NURS 3021H Clinical Practice Focused on Chronic Disease Management

 Mid-Term Evaluation Final Evaluation

Student: Erin Power

Clinical Instructor: Pam Caldwell

Clinical Placement Hospital: Peterborough Regional Health Center Unit: D2

Date: February 18, 2018

Missed Clinical Hours: 0 Missed CLC Lab Hours: 0

 NURS 3021H Clinical Practice Mid-Term 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, evidence-
informed 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.
 NURS 3021H Clinical Practice Evaluation

Progress
Course Objective Evidence/Indicators SP/S ND UP/U
1. Demonstrate accountability and responsibility in the - I arrive on the floor fifteen minutes before
teaching-learning relationship. I am scheduled to being.

- I am dressed appropriately (clean white

shirt, with white undershirt, clean black
scrub pants, stethoscope, preclinical
assignments, and drug cards).

- In week five, I sought out guidance when I

feel as if I require it. When preparing for a
sterile dressing I talk through the process
with clinical instructor prior to beginning.

- The second day of week five, after going

through the dressing change once with my
clinical instructor, I walked one of my class
mates through it as well.

- I have my clinical instructor check over my

progress notes prior to charting them in
order to clarify that I have recorded all
important, relevant information, while
leaving out irrelevant information.

- Each week when I am assigned to

administer medications I go through my
MAR at the start of my shift and orginze
what medicatictions will be administered
at what time. I review the use of each
medication. I am prepared on time to
administer my medications and seek out
my instructor to supervise me doing so.

2. Explain the experience of chronic illness in individuals
receiving care in chronic care settings
- In week five, when my clinical instructor
asked me why I thought my patient was
receiving 16mg of Potassium, I was honest
in my answer and said that I was not sure,
but that I would think that one of their
medications it potassium wasting. After
reviewing medications with instructor, we
saw that none of the medications were
potassium wasting. We took it further and
reviewed the patients chart to gain a
better understanding of why the patient
had this prescription.
- I actively participated in two simulations.
- I completed a reflection as to one of my
experiences on the palliative floor.
Erin comes to clinical prepared with her
preclinical, dressed professionally and with
her ID badge visible. She participates in
self directed learning and comes to myself
or the staff with any questions.
- In week three I had a patient who was
isolated from his family. He explained to
me the regret he had in life. At first this
conversation was uncomfortable.
However it became easier as it was
apparent he wanted to talk about it. I
asked him how he had been cut off, if he
had ever tried to reach out, what stopped
him. Although he was unable to verbalize
exact detail I felt as if this conversation
was therapeutic for him. He did not have
any close friends in his life that he would
have talked about this with.
 In week four I has the same patient, whom
had been reconnected with his daughter
via the units social worker. When I asked
him how he felt about his daughter
coming in to visit he told me that he was
happy that he would not have to die
alone. He was worried that when he
passed, there would not be anyone for the
hospital to call. I can imagine that being a
terrifying feeling, that no one would even
notice when I’m gone.

- In week five I had a patient who was

unable to get comfortable. She was in pain
no matter what way we positioned her.
The only way she was able to be out of
pain was to be heavily sedated. This was
very hard to watch as the previous week
she was lively and joking in her bed. She
wanted to get up into her chair for meals
and put on he own clean night gowns in
the mornings. On Thursday I saw a
decline. She was in a lot of pain and
wanted to just stay in bed. When her
husband arrived in the morning she
wanted to get up because she didn’t want
him to see her as if she were suffering.
However this move to the chair and back
was very hard on her. Once back in bed
she slept for the rest of the day. Only
waking to pain when being repositioned.
On the Friday she became worse. She was
unable to verbalize anything other than it
hurts. She did not get out of bed that day
and needed her PRN analgesic every two
hours. Unfortenly, this analgesic caused

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.
her to sleep, only rousing to pain.
Watching this rapid decline was very hard
to watch, however also acted as a
motivator to help keep her as comfortable
as possible in her final days of life.
- In week six I had a patient who was
extremely short of breath. He was living
with COPD and lung cancer. Every time he
would be repositioned he was have long
coughing fits. The coughs were wet
sounding, and at times he would begin to
gag as a result of the phlegm. For this
reason we tried not to roll him too much,
however he had a stage one pressure
ulcer on his coccyx which he would be
sitting on constantly if we didn’t
reposition him.
These are fantastic reviews of the patient
experience in a chronic care setting. Such a
good example of the use of therapeutic
communication.
- In week five I was clearly able to see how
chronic illness effects not only the person
living with it, but their families as well.
While my patient was approaching end of
life, her family was constantly present. He
husband only left her side for an hour,
when he went home to get cleaned up
himself. When he came back he did not
look freshened up at all. He expressed to
me how he didn’t know what he was going
to do when she was gone, they had been
married for sixty years. He didn’t know
how to live without her anymore. He was
 heartbroken to be watching her go
through pain. He expressed his frustration
with the disease process, as three days
ago his wife was laughing with him. I just
listened to his concerns, and fears for his
future. I shed a tear myself as I couldn’t
imagine how he felt watching the women
he loves in constant pain.

- In week six I had a patient who had

extreme shortness of breath. He was on 5L
O2 nasal prongs. We also administered
morphine to combat pain, while also
decreasing the respiratory rate to help
keep him more comfortable.

I inquired about possibly humidifying the

O2 prior to administration to the patient,
as he is at risk for irritated nasal passages
from the high flow rate of the O2,
secondary to his decrease fluid intake.

- As the majority of my patients have had

decrease mobility as a result of their
illness. I pay close attention to the skin
integrity on their coccyx and heels, as
these areas are prone to pressure ulcer
development. When areas are reddened I
apply no sting spray and chart my findings.
- I had one patient in particular on week
five who had an unstageable pressure
ulcer on his heal. I followed the care plan
and provided cleansing of the wound, and
detailed documentation. The following
day I was able to see changes in the
wound the following day in response to

4. Identify symptoms and common medical treatments of
selected chronic illness.
the wound treatment. The eschar tissue
was becoming loosely attached, the
wound bed developed more slough.
- In week two when my patient expressed
to me that he did not have any family or
close friends, I could sense that he was not
coping well with his prognosis. He was
very willing to discuss his situation, I think
that acted as a mechanism of coping. He
was able to express his fears and concerns
openly.
- My patient from week six seems to be
coping well with his prognosis. He is
cheerful, and still seemed to want the
most out of life. He was cracking jokes
with me, although he is very ill, he sees so
full of life. He expresses his concerns the
best he can, and is admit that he is
perfectly positioned before you leave his
room.
Again, a very concise summary. Erin was
able to touch on all aspects of experience
of chronic illness in relation to nursing
process.
- Being on the palliative unit, the focus has
been keeping patients as comfortable as
possible.
- Pain is controlled mostly though narcotics
via subcutaneous lines. After practicing
on a sponge square, I have successfully
initiated four lines. With the supervision of
my clinical instructor I have primed the

5. Demonstrate select nursing and collaborative interventions
related to caring for the person with chronic illness such as
specific assessments, medication administration, physical
and chemical restraints, enteral feeding & residual
volumes, NG tube insertions, wound care, patient
controlled medication administration pumps.
lines, chosen appropriate sites, inserted
the line, and check for patency.
I regularly ask my patients what their pain
level is on a scale of one to ten. For the
lower levels of discomfort I help the
patient reposition. For rated five or higher
I ask the patient if they would like some of
their PRN medications.
- Fatigue is a common side effect of the
analgesic. Therefore many of my patients
have been unable to make significant
movements themselves. Every two hours I
reposition my patients in order to combat
skin break down.
- Two of my patients (week two and week
five) have had plural effusions. Both had
shortness of breath, which resulted in
them being on 3L O2 via nasal prongs.
Both patients were more comfortable
being position with their heads elevated.
Erin has been able to cover symptoms of
chronic illnesses and the side effects of
medical treatments.
- In week 3 one of my patients who is
diabetic became light headed and
diaphretic about 30min after receiving hs
medication, including metformin. When
medications were administered her BS
was 4.6, as this is on the low side of
normal, I advocated that we check her BS
again, just to rule out hypoglycemia.
- On Thursdays I complete a Braden scale

6. Identify potential consequences/complications of select
chronic illnesses and related interventions.
assessment on my patients. If their score
is below 18, I being a pressure ulcer
prevention form.
- In week 4 I followed the orders from the
wound care nurse to complete a dressing
change on one of my patients.
- When I am assigned meds on a day I pay
close attention to my patients PRN
medications. For example, if a patient
were to tell me they were in 8/10 pain I
would know if they were eligible for a PRN
analgesic or not yet.
- In week five and six, both of my patients
required to be fully fed their meals. I
managed my time in order to get both of
my patients fed and comfortable, before I
was scheduled to leave the floor for my
break.
Erin has covered the nursing interventions
in the daily care of her patients. I would
like to see a point to cover the
collaborative interventions to include
other members of the health care team.
- In week two, after administering pain
dilaudid to one of my patients, I noticed
that they were very light headed and
drowsy. While the patient wanted to get
up to go to the bathroom I expressed my
concern to them in relation to a potential
fall. Instead I suggested to the patient that
instead we use a bed pan. While the
patient was not overly happy about having

7. Under the supervision of a Registered Nurse, demonstrate
safe, competent, evidence-informed, holistic nursing
practice with clients with chronic illness
a. Use a wide range of effective communication
strategies and interpersonal skills to appropriately
establish, maintain, re-establish and terminate the
to use a bed pan, they understood the fall
risk related to their reaction to
medication.
- In week six, one of my patients did not
want to wear his O2 nasal prongs.
However when he would take it off he was
very short of breath. We kept the head of
his bed elevated and strongly encouraged
him to wear his O2.
- In week six, I had a patient who was very
confused. The patient was attempting to
crawl out of bed. My instructor and I put
him back into bed, set a bed alarm, and
out up all four bed rails in order to keep
the patient safe.
- Many of my patients have expressed their
frustration with their situation. One of my
patients in particular in week 2 was living
with depression. I took time to just sit with
him and talk. Validating a person’s
concern can help them cope with their
situation.
Erin has demonstrated that she is able to
identify consequences and complications
of treatments. She takes steps to ensure
patient safety, and shares this information
with the nurses and myself.
- I complete my drug cards prior to clinical.
This way I know what the medications are
for and what to monitor for side effects.
- I complete pre and post clinical work
 nurse-client relationship
b. Demonstrate accountable, responsible and ethical
practice
c. Engage in respectful, collaborative, therapeutic
and professional relationships
i. Demonstrate therapeutic use of self
ii. Create a culturally safe environment
d. Apply nursing models and theories
e. Demonstrate health promotion and illness
prevention practices
f. Demonstrate patient advocacy
g. Predict outcomes of nursing care
h. Evaluate client response to nursing care
i. Critically appraise own practice in relation to
nurse-client/family interactions and as a member
of the health care team
sheets.
- I turn on bed alarms and put call bells
within reach so that patients are able to
get assistance easily.
- I completed a reflection based off my
experience thus far.
- After administering a PRN medication I
follow up with the patient in about thirty
minutes to checks its effectiveness.
- I chart in a timely matter. I provide specific
details in my charting.
- In week three I asked my primary nurse if
we should initiate a subcutaneous line for
a patient who was receiving routine
subcut medication.
- I reposition my patients every two hours,
or sooner if they express discomfort.
- I look for assistance from my peers when
they are more familiarly with procedures
than I am. I look for assistance in brief
changes when I know a patient in either
large or has very limited mobility.
- I ask patients if they have a preferred way
of completing a task.
- I am always willing to give one of my peers
a hand with their patients.

8. Critically appraise own practice in relation to nurse-
client/family interactions and as a member of the health
care team
- I share procedures that are happening on
my patients with my peers if they have not
performed a skill and I have.
- I am ready for breaks on time so that I am
not causing my peers to be waiting on me.
Erin has been able to show herself to be a
member of the health care team. She
advocates for her patient's needs and asks
for assistance when necessary and
appropriate.
- In week three, I had expected one of my
patients to have a procedure done to have
a tube removed during the morning shift.
When I arrived for the afternoon I checked
the chart and it had no mention of the
procedure. When I went in to talk with my
patient I asked if the procedure happened,
and he told me it had. I took his word for
it. Later when his daughter was there I
mentioned that the tube had been
removed, and with a confused look on her
face she said no that was canceled. I felt
so clueless in that moment. I now will
always make sure to check dressings and
lines myself.
- I adjust my tone according to the patient I
am working with. In weeks three, five, and
six I have had patients who loved to joke
with me, therefore I was very upbeat and
bubbly while caring for them. On the
other hand I have had patients who are
not open to joking. I tone down my

9. Participate in professional development based on
reflective practice and critical inquiry
cheerfulness and become more of an
active listener for them.
- I collaborate with my primary nurses in
order to develop a plan for my shift. After
reviewing my patient’s kardex and MAR, I
develop what my plan is. I then approach
my primary nurse, tell them my plan, and
ask if they would prefer me to do things
differently or add/remove tasks from my
day. I have changed my approaches based
off my primary nurse after having worked
with many of them multiple times.
Erin understands her role as a student and
as a member of the health care team. She
demonstrates accountability to myself, the
nurses, the patients and their families. The
incident described above was brought to
my attention. Erin was able to take
constructive feedback well and apply it to
her practice.
- I have completed eight hours of simulation
time. I actively participated and came to
the simulations with all of my prep work
completed.
- I attend skills lab weekly, with all of my
prep work completed. I come prepared
with questions for my lab instructor.
- I complete drug cards, and carry them
with me on clinical days.
- When I see procedures being done that I
am not sure as to their reasoning I ask my
 clinical instructor, or my primary nurse for
that patient.

- I reflect on my encounters with patients

and determine what went well vs what
could have been improved on. I use this
the next time I interact with these
patients, as well as in my new patients.

- I do not let my bias effect my care

provided. (i.e patient suffering with lung
cancer, who admits to smoking, and had
only quite smoking because they were
admitted to the hospital)

Great review of self reflection!

Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment)

Erin has shown herself to be member of the health care team on D2. She seeks out opportunities to learn, but also takes
a leadership role in offering learning opportunities to her peers. Her time management has improved, as well as her
knowledge regarding medications and diagnoses.
Signature of Course Lead: Date:

Signature of Clinical Instructor: Date:

Signature of Student: Date: