Self Assessment

2015 - 2015 - Final NURS - 208 Course Learning Outcomes (201509)

NUR 208 Practical Nursing Practice 4 (PN, 06-Sep-2015 - 31-Dec-2015)
Student :
Clinical Teacher/Preceptor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Period :
Student hours :
Required Hours :
Validated hours :

Natasha English
Christina Benjamin
Judy Martin
Trillium Health Partners/Mississauga Hospital
Agency
ComplexCC
06-Sep-2015 To 31-Dec-2015
144
168
156

Teacher comment for validated hours:

156
I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes

Student Rating

Teacher Rating

1. COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK

1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies

Satisfactory

Satisfactory

and procedures.
N.E. : I follow standards, legislation, and Trillium's policies and procedures whenever I go to clinical, even if it means declining to do
something that I know is not within my scope

1. 2 Act in a responsible, ethical and accountable manner.

Satisfactory

Satisfactory

N.E. : I always act in a responsible, ethical and accountable manner in and out of clinical. I use the three principles to guide my practice.

1. 3 Determine how the three factor and practice decision-making frameworks influence client

Satisfactory

Satisfactory

care.
N.E. : I look at the three factor framework when providing care. I look at the client factors, the nurse factors and the environment. When
looking at the client I look at their complexity, and their outcomes. The nurse factor is my competencies and skills. The environment is
where I am practicing and how it can influence care (i.e. supplies, PT's)

1. 4 Use evidence informed practice and a theory-based approach to care.

Satisfactory

Satisfactory

N.E. : I always use evidence and theory based approach to care. I also incorporate this with my hands on knowledge. Evidence and theory
is important and I always refer back to what I've learned, and why it's important.

1. 5 Carry out safety-based practices and risk management principles to ensure client safety
and a safe environment.

Satisfactory

Satisfactory

N.E. : Safety and risk management is at the forefront of my nursing care. I had a patient who was mobile, but needed assistance because
of the fall risk. I always made sure she had slippers on, had her walker locked when she was getting up, nothing in the way, and when she
was in bed it was in the lowest position and side rails up.

1. 6 Ask questions and clarify the plan of care, unclear orders or directions, and whenever

Satisfactory

Satisfactory

uncertain.
N.E. : I always ask questions when I need further direction or clarity. A patient a few weeks ago had a saline lock and needed push Lasix. I
knew I was doing meds during the time it was to be administrated but was not sure if I was able to do it. I went to the nurse and my clinical
teacher and asked for clarity. It was not a drug I could administer.

1. 7 Demonstrate professional behavior by seeking assistance in situations in which there is

Satisfactory

Satisfactory

Satisfactory

Satisfactory

unsafe,
unacceptable and/or unprofessional behavior.
N.E. : I have not encountered this.

1. 8 Demonstrate understanding about the role of the nurse within health care.

N.E. : I have demonstrated this by providing safe care, administering medications, researching, discussing concerns, sharing with the
health care team, listening, and documenting.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
Natasha provides safe and ethical care to 2 complex pts.

2. ACCURATE AND RELEVANT COMMUNICATION

2. 1 Participate in team sharing and discussions.

Satisfactory

Satisfactory

N.E. : I consistently participate with my peers, nurses, intraprofessional health care team, and clinical instructor.

2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic

Satisfactory

Satisfactory

methods.
N.E. : I consistently document everything and feel as though I've improved on getting everything done in a timely manner.

2. 3 Report relevant information to the appropriate personnel.

Satisfactory

Satisfactory

N.E. : I consistently report relevant information. For example, last week when I took my patient's BP the diastolic was slightly lower than
the normal range. I went to the nurse to inform her and we discussed that it was normal for this patient.

2. 4 Use communication techniques with the client and the inter-professional health care

Satisfactory

Satisfactory

team.
N.E. : I consistently use different communication techniques with the clients and health care team. One example is that I had a patient who
does not speak, and has diminished cognitive ability. Instead of just asking her questions, I would point to things as I was speaking and
hold up objects so she would be able to visualize what was happening.

2. 5 Ensure privacy and confidentiality according to the Personal Health Information

Satisfactory

Satisfactory

Satisfactory

Satisfactory

Protection Act (PHIPA).

N.E. : I always maintain privacy of my patients information.

2. 6 Use technology to retrieve and share information including research, data and other
information.

N.E. : Use of technology was done on every clinical day. I used it to document, research drug information, and look up information about
the clients.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Natasha maintains confidentiality and charts as per THP policy.

3. CARING RELATIONAL PRACTICE

3. 1 Use effective communication techniques.

Satisfactory

Satisfactory

N.E. : I believe I consistently used effective ways to communicate with patients and the team. I have not had an issue with communication.

3. 2 Establish therapeutic caring, compassionate, and culturally safe relationships with clients

Satisfactory

Satisfactory

and health care team members.

N.E. : I believe I have established all of these with my patients and those around me. I am patient, open and honest with all those I interact
with, and listen to their wishes and beliefs.

3. 3 Demonstrate therapeutic use of self to foster client well-being.

Satisfactory

Satisfactory

N.E. : I believe I demonstrate therapeutic use of self during every clinical session by using my knowledge, skills, and abilities to provide
safe and competent care. I also demonstrate that my beliefs may be different than clients and other health care providers but I still listen
and respect.

3. 4 Use self-awareness to identify the effects that beliefs, values, and personal experiences

Satisfactory

Satisfactory

have on relational practice.

N.E. : I often reflect on my own beliefs and how they can effect my practice. I generally go into most things with an open mind and I find
that has helped, even when the wishes of the client or the family may be different from my beliefs.

3. 5 Collaborate with clients and members of the inter-professional health care team and

Satisfactory

Satisfactory

consult appropriately.
N.E. : I often am talking with clients, their families, and members of the team, so I can have a greater understanding of my client, and any
relevant information. If I have questions I don't hesitate to go to the appropriate person.

3. 6 Support the diversity of clients and the inter-professional health care team.

Satisfactory

Satisfactory

N.E. : I understand and support that there is diversity amongst the people I'm interacting with. Diversity is a great way to learn, therefore I
embrace it and welcome the differences.

3. 7 Display sensitivity and respect for clients cultural, religious, and other beliefs and values

Satisfactory

Satisfactory

influencing their choices and decisions.

N.E. : Respect is really important to me. I always show respect for clients, even when their beliefs may differ from my own. I understand
that it is important to respect that their culture and beliefs may influence the type of care they may wish to have.

3. 8 Provide effective client education.

Satisfactory

Satisfactory

N.E. : Often I find that my patient education is surrounding the medicine they receive, however one instance of patient education was when
a patient was having issues with edema. I reminded her that keeping her arm on the pillow, instead of hanging at her side would be helpful .

Teacher comments for CARING RELATIONAL PRACTICE :

Natasha has a genuinely caring attitude towards her pts and this shows in the care she provides.

4. LEADERSHIP AND ADVOCACY

4. 1 Apply appropriate conflict resolution skills in therapeutic client and other interactions.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I have not had to use conflict resolution skills.

4. 2 Evaluate and refine leadership skills to develop solutions and create a positive work
environment.

N.E. : I believe I have gotten better at evaluating my leadership skills to see where I can improve and where I am strong. For example, when
leading my peers in doing wound care, I would often help them open all the materials, get things for them, and give hands on help with the
dressing, but the last week I realized that may not be the best way. So I stood back more and had my peer do everything. It helped to see
the difference in this style.

4. 3 Provide feedback to peers and accept feedback from peers and members of the inter-

Satisfactory

Satisfactory

professional health care team.

N.E. : I got a chance to provide feedback when helping my peers do wound care. One instance where I received feedback was when I was
trying to

4. 4 Advocate for clients, self, others, and quality practice environment.

Satisfactory

Satisfactory

N.E. : I haven't really had a situation where I've had to advocate for anything, but I keep in mind that this is important and I should be
prepared to be an advocate at any time. I understand the importance of it.

4. 5 Support clients rights for self-determination and choice.

Satisfactory

Satisfactory

N.E. : This is at the forefront of my practice. I know how important it is to listen to clients because client centred care is important.

4. 6 Respond appropriately to unsafe, unacceptable, and unprofessional behaviours.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I have not encountered any of these.

4. 7 Collaborate and consult when implementing health care and nursing practices that are in
the best interests of the public and protect the public through collaboration and consultation.

N.E. : I collaborate and consult with my peers often, as I've walked them through wound care, but also received instructions on how to do
other tasks properly and safely. For example, last week I consulted a peer on how to run a feeding.

4. 8 Contribute to the creation of quality practice solutions and strategies.

Satisfactory

Satisfactory

N.E. : I have not have the opportunity to contribute to the creation of practice solutions and strategies.

Teacher comments for LEADERSHIP AND ADVOCACY :

Natasha provides leadership to her colleagues an example of this is with Trach care and dressing changes.

5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES

5. 1 Incorporate the clients unique needs and expected outcomes into holistic and client-

Satisfactory

Satisfactory

centred plans of
care.
N.E. : I always incorporate these into my care. I realized that even though 2 patients may be similar, they still have unique needs and I have
to appreciate that in order to provide proper care. It's important to provide proper client centred care.

5. 2 Develop theory-based plans of care that are holistic and client centered and are

Satisfactory

Satisfactory

articulated competently in writing and orally.

N.E. : I have been able to develop a plan of care for patients, that are holistic and client centred. I incorporate their unique needs and what
needs to be done for them that day. I am able to competently articulate this.

5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.

Satisfactory

Satisfactory

N.E. : This is an area where I believe I've improved throughout the course of the clinical placement. When I began taking two patients I
found it took a lot of time to do everything in a timely manner and in a way that was best for the clients. However after having more than
one patient for a couple weeks, I found it easier to prioritize care. For example, doing trach care with the bed batch, and doing any wound
care during the bath. Instead of doing the bed bath, and then coming back to do trach care, and coming back to do wound care.

5. 4 Collaborate in the evaluation and modification of plans of care.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I haven't had an opportunity to collaborate in the evaluation/modification of plans of care.

5. 5 Safely and competently implement and evaluate nursing assessments and nursing
interventions in a manner that demonstrates knowledge and skill.

N.E. : I use my knowledge acquired thus far to implement and evaluate nursing assessments/interventions. For example, a patient was
getting digoxin as one of her meds. So before administering it, I listened to her apical pulse and determined that her HR was high enough
that she could have it. Had it been below 60 I would have consulted with a nurse or my clinical instructor.

5. 6 Use the Three-Factor and practice decision-making frameworks to guide practice.

Satisfactory

Satisfactory

N.E. : I consistently use the three factor framework because I understand the the client, my own practice, and the environment we're in all
have an impact on the well being of the client. For example, if a nurse asks me to help transfer a client needing a mechanical lift I know to
decline because of several reasons. It is against hospital policy, and I also have not been trained on how to safely transfer patients with
this method. My lack of competence could severely injure a patient.

5. 7 Prioritize nursing care and nursing interventions in order to manage workload, time, and

Satisfactory

Satisfactory

physical
resources.
N.E. : This is an area where I can still grow, but I believe I have been able to demonstrate that I am capable of prioritizing everything so I
can manage the workload, time and resources.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Natasha includes her pts in their care giving them choice when they cannot do for themselves.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

6. 1 Collaborate with clients and members of the inter-professional health care team to assess

Satisfactory

Satisfactory

clients, determine health needs, and to achieve mutually agreed expected outcomes.
N.E. : I often collaborate with the other nurses, my peers, and the PT's. I am not hesitant in asking them for assistance or discussing
situations with them. I also will incorporate their needs into my care. For example, if a PT needs to work with a patient or get them up, I'll
collaborate with them on the time so we both know what needs to be done before that time comes.

6. 2 Contribute as a member of the inter-professional health care team to respond to the

Satisfactory

Satisfactory

changing needs and expected outcomes of clients.

N.E. : There was an instance with a patient who was mobile, but required oxygen, and had to use the bathroom. During morning report, the
evening nurse said she changed the oxygen tubing to be shorter so she wouldn't get it tangled in the evening. The long oxygen tubing was
still there, so when the patient had to get up and use the washroom I mentioned to the nurse that I would put the long tubing back on so
that she could have her oxygen as she went to the bathroom.

6. 3 Seek out assistance and consult with members of the inter-professional health care team.

Satisfactory

Satisfactory

N.E. : Whenever I have questions or concerns I don't hesitate to consult with the nurses, PT's or PCA's on the unit.

6. 4 Use teamwork, consensus building, and conflict resolution skills to meet expected client

Satisfactory

Satisfactory

outcomes.
N.E. : I use teamwork and consensus building consistently during each clinical shift. My peers and I offer help to each other when needed,
and we also discuss ways that we can solve problems, or more difficult situations with each others patients.

6. 5 Use effective, collaborative, and consultative strategies to meet clients needs within a

Satisfactory

Satisfactory

changing
environment.
N.E. : I feel as though I collaborate and consult quite a bit with nurses and my peers. Last week I consulted with one of my peers who had
my patient the week before. I asked her about the morning care, and how she went about it to get some insight on how to go about my plan
of care. It was helpful and she was able to give some information that she found useful. This was great because it helped to meet these
client's needs.

6. 6 Interact with members of the health care team respecting their unique role and
competencies.

Satisfactory

Satisfactory

N.E. : I consistently interact with the health care team, and understand their role and what their competencies are.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Natasha works well within the HCT on the unit. She is a team player.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

7. 1 Act in the best interests of clients and protect clients from harm through collaboration

Satisfactory

Satisfactory

and consultation with members of the inter-professional health care team and through
competent and safe practice.
N.E. : I consistently act in the best interests of the clients. If there is anything I'm unsure of I consult with nurses so I do not cause harm to
my patient. For example, a patient I was caring for had a dressing on her foot that was covering an abrasion. I wasn't sure what type of
materials they used and there was no order, so I consulted with the nurse and clinical teacher to find the appropriate materials.

7. 2 Engage in ongoing reflective practice to identify strengths, areas for improvement; and,

Satisfactory

Satisfactory

integrate feedback into practice.

N.E. : I am constantly reflecting on my practice to see what I did well at, and what I can improve upon. I believe this is important and I am
consistently thinking about these things, even during my nursing care.

7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance

Satisfactory

Satisfactory

program (CNO).
N.E. : I completed my learning plan this semester and also looked at my old learning plans to evaluate how I did.

7. 4 Seek out learning opportunities and feedback that foster professional development; and,

Satisfactory

Satisfactory

integrate these into practice.

N.E. : I always seek out as many learning opportunities as possible, from other nurses and my peers. If I have to opportunity to learn and
witness something new, I will take it.

7. 5 Use nursing research to foster professional development.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I haven't had an opportunity to use nursing research.

7. 6 Use a theory-based approach and evidence-informed practice.

N.E. : I consistently use theory and evidence in order to provide nursing care. Whether it be for wound care, catheter care, injections, or
anything else. This guides my practice.

7. 7 Apply knowledge of changes to the health care system, technology, and in society as

Satisfactory

Satisfactory

these affect nursing practice.

N.E. : I haven't had much of an opportunity to apply a knowledge of changes but I can think of an area and that involves documentation.
The unit still uses paper charts, but they also document on the computer. Sometimes you have to adapt and go back and forth and switch
between technology and non-technology.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Natasha is eager to learn and expand her skill set, I encourage her to continue to be prepared for clinical.

8. USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING

8. 1 Use critical thinking and problem-solving skills to inform decision-making in all aspects

Satisfactory

Satisfactory

of nursing care.
N.E. : I do use critical thinking and problem solving during every clinical practice. It's an area where I can improve however I do use it.

8. 2 Use critical thinking, problem-solving and decision-making skills to assess clients and to

Satisfactory

Satisfactory

determine nursing diagnoses, expected outcomes, nursing interventions, and evaluative

criteria.
N.E. : These are all important skills which I am working on improving, even though I have improved since the beginning of clinical. One is
example is when a patient had edema. We placed a pillow under her arm while she was sitting in a chair, and then when I transferred her to
the bed I ensured her arm was still elevated. I checked on her to see how her arm was and was evaluating my intervention.

8. 3 Evaluate critical thinking, problem-solving, and decision-making skills and design a plan

Satisfactory

Satisfactory

to improve
these.
N.E. : I feel as though I have improved on these skills by really putting effort into using them and improving them. I still need to grow more,
however I definitely think I've become better at critical thinking, looking at problems and coming up with solutions and making decisions.
For example, a few weeks ago everyone was really busy and I didn't have a peer to assist me in doing a bed bath. So I figured out how I was
going to turn him safely and I completed the bed bath efficiently, and with ease.

8. 4 Integrate knowledge from a variety of nursing, health, and other theory into nursing

Satisfactory

Satisfactory

practice to provide safe and competent care.

N.E. : I use all my acquired knowledge when I am providing nursing care. I use information I've learned in theory, pharmacology, and
ethics, and I also go back to my experiences and draw information from there.

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

N.E. : After having two patients for multiple weeks, I have learned to prioritize much more effectively. Making a mental plan of my day helps
when doing meds, morning care, meals, wound care, and all other components.

8. 6 Demonstrate professionalism and accountability.

Satisfactory

Satisfactory

Satisfactory

Satisfactory

N.E. : I am professional during every clinical setting and accountable for my actions.

8. 7 Use the practice decision-making and the nurse-client-environment frameworks to inform

and guide practice.

N.E. : I demonstrate this by ensuring I look at the three factor framework when I provide nursing care. It's important to understand the
nurse, client, and relationship and how they effect my practice. For example when I had a patient who needed push Lasix, I had to examine
these factors. I knew I was not competent in the skill, I knew there was a restriction on students provided push meds (environment), and I
knew that the client may have an outcome which i was not able to manage.

Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING :

Natasha is able to walk through scenarios and apply the best action.

Student Final Summary with Strategies for Continued Growth

- Keep working on developing head to toe assessment
- Become more comfortable in using theory based care (review theory over the winter break)
- Self reflect on my practice over the semester and determine areas where I can improve, areas where I am strong
- Practice skills over the winter break (i.e. IM injections and priming IV tubing)
- Continue working on leadership skills

Teacher Final Summary with Strategies for Continued Growth

It has been a pleasure working with Natasha and watching her grow to be able to care for 2 complex pts. We are lluck that she has chosen nursing as
a career. Best of luck with pregrad.

Student's References
My clinical practice
CNO Practice Guideline: RN and RPN: The Client, The Nurse, and The Environment

Grade

Satisfactory

Unsatisfactory

Referred to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Program Coordinator Feedback

The Program Coordinator has reviewed the evaluation

Yes

No

Student Sign Off

I met with my Clinical Teacher/Preceptor and discussed my evaluation

Yes

No

In general this evaluation accurately reflects my performance

Yes

No

Student Comment
Acknowledged