NURSING 3020 Clinical Evaluation

NURS 3020H

Clinical Evaluation
Midterm Final

Student Name: Emily Andrews

Clinical Instructor: Janet Scott

Missed Clinical Hours: 8 Missed Lab Hours: 0

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Objectives
1 Prepared to provide nursing care that includes
comprehensive, collaborative assessment, evidence-
informed interventions and outcome measures.
Progress
Indicators/Evidence S U
I have completed comprehensive head to toe assessments and charted
findings on patients each day at clinical. I had set a goal to chart as I
obtained information and have since accomplished this.
I have reported to other nurses, students, and clinical instructor when there
is information necessitating reporting (ex. unusual vital signs). When I
complete/ assist in tasks for a patient that their nurse may want to know
(like the completion of a bowel movement) I ensure I let them know and
inform them I will also chart the task accomplished.
I complete pre-clinical research to ensure that I am prepared to handle
unique needs of the client and potentially answer questions if they have
them. I also complete post-clinical research to fill in any gaps in the
information I acquired about the persons care and advanced my
knowledge of diagnostic testing and medications.
I arrive to clinical on time, in a clean uniform and am prepared to work.
I have completed basic AM care, feeding, toileting, brief changes and basic
catheter care. I have also completed basic HS care.
I have assisted in priming of IV lines and admission of a client from the
ED onto the cardiac/ medicine floor.
I have observed the insertion of a catheter, dressing changes, trach care,
and three procedures in the cath lab. I have observed admission of a
patient to the ED, and the attempt to establish IV access on someone
who did not have any good veins. I watched a doctor intubate this
patient.
Emily is learning how to complete comprehensive assessments, as well as
focussed assessments. She is learning how to identify priority health needs,
and subsequent interventions with the collaboration of the CI and members
of the HCT.
I have flushed IVs and catheter lines. I have completed bladder scans.
I have worked with a client with an ostomy bag and helped in a shower
and burping the bag.
I have administered medications (PO and IV) with the supervision of a
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clinical instructor. I administered almost every two hours and had to

remain aware of the time and find the clinical instructor in advance to
remind her of the impending dosage needs. I also saw the
administration of medication through an NG tube.
Emily comes to clinical prepared and ready to give evidence based, safe
care to her patients. She completes detailed comprehensive
assessments on each of her pts. She is able to complete a
number of interventions such as medication administration,
bladder scans and flushing an IV. She is learning how to identify
priority health needs, and subsequent interventions with the collaboration
of the CI and other members of the HCT

2 Establishes and maintains therapeutic, caring and culturally I have built relationships with staff nurses and students to provide the best
safe relationships through effective communication. possible client centred care.
I attempt to interact with family and visitors so they know who I am and
when I do not have the answers to their questions I attempt to find the
answer for them. For example, I had a client who was to be having a
paracentesis but it was rescheduled from the morning to sometime in the
afternoon. The family was concerned that he was NPO until the procedure
was complete. To ease their worries I attempted to get information about
when they could expect the paracentesis to be performed and brought the
patient ice chips while he waited.
I now have understand the nature of acute care and the differences that
are involved in this type of relationship building (compared to something
like longterm care). It certainly does not mean that you do not attempt to
build a relationship - the relationship may just be more professional and
therapeutically directed.
I have used bedside reporting with other clinical groups when they are
coming on to the floor for their shift.
Emily is learning how to use collaboration and communication to achieve
optimal health benefits for her clients. She communicates information to
the MRN, CI and other members of the HCT. She is starting to build caring
relationships with her clients and their family in this acute care setting
I was involved in the team that cared for a patient and his family as

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they realized that their loved one was going to die and assist them in
this transition. This involved mostly emotional support but also
helping them get resources (like doctor notes) so that other family
members could get accommodations at work or school to say their
good-byes.
I have brought abnormal or concerning findings to my most
responsible nurse so that we are able to collaborate on the care of the
individual and decide whether action should be taken by a student, a
nurse, or a doctor. In one particular case I realized that a patient had
not had a BM in a week despite receiving laxatives. After informing
my MRN we decided a suppository was necessary and we delivered the
medication.
I discussed with occ. health a client who was having trouble eating
because of forgetfulness related to her dementia and discussed ways
that could help the client be more successful eating on her own. I
charted this information and passed the tips from occ. health to the
next student and the MRN.
I have worked with clients who have difficulty communicating for
various reasons and was successful at findings methods of
communication that allowed me to assist them in their care. This built
a strong relationship between us because I was able to interpret their
messages and address their needs.
Emily is learning how to collaborate with the allied
health care team by reporting incidents to the
MRN. She communicates frequently to the CI to
attain help and guidance
is learning how to use collaboration and
communication to achieve optimal health benefits
for her clients. She communicates information to
the MRN, CI and other members of the HCT

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3 Applies the four ways of knowing and informational
technologies to effectively care for diverse, acutely ill
patients.
I have learned to use and find required information related to care on the
meditech system. I have also become accustom to the medication
dispensing system and would feel comfortable gathering medications
on my own.
I draw upon empirical knowledge through the use of learning tools like
textbooks, Mosbys videos, and internet sources to develop an
understanding of the science and mechanics of nursing. For example, I use
these tools to complete pre and post clinical and prepare for labs and
simulations. I also used video to prepare refresh my memory of skills
before I perform a challenging task (if I know ahead of time) like
delivering IV medication.
I am attempting to develop a deeper understanding the esthetics of nursing
more by watching experienced staff work with clients and see how they
interact with each person. I am looking to continue to see the creative
solutions they have to providing care and attempting to mirror that
resourcefulness in my practice. I have worked to develop this skills by
asking nurses and nursing students how they perform certain tasks, or
if we do a task that I am taking the lead on, I ask if they do anything
different in their own practice. By this I am hoping to learn new ways
to do things that are perhaps more efficient, more comfortable for
clients, and more ergonomically correct.
I am using personal knowledge when I am seeking to understand the
emotional needs that my client has while staying in the hospital. For
example, if I can tell that a client has a low mood but perks up when I
make time to talk with them, I know they may need more social interaction
and I can attempt to make that a priority for care of that patient. I feel I
have further shown this skills when I attempt to communicate with
clients who have communication challenges. This barrier may mean
that staff or students do not spend as much time understanding who
they are and what their personal needs are because of the difficult
nature of the task.
As above, Emily is applying her knowledge of meditech to enhance her
understanding of the disease process with each client. She completes her
pre and post clinicals well and shows evidence of understanding. She is
learning how to document her care concisely and in a timely manner
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4 Adheres to professional practice standards and
organizational policies to contribute to a culture of safety.
I am applying ethical knowing through discussing ethical issues as they
arise in post clinical, including the topic of organ donation as it
became relevant in the seminar my partner and I facilitated. I have
also observed nurses discussing with family members the appropriacy
of their loved ones code status and observed the art of respecting
family's wishes while also providing complete and honest information
that the family needs to make a choice about end of life care.
Emily has recognized the importance of using the four ways of
knowing in providing efficient and quality daily care. Not only does
she use ethical knowing to discuss ethical situations in post clinical, but
also empirical knowledge in the way she was able to present a
comprehensive and interesting presentation on the functioning of the
liver.
I have attended all labs and simulations to ensure that I have proven
competency in a skill set before performing that action in clinical. I
complete my lab guide and readings to gain knowledge of the the best way
to complete each skill.
I recognize my limitations in providing care. When asked by nurses to
assist or complete tasks like drug administration I will confirm with the
instructor if I can perform the skill. Also when I am unsure of how to
complete a task I have asked other students or the instructor for help or
I am aware of the skills that I have been trained in but am not able to
I have listened and followed skills taught by one of PRHCs infection
control nurses. I follow the 4 moments of hand hygiene, use gloves when
appropriate, and dispose of bodily fluids in the appropriate receptacles. I
have also researched the requirements of working with someone who uses
hazardous medication and asked my lab instructor to validate my
understanding of the unique precautions.
Emily has been analyzing and reflecting on situations that have occurred in
clinical, and discussed them with her peers. She writes reflective papers
showing her reflection process and the learning she has obtained. She
builds trusting relationships with her clients to support them in their health
decisions
I have strived to research best practice guidelines and have included
them in critical reflections and post-clinical submissions. I have
researched these BPGs as they relate to working with clients with
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dementia and depression, and establishing therapeutic relationships in

challenging situations.
I have also researched peer-reviewed nursing literature to guide my
reflections and post clinical write up when I am lacking knowledge or
looking for a better way to perform the task in the future.
Emily is learning about some of the practice
standards and is applying them to her care as
indicated above Ie documentation. She has
practiced writing SOAP and narrative notes and
ensures the documentation is correct prior to
inserting it in the chart.

5 Exercises leadership to enhance patient care, and support When my patient is settled and has no immediate needs, I have asked other
professionalism in practice. students if they need help with anything. I have given and received
assistance on many occasions. I have also gone to nurses and said I am
thinking about doing X (for example, setting up the patient in room 84-2
with a bath), would this be helpful for you or is there anything else you
need done?.
I have inquired to ensure that all students have had a chance to have a
break, and I offer to provide care for their patients while they are gone. I
believe relieving fellow nursing students can help them relax or regenerate
and come back to the floor better able to provide the highest level of
patient care.
When discussing a difficult patient in post conference I advocated for that
patient by presenting alternative reasons for his unwillingness to assist in
his care. I reminded my partner that with the diagnosis he had there was a
chance that toxic products were building up in the body and his ability to
understand our requests of him was limited. I also suggested that he was
able to do more things when his wife was around because that sense of
familiarity can help patients become more oriented and aware. I think it is
important to remind co-workers to search for alternative explanations for
why someone appears to be incapable of their own care or why they may
need various levels of assistance depending on their health and abilities at

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that time.
Emily is starting to build her leadership skills as above. She does help her
co workers when she is able and will try to provide care for clients other
than her own, that are calling for help. She is learning how to complete
bedside report at the end of her shift
I have led a group seminar on the topic of hepatic encephalopathy. I
have increased my peers knowledge on the diagnosis, lab tests,
treatment and the effects that comorbidities will have have a client
with this diagnosis. We also discussed the ethics of organ donation
when the patients organ was destructed by preventable means
(alcohol).
I confronted a nurse about the use of signs to indicate patients who are
on hazardous medications, and educated a peer about safety measure
around these patients when the nurse ignored the request to hang an
alert sign. I could have put up the sign myself but I was worried about
how this would affect the culture between staff nurses and student
nurses. In the future I could maybe inform the nurse that I am going
to put it up because I know not all my peers know what precautions
are needed when there is no sign indicating the issue.
Emily supports and encourages the professional
development standards in herself and others, and
is forthcoming to add her ideas to problem solving.
(as indicated above). She uses reflection on a daily
basis and discusses this in post clinical.

Emily has completed all of the goals and objectives necessary for this course. She is a strong member of the team, and is able to deliver safe, competent,
evidence based care to all of her clients

Student Areas of Strength

1. Identifying my personal learning needs and seeking help from clinical instructor, lab instructors, peers or staff nurses to ensure high quality and safe
patient care.

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2. Establishing therapeutic relationships and including the client in their care.

3. Tailoring care to the client and identifying when they need a nurse who is more directional (ex. do this) or more centred around patient control (would
you like to do this) and striking a balance between the two.

Student Areas for Future Development

1. Being more of an advocate for my beliefs around client care and student safety.
2. Displaying more confidence in skills I have practiced and be willing to feel some unease or discomfort when performing a task as long as it does not
impact patient safety.
3. Writing complete, succinct, and organized SOAP and narrative notes. Also prioritizing charting so it does not get done in a rush.

Attendance
Thurs Fri Thurs Fri
Week 1 SIM Week 6
Week 2 Week 7 SIM
Week 3 SIM X Week 8
Week 4 Week 9
Week 5 Week 10 8 8

Total number of clinical hours completed______136______

Clinical Component Satisfactory

Clinical Learning Center Completed

Signature of Instructor____________________________________ Date_______________________________

Signature of Student______________________________________ Date________________________________

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