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 :

Danna Gonzalez
Nicolette Duperrouzel Nicholls
Judy Martin
The Scarborough Hospital Birchmount Campus
Agency
4A Medicine
06-Sep-2015 To 31-Dec-2015
168
168
168

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.
D.G. : I comply with regulatory standards, relevant legislation and the practice setting's policies and procedures. For example, I administer
medications keeping in mind the client's rights. When I want to accompany a client for diagnostic testing, I first ask for permission from the
technicians and the physician if I can join them to observe and learn from the procedure.

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

Satisfactory

Satisfactory

D.G. : I act in a responsible, ethical and accountable manner by arriving early to learn about the clients assigned to me, as well as
introduce myself to the nurses I have to work with for the day.

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

Satisfactory

Satisfactory

care.
D.G. : The three factor and practice decision-making frameworks influence client care by reminding me to always ensure the safety of my
clients based on my competency and the environment. If I feel I should be supervised when providing certain care, I seek for assistance
from a peer, nurse, or my clinical teacher. This ensures me that if something were to go wrong, someone can assist me, or I can be guided
through what I should do first to ensure client safety.

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

Satisfactory

Satisfactory

D.G. : I use evidence informed practice and a theory-based approach to care by arriving to the unit prepared with the appropriate
equipment including my pen light, stethoscope, and med cards. When I am unfamiliar with procedures or diagnoses that my clients have, I
use the computers in the unit to learn about them.

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

Satisfactory

Satisfactory

D.G. : I carry out safety-based practices and risk management principles to ensure client safety and a safe environment. When drawing up
medications from a vial or ampule, I make sure that I am a certain distance and angle from my clinical teacher or a peer who may be
watching to keep them from harm. I make sure to recap the needle before leaving the medication room to prevent any injuries.

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

Satisfactory

Satisfactory

uncertain.
D.G. : I always ask questions to clarify the plan of care, especially where there are orders that I cannot read accurately. Whenever I am
uncertain about anything, I first try to research for information myself, then clarify with the nurse to make sure that I understand the plan of
care correctly.

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

Satisfactory

Satisfactory

unsafe,
unacceptable and/or unprofessional behavior.
D.G. : I have never encountered or been in a situation that required me to seek assistance for unacceptable or unprofessional behaviour,
but I did find myself asking my peers for assistance when repositioning my clients in bed because I felt it was unsafe for me to do on my
own.

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

Satisfactory

Satisfactory

D.G. : I demonstrate understanding about the role of the nurse within health care by respecting and acknowledging the competencies of
the other members of the interprofessional health care team. Because I know that I am not authorized to perform certain medical
procedures, it is my responsibility as a student nurse to report to the appropriate personnel to ensure that the client is being properly
cared for.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
Danna practices in a competent and safe manner when providing her clients care, she seeks assistance when required (help with turning a
client, clarifying orders that she is unable to read, looks up diagnosis', treatments and medications that she is unfamiliar with). She always
appears professional by wearing the appropriate uniform and having all her equipment. She now has a clearer understanding of the nurses
role within the health care system,

2. ACCURATE AND RELEVANT COMMUNICATION

2. 1 Participate in team sharing and discussions.

Satisfactory

Satisfactory

D.G. : I have been able to participate more in team sharing discussions. This includes telling the clinical group about any new procedures
that I have done and the kinds of medications involved. One example is when one of my clients had to be given insulin, dextrose, and
Kayexalate to decrease the potassium levels in her blood before giving a unit of red blood cells.

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

Satisfactory

Satisfactory

methods.
D.G. : I feel more confident than when I first began my placement when it comes to documenting on time as well as accurately. I have
finally gotten used to the electronic documentation system in the unit. I have also learned to document specific data (blood pressure, pulse
rate, other significant findings) on clients' medication administration records to ensure that I have carefully read the instructions related to
the medication to be administered for the patient.

2. 3 Report relevant information to the appropriate personnel.

Satisfactory

Satisfactory

D.G. : In the clinical setting, I have been given the opportunity to report information to the appropriate personnel. When I have to leave to
go on my break or to accompany a client for a scheduled diagnostic test, I make sure to inform the nurse I am working with where I will be
going. If my nurse is also on her break, I report to her buddy nurse so that she is able to check on my other client while I am away.

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

Satisfactory

Satisfactory

team.
D.G. : I use different communication techniques with my clients and the inter-profesisonal health care team. When speaking with my
clients, I have to assess their level of understanding to determine the best way I can explain how medications work, and why they are
receiving it.

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

Satisfactory

Satisfactory

Protection Act (PHIPA).

D.G. : I have ensured privacy and confidentiality according to the Personal Health Information Protection Act by always logging out of the
documentation system before leaving the computer to provide care for a client or help another nurse. This not only prevents another
person from seeing another client's health information, but it also prevents documentation errors.

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

Satisfactory

Satisfactory

information.
D.G. : I have improved on using technology to retrieve and share information. During one of my shifts, I had to give a stat order of
potassium chloride to one of my clients. Because my nurse did not tell me why I had to administer it, I looked through my client's
potassium levels from the recent lab results. It showed that his potassium levels were at 3.1mmol/L, so it was an indicator that he did need
the medication to help increase the levels back up.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Danna communicates with her clients and provide education to them during her care. She is also sensitive to their cultural, religious and
other beliefs and values and will assist them to maintain their choices. She will collaborate with members of the inter-professional team
(physicians, nurses, pharmacy and other members of the interdisciplinary team) and impart relevant information to appropriate personnel.
She ensures the privacy of her clients whenever she is providing care. Danna documents clearly, accurately and precisely during the shift
but sometimes is not able to document in as timely a manner.

3. CARING RELATIONAL PRACTICE

3. 1 Use effective communication techniques.

Satisfactory

Satisfactory

D.G. : I use effective communication techniques with my clients. For example, one of my clients had to be discharged using with oxygen
therapy. When I noticed how anxious it made her seeing the oxygen tank, I helped her draw and explain the procedures of turning the
oxygen on and off. There were colour indicators on the lever of the tank which i included in the illustrations so that she can remember them
better.

3. 2 Establish therapeutic caring, compassionate, and culturally safe relationships with clients
and health care team members.

Satisfactory

Satisfactory

D.G. : I was able to establish a therapeutic caring, compassionate, and culturally safe relationship with the clients as well as the health
care team members. When I informed the dietitian and my nurse about my client's complaint of receiving meat for dinner even though her
health records indicated that she is vegetarian, I ensured my client that she would be getting a different plate of food rather than just
encouraging her to eat the rest of the plate that was not touching the meat. I have also offered to help my nurses when I found that I had
time to spare.

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

Satisfactory

Satisfactory

D.G. : I have been able to demonstrate therapeutic use of myself to foster client well-being. When I was helping a colleague change her
client's brief, we had to turn him towards me. It was difficult for him to move because of his generalized weakness, so I made sure to ask
him how he was doing, and to let him know that we were almost done to reduce the anxiety he may have felt.

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

Satisfactory

Satisfactory

have on relational practice.

D.G. : I used self-awareness to identify the effects that beliefs, values, and personal experiences have on relational practice. For example, I
noticed that one of my client's family members stayed with him the entire afternoon until my shift was over. So addition to speaking to the
client, I also spoke to the wife and children what I was doing at the moment (such as assessing vital signs). I did this because I found that
the family members always wanted to keep track of the father's health condition, as they were very close to each other.

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

Satisfactory

Satisfactory

consult appropriately.
D.G. : I collaborated with the clients and members of the interprofessional health care team by helping the client or dietitian ask questions
relevant to the care plan. For example, a couple of days before one of my clients was discharged, the dietitian had to teach the daughter
how to make thick fluids with homecooked meals so that the client would be able to eat food without any difficulty in swallowing. I was able
to tell the dietitian that the client was able to finish his meals for breakfast and lunch.

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

Satisfactory

Satisfactory

D.G. : I have been able to support the diversity of clients and the interprofessional health care team. Even if many of the clients I had were
receiving treatment for diabetes, I do not treat them all the same way because they are completely different individuals. The same can be
said about the interprofessional health care team. I do not see the social worker, dietitian and physicians as frequently as I see the nurses
in the unit, but I try to take advantage of their knowledge and ability to help me when I need to provide them information on a specific
client.

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

Satisfactory

Satisfactory

influencing their choices and decisions.

D.G. : I displayed sensitivity and respect for my client's cultural beliefs that influenced her choices and decisions after learning that going
home with an oxygen tank made her anxious. She explained to me that she was used to seeing larger tanks used in hospitals, which
always made her scared about going near or touching the tanks. I took the time to teach her how to turn the oxygen flow on and off and
that she did need to carry it while she was at home. The patient reported to me that she will probably feel more comfortable when she
spends more time using the tank.

3. 8 Provide effective client education.

Satisfactory

Satisfactory

D.G. : I was able to help provide client education with my clinical teacher when we had to administer insulin and one amp D50 before
starting an infusion of one unit of red blood cells. She did not understand why she had to receive a huge volume of sugar because she was
already diabetic. With the help of my clinical teacher and I, my client was better able to understand that the medications were being used to
help lower her potassium levels.

Teacher comments for CARING RELATIONAL PRACTICE :

Danna develops caring relationships with her clients, she provides informal health teaching to her clients and will find effective ways to
communicate with the clients. She is sensitive to their cultural diversity, religious and beliefs and values that influence the clients
decisions and choices. She collaborates with members of the health team when providing care to the clients.

4. LEADERSHIP AND ADVOCACY

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

Satisfactory

Satisfactory

D.G. : I apply appropriate conflict resolution skills in therapeutic client and other interactions. When I feel like I cannot communicate
effectively with a client who speaks another language, I ask a peer to translate for me so that I am able to report and document information
that the client reports to us.

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

Satisfactory

Satisfactory

environment.
D.G. : I always evaluate my leadership skills at the end of my shift every week. Even though I offered to help my nurses care for their other
clients, I should have taken the initiative to ask to care for a third person at the beginning of the day so that I can further challenge my time
management skills and prioritizing care to clients.

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

Satisfactory

Satisfactory

professional health care team.

D.G. : I have been able to accept feedback from the nurses I have had the pleasure to work with at my placement. They have given me
advice on taking advantage of the resources available in the unit in relation to medication administration, as well as working efficiently
when there is little time to spare.

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

Satisfactory

Satisfactory

D.G. : I have been able to advocate for the clients, myself, my peers, and the quality practice environment. Whenever one of my clients was
being transferred to another bed, I try to let those who are helping that he is weak and and experiences pain on his right leg to prevent
unintentional harm during the procedure. I also try to keep my clients' rooms clean by throwing out unused and dirty items.

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

Satisfactory

Satisfactory

D.G. : I was able to support one of my client's rights for self-determination and choice by allowing him to walk around in his room as well
as around the hall using his walker. I also supervised him as he used the shower to wash himself because he did not want to just warm
damp towels.

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

Satisfactory

Satisfactory

D.G. : I was able to respond appropriately to unsafe behaviour when I was helping my peer give her client a bed bath. He understood that
we were giving him a bed bath, but when my peer began to clean his more sensitive areas, he slapped her cheek. Rather than becoming
angry with what happened, I made sure that she wasn't hurt. I also made sure that both mine and my colleague's face was out of the client's
reach.

4. 7 Collaborate and consult when implementing health care and nursing practices that are in

Satisfactory

Satisfactory

the best interests of the public and protect the public through collaboration and consultation.
D.G. : I was able to collaborate and consult health care and nursing practices in the best interests of a client's family when they came to
visit him for the afternoon and evening. After resting for 2 hours, the sedatives had worn off and my client was finally allowed to eat and
drink. Although the client was not hungry, the family and I encouraged him to eat some snacks. One of my client's daughters brought back
homemade soup, to which he agreed to drink.

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

Satisfactory

Satisfactory

D.G. : I have been able to contribute to the creation of quality practice solutions and strategies by consulting with my supervising nurse
about when specific care should be given. When the nurse informed me that my client was to receiving nothing by mouth, I clarified with
her, the charge nurse, and the physician if he should still receive his morning medications by mouth. The nurse and I found out a couple of
hours later that we could administer him his morning medications even if they were to be given at a later time.

Teacher comments for LEADERSHIP AND ADVOCACY :

Danna is working on her leadership skills by creating a plan of care for her clients that enables them to help make decisions about their
care, she collaborates with members of the health team to verify that it is appropriate prior to providing the care. She is accepting of
feedback given to her from the buddy nurse or instructor. She is always pleasant to staff and clients, she ensures that the clients beds are
in the low position, she ensures that she implements nursing practices as she follows nursing guideline and best practice guidelines.

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.
D.G. : I have incorporated my clients' unique needs and expected outcomes into holistic and client-centred plans of care. For example,
when I had to administer Lasix and potassium chloride to one of my clients, I made sure to look at my client's current potassium levels so
that I would be able to compare them after administering medications and having blood collected from him. Although the lab results were
not available before my shift ended, I would have checked to make sure that my client's levels were within the acceptable range.

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

Satisfactory

Satisfactory

articulated competently in writing and orally.

D.G. : I have been able to improve on developing plans of care, and made sure to record them on the documentation system as patient
care notes. When also reporting to the nurse for the night shift, I make to let them know any procedures or care I provided as well as my
expected outcome. For example, I informed the nurse on night shift that the client I had did not have a bowel movement throughout my
entire shift even though he finished most of his meals and walked around his room frequently.

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

Satisfactory

Satisfactory

D.G. : I used knowledge, skill and judgement to assess my clients, as well as prioritized needs and outcomes. When I found that my client
needed to receive a unit of blood product, I wanted to make sure that I had all the appropriate supplies ready to use at my client's bedside.
With the help of my clinical teacher, I was able to set up and prime the tubing for the normal saline using the IV pump. While I waited for the
unit of blood to arrive, I used my time to assess and record my client's vital signs and made sure to keep the machine with my client as I
had to reassess them every 15 minutes for an hour after administration.

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

Satisfactory

Satisfactory

D.G. : I was able to collaborate with my supervising nurse in the evaluation and modification of our client's plan of care when we noticed
that her blood sugar levels had been consistently high through the morning and early afternoon. Although the client was administered her
antidiabetic medications as ordered and on schedule, her blood sugar levels did not decrease as much as we wanted. The nurse consulted
with the physician to speak to the client's daughter about future medications that she may need to consider if her blood sugar levels
remained high.

5. 5 Safely and competently implement and evaluate nursing assessments and nursing

Satisfactory

Satisfactory

interventions in a manner that demonstrates knowledge and skill.

D.G. : I have safely and competently implemented and evaluated assessments and interventions by performing them in an order that would
best suit my individual clients. For example, when giving bed baths to my clients, I perform a thorough integumentary assessment
throughout their whole body.

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

Satisfactory

Satisfactory

D.G. : I used the three factor and practice decision making frameworks to guide my practice. For instance, when my client needed to
receive blood product in the morning, I knew I had to ask for assistance from my clinical teacher because I had not performed the
procedure before. Ensuring that all of the appropriate equipment was in the room, I was able to prepare the tubing, assess the vital signs,
and administer proper medications efficiently.

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

Satisfactory

Satisfactory

physical
resources.
D.G. : It took some time, but I have improved on prioritizing nursing care to manage my workload, time, and physical resources. When my
clinical teacher is unavailable to administer medications with me in the morning, I make time to give my clients a bed bath or help feed
them to make use of my time.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Danna is able to plan the care of her clients, she uses the Three factor framework and will research the reasoning of procedures or
treatments or seek assistance to clarify the plan of care in situations where she might not understand the reasoning. She will give the
client a choice whenever possible so that they are able to participate in the care being provided to them. She is learning how to prioritize
her nursing care and has been able to manage the workload assigned to her.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

6. 1 Collaborate with clients and members of the inter-professional health care team to assess
clients, determine health needs, and to achieve mutually agreed expected outcomes.

Satisfactory

Satisfactory

D.G. : I collaborated with my supervising nurse and one of the physicians when my client was scheduled for an ERCP. The physician
explained the procedure to me as it occurred, and when the client returned to his bed, the nurse and I assessed his vital signs to ensure
that he was receiving enough oxygen in his system.

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.

D.G. : I contributed as a member of the inter-professional health care team by, for example, frequently checking for new orders in my
clients' charts, rechecking a health records and asking my supervising nurse to clarify any procedures and medication orders with me to
ensure than the clients are receiving quality care.

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

Satisfactory

Satisfactory

D.G. : In addition to seeking out assistance for transferring, turning and repositioning my clients on their beds, I ask for help from my
clinical teacher when performing a specific procedure I had not done before. For example, I had never administered blood products before
and because my clinical teacher knew that, she was able to guide me throughout the procedure.

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

Satisfactory

Satisfactory

outcomes.
D.G. : I have often used teamwork and conflict resolution skills while collaborating with my nurse. We communicate to each other if there
are any changes of care, who will provide which care so that we stay up to date with the client's condition. For example, when one of my
clients had not voided throughout the shift even after being administered Lasix, we had to perform a bladder scan, inform the physician of
the volume of urine in the bladder, and monitor the client before deciding on performing catheterization.

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

Satisfactory

Satisfactory

changing
environment.
D.G. : I used effective, collaborative and consultative strategies to meet the client's needs within a changing environment. One of my
clients had to be relocated into two different rooms within 24hrs. With the help of the charge nurse and the porters, we were able to move
all the client's personal items as well as his bed to the other room. I supervised the client as he used his walker to talk to the other room
and made sure there were no objects he could step or trip on.

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

Satisfactory

Satisfactory

competencies.
D.G. : I interact with members of the health care team while respecting their unique roles and competencies. For example, when my client
complained of receiving the wrong type of meal she wanted according to her diet, I knew to contact the dietitian.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Danna will collaborate with the inter professional health care team members, she is learning who they are and what their roles are while on
the unit, she will work as a member of the team to assess and provide care to the clients. Danna will assist her peers when they require
help with the care of their clients.

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.
D.G. : I act in the best interest of clients and protect them from harm through collaboration and consultation with members of the
interprofessional health care team. One of my previous patients had a saline lock that did not have a date written next to the dressing, and
there was no medication order that required an IV. I informed my supervising nurse about it, and we both decided that it would be best to
have the saline lock removed since it was not being used. We also did not want to risk keeping the catheter inserted for more than than 96
hrs.

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

Satisfactory

Satisfactory

integrate feedback into practice.

D.G. : Every week during clinical I always try to reflect on how my day went and what I could have done better. I try to take note of any
suggestions and additional information that my clinical teacher told me to research more on to that I can better understand why my client
had to receive certain medications or a certain diagnostic testing.

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

Satisfactory

Satisfactory

program (CNO).
D.G. : Based on my peer feedback, I was able to formulate a new learning plan for my future clinical experience. This included managing
my time to better prepare myself for multiple clients, and collaborating more with the interprofessional health care team to ensure that my
clients are receiving holistic care.

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

Satisfactory

Satisfactory

integrate these into practice.

D.G. : When any of my clients are scheduled for a diagnostic testing that I have never had the opportunity to observe before, I inform my
clinical teacher and the client's nurse that I will be accompanying him. This gave me the opportunity to listen to the doctor and the
technicians talk me through the procedure as it was happening. I was able to share my experience with my clinical group during post
conference.

7. 5 Use nursing research to foster professional development.

Satisfactory

Satisfactory

D.G. : To foster professional development, I arrive before my shift starts to give myself time to learn about medications I have to
administer that I am not familiar with. I make sure to write the information down so that I would not have to search the information again.
When my clinical teacher is supervising me dispensing medications from the cart, I make sure to tell her what the medication is used for
and why my client needs to take it or why the medication should be put on hold.

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

Satisfactory

Satisfactory

D.G. : I use a theory-based approach and evidence-informed practice by always researching medications, procedures, and medical
diagnoses that I am not familiar with. When my client was scheduled for an ERCP, I had to research what the procedure was and had to
look at images to understand which parts of the body would be affected.

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

Satisfactory

Satisfactory

D.G. : Although different hospitals use different versions of electronic documentation system, I have become more familiar with the
system used in the unit. It used to take me a fair bit of time to navigate through the sections, especially when I had to multiple clients,
because I had to make sure I was not documenting information for the wrong client.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Danna has grown in her role as a nurse, she is confident in the care that she is providing, but will seek clarification or guidance if she is
unsure about some of the care to be provided. She will review care provided and determine how it could be improved upon, she takes the
feedback given to her and does better next time. She uses the theory learnt in classes and implements them into practice. She researches
her medication and is aware of their uses and side effects prior to administering them to the clients, she practices the eight rights of
medication administration.

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.
D.G. : I have improved on using my critical thinking and problem-solving skills with the help of my clinical teacher. When I performed my
first in-and-out catheterization on one of my nurse's clients, I held the wrong set of tongs with my sterile gloves by mistake. Because there
was an extra pair of sterile gloves available, I was able to complete the task without having to restart the procedure entirely. I learned that I
should always try to think ahead, and come to the client's room prepared just in case something wrong happens.

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.
D.G. : I used critical thinking, problem-solving and decision-making skills to assess my clients and to determine nursing diagnoses,
expected outcomes, nursing interventions, and evaluate criteria. After my client returned from the ERCP, I made sure to assess my client's
vitals. I reported to my nurse that his oxygen saturation decreased to 89%, so I administered 2L of oxygen to him via nasal prongs, then
reassessed the effectiveness in case more oxygen had to be given.

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

Satisfactory

Satisfactory

to improve
these.
D.G. : I evaluate my critical thinking, problem-solving, and decision-making skills whenever my clinical teacher or supervising nurse asks
me a question on a procedure or medications. For example, my clinical teacher asked me why I had to give my client Lasix with the
potassium chloride. Even though I knew the Lasix did, I did not connect the two medications together until she asked me more questions
that helped me answer her question. I learned that I have to be more aware of how the medications can interact with each other as well as
affect the body.

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

Satisfactory

Satisfactory

practice to provide safe and competent care.

D.G. : I was able to integrate knowledge from my courses to provide safe and competent care. For example, I learned that my client was
going to receive Kayexalate to help lower her potassium levels. It just so happened that I learned about Kayexalate the day before in my
theory class, so I had an idea of how it worked.

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

D.G. : I feel I have improved on being able to prioritize my days at my clinical placement. When I first started, I found myself standing and
waiting to administer medications with my clinical teacher. Nowadays if my clinical teacher is helping another colleague with medication
administration or providing other care, I check if there are any new orders for my clients or check to see if my clients need to be changed.
At times I would ask my clinical teacher about how long it might take for her to help me with medication administration so that I can
provide morning care for my clients.

8. 6 Demonstrate professionalism and accountability.

Satisfactory

Satisfactory

D.G. : I demonstrate professionalism and accountability by always introducing myself to the interprofessional health care team members
whenever I speak to them for the first time. I also inform the nurses I work with the procedures I will be able to do, such as medication
administration, vital signs, and bed baths.

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

Satisfactory

Satisfactory

and guide practice.

D.G. : I use the practice decision-making and nurse-client-environment frameworks to inform and guide practice. For example, when my
client wanted to shower, I felt uncomfortable going to the shower alone with him in case he needed help to bear his weight on anything or if
he fell. I asked a peer to come with me to ensure that the client did not slip on the wet floor or had any other complications.

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

Danna has always attended clinical in her full uniform. She is aware that she is accountable for care provided to her client, she advises her
buddy nurse of care provided to her client as the buddy nurse is accountable for the client as well. Danna is able to problem solve and
make decisions when providing care to her clients, she is expanding on her critically thinking skills, with guidance she is able to work
through problems and make decisions based on the outcomes. She is encouraged to continue applying critical thinking to each situation
when providing care and planning care for the clients.

Student Final Summary with Strategies for Continued Growth

I feel I have improved on my nursing skills since I first started in September. I felt I had more opportunities to practice my skills on certain procedures
such as catheterization, caring for clients with tube feeds, provide wound care, administer injections, and use a different documentation system. I
believe that I will always have to keep improving on my time management skills because my workload is never the same every week and I know that I
can't always be assigned the same clients.

Teacher Final Summary with Strategies for Continued Growth

Danna learns from feedback given to her, she takes the feedback and improves on that area the next time (e.g. organizational time management).
She can plan, organize, implement and evaluate the care being provided to her client. She occasionally seeks out learning experiences (viewing
diagnostic procedures such as x-rays, ultrasounds, etc.). I encourage her to continue interacting with her clients/families, her peers and other
members of the health team as it will give her a greater learning experience. It was a pleasure working with Danna and I wish her all the best in her
nursing career.

Student's References
College of Nurses of Ontario. (2013). Practice Standard: Therapeutic Nurse-Client Relationship, revised 2006. Retrieved from
http://cno.org/globalassets/docs/prac/41033_therapeutic.pdf
College of Nurses of Ontario. (2014). Practice Guideline: RN and RPN Practice: The Client, the Nurse and the Environment. Retrieved from
http://cno.org/globalassets/docs/prac/41062.pdf
College of Nurses of Ontario. (2009). Practice Guideline: Culturally Sensitive Care. Retrieved from
http://cno.org/globalassets/docs/prac/41040_culturallysens.pdf

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
I enjoyed my clinical experience at the hospital as it helped me improve on my nursing skills, and enhance my critical thinking skills. I will use what I
learned from my experience at the hospital for my pre-grad experience next semester.