NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Final Evaluation
Student: Melissa AmosMelissa Amos
Clinical Instructor: Melissa Farrow
Clinical Placement Hospital PRHC
Missed Clinical Hours: 8

Satisfactory

Unit C2

Missed CLC Lab Hours: 0

Unsatisfactory

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, evidenceinformed 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 Final Evaluation

Course Objective
1. Explain the experience of chronic illness in individuals
receiving care in acute settings

Progress
Evidence/Indicators
Week 9:
This week I went to the wound care
clinic in order to observe chronic
wounds. I was able to examine
wounds such as stage 4 pressure
ulcers, venous ulcers, diabetic foot
ulcers, and frostbite. This helped me
to better understand how to dress
these wounds, as well as the
experiences that patient may
experience while undergoing
treatment. Additionally I was able to
see wounds that I would not have
been able to experience on my
particular floor.
Week 7:
This week I escorted a patient to the
cast clinic as well as the X-ray. I was
able to better understand their
experience of constant tests and not
fully understanding their situation.
This allowed me the opportunity to
help explain the situation and to
understand why some patients may
become anxious and nervous in the
hospital setting.
Week 7:
I cared for a patient this week with
MRSA and a perforated bowel. This
patient appeared to have been

Satisfac
tory

Unsatisfac
tory

2. Interpret critical aspects of the persons experience of

chronic illness in relation to common signs and symptoms,
responses to treatment, patterns of coping, and impact on
individual and family relationships.

undergoing treatment at the hospital

for quite a while. This patient was
interesting to deal with because not
only were they in isolation due to
their MRSA but they also did not
appear to fully understand their
diagnosis. This experience caused me
to reflect on the experiences of those
who are still processing their situation
and have not accepted the reality of
their situation. This was different
from other patients that had been on
the floor for years, and had accepted
their diagnosis.
Week 7:
The patient this week had not been
properly informed that their condition
meant that they were essentially
palliative. This meant that I had to
identify what they understood about
their condition and work from there,
as it was not my place to inform the
patient and his wife about the extent
of his condition. This also helped me
to understand their coping
mechanisms in response to their
conditions. They appeared to not
want to accept their condition so both
the patient and his wife were in the
denial phase.
Week 6:
Worked with a patient that was
experiencing extreme pain located at
the buttocks due to poor skin
integrity. This was associated with the
patients refusal to exit the bed, and

3. Identify symptoms and common medical treatments of

selected chronic illness and disease process in individuals
receiving medical, rehabilitation or long term care.

excessive voiding that occurred,

increasing the risk of skin breakdown.
I was able to assess the effect of
bedrest and inactivity along with
extreme moisture on the overall
physical and emotional wellbeing of
the individual. These were the result
of the patients coping as well as the
side effects of the medications the
patient was on that increased
voiding.
Week 8:
This week I had a patient that was
completely unresponsive to stimuli.
This patient was on a G-tube, and
also had a tracheostomy. Because of
their condition they were non verbal,
and it is believed that they are not
oriented in any way. Because of this I
observed that the patient had never
had visitors (at least while I was on
the unit) and therefore did not appear
to maintain any relationships with
those other than the nursing staff.
While it may seem unnecessary to
maintain a relationship with a person
who is unable to respond in any way I
found it interesting that because of
their chronic illness they did not have
any relations with others. This
demonstrated to me that chronic
illness can create complicated
dynamics within a family.
Week 6-10:
I have developed a firm
understanding of frequently used

4. Demonstrate selected nursing and collaborative

interventions related to palliative approach, clinical
pathways, health promotion and self-management,
functional assessment, nutritional assessment,
musculoskeletal assessment, respiratory assessment,
head/neck/eyes/ears assessment, wound care and end of
life care.

medications for those experiencing

chronic illness. This has been done
through regular post clinical
assignments and medication
administrations. I now better
understand general classes such of
drugs and their purpose, such as
laxatives, and proton pump inhibitors.
Week 9:
Identified common dressings and
wounds caused by chronic illness
while in the wound care clinic.
Understood the treatments and
dressings applied and why they were
being used for each patient.
Week 6-9:
Helped other patients to care for a
patient that was experiencing
extreme emotional changes as a
result from their diagnosis.
Researched the condition in order to
better understand the progression of
the symptoms, and how they affect
both the patient and the care that
can be provided to them.
Week 7:
Performed wound dressings
independently on a forefoot
amputation and a coccyx wound,
additionally applied ointment to a
penis. Determined the required
supplies for dressings and maintained
sterile technique when changing
them. I used more supplies than
before and had a better
understanding of the reasons behind

5. Identify potential consequences/complications of chronic

disease process and related interventions.

the use of these products, as

explored in wound care labs.
Weeks 6-10:
Perform required assessments
independently, without help from
other students or instructors with the
exception of help repositioning
patients should I need help to move
them. Rarely, if ever seek clarification
on assessments, as well as charting
and progress notes. Have adapted
progress note skills to only include
the pertinent information as needed.
Week 7:
Worked with a patient that had just
been given permission from the
orthopedic surgeon to become WBAT.
Worked with her to understand what
the surgeon was saying and what this
would mean for her care. Additionally
helped her to begin to transfer and
put more weight on her limb. This will
help her to regain more
independence and help improve her
ability to manage her own condition.

Weeks 7-10:
I have become more comfortable
independently assessing patients for
disease related consequences such
as pressure ulcers and areas of
impaired skin integrity. After these
assessments I feel more confident
independently assessing patients
charts and determining the pertinent
information for progress notes.

6. Under the supervision of a Registered Nurse, demonstrate

safe, competent, evidence-based, holistic nursing practice

Weeks 6-8:
Worked with patients that had
experienced alcohol abuse.
Understood how this abuse relates to
their current condition. Such as how
the alcohol disrupted body balances,
caused damages to the liver, CNS
and other body symptoms, and the
role this condition had on their
present condition. Understood the
role of thiamine supplements in their
condition, and other behavior
changes that are a result of the
condition.
Week 8:
Worked with patient that I had
previously had who has extreme
contractures. I know have a better
understanding of the interventions
that can be taken with the patient in
order to attempt to minimize
complications, and to improve my
own ability to care for them. For
example understanding how to move
and reposition the patient in order to
attempt to minimize potential pain
that they may or may not be able to
experience. Along with this I did
attempt to perform some range of
motion exercises to try to increase
muscle tone. Additionally, I positioned
gauze in areas at risk for skin
breakdown in an attempt to minimize
skin breakdown.
Week 7:
Working with a patient that did not

with clients with chronic illness

a. Apply nursing models and theories
Self management
Motivational interviewing
Addictions
Palliative approach
b. Demonstrate therapeutic use of self
c. Engage with patients in an ethical and culturally
sensitive manner
d. Demonstrate health promotion and illness prevention
practices
e. Demonstrate patient advocacy
f. Predict outcomes of nursing care
g. Evaluate client response to nursing care

appear was well informed about their

condition I used relational practice
skills discussed in the accompanying
theory class to attempt to understand
where they understanding stood in
relation to their condition. This
allowed me to adapt their care to
their understanding and priorities,
while maintaining my role as a
nursing student.
Week 7:
While accompanying a patient to the
cast clinic I determined that she was
anxious about the trip. In order to
help her calm down I attempted to
use myself therapeutically. I asked
her to talk me through what was
anxious and explain what the
procedure was as she did not appear
to
understand
the
process.
Additionally I accompanied her into
her meeting with the doctor as she
continued to be anxious and fearful of
being alone during the process.
Week 1-9:
I weekly have applied nursing models
and theories to my patient care, and
as the term has progress I have
become
more
comfortable
recognizing the needs of the patients
and adapting my model of care
appropriately. For example I now feel
confident
using
motivational
interviewing in order to help patients
understand what is upsetting them.

7. Critically appraise own practice in relation to nurseclient/family interactions and as a member of the health
care team

Week 7:
I worked with other team members to
help them as I was assigned the role
of team leader for the day. I helped to
be an extra set of hand or to help
perform care if they were unable to.
This helped me to better understand
my role within the collective group
and the importance of teamwork as
opposed to individual work.
Week 7:
I worked with a patient that had not
been told of their results from tests in
the morning. These tests determined
that their care would dramatically
change towards palliative. However
as a student I am not allowed to
reveal this news to the patient, as
that is the role of the doctor.
Determining what my role within the
healthcare team entailed was
important for me in this
circumstance. While I wanted to
inform him of the reality of his
situation I had to assess what was
within my scope of practice. After I
had established this I adjusted my
practice to accommodate my scope.
This was done by providing care to
the patient and when asked revealing
that I was not permitted to discuss
the results of the tests as I am only a
student and not qualified to
administer this information as I am
not well informed enough to.
Week 9:

8. Participate in professional development based on reflective

practice and critical inquiry

I visited the Wound Care Clinic in

order to develop my understanding of
wounds and how to care for them. As
a member of the healthcare team I
required to have a confidence in my
understanding of wounds, as it is
within my scope to treat them. I was
well prepared and open to learning as
much as I could from the experience
so that I as a member of the
healthcare team would be able to
provide the best possible care to my
patients. Additionally I aimed to be
able to work in collaboration with my
peers in order to continue to increase
my knowledge on the topic.
Week 7:
This week I reflected on a ethical
concern that I encountered within the
unit and addressed this dilemma
using the RNAOs BPG guidelines.
This encouraged critical thinking
about current issues facing nursing.
Week 1-8:
I have continually filled out bowel
record sheets, restraint sheets as well
as braden scales. While initially I
would simply report on may patients I
have grown to perform these records
when necessary for other students or
nurses patients. Instead of simply
reporting off bowel movements to the
respective staff/student instead I will
fill out the bowel records and inform
them of the bowel movement and
that I have documented it.

Week 5-9:
I have increased my workload from
one patient to two. This has helped
me to learn to not only prioritize but
also how to time manage. These skills
have helped me to develop and a
nursing student. I have learned about
prioritizing patient needs and
managing commitments to others as
well. For example I have learned how
to administer medications, perform
morning care and help others with
commitments I made to them within
a specified amount of time.

Areas of Strength Identified by Student

1. Proper charting
2. Seeking assistance with unfamiliar concepts and skills
3. Working with other members of the healthcare team.
Areas for Future Development Identified by Student
1. More skillfully executed progress notes
2. Increased confidence in my skills and assessments
3. Time management
Clinical Instructor Comments (All areas marked as unsatisfactory must have a
comment)

Attendance Hours Per Shift

Week
1
Week
2
Week
3
Week
4
Week
5

Thu
rs

Fri

Week 6
Week 7
Week 8
Week 9
Week 10

Thu
rs

Fri

Total number of clinical hours completed: /160 Hours

Clinical Component Outcome:

Satisfactory

Unsatisfactory

Clinical Learning Center Completed (to be completed by Course Lead)

Satisfactory

Unsatisfactory

Signature of Instructor:

Date:

Signature of Student:

Date: