First I will explain situation through Kim’s Model. After I entered to patient was has anxiety and
ineffective coping with the symptoms appear to her and also the environment because the night nurse didn’t
introduce appropriate care to her, as she didn’t give her information about withdrawal symptoms, didn’t do the
environment suitable for her, didn’t support her and has bad facial expression with the patient. After I entered to
the patient I and my colleague we introduced very good care to the patient, as give more information, good facial
expression, support her and many of intervention so the anxiety relived and patient became able to cope with
treatment and environment. So after I did research I found that e if the patient received appropriate care as
safety environment, support, complete intervention for improve patient condition, good way of communication
and do the patient able to take decision making this do the patient gain trust, feel high self-esteem and feel safe.
So I learned from this situation should introduce appropriate care to the patient this do the patient accept
treatment, coping with environment and feel safe. (Jarrar, et al. 2015). I prepared very well before I come to
simulation lab very well from handout and from Elsevier, so I was able to share information with my colleagues
and clinical instructor during discussion. Also was able to deal with the patient as do complete assessment and
complete intervention. Also I did action plan before I come was about CO1 Assessment (Assess Physical,
Psychological, environment) I could do I and my colleague as we could do complete assessment. CO7 (critical
thinking) as I and my colleague achieved it through get complete date and integrate it and many of thing we did it
and I will explain more in CO7. I Was follow GTNI uniform policy and prepared my equipment. I was follow steps
when I do any procedure for avoid any error. Achieved safety and identification for avoid any hazard happen
such as medication error or injury. I respect professional boundaries as I didn’t ask the patient about things not
from role ask about it and I was take a permission from the patient before I touch her or when I do any
procedure. I was respect everyone in the area my colleagues, clinical instructor and deal with them a
professional way. Also speak a good way with the patient so she trusted me and accept treatment. I was share
my information with my colleagues and clinical instructor during simulation lab and If I didn’t know any question I
was ask my clinical instructor and she was answer me.
Week 3 Faculty: actually you do go effort to achieve this objective during the simulation lab by promote a spirit of
inquiry and innovative thinking in the pursuit of learning among peers and colleagues in the development of a
caring, professional identity
Week 4 Student:
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Course Objective 3
Integrate therapeutic communication into relationships among individuals, families and members of the
interprofessional team to promote wellness and adaptation (CIII)

Competencies:
1. Facilitates therapeutic communication with the complex patient and their family (CIII)
2. Analyzes communication techniques with complex patients and families to determine effectiveness (CII)
3. Consistently collaborates with interprofessional team regarding complex patient information and nursing
student responsibilities (AIII)
4. Documents pertinent patient data concisely, accurately and in a timely manner using electronic medical
record when appropriate (PSII)
5. Responds promptly to changes in patient status (CII)
6. Effectively transfers complex patient and family care responsibilities to appropriate interprofessional
team (“hand-offs”) (PSII)

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Feedback:
Week 2 Student:
What are the barriers and facilitators to your communication? Age, educational level, any chronic or sensory
problems ? This should be your start in the RJ

when I deal with the patient I used many of therapeutic communication such as open-end question when I ask
the patient do you have past medication history he answer me, I was have stroke, this question was effective
with the patient as he start to give me many of information about his disease, as the patient didn’t able to speak
more I used closed-end question such as do you have allergy he answer me no as the patient was comfortable
when I use this type of technique. As the patient was has stress I start to use touch techniques with him and was
helpful to the patient. I was deal with him acceptable a good way for gain trust and he trusted me.

Also I was deal a good way with everyone in the area including my colleagues and we were co-operative with
us and help us for introduce appropriate care to the patients, also I was deal a good way with my clinical
instructor and all the nurses in the area. I could do documentation but my defect do it in timely because found
another things that attract my attention to do it. I was observe my patient immediately if any change happened
also I was ask my clinical instructor about things I didn’t know it and was helpful to me and answer my questions.
I was do ISBAR handover and give handover to the nurse that assigned to case for she following the care. Also I
was give ISBAR handover to my colleague that was assigned leader in this day.
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Week 2 Faculty:
Your documentation needs tremendous improvement, you left blank pages in the clinical pack which is
required from you to be fulfilled during the clinical period. Indeed, you are avoidant and tend to stay isolated from
your colleagues and clinical instructors during the clinical period. Thus, you need to improve yourself based on
those comments and add them to your coming week’s action plan.
Week 3 Student: I used with the patient therapeutic technique like open- ended questions to express her
feelings as I asked her what do you feel, she answered me I feel anxiety because I didn’t able to do my role. This
technique was effective as the patient started to tell me about the whole story about the addiction. Also I used
close- ended questions as the patient was having severe pain as this technique was effective to decrease the
patient’s fatigue and also to make her decrease her anxiety. When I ask her Do you have children, she answered
me yes and this was effective with the patient was didn’t able to complete a sentence, also I used non- verbal
communication such touch technique and eye to eye contact for support the patient and gain trust and the
patient trusted me. I was deal a professional way with my colleague as we were co-operative and we could
introduce appropriate care to the patient and the patient trusted us. I used ISBAR handover when I called the
doctor to prescribe the medication for my case. I did documentation after I finished because the documentation is
evidence about the work but I didn’t complete it because was not find enough time, but I will consider to it next
time. I and my colleague we were more organize as one prepare the medication and one with the patient, so we
could do appropriate intervention to the patient. I was share my information with my colleagues and clinical
instructor during simulation and this was helpful to me for gain more knowledge. Also I told the doctor about
changes and signs&symptoms appear to the patient and prescribed to me the medication.
Week 3 Faculty: actually you used different and effective communication techniques with your pt. but you need
also to assess barriers for communication and how you respond promptly to the changes in your pt.’s condition
Week 4 Student:
Week 4 Faculty:
Week 5 Student:
Week 5 Faculty:
Make up 1 Student:
Make up 1 Faculty:
Week 8 Student:
Week 8 Faculty:
Week 9 Student:
Week 9 Faculty:
Week 10 Student:
Week 10 Faculty:
Week 11 Student:
Week 11 Faculty:
Make up 2 Student:
Make up 2 Faculty:
Make up 3 Student:
Make up 3 Faculty:
Make up 4 Student:
Make up 4 Faculty:

Course Objective 4
Demonstrate skill in the use of teaching-learning principles to promote health education with individuals
and families (PSII)

Competencies:
- 14 -
 1. Correlates factors that influence the complex patient’s and family’s readiness and ability to learn,
learning style, life style and level of health literacy (CII)
2. Operationalizes a teaching plan based on patient and family needs utilizing mutually formulated goals
(PSII)
3. Modifies teaching content and methodology based on patient and family response (CII)
4. Documents patient and family teaching and response (PSII)

Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make

term
up up
Student 3 3

Faculty 3 3

Feedback:
Week 2 Student:
What are the barriers and facilitators for the communication session?
First I did evaluation to the patient education as the patient didn’t able to read so I start to give him health
teaching by verbal also told his brother about this health teaching that was about, give more information about
the disease and medications, also about a healthy diet is low fat diet and can eat soft diet such as Yoghurt and
chess. Fruits (include banana), vegetables, whole grains, nuts, seeds and oily fish. No smoking because it from
risk factor of happening atherosclerosis, also take medication as direct for maintain normal BP and maintain
normal blood sugar(Alvidrez, et al 2017).

Advise his brother to change his position every 2 hours for avoid bed sores, teach him about ROM for encourage
activity, encourage soft diet as the patient was easy to eat it. Care for provide a good hygiene also be aware
about catheter for avoid any cutting. , advised his brother to deal with him in appropriate way how and stay with
him most of the time also do his sons to stay with him for decrease patient stress. The patient and his brother
were verbalize to me what they understood. I did documentation about this health teaching.
Week 2 Faculty:
You need to refer to the health teaching in your clinical pack and the materials that you have used during the
clinical placmenet as an evidence of achievement for this objective.
Week 3 Student: first I assessed the way that the patient able to understand me by it, and the patient was able to
understand me by verbal. I and my colleague didn’t give complete health teaching but the health teaching we
gave it was. Information about the medication as we told the patient that acetaminophen is analgesic and anti-
pyretics (pain relieving), Diazepam is anti-anxiety. Also we told him about the trigger of abuse, as told him to be
away from it after finish this treatment for avoid be abuser again. Told her about withdrawal symptoms are
(sweating, tachycardia, runny nose, dilated pupils. Nausea and vomiting, increased respiration, tearing and
diarrhea).distracting technique for pain relieving and we taught her to do it. Support her for relief anxiety. Told
her that the withdrawal symptoms will disappear after several days after taking the medication, this motivate her
to cope with the treatment. Motivate her more and more to accept treatment to return to her normal life again. I
was do the patient verbalize to me what I said for ensure that she understood us and was able to understand us.
But I didn’t do documentation about health teaching we gave it but next time I will consider to it.
Week 3 Faculty: Aly you need to assess first the factors that hinder the pt. ability to receive the health teaching.
Also you need to be more assertive to give your pt. a health teaching by preparing for the health teaching
session day before the simulation lab.
Week 4 Student:
Week 4 Faculty:
Week 5 Student:
Week 5 Faculty:
Make up 1 Student:
Make up 1 Faculty:

- 15 -
Week 8 Student:
Week 8 Faculty:
Week 9 Student:
Week 9 Faculty:
Week 10 Student:
Week 10 Faculty:
Week 11 Student:
Week 11 Faculty:
Make up 2 Student:
Make up 2 Faculty:
Make up 3 Student:
Make up 3 Faculty:
Make up 4 Student:
Make up 4 Faculty:

Course Objective 5
Integrate the ethical, legal, regulatory and professional standards of nursing practice to protect the rights of
individuals and families in the provision of care (AIII)

Competencies:
1. Assumes responsibility for respecting patients, families and interprofessional team members (AII)
2. Uses ethical, legal, regulatory guidelines and professional standards of nursing practice including
mandated reporting regulations (CII)
3. Promotes confidentiality of all patient information (AII)
4. Facilitates strategies to minimize incivility and to promote conflict resolution(PSII)

Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make

term
up up
Student 3 3

Faculty 3 3

Feedback:
Week 2 Student: when I deal with the patient I was careful when I deal with him for avoid any complication
happen, as first I checked safety and I identification also I was follow steps when I do any procedure for avoid
any error happen. I was follow infection control principles for avoid spread any type of infection. Also I respect
the patient when I deal with him so the patient respect me and trusted me also his brother trusted me how? .
Also I was respect my colleagues and nurses in the area so their respected me and we were co-operated with us
for introduce appropriate care to the patient, also I was respect my clinical instructor so him was respect me and
help me for anything, I don’t know about it.

I revised Principles of ethics so it helped me when I deal with the patient such as respect patient give him
chance for decision making, not harm the patient physical and psychological, do everything that benefit for the
- 16 -
patient and I could achieve all of this. I respect patient confidentiality as I didn’t tell anyone about special
information the patient and his brother said it to me, also when I speak about him I was use initial name. Also I
was co-operate with nurse that assigned to the case for introduce appropriate care to the patient and we were
solve any problem a professional way and didn’t happen conflict between us.
Week 2 Faculty:
Acceptable, but you need to respond to each competency alone in a separate paragraph . Indeed, add example
explaining how you were able to achieve each competency. You need to read about the factors that helps in
Facilitates strategies to minimize incivility and to promote conflict resolution.
Week 3 Student: when I and my colleague deal with the patient first we achieved safety and identification for
avoid any complication happen. We were aware about her pain so we did distracting technique for her and called
the doctor and doctor prescribed pain relieving medication and patient became comfortable after it. I and my
colleague we were follow steps when I do any procedure for avoid any error happen.
I and my colleague we were co-operative with us so we introduced appropriate care for the patient. Also I was
respect patient when I deal with her, have a good facial expression so the patient was accept dealing with us. I
was respect everyone in the simulation my colleagues, my clinical instructor so they also trusted me and I was
share information with them, this was helpful to me as I gained more knowledge from it.
When I work I was follow infection control principles for avoid spread any type of infection. Support the patient
and give her more information about her condition.
I revised principles of ethics from ethics handout so it helped me when I deal with the patient such as, do benefit
for the patient, not harm the patient, allow the patient to take decision making and respect the patient so the
patient also respected and trusted me.
I saved patient confidentiality as when I talk about her I was use initial name and didn’t tell anyone about special
information gave it to me.
I and my colleague were co-operative with us so didn’t happen conflict between us.

Week 3 Faculty: accepted Aly as you follow almost of the competencies above , but again you need to reflect om
competency No. 4 about the strategies you are used during the simulation lab to reduce the conflict as there is
many strategies you are already use like explain the procedure for your pt. and what are you doing when the pt.
ask you to give him some morphine and you tell him that you will assess him first and will see what you can do to
help him …. What about the attitude of the N-shift nurse when give you SBAR hand over regarding the pt.
condition and how you should deal with this attitude.
Week 4 Student:
Week 4 Faculty:
Week 5 Student:
Week 5 Faculty:
Make up 1 Student:
Make up 1 Faculty:
Week 8 Student:
Week 8 Faculty:
Week 9 Student:
Week 9 Faculty:
Week 10 Student:
Week 10 Faculty:
Week 11 Student:
Week 11 Faculty:
Make up 2 Student:
Make up 2 Faculty:
Make up 3 Student:
Make up 3 Faculty:
Make up 4 Student:
Make up 4 Faculty:

- 17 -
Course Objective 6
Implement leadership and management skills to improve patient outcomes (PSII)

Competencies:
1. Directs nursing care to maximize health considering factors that facilitate or interfere with effective team
functioning within the macro and microsystems (PSII)
2. Promotes behaviors that reflect assertiveness and initiative in professional situations (PSII)
3. Promotes relationships with other interprofessional team members, to achieve shared goals (PSII)
4. Advocates for the complex patient with the interprofessional team to achieve shared goals (AII)

Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make

term
up up
Student 3 3

Faculty 3 3

Feedback:
Week 2 Student: I could apply leadership as I could do complete assessment to the patient, do complete
intervention, give health teaching and bring anything the patient want it. I was co-operative with the nurse for
introduce appropriate care to the patient, check safety, follow infection control for avoid any hazard happen. Help
my colleague when need help for caring to the patient.

COMPTENCY # 2 I was assertive when I transport the patient by helping from his brother and other nurses from
bed to chair and move to room of electrocardiography, also do care for the patient, taking history from the patient
and helping him to eat. I was initiative to do ECG in this day and after my clinical instructor said to me do it for
this patient, I hurried to do it and my colleague with me and we did it a correct way and we can receive result and
my clinical instructor did evaluation to by checklist.

In the area I and my colleagues were co-operative with us and help us, so the patients were love dealing with us,
also we were co-operative with the nurses in this area so they trusted us and love dealing with us. Also I and my
colleague we were careful as didn’t anyone give medication didn’t know information about it. I was co-operate
with my colleague that have leadership assignment as give her ISBAR hand over about my case.

I advocate for the patient as his urine bag filled until 1100 ml and the nurse didn’t empty it, I told the nurse to
consider to it next time and I brought urinal and empty it and calculate amount and observe color and start to
observe bag every one hour for avoid any complication happen. I did delegate to my colleague for bringing some
equipment to me such as gloves, tissue and urinal when I work with my patient as my patient was need close
observation.
Week 2 Faculty:
Acceptable, but you need to read more about advocacy and initiation to be able to find new methods to
achieve it .
Week 3 Student: For this week I was in psychiatric simulation labp, I was deal with a patient had substance
abuse, I was the primary nurse, so I was able to lead the situation while I was dealing with the patient, I was a
leader when I distribute task between me and my colleague as I will be beside the patient and you prepare the
medication for didn’t leave the patient alone.
so I put in my mind how to select the nursing strategies demonstrate beginning leader ship and management
skills considering the factor that facilitate with the team work, so related this I selected some strategies for
leadership skills, like positivism, so I started to appear my positive attitude while I was dealing with the this
- 18 -
patient and don’t judge upon her.
I was assertive when I do complete assessment to the patient, complete intervention, support her for do her
accept treatment and return to her normal life again. The patient accept it and became able to cope with the
treatment.

Also I was able to use self-confident while I was dealing with the team of group like while I spoke to the doctor. I
was imitative for do ISBAR handover and tell the doctor about for prescribed the medication and doctor
prescribed to me the medication. I did delegate to my colleague to prepare this medication while I speak with the
patient for give health teaching to the patient and observe if any changes happen. So I and my colleague we
were more organize during the work and we could do appropriate care for the patient.
I advocate for the patient as I found the patient had severe pain, I and my colleague did pain assessment very
quickly and I told the doctor about it so the doctor prescribe the medication and patient became comfortable after
it.
Week 3 Faculty: accepted reflection as you follow almost of the competencies above
Week 4 Student:
Week 4 Faculty:
Week 5 Student:
Week 5 Faculty:
Make up 1 Student:
Make up 1 Faculty:
Week 8 Student:
Week 8 Faculty:
Week 9 Student:
Week 9 Faculty:
Week 10 Student:
Week 10 Faculty:
Week 11 Student:
Week 11 Faculty:
Make up 2 Student:
Make up 2 Faculty:
Make up 3 Student:
Make up 3 Faculty:
Make up 4 Student:
Make up 4 Faculty:

Course Objective 7
Analyze nursing theory, related theories and research when making decisions regarding nursing care of
complex individuals in the development of clinical reasoning and nursing judgment (CII)

Competencies:
1. Transfers previous knowledge, skills and attitudes in the provision of nursing care to the complex
patient and family (PSII)
2. Integrates critical thinking skills and shared decision-making in the development of clinical reasoning
and nursing judgment (PSII)
- 19 -
Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make
term
up up
Student 3 3

Faculty 2 3

Feedback:
Week 2 Student: I was deal a good way with my patient and all the people in the area, I read more about my
case so I was have knowledge about the case, I revised skills from Elsevier such as ECG so I could do it during
practice a correct way. I could apply critical thinking through link between theory and practice as I read about the
case, I could give health teaching according to his condition, ask about smoking as it risk factor for happen
atherosclerosis, I did complete assessment such as ABCD assessment, V.S to know the normal and abnormal
data also checked lab tests, and other assessment such as GCS as the patient was not oriented. Had sluggish
pupil. Start to do PVC assessment if found any signs of infection also checked WBC. Start to assess activity as
the patient was had impaired physical mobility, so I start to do ROM and change position for avoid bed sores
also told his brother to change his position every 2 hours. Also give him health teaching about appropriate diet
he need. Do area clean and suitable around him for become comfortable and avoid any complication happen. I
Used appropriate way of communication with him to understand me and for him be relaxed when he speak with
me, also used touch technique with him for emotional support as the patient was has stress and anxiety. Also do
documentation but my defect do it in appropriate time.
Week 2 Faculty:
You were able to transfer knowledge into practice , yet unable to integrate critical thinking skills while
discussing your patient medications, lab results…etc. 3
Week 3 Student: I was deal with the patient a good attitude so her accept dealing with me, I prepared very well
before I come and shared information with my colleagues and my clinical instructor so I was have more
knowledge about patient condition, also I was have a good skills when I deal with her. The critical thinking was
one from my objective and I could achieve it through link between theory and practice through, ask about the
trigger and told the patient avoid return to it again. Also when I deal with the patient I knew that the patient in
withdrawal symptoms of opioid so I start to give her more information about it. And this will disappear after
several days after taking the medication. Use touch technique with the patient and eye contact for support her as
she was anxious because she didn’t able to do her role. After I found that the patient has severe pain, I start to
do distracting technique for her be relax also doctor prescribe medication for her and she became comfortable
after it. Do environment suitable for the patient and have good facial expression while I deal with the patient so
do the patient more relax and accept treatment. Also before I give him medication I was explain to her, the
importance of this medication. I was save side rails up for avoid any hazard happen. Co-operation between and
my colleague do us introduce appropriate care to the patient.
Week 3 Faculty: accepted situation about how you able to achieve this objective during the simulation lab.
Week 4 Student:
Week 4 Faculty:
Week 5 Student:
Week 5 Faculty:
Make up 1 Student:
Make up 1 Faculty:
Week 8 Student:
Week 8 Faculty:
Week 9 Student:
Week 9 Faculty:
Week 10 Student:
Week 10 Faculty:
Week 11 Student:
- 20 -
Week 11 Faculty:
Make up 2 Student:
Make up 2 Faculty:
Make up 3 Student:
Make up 3 Faculty:
Make up 4 Student:
Make up 4 Faculty:

Course Objective 8
Extrapolate pertinent data from research findings in an evidence-based approach to providing nursing care for
the complex individual (CIII)
Competencies:
1. completes data collection and research of the complex patient to prepare for clinical assignment (PSII)
2. Proposes the best current evidence considering patient’s preferences, experiences and values to
provide nursing care (CII)

Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make

term
up up
Student 3 3

Faculty 3 3

Feedback:
Week 2 Student: This reference of the article that I collect from it information found in Kim’s mode in CO2:

 Edwards, S. Axe, S. (2015). The Ten (R) of safe multidisciplinary drug administration. MA health care.
Nursing prescribing. Vol 13 NO 8

Reference of article that I collect from information about atherosclerosis That I mentioned it in assessment and
health teaching
 Alvidrez, R. Bahnson, E. (2017). Atherosclerosis: Pathogenesis, Genetics, and Experimental Models.
John Wiley& Sons, Ltd.
Collect information from medical surgical book and this is the reference

 Lewis, S., Dirksen, S., Heitkemper., Bucher.L.,Camera, I. (2014). Medical Surgical Nursing Assessment
and Management of clinical problem. (9th ed) Philadelphia.

I collect the information about the medication that I mentioned it in assessment and intervention from Davis drug
and this is the reference

 Deglin, J., Vallerand, (2015). Davis Drug Guide for Nursing. (12th ed). USA: F.A Davis Company. Page.

- 21 -
I collect nursing diagnosis from nanda book and this is the reference

 Carpenito, L. (2015). Nursing Diagnosis: Application to Clinical practice. (12th ed). Philadelphia:
Lippincott, page.
Week 2 Faculty:
Used appropriate APA format
Week 3 Student: I collect the information about the drug that I mentioned it, in assessment, intervention and
health teaching from Davis drug
The Reference:
 Deglin, J., Vallerand, (2015). Davis Drug Guide for Nursing. (12th ed). USA: F.A Davis Company. Page.

I collect nursing diagnosis from Nanda book and this is the reference:

 Carpenito, L. (2015). Nursing Diagnosis: Application to Clinical practice. (12th ed). Philadelphia:
Lippincott, Page.

I collect information that I wrote it in Kim’s Model from article and this is the reference of it.

 Jarrar, M., Shamsudin, A. (2015). The impact of patient to Nurse Ratio Quality of care and patient safety.
Global journal of health science. V 11, P326

Week 3 Faculty: accepted trusted sources

Week 4 Student:
Week 4 Faculty:
Week 5 Student:
Week 5 Faculty:
Make up 1 Student:
Make up 1 Faculty:
Week 8 Student:
Week 8 Faculty:
Week 9 Student:
Week 9 Faculty:
Week 10 Student:
Week 10 Faculty:
Week 11 Student:
Week 11 Faculty:
Make up 2 Student:
Make up 2 Faculty:
Make up 3 Student:
Make up 3 Faculty:
Make up 4 Student:
Make up 4 Faculty:

- 22 -
Course Objective 9
Participate in the use of quality improvement promoting safety processes in the care of the complex
individual and environment (microsystem) to generate improvement in the health care system
(macrosystem) (AII)

Competencies:
1. Collaborates with interprofessional team members to continuously improve the quality, safety and
continuity of nursing care of the complex patient (AII)
2. Communicates observations or concerns to faculty and appropriate interprofessional team members
considering the impact of hazards, near misses, errors and inefficiencies (PSI)

Week 2 3 4 5 6 7 Mid- 10 11 12 13 Final Make Make

term
up up
Student 3 3

Faculty 3 3

Feedback:
Week 2 Student: after I entered to the patient first checked identification then safety for avoid any complication
happen such as injury or fall. I was follow infection control principles for avoid spread infection as I was follow
five moments of hand hygiene and glove pyramids. I was follow steps when I do any procedure for avoid any
error happen. I could do complete assessment and did many of the intervention according to it I gave the patient
health teaching about disease, diet and activity.

I was co-operate with the nurse that assigned to the case so we could introduce appropriate care to the
patient and didn’t happen conflict between us. I was observe my patient all the time if any change happen, also I
was observe urine bag every hour to document the amount or happen any abnormality. I was deal a professional
way with my patient for gain trust and he trusted me. Also speak a professional way with everyone the area so
we were co-operative and help us for introduce appropriate care to the patient. I read about my case and shared
information with my clinical instructor in hospital. I did documentation after I finished my work because the
documentation is evidence about the work but I wasn’t do it in timely because I was do many of things. Also I
gave handover to nurse was assigned to case for following the care, also I gave ISBAR handover to my
colleagues were assigned leader in this week.
Week 2 Faculty:
It is better to include new innovative question in this part in the following topics:
1. Infection control protocols
2. Fall Risk prevention
3. Prevention of Medication error
4. Quality Documentation
Etc. you are advised to use PICO format to explore new topics related to your practice and discuss it with your
clinical instructor
Week 3 Student: I was primary nurse in simulation lab. After I take handover from night nurse, I and my
colleague distributed the task and entered to the patient. First, we checked safety and identification for avoid any
error or hazard happen. I was follow infection control principles as follow five moments of hand hygiene and
gloves pyramids.
I was aware about patient pain as the patient was has severe pain and we do care for it, as distracting technique
and doctor prescribe medication. So the patient became comfortable after it.
I was speak a good way with the patient, also have good facial expression and all the time respect the patient so
the patient also respect and trusted me. I was speak a professional way with my colleagues and clinical
instructor, so they also were speak to me a good way. I and my colleague during work we were co-operative and
- 23 -
organize so we did a good work, as we did complete assessment and complete intervention and prevent any
complication may happen.
I prepared very well about substance abuse and shared information with my colleagues and my clinical instructor
during simulation so I gained more knowledge from it.
I did ISBAR handover and gave it to the doctor and the doctor prescribed the medication according to it. Also
after I finished I did documentation because the documentation is evidence about the work but I didn’t do it
completely because was not have enough time but next time I will consider to it.
Week 3 Faculty: accepted reflection as you follow the competencies above but I need you to consider Mr.
Hossam comments in the last week.
Week 4 Student:
Week 4 Faculty:
Week 5 Student:
Week 5 Faculty:
Make up 1 Student:
Make up 1 Faculty:
Week 8 Student:
Week 8 Faculty:
Week 9 Student:
Week 9 Faculty:
Week 10 Student:
Week 10 Faculty:
Week 11 Student:
Week 11 Faculty:
Make up 2 Student:
Make up 2 Faculty:
Make up 3 Student:
Make up 3 Faculty:
Make up 4 Student:
Make up 4 Faculty:

- 24 -
- 25 -