NURS 3021H Clinical Practice Focused on Chronic Disease Management – Winter 2024

Mid-Term Evaluation X Final Evaluation

Student: Alysia Forde-Klumb

Clinical Instructor: Valerie Adamarczuk

Clinical Placement Hospital: Peterborough Regional Health Centre Unit: A2

Date: April 5th, 2024

Missed Clinical Hours: 12 (due to instructor cancellation) Missed CLC Lab Hours:
 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 responsibility Student: Student:
in the teaching-learning relationship. 1. I showed accountability and
responsibility by completing drug
Progress Midterm Progress Final cards and mandatory online learning
modules for both my case study
 SP  S simulations on congestive heart
 ND  U failure and chronic obstructive
 UP pulmonary disease. This ensured Clinical Instructor:
that I was prepared and actively
engaged in the educational activities
provided.
2. Throughout my clinical rotations, I
demonstrated accountability and
responsibility by promptly
conducting vital signs and head-to-
toe assessments upon receiving
reports from the nurse. Additionally,
I prioritized the safety of my patients
by conducting hourly checks to
monitor their well-being.
3. Within the clinical setting, I actively
sought opportunities to learn and
contribute to patient care. I
approached nurses assigned to my
patient and eagerly volunteered to
assist with tasks, demonstrating
accountability and responsibility in
engaging with the healthcare team.
Furthermore, during periods of
downtime, I promptly responded to
patient call lights on the unit,
 providing necessary care and
support.

Clinical Instructor:
-Alysia arrives to clinical on time, in
proper uniform, completed preparation
for clinical.
-Alysia completed all assignments on
time and to the best of her ability.
-Alysia always provides safe, quality
patient care to her own patients and
others on the floor. She always acts in
accordance with Fleming college, PRHC
and CNO standards.
-Alysia always applies the correct
treatments to her patients and
advocates for them to the
interdisciplinary team.

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

individuals receiving care in chronic care 1. I cared for a 39-year-old patient who
settings had suffered a stroke and was in a
stupor state, exhibiting restricted
Progress Midterm Progress Final movement and communication. Despite
his limited verbal abilities, he conveyed
 SP  S his consent through hand squeezes,
 ND  U emphasizing the importance of non- Clinical Instructor:
 UP verbal communication in chronic care
settings. Observing the need for oral
suctioning, I ensured to obtain his
agreement before proceeding with the
procedure, respecting his autonomy
even in his compromised state.

2. I provided care to an 86-year-old

 woman recovering from a right-sided
stroke. During my assessment, she
voiced her struggles with shortness of
breath when lying flat. By suggesting
positional adjustments such as elevating
her head or lying on her side, I aimed to
alleviate her discomfort and enhance
her respiratory comfort, highlighting the
holistic approach necessary in
addressing chronic conditions.

3. I cared for a 39-year-old male patient

also recovering from a stroke. Upon
assessment, his oxygen saturation was
92%. Despite implementing various
interventions like oral suctioning,
positioning, and breathing exercises, his
oxygen levels did not improve. I
administered one liter of oxygen, closely
monitored his status, and observed an
increase in his oxygen saturation to 96%.
This shows that ongoing monitoring is
required in chronic care settings, where
patients often confront recurrent health
issues despite diligent intervention.

3. Clinical Instructor:
-During post conference Alysia has been
able to verbalize her patients experience
of their chronic conditions.
- Through therapeutic conversations
with her patients Alysia goes beyond the
disease specific symptoms and
confidently investigate ones description
and experience.
-She is able to associate determinants of
 health affects ones experience of chronic
conditions
4. Interpret critical aspects of the person’s Student: Student:
experience of chronic illness in relation to the 1. I provided care for a patient who had
nursing process such as common signs and experienced a right-sided stroke.
symptoms, responses to treatment, patterns Drawing from my understanding of
of coping, and impact on individual and family stroke symptoms, I anticipated
relationships. potential effects on the left side of
Progress Midterm Progress Final her body. During my initial
assessment, I noted a left facial Clinical Instructor:
 SP  S droop, garbled speech, and
 ND  U weakness in her left arm, common
 UP manifestations of stroke-related
impairments that impact daily life
and functioning.
2. I attended to a patient who had
suffered a stroke and attended
physiotherapy daily. While assisting
her to the washroom using a Sera
Steady device, I observed her ability
to lift her feet onto it and stand
independently. Both she and her
husband shared with me their
appreciation for the effectiveness of
ongoing physiotherapy in rebuilding
muscle strength and restoring
independence, highlighting the
importance of proactive
management in chronic illness care.
3. I provided care for a patient who had
a stroke. Despite facing ongoing
mobility challenges, she
demonstrated resilience.
Maintaining a positive attitude, she
expressed hope for her continued
recovery journey and shared her
 aspirations for life after discharge,
including activities like visiting her
favorite restaurant in Peterborough.
This shows the significance of
adaptive coping strategies and goal-
setting in navigating the complexities
of chronic illness management.

Clinical Instructor:
- Alysia submits each week a nursing
care plan that outlines the nursing
process.
-Alysia utilizes the 5 processes in her
practice subconsciously when providing
patient centre care.
-In relation to the stroke floor, Alysia Is
able to retrieve information from various
sources and analyze the data, She is
then able to formulate a NANDA nursing
diagnosis in relation to the stroke
patient, Goals are created from the
diagnosis and the interventions are put
into action. Evaluation of the actions are
completed by the end of shift.
5. Identify symptoms and common medical Student: Student:
treatments of selected chronic illness. 1. The patients I have cared for have all
experienced strokes. Each of them
Progress Midterm Progress Final has been prescribed anticoagulant
medication to take daily.
 SP  S Anticoagulants are commonly used
 ND  U to prevent conditions such as deep
 UP vein thrombosis in stroke patients. Clinical Instructor:
2. I provided care for a patient who had
a stroke and reviewed their
laboratory results. They underwent
 INR and PT tests, which are standard
procedures for stroke patients to
assess their coagulation status and
the effectiveness of anticoagulant
medication. Elevated levels of INR
and PT could indicate over-
anticoagulation, posing a potential
risk of bleeding complications.
3. I attended to a patient recovering
from a stroke who received daily
sessions with a speech therapist due
to aphasia resulting from the stroke.
Speech therapy is an integral part of
rehabilitation for stroke survivors,
helping them to regain and improve
their verbal communication skills
amidst the challenges posed by
aphasia.

Clinical Instructor:
-Through health history, physical
assessment Alysia is able to verbalize
and document applicable medical
treatment in relation to various chronic
conditions such as COPD, Stroke,
alzheimers, heart disease, diabetes, CKD.
-She is able to identify medicinal,
holistic, physical treatment for the stoke
patient.
6.
7. Demonstrate select nursing and collaborative Student: Student:
interventions related to caring for the person 1. I provided care for a patient who had
with chronic illness such as specific suffered a stroke and required a
assessments, medication administration, nasogastric (NG) tube for medication
physical and chemical restraints, enteral and feeding. I conducted research on
feeding & residual volumes, NG tube NG tube care protocols, including the
insertions, wound care, patient-controlled importance of flushing it before and
medication administration pumps. after administering medications and Clinical Instructor:
enteral feeds. Subsequently, I
Progress Midterm Progress Final implemented these procedures
successfully.
 SP  S 2. During a patient assignment, I was
 ND  U tasked with administering
 UP medications. Prior to medication
administration, I prepared drug cards
for each medication to ensure a
comprehensive understanding of
their purpose and to prioritize
patient safety. I administered oral
medications by crushing them for
administration through the patient's
NG tube and administered a
subcutaneous anticoagulant
injection in their abdomen.
3. I performed wound care for a patient
with a small round wound on their
big toe who had osteomyelitis. I
cleansed the wound with normal
saline solution, dried the wound,
applied inadine to the wound site,
and securely wrapped it with gauze.
Additionally, I documented the
wound care provided for the patient.
Clinical Instructor:
-Alysia has had the opportunity to
perform various dressing changes; She
has been bale to administer medications
through an NG tube, oral and
subcutaneous medications. She has
been able to see and practice
programming enteral feeds.
8.
9. Identify potential Student: Student:
consequences/complications of select chronic 1. A patient I cared for experienced a
illnesses and related interventions. right-sided stroke, presenting
symptoms of malaise, fatigue, and
Progress Midterm Progress Final left-sided weakness, leading to
difficulties in swallowing and food
 SP  S spillage during meals, contributing to
 ND  U decreased appetite. These Clinical Instructor:
 UP challenges can lead to complications
such as malnutrition and aspiration
pneumonia. Sensing her need for
assistance, I provided support during
meal preparation by opening
packages and utensils, offered a
towel to catch falling food,
encouraged upright seating for
easier swallowing, and remained by
her side during meals to prevent
aspiration. As a result of these
interventions, she exhibited
increased confidence, consuming
75% of her meal during my
observations.
2. Stroke patients may experience
challenges in maintaining
independence, leading to feelings of
depression. While caring for a stroke
patient concerned about returning
home alone due to age-related
concerns, we collaborated on
strategies to promote independence
both in the hospital and upon
discharge. This patient-centered
approach aimed to reduce the risk of
depression and improve overall
quality of life. Together, we
 discussed activities she could
practice independently, such as
personal grooming tasks like washing
and brushing her hair, and self-
sufficient meal preparation, which
may contribute to enhanced mood
and reduced depressive symptoms.
3. I provided care for an older stroke
patient with meal setup, she
expressed frustration about feeling
unable to wake up, indicating
potential emotional and
psychological complications such as
depression or anxiety.
Demonstrating empathy, I validated
her feelings while reassuring her of
her abilities to speak, eat, and move.
Throughout the day, I engaged in
attentive listening and interactive
communication to provide emotional
support and companionship,
addressing potential mental health
consequences of stroke and related
interventions.

Clinical Instructor:
-Alysia is able to verbally identify
complications associated with the stroke
patient. She is able to tailor the patients
care plan in order to provide the best
patient centered care.
-Alysia I able to notice and verbalize
possible consequences of various
treatments. She is attentive to pre and

10.
11. 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
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
Progress Midterm Progress Final
 SP  S
 ND  U
post follow-up to interventions.
Student: Student:
1. In my clinical rotation, I cared for a
stroke patient with compassion and
respect, despite the challenges she
faced with eating. While she only
consumed a small portion of her
meals, I encouraged her to eat while
Clinical Instructor:
respecting her decision when she
communicated her reluctance. This
demonstrated my commitment to
ethical and person-centered care,
ensuring the patient's autonomy and
well-being were prioritized.
2. I provided oral care to a stroke
patient in a stupor state, using
appropriate techniques such as
brushing his teeth with a Toothette
and mouthwash. Additionally, I
employed oral suction to prevent
fluid buildup, reducing the risk of
aspiration. By implementing these
preventive measures, I contributed
to maintaining the patient's oral
health and preventing complications
associated with poor oral hygiene.
3. During my clinical assignment, I
advocated for a patient's safety
when I observed edema in her right
arm, exacerbated by a constricting
wristband. Recognizing the potential
harm, I promptly alerted the nurse
and took immediate action to
  UP
12. Critically appraise own practice in relation to
nurse-client/family interactions and as a
member of the health care team
remove the wristband, ensuring
adequate circulation and preventing
further complications. This advocacy
for patient safety shows my
commitment to prioritizing the well-
being and best interests of those
under my care.
Clinical Instructor:
-Alysia is very professional and attentive
in communicating with her patients,
peers, instructor and the
interdisciplinary team. She brings forth
valuable information and asks great
questions.
- Alysias nursing decisions are well
thought, planned and implemented
appropriately, thus, enforcing her
accountability as a nurse.
-Her quality of care is of high standard
while obeying PRHC policies and
standards and patients needs (ethical
practice)
Student: Student:
1. While caring for a stroke patient, I
attended to their room to change
their bed linens while they were
undergoing physiotherapy. Upon
arrival, I encountered a family
Progress Midterm Progress Final member in the room. Introducing Clinical Instructor:
myself, I learned that he was the
 SP  S patient’s uncle and had just been
 ND  U informed about his nephew's
 UP hospitalization for a stroke that day. I
provided information about the
ongoing physiotherapy session and
assured him that his nephew would
return afterward. Observing the
uncle's emotional distress, I offered
empathy and initiated a conversation
to better understand his feelings. He
shared fond memories of his
nephew, and I actively listened while
providing supportive presence.
2. During an in-person case study on
congestive heart failure, I had the
opportunity to practice inserting a
peripheral IV into a simulation arm. I
have not practiced this skill for some
time, I encountered difficulty
recalling the sequence to perform
the intervention. Recognizing my
limitations, I sought assistance from
my peers to complete the task. Later
that day, upon reflection, I
recognized the importance of
teamwork and leadership in nursing
practice. By actively seeking
assistance from my peers, I
demonstrated effective leadership
skills and a commitment to
improving my nursing practice.
3. Throughout clinical this semester, I
 have shadowed several nurses and
critically appraised my interactions
with them. Upon assessment, I
recognized that while I effectively
communicated patient care with the
nursing staff, I perceived myself as
shy and slightly uncertain. To
address this, I aim to cultivate more
confidence in my communication
skills and engage in proactive
interactions with the nursing team
during clinical rotations. Moving
forward, I am dedicated to stepping
out of my comfort zone, actively
seeking feedback from nursing staff
to strengthen my confidence and
collaborative abilities as a valued
member of the healthcare team.
Clinical Instructor:
-Alysia actively seeks out learning
opportunities. She has a vast knowledge
and is able to apply it to the clinical
setting and teach her peers.
-Alysia has received positive
compliments form patients and family
members regarding her professionalism
and care.
-Alysia constantly ask and seeks out
ways to better herself for conversing
with various members of the
interdisciplinary team. She works well
with other nurses and is working
towards feeling more comfortable with
contacting physicians
13. Participate in professional development based Student: Student:
on reflective practice and critical inquiry 1. During the congestive heart failure
case study, at the conclusion,
Progress Midterm Progress Final students engaged in a debriefing
session where we reflected on our
 SP  S performance. I identified that I
 ND  U performed vital signs effectively with
 UP my peers and recognized the need to Clinical Instructor:
enhance my proficiency in
calculating IV flow rates.
2. Given my clinical placement on the
stroke unit, I aimed to enhance my
proficiency in using the Canadian
Neurological Scale (CNS). To achieve
this, I actively sought educational
resources such as instructional
videos and literature to refine my
skills. During a recent shift, I
conducted three CNS assessments
and now feel confident in my ability
to perform them accurately.
3. My initial clinical shift, I encountered
challenges with documentation of
parts of my patient's assessment. I
received constructive feedback
highlighting areas for improvement,
and I took proactive steps to address
these areas. Since, I have made
enhancements to my documentation
practices to ensure thorough and
accurate recording of patient
information.
 Clinical Instructor:
-During post conference Alysia practices
self reflection and is able to identify
areas of strength and areas of
improvement.
-Alsyia is self aware of her limitations,
she seeks help when feeling
uncomfortable, overwhelmed, unsure or
upset.
This section to be filled out by the student. Student Areas of Strength Student Areas of Strength

1. Conducting vital sign assessments 1.

with patients.
2.
2. Establishing trusting therapeutic
patient-nurse relationships. 3.

3. Enhancing understanding of the Student Areas for Future

experiences of patients with chronic Development
illnesses.
1.

Student Areas for Future 2.

Development
3.
1. Enhancing proficiency in utilizing the
Canadian Neurological Scale with
patients.

2. Building confidence in delivering

nursing interventions for patients.

3. Improving skills in providing wound

care for patients.
 Clinical Instructor Summative Comments:
Alysia is a very caring, empathetic, knowledgeable and strong student. She is a methodical individual who actively seeks out
learning opportunities, take feedback positively, and is a great team member and leader. She is a excellent communicator and
always working on bettering herself as a novice nurse. She is growing her critical thinking and assessment skills. Her
assignments are well done and her nursing process in clinical is excellent. I thoroughly enjoy supporting Alysias growth and
look forward to seeing her grow more the next few weeks.

Clinical Practice Attendance (12 Hours Per Shift)

Shift 1 Shift 2
Week 1 12 12
Week 2 12 12
Week 3 12 0

Total number of clinical practice hours absent: ___12 due to instructor cacellation_______

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

Clinical Learning Centre

Total number of clinical simulations completed /2

Total number of labs completed /5

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

Signature of Course Lead: __________________________________Date: _____________________

Signature of Clinical Instructor: __________________________________Date: _________________

Signature of Student: Alysia Forde-Klumb Date: February 13th, 2024