Nurs 3020 Clinical Midterm Evaluation Acarpenter

NURSING 3020 Clinical Evaluation

NURS 3020H Clinical Evaluation Midterm Student Name: Amanda Carpenter Clinical Instructor: Jen Parris Missed Clinical Hours: 0

Missed Lab Hours: 0

Medication Test: 100%

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NURSING 3020 Clinical Evaluation

Program Goals Graduates are generalists entering a self-regulating profession in situations of health and illness. Graduates are prepared to work with people of all ages and genders (individuals, families, groups, communities and populations) in a variety of settings. Graduates continuously use critical and scientific inquiry and other ways of knowing to develop and apply nursing knowledge in their practice. Graduates will demonstrate leadership in professional nursing practice in diverse health care contexts. Graduates will 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 Graduates will establish and maintain therapeutic, caring and culturally safe relationships with clients and health care team members based upon relational boundaries and respect. Graduates will be able to enact advocacy in their work based on the philosophy of social justice. Graduates will effectively utilize communications and informational technologies to improve client outcomes. Graduates will be prepared to provide nursing care that includes comprehensive, collaborative assessment, evidence-informed interventions and outcome measures.

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NURSING 3020 Clinical Evaluation

Progress Objectives 1 Prepared to provide

nursing care that includes comprehensive, collaborative assessment, evidence-informed interventions and outcome measures.

Indicators/Evidence

Developing as expected

Needs Improvement

Does not meet expectations

During my acute clinical experience on a telemetry floor of PRHC, I have provided nursing care that includes comprehensive, collaborative assessment, evidence-informed interventions and outcome measures. Three example of my nursing are as follows: 1. I was assigned at least 1 patient per week that I was responsible for. With these patients I would complete at least two comprehensive head-to-toe assessments per shift. During assessment I would recognize and clinically acknowledge my understanding from pre-clinical preparations with individual patient assessment findings. Such as, edema, rales, and fluid retention seen in CHF. Recognizing that my patient’s diagnosis of pneumonia was caused by aspiration related to comorbidities of developmental delay. 2. I tailored my assessments to the specific patient needs by adding evidence-informed outcome measures such as; a full neurologic vital sign assessment for a patient with cerebrovascular accident, thorough and frequent respiratory assessment on a patient with pneumonia, abdominal and airway assessments of NPO patient, and ensured an apical pulse reading of >60bpm of a patient receiving Digoxin. 3. I worked collaboratively with the patient’s primary nurse in order to advocate for abnormal vital sign findings, changes in patient status such as; difficulty breathing due to an adjustment in oxygen therapy, epistaxis on a patient taking anticoagulants, and above baseline tachycardia on a patient with Atrial Fibrillation. MIDTERM Amanda has arrived to clinical each week fully prepared with each of her patient’s diagnoses and comorbidities researched. Amanda introduces herself to the primary nurse and then 3

NURSING 3020 Clinical Evaluation heads directly to her patient’s room to start her assessments. Amanda admittedly states that she still feels uncomfortable waking up her patients but also understands the importance of a head to toe assessment at the beginning of every shift. Additionally, Amanda formulates a plan with her primary nurse to provide optimal care throughout the day. This coincides directly with the CNO ETP#6 whereby Amanda displays initiative, confidence, and self-awareness, and encourages collaborative interactions within the nursing and health care team, with the client as the center of the health care team. As per CNO guideline #33, Amanda proactively seeks new information, knowledge, and best practices for use in the provision of nursing care. She asks appropriate questions and has identified areas of learning from her mistakes, such as measuring urinals when on diuretics. Most importantly, Amanda can analyze and critique the information gathered from her patient’s assessments and presentation and identify a sick patient or further interventions.

2 Establishes and maintains I have demonstrated therapeutic care, culturally safe practices therapeutic, caring and culturally safe relationships through effective communication.

and effective communication by demonstrating therapeutic use of self by engaging meaningfully with my patients to understand their unique illness experience and identifying personal situational challenges by: 1. Supporting a patient while accompanying them to an endoscopy to insert an NG tube and advocating for their fears, wishes and concerns to the medical staff there. Such as requesting that the staff speak up in order for the patient to hear them and gain a more meaningful response from the patient. Further, acknowledging and supporting a patient’s experience of vivid dreams due to the effects of their medication, Prednisone. 2. Establishing trust and nonverbal communication with a patient with expressive aphasia. Using creative body language and facial expressions to effectively communicate our goals. I believe that this challenge and 4

NURSING 3020 Clinical Evaluation outcome was rewarding for both of us. 3. Understanding and anticipating needs of persons with acute illness by applying knowledge that family support is meaningful to patient outcomes. I intentionally completed patient cares around times of visitors, as possible. MIDTERM Amanda has an easy and approachable communication style and it is able to naturally create therapeutic relationships with each of her patients. There is a quiet confidence that patients respond well to and feel comfortable sharing their experiences with. On week one, Amanda was given a challenge to care for a non verbal, developmentally delayed, full care patient. With only a moment of hesitancy, Amanda pushed passed her nerves and by shift end, I could see her sitting at bedside, smiling and interacting with her patient in a very special way. In line with the CNO ETP # 51, Amanda addresses client’s health challenges and can identify strategies for health planning.

3 Applies the four ways of knowing and informational technologies to effectively care for diverse, acutely ill patients.

I applied the 4 ways of knowing for diverse, acutely ill patients by: 1. Understanding and observing the unique needs for ethical considerations of a patient undergoing an emergency cardiac catheterization. 2. Trusting my aesthetic way of knowing when I ensured all my patient’s rooms were set up for a suction, particularly NPO and SVA patients. 3. Using the information available in telemetry monitoring on the unit to understand the unique medical manifestations of my various patients with; atrial fibrillation, STEMI, NSTEMI, CVA, CAD, CABG, and aortic stenosis. MIDTERM Amanda is reliable, punctual, and accountable. She works very well independently yet just as effectively with the primary nurse or peer. Each week, Amanda submits a 5

NURSING 3020 Clinical Evaluation comprehensive list of skills obtained/observed and also self identifies learning needs. Documentation is concise and systematic and coincides with the CON ETP # 43 wherein the student documents assessment data in accordance to evidenced-informed practice. However, one area for development is for documentation to be completed in a more timely manner.

4 Adheres to professional

practice standards and organizational polices to contribute to a culture of safety.

Adhering to professional practice standards by: 1. Demonstrating accountability by reflecting and acknowledging when and how it is best for me to improve my skills and abilities, such as to follow-up with patient outcomes of my nursing interventions and recognizing my obligations to closely monitor and balance patient intake/output records. 2. Meeting organizational expectations and responsibilities by completing protocols such as; hand-hygiene courses, timely documentation, and recording the tour of duty. 3. Demonstrating a commitment to patient and staff safety; by ensuring bed rails are up, curtains/doors are closed during intimate care, maintaining hand hygiene, ensuring medication rights and bedside checks, and cautiously practicing infection control protocols. MIDTERM As per CNO guideline #59, Amanda applies workplace health and safety principles, including infection control practices and appropriate protective devices, when providing nursing care to prevent harm to clients, self, and others by following the PPE standards and policies set at PRHC. Proper use of call bells, patient tables, side rails, bed alarms, and mechanical lifts are followed for patient protection. Amanda has demonstrated safe and efficient medication administration while following all of the related “Rights”. During week 4, Amanda had a patient that was at risk for aspiration and an NG was ordered. It was determined by Amanda and the nursing team that the NG was not safe to insert by an RN at the bedside for fear of further 6

NURSING 3020 Clinical Evaluation risk/complication. While awaiting tube placement in Endoscopy, Amanda ensured safe positioning and suction equipment was available to the patient.

5 Exercises leadership to

enhance patient care, and support professionalism in practice.

I have exercised leadership and professional practice by: 1. Supporting my peers with their patients whenever possible. Whether it be a quick boost of their patient in bed or assisting them with a new client’s bed bath. 2. Encouraging my peers by complimenting their new experiences, such as; congratulating their first successful enema or lending support during a colostomy bag change. 3. Demonstrating leadership and professional practice by asking questions in group settings and questioning procedures for deeper understanding and commitment. MIDTERM Amanda is professional and accountable every shift. She is engaged and open to every new experience that presents itself. Each week, pre and post clinical is done thoroughly and mindfully. Amanda contributes to group discussions and new ideas for the clinical group. As her first reflective practice assignment, Amanda identified some major take away pieces from her experience in the Cath Lab. Besides being “impressed at the level of technology”, Amanda appeared to appreciate the direct approach that the Cardiologist took with the patient to deliver a serious prognosis.

Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment) MIDTERM Amanda is excelling this semester. She displays a quiet leadership quality that her peers and staff respond well to and has a level of professionalism that is notable. The rest of this rotation can be devoted to providing competent care for a two patient assignment as well as gaining as many skills and experiences as possible to build upon her personal practice.

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NURSING 3020 Clinical Evaluation

Signature of Instructor___________________________________________________

Date _____________________________

Signature of Student_____________________________________________________

Date ______________________________

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