Marissa Nurs3021 Midterm Evaluation

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, evidenceinformed 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 MIDTERM

1. Demonstrate accountability and responsibility in the teaching-learning relationship.

Student: - Arrive to placement on time in full uniform with pre-clinical assignment complete from report on patient - Made sure to ask questions to my peers and instructor for guidance with difficult decisions or tasks (ie. Charting properly or discussing an abnormal assessment result and 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 - When giving medications, having the prior knowledge about what the medication is and why the patient is taking it

Progress Midterm

Progress Final

 SP  ND  UP

 S  U

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

Evidence/Indicators FINAL

Student:

Clinical Instructor:

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 individuals receiving care in chronic care settings Progress Midterm

Progress Final

 SP  ND  UP

 S  U

Student: - Patients who are on a good plan of recovery but then start to regress, may feel frustrated and hopeless - Other patients with not many visitors may get lonely – this can increase if they are not able to 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

Student:

Clinical Instructor:

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 experience of chronic illness in relation to the nursing process such as common signs and symptoms, responses to treatment, patterns of coping, and impact on individual and family relationships. Progress Final Progress Midterm  SP  ND  UP

 S  U

Student: Student: - Experience interacting and care with patients with varying degrees of hemiparesis and other effects of stroke - Learned and implemented knowledge of proper body mechanics with positioning and Clinical Instructor: transferring patients who are recovering from a stroke – such 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 treatments of selected chronic illness. Progress Midterm

Progress Final

 SP  ND  UP

 S  U

Student: - Performed Canadian Neurological Scale assessment, GCS and PERRLA assessments on patients with varying degrees of disability every shift - Watched a chest X-ray on a patient - 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

Student:

Clinical Instructor:

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 interventions related to caring for the person with chronic illness such as specific assessments, medication administration,

Student: - Have given meds on 2 evening shifts, including PO and SUBCUT

Student:

physical and chemical restraints, enteral feeding & residual volumes, NG tube insertions, wound care, patient-controlled medication administration pumps.

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Progress Midterm

Progress Final

 SP  ND  UP

 S  U

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insulin Performed a staple removal on a pt. admitted for rehab of a hip surgery Performed a dressing change and cleaning using aseptic technique Flushed an NG feeding tube Performed Braden scale assessments on patients to identify risk of pressure ulcer development

Clinical Instructor:

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 of select chronic illnesses and related interventions. Progress Midterm

Progress Final

 SP  ND  UP

 S  U

Student: - Patients recovering from a stroke may experience a variety of disabilities based on the location and seriousness of the stroke. I have interacted with patients with varying degrees such as full independence to full paralysis on one side. I have also interacted with patients with dysarthria and aphasia and well as a patient who is dysphagic and can only

Student:

Clinical Instructor:

-

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: demonstrate safe, competent, evidence- Arrived on time to every shift in informed, holistic nursing practice with clients full uniform with chronic illness - Approach every patient with an a. Use a wide range of effective open mind and unbiased attitude communication strategies and - Apply nursing models such as the interpersonal skills to appropriately self-care theory to every patient establish, maintain, re-establish and on the assigned post-clinical terminate the nurse-client relationship assignment that is submitted to b. Demonstrate accountable, responsible my clinical instructor and ethical practice - Applied Orem’s self-care theory c. Engage in respectful, collaborative, with all patients by encouraging therapeutic and professional independence in a safe manner relationships i. Demonstrate therapeutic use of self

Student:

Clinical Instructor:

d. e. f. g. h. i.

ii. Create a culturally safe environment Apply nursing models and theories Demonstrate health promotion and illness prevention practices Demonstrate patient advocacy Predict outcomes of nursing care Evaluate client response to nursing care Critically appraise own practice in relation to nurse-client/family interactions and as a member of the health care team

Progress Midterm

Progress Final

 SP  ND  UP

 S  U

8. Critically appraise own practice in relation to nurse-client/family interactions and as a member of the health care team

Progress Midterm

Progress Final

 SP  ND  UP

 S  U

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.

Student: - Incorporated specific communication skills to interact with patients with varying degrees of aphasia and other deficits (ie. Keeping sentences short and direct) - Incorporated teaching skills to educate patients and their families about their recovery process and next steps - Used therapeutic communication skills to build a relationship with every patient I am caring for on every shift

Student:

Clinical Instructor:

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 on reflective practice and critical inquiry Progress Midterm

Progress Final

 SP  ND  UP

 S  U

Student: Student: - Participated in post-conferences where topics such as proper body mechanics, and positioning as well as the type of stroke and common symptoms were discussed - 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

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.

This section to be filled out by the student.

Student Areas of Strength

Student Areas of Strength

1. I believe I can effectively manage my time to get charting and tasks complete in a timely manner

1.

2. I believe I am good at asking questions if I do not know something in order to learn the most that I can from this experience 3. I believe I am good at supporting my fellow students with tasks if they need assistance Student Areas for Future Development 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

2. 3. Student Areas for Future Development 1. 2. 3.

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 Week 1 Week 2 Week 3 Week 4 Week 5

Thurs Fri Week 6 Week 7 Week 8 Week 9 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 Total number of labs completed / 11

/4

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

Unsatisfactory

Signature of Course Lead: __________________________________Date: _____________________

Signature of Clinical Instructor: __________________________________Date: _________________

Signature of Student: ______________________________________Date: _____________________