NURS 3021H Clinical Practice Focused on Chronic Disease Management

Mid-Term Evaluation Final Evaluation      

Student: Megan Scott

Clinical Instructor: Desiree Langer

Clinical Placement Hospital: Kelowna General

Date: Saturday, October 24th, 2020

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, 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.

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 Evidence/Indicators
MIDTERM FINAL
1. Demonstrate accountability and Student: Student:
responsibility in the teaching-learning  I have demonstrated
relationship. accountability and responsibility
with by not missing a lab, clinical
Progress Midterm Progress Final debrief or clinical shift on
Shadowhealth.
 SP  S  I am accountable towards
 ND  U charting my findings after I Clinical Instructor:
 UP complete an assessment or
procedure in the lab setting, as
well as in Shadowhealth. This
includes a health history,
additionally objective and
subjective data.
 I am also following the TFSON
guidelines for online clinical such
as professionalism and integrity.
 As for my assignments, I make
sure that I always have the in on
time and complete for my
instructor to evaluate.

Clinical Instructor:
Megan has demonstrated accountability
and responsibility in the teaching-
learning relationship by consistently
participating in weekly Shadow Health
debriefs.  Each week, Megan has
completed the required Shadow Health
assignments prior to debrief, and she has
consistently participated in the group
debrief. Megan asked questions
 throughout debriefs that led to further
reflection and discussion. Megan
submitted her Evolve quizzes, Shadow
Health assignments and was prepared
and successful in all skills essentials. 

2. Explain the experience of chronic illness in Student: Student:

individuals receiving care in chronic care  The experience of chronic illness
settings in a chronic setting as a nursing
student is to provide care to
Progress Midterm Progress Final people who have pre-existing
or long-term illness that is more
 SP  S than 6 months, that usually comes
 ND  U with a lengthy intervention Clinical Instructor:
 UP  Individuals living with a chronic
illness are likely affected in more
than one aspect. These aspects
could include their social
supports, their continuity of
ADL’s, financially, physically,
and mentally
 An example of this was
demonstrated in Shadowhealth
with Edward Carter. This patient
was diagnosed and admitted with
progressive osteoarthritis. He was
in a lot of pain and reported that it
is difficult for him to perform his
ADL’s. This physical aspect in
chronic illness limits individuals
to participate in activities that
they use to. This limitation can
lead to an array of emotions with
mixed feelings for how to cope
with the illness.
 The experience for chronic illness
is different for individuals
 because of how people perceive
and view their illness and health
conditions. An example of this is
if one chronic illness is more life-
threatening than another, such as
cancer.

Clinical Instructor: Megan can explain

the experience of chronic illness in
individuals receiving care in chronic care
settings.  In this first half of the semester,
Megan has interviewed many patients in
Shadow Health, and has come across
many different chronic diseases such as
diabetes, hypertension, and asthma. 
Megan has learned how to empathize
with the simulation patients, and how to
utilize opportunities to educate.  As a
group, we have discussed in debrief the
some of the many ways a chronic illness
can affect an individual’s every day.  

3. Interpret critical aspects of the person’s Student: Student:

experience of chronic illness in relation to  I had the opportunity to
the nursing process such as common signs communicate with a family
and symptoms, responses to treatment, member to educate them about
patterns of coping, and impact on the treatment and care for when
individual and family relationships. they go home on Shadowhealth.
Progress Midterm Progress Final In other cases, this could be the
POA, the guardian for a child, Clinical Instructor:
 SP  S primary caregiver, etc,.
 ND  U  Hand hygiene when entering into
 UP a patient’s room, as well as
providing privacy
 Vitals are important to determine
a medical problem. In
Shadowhealth, there have been
several times for an intervention
 to perform vitals q4h and to
maintain normal ranges, and
otherwise notify the prescriber
 Recommendations in SBAR can
be a big part of the interventions
for the patient. An example of
this from Shadowhealth is when I
used SBAR and recommended to
maintain patient safety by leaving
the call bell nearby, continue
using a warm toilette for the pain
from his OA, physical and
occupational therapy, and lastly,
exercises to increase his range of
motion.
 An example of this was
demonstrated with Patricia
Young. This patient was
diagnosed with incontinence and
confusion. The patient lives with
her daughter, who is able to take
care of her since her husband
passed away. Due to the
increased state of confusion,
Patricia was becoming less aware
of her surroundings and memory.
The impact of having support
systems and family relationships
is very special and important,
especially for patients who
experiencing a chronic
illness/disease.
 Patterns of coping are
experienced differently by
everyone and towards how the
adapt to their new lifestyle.
Examples of positive coping
methods could be counseling,
 diversional activities, relaxation
techniques, education classes,
social interactions, friends, family
and support groups.

Clinical Instructor: Megan was able to

explore several patients’ experiences of
chronic illness in relation to the nursing
process through the completion of three
care plans of virtual patients Robert Hall,
Patricia Young and Edward Carter in
Shadow Health. Megan was able to
interpret critical aspects such as labs,
common signs and symptoms, responses
to treatment, patterns of coping and the
exploration of the impact of the chronic
illness on the individual and family
relationships and discuss these aspects in
debrief. Megan was able to appraise each
patients physical and psychosocial needs
and determine each patient’s learning
needs and readiness to learn. Megan
developed her care plan based on mutual
goal setting to meet the patient’s needs
and then develop a teaching plan based
on mutually pre-determined behavioural
outcomes to meet the patient’s needs. By
using percussion, auscultation,
inspection, and palpation, Megan has
learned the techniques of a good head to
toe physical assessment. The conceptual
labs have allowed Megan to be able to
hear and identify different respiratory
and cardiac sounds.

4. Identify symptoms and common medical Student: Student:

treatments of selected chronic illness.  Common symptoms and medical
treatments in elderly patients
Progress Midterm Progress Final living with chronic illness can be
loss of interest with life,
 SP  S immobility, feelings of sadness,
 ND  U fatigue and lasting pain. Common
 UP chronic illnesses could include Clinical Instructor:
hypertension, UTI/incontinence,
arthritis, etc.
 Due to the inability of chronic
illnesses being cured, some of the
common treatments can include
collaboratively creating a care
plan with a team of HCP to
provide best quality of life,
pharmacological and non-
pharmacological strategies for
management, reaching out to
support systems
 Examples of pharmacological and
non-pharmacological strategies
were present in one of my
Shadowhealth modules. The
patient I was caring for was
admitted with progressive OA
and his ability to continue his
ADL’s were impaired. The
pharmacological strategies used
in this module were pain
management, such as morphine.
The non-pharmacological
strategies used in this module
were using an ambulatory device,
warm compress/ice pack and
physical and occupational
therapy.
 Self-management is another
treatment option is the patient is
able to do so at home. Self-
management is focusing on the
 skills to manage conditions as
home, which would include
having the necessary medications
and equipment.

Clinical Instructor: Megan has had the

opportunity to work with virtual patients
Tina Jones, Robert Hall, Patricia Young,
and Edward Carter over the last 6 weeks.
Each of the virtual patients have
presented differently and Megan has had
experience in the following areas with
chronic conditions/illnesses: Diabetes,
Obesity, Foot wound, mild retinopathic
changes, foot neuropathy, asthma,
environmental allergies, chronic acne,
abnormal hair growth, HTN, orthostatic
hypotension, medication over use,
arthritis, falls, BPH, DVT, dehydration,
UTI, delirium, osteoarthritis, CKD, pain,
afib and hypercholesteremia. Megan was
able to note that some prescribed
medications were on the BEERs list and
was able to provide education to the
patient about this and was able to provide
education on non-pharmacological
interventions. In lab and skills essentials
Megan has demonstrated her knowledge
in the following areas in relation to
treatments for chronic conditions: head
to toe assessments, functional
assessments, intravenous medications,
injections, complex wound care, and
catheterizations

5. Demonstrate select nursing and Student: Student:

collaborative interventions related to caring
 for the person with chronic illness such as  Specific assessments that could
specific assessments, medication be performed for an individual
administration, physical and chemical with chronic illness is head to toe
restraints, enteral feeding & residual assessment to collect information
volumes, NG tube insertions, wound care, through each system of the body.
patient-controlled medication This assessment provides a Clinical Instructor:
administration pumps. baseline of the individuals health.
Through doing this I am able to
Progress Midterm Progress Final determine any abnormal findings,
document them, and engage in a
 SP  S plan of care.
 ND  U  Another assessment could be
 UP depression screening, cognitive
testing and health history. A
depression screening tool that I
have used this semester is CAM
(Cognitive Assessment Measure).
I used this on a patient in
Shadowhealth who presented
with signs of social isolation,
spills of dizziness, and placed on
falls risk. I have been able to use
this tool multiple times in my
Shadowhealth modules,
especially with patients who are
at risk for social isolation and
loneliness.
 Unfortunately, due to online
clinical, I am unable to prepare
and administer medications, but I
am able to practice in our lab
sessions. Additionally, I
successfully passed the
medication quiz at the beginning
of the term.
 I am able to practice wound care
in our labs. I am able to properly
assess the wound, as well as
 determining the characteristics
about the wound, along with
documentation.
 Some interventions that relate to
patients with chronic illnesses
would be providing insight to
resources that would benefit the
patient towards coping and
adapting. It could also include
being supportive throughout the
process if they have any
questions or doubts about the
procedure and treatments for
afterwards.

Clinical Instructor: Megan has

demonstrated knowledge of many
nursing interventions related to caring for
a person with chronic illness, which is
evidenced by her successful completion
of the following quizzes in Evolve:
Promoting Family Support &
Participation, applying elastic stockings,
using restraint alternatives, applying
restraints, assessing the musculoskeletal
system, performing range of motion
exercises, assessing the abdomen,
assisting with positioning a patient in
bed, assessing the skin, hair and nails,
assessing the male genitourinary, rectum
and prostate, assessing the female
genitalia and rectum, assessing the
breasts and axillae, assessing pain, head
to toe assessment, discontinuing
intravenous therapy, troubleshooting
intravenous infusions, using an infusion
pump, dressing the infusion site,
changing IV dressings, changing IV
 tubing and fluids, regulating an IV
infusion, measuring input and output,
preparing an infusion site, administering
intramuscular injections, administering
intradermal injections, administering
subcutaneous injections, drawing up
more than one type of insulin, preparing
and administering insulin, preparing
injections from an ampule, preparing
injections from a vial, performing blood
glucose testing, preventing medication
errors, screening urine for chemical
properties, providing catheter care,
obtaining a specimen from an indwelling
catheter, performing intermittent straight
catheterization, collecting a midstream
urine, applying a condom catheter, using
wound drainage systems, irrigating
wounds, changing a dressing, adding
items to a sterile field, establishing and
maintaining a sterile field, assessing
wounds, performing sterile gloving,
caring for pressure injuries, and
collecting a specimen for wound culture.

6. Identify potential Student: Student:

consequences/complications of select  The examples of potential
chronic illnesses and related interventions. consequences/complications of
chronic illnesses and related
Progress Midterm Progress Final interventions are:
1. Asthma/COPD: An example of
 SP  S this was demonstrated in
 ND  U Shadowhealth when the patient Clinical Instructor:
 UP continued to surround herself
with the triggers that led her to
have an asthma attack. She was
allergic to cats and continued to
go to her sister’s house, who has
 a cat. This is a consequence
because the patient was setting
herself up to have an asthma
attack.
2. UTI/Incontinence: There were
two examples of this from
patients on Shadowhealth. Both
patients experienced symptoms of
frequent urination, not making it
to the bathroom in time, and in
one of the patients; a burning
sensation. An intervention for the
patient with a UTI was to
increase fluids. A consequence
that comes with this chronic
illness especially in the elderly is
decreased confidence,
embarrassment and lack of
independence associated
incontinence.
3. Wound/Infection: A patient on
Shadowhealth arrived at the
hospital with pain in her foot
from a previous fall on a sharp
object. The complication of this
chronic illnesses would be
infection if the wound is not
properly taken care of – poor use
of sterile technique, or not
starting antibiotic therapy.

Clinical Instructor: Megan was able to

identify potential complications and
consequences of chronic illness such as
diabetes, hypertension, asthma, arthritis
hypercholesteremia, osteoarthritis,
chronic kidney disease , heart disease,
etc. through the completion of virtual
clinical experiences in Shadow Health ,

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 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
by participating in debriefs and
completing labs and skills essentials on
line. In debrief she was able to link labs
to the development of further potential
complications. She was able to
demonstrate her knowledge in the
following areas in skills essentials
participation and quizzes. Megan,
through her Shadow Health experience
was able to identify that patient Tina
Jones experiencing a foot wound related
to a fall was healing poorly. The patient
also had T2DM which put her at risk of
infection and possibly leading to
amputation. Megan was able to identify
the complications and risks of both of
these complications.
Student: Student:
 I demonstrate accountability by
not missing a lab, simulation, or
clinical shift
(Shadowhealth/Debrief). I am
accountable towards charting my
findings after I complete an
assessment. Clinical Instructor:
 An example of reliability was
demonstrated in our fifth week
when the interview guide on
Shadowhealth was removed. This
gave me an opportunity to rely
directly on my ability to perform
a full assessment without any
prompts – which I have
successfully been able to this far.
 I have used a wide range of
communication strategies to
establish and maintain a nurse-
client relationship. I always
 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.
j. Participate in professional
development based on reflective
practice and critical inquiry.
Progress Midterm Progress Final
 SP  S
 ND  U
 UP
provide privacy when I enter into
the patients’ room and introduce
myself. I ask open ended
questions which allows more
room for discussion and allows
time to think.
 I demonstrate patient advocacy
by asking what their pain is and
addressing that I can get
medication for them if needed
and contacting the physician for a
different order.
 I am able to evaluate the client
response to nursing care when I
complete the SBAR and care plan
at the end of each module on
Shadowhealth. I am able to
reflect and determine if the care
plan and goals have been
achieved by the end of the time
with the patient.

Clinical Instructor: Megan has used a

variety of nursing models and theories to
help with completing the scenarios in
Shadow Health such as infection control,
hygiene safety, therapeutic
communication, relational theory and
ethical models of care as well as learning
theory and interpersonal theory. Megan
has the opportunity each week in her
Shadow Health experiences to provide
education to her virtual patients on health
promotion and prevention such as:
education regarding diet, activity levels,
non-pharmacological pain interventions,
personal care and illness prevention
(UTI’s), falls prevention and education
 regarding proper medication usage and
dosing. Megan has actively participated
in debriefs each week. She has had the
opportunity to discuss the interventions
and education listed above and the
importance of providing this education
and then links it back to her virtual
patient for that week. Megan has
demonstrated her competence in this
outcome in her SBAR documentation
and nursing notes. In this, Megan has
included appropriate recommendations
regarding the patient’s medications and
interventions to present to the MRP.

8. Successful completion of all NURS 3021H Student: Student:

Clinical Learning Centre Lab activities and  Since the beginning of the
clinical simulations. semester, I have completed the
skills modules and tests related to
Progress Midterm Progress Final what we are practicing in lab that
week. I have achieved 100% on
 SP  S all of the module quizzes.
 ND  U  Before each lab, I review and Clinical Instructor:
 UP document my readings. In doing
this, I feel prepared to
successfully complete my lab
with the proper knowledge,
techniques and skills.
 Every other week we participate
in a formal testing associated
with the skills that we practiced
in the week before. I have
successfully passed the three
formal testing sessions; Head to
toe Assessment, IV calculation
and administration and Catheter
and Wound care.
 Clinical Instructor: Megan was able to
participate in professional development
based on reflective practice and critical
inquiry through her participation in
online debrief sessions. She was able to
demonstrate her competency to care for
individuals with chronic illnesses by
demonstrating her knowledge and
judgement required for safe and ethical
nursing practice during debriefs. Megan
actively engaged in therapeutic
communication and reflective practice as
required to participate well in Shadow
Health, lab and skills essentials
demonstrates that she knows how to
make sound, ethical decisions related to
patient care. This was demonstrated by
achieving over 90% in the Shadow
Health modules, 100% in the skills
essential quizzes and pharmacology
quizzes and by good participation in the
debrief sessions.

This section to be filled out by the Student Areas of Strength Student Areas of Strength
student.
1. Ability to learn from mistakes 1.

2. Organization and Punctuality 2.

3. Time Management 3.

Student Areas for Future Student Areas for Future

Development Development

1. Communication Skills 1.

2. Analytical/Critical Thinking 2.
 3. Self-confidence when 3.
performing different skills in
lab

Clinical Instructor Summative Comments:

Clinical Practice Attendance (8 Hours Per Shift)

Thurs Fri Thur Fri

s
Week 1       x Week 6       x
Week 2       x Week 7            
Week 3       x Week 8            
Week 4       x Week 9            
Week 5       x Week 10            

Total number of clinical practice hours absent: 0

Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory Unsatisfactory

Clinical Learning Centre

Total number of clinical simulations completed       / 4

Total number of labs completed       / 11

A B A B
Head to toe,            Post-mortem,            
Functional Ass.         Trach care            
    
 
IV, IV            NG, Focused            
medications,         Head Exam            
Injections     
 
Wound,            OSCE Final            
Catheterization         Test            
    
 
Clinical Instructor Summative Comments (Midterm):

Megan is progressing as expected at midterm. She is kind, respectful of others and professional during debriefs. She has a good
attitude toward her learning and is always smiling. Megan is always prepared for her online debriefs and participates well. She is able
to develop good therapeutic relationships with her virtual patients to get the information she needs. Megan has been able complete her
documentation and provide SBAR for them. Megan has identified areas for improvement. Keep up the good work!

Midterm Evaluation (completed by Clinical ✅ Unsatisfactor

Instructor): Satisfactory y
Clinical Instructor Summative Comments
(Final):
 Final Evaluation (completed by Clinical Unsatisfactor
Instructor): Satisfactory y

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

Signature of Course Lead: __________________________________Date: _____________________

Signature of Clinical Instructor: Désirée Langer RN Date: Oct. 27/20

Signature of Student: Megan Scott Date: Saturday, October 24th, 2020