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Self Assessment

2016 - 2016 - Final NURS - 208 Course Learning Outcomes (201509)


NUR 208 Practical Nursing Practice 4 (PN, 06-Sep-2016 - 09-Dec-2016)
Student : Tiange Cui
Clinical Teacher/Preceptor : Mercelies McHugh
Program Coordinator : Judy Martin
Location : William Osler Health Centre/Etobicoke General
Hospital
Placement Setting : Agency
Unit/Office/Clinic : 7W Neurology
Description : Neurology is a unit that required high quality and
speedy care that can delivery to patients. As a fast
workplace, it expects the nurses are able to prioritize
tasks and time managed. Therefore, it is challengeable
but also a great working and learning experience.
Students with adjustment will know how to apply
knowledge effectively and deal with patients under
stress, they will be more competent in the future
practice.
Period : 06-Sep-2016 To 09-Dec-2016
Student hours : 196
Required Hours : 196
Validated hours : 196
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

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

procedures.

T.C. : Timely arrived at the facility; followed dress code; prepared equipment ; maintained hygiene standards; documented correctly; ensured safety.

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

T.C. : Was able to prior 30 minutes to the facility for assigned patients. Dressed properly and maintained hygiene; Ensured safety based on three

frame- work elements. Documented timely and correctly. Therapeutic communication with clients. Cooperated and collaborated with other health care

providers. Reported if any unsafe or potential factors that would harm the client.

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

T.C. : The three factor contains nurse, client, and an environment. The decision-making expects the nurse can effectively collect the information and

use it to prioritize the care with a critical thinking that covers all the factors. For example, when I care for multiple patients, there is client need bedbath

while another need medication, I would give medication first. However, when I went to the medcow and many nurses lined up to wait. Considering the

1 hr before and after for med, and both were stable based on vitals, I would give bath and then get the med for clients.

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

T.C. : Reviewed the clients for preparation, researched and applied knowledge based on the information. Updated care plan timely.
Satisfactory Satisfactory
1. 5 Carry out safety-based practices and risk management principles to ensure client safety and a

safe environment.

T.C. : Lowest bed and put side rails up before leave. Kept clear pathways. Free restrain environment for clients. light control. call bell in reached.

Locked bed and wheelchair.

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

T.C. : Participated change shift report and nursing round. Seek help from the primary nurse or the instructor if any unsure that would potentially cause

harm to clients.

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

unacceptable and/or unprofessional behavior.

T.C. : Once I dealt with a confused client who was trying to take off the nasal prone, I was trying to communicate with her while she started to hit me.

At this time, I ask help from the primary nurse to get the advice that can effectively solve the problem.

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

T.C. : Caregiver, educator, advocator , organizer, communicator.

Therefore, maintaining the safety within three factors is really significant. Nurses are obliged to be accountable who can deliver a safe care and keep

clients' privacy. Also, they are expected to work both inter-professionally that can provide a holistic care for clients,

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :

Tina has become more conscious of her professional attire and is usually prepared for her clinical practice. Her research is more thorough.
This is reflective in her medication administration. She is professional and respectful in her approach and readily asks questions when
unsure. Her practice has been safe.

2. ACCURATE AND RELEVANT COMMUNICATION

Satisfactory Satisfactory
2. 1 Participate in team sharing and discussions.

T.C. : Performed an effective teamwork. Participated nursing round and report. Presented own idea and communicated with other caregivers.

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

T.C. : Be able to finish necessary documents that are expected followed by the hospital policy. Knowing to add additional notes such as focus note

for abrupt changes.

Satisfactory Satisfactory
2. 3 Report relevant information to the appropriate personnel.

T.C. : Effectively communicated with the client's family members to get support and understanding. Reported any severe condition or change that

need to be further assessments or interventions to the primary nurse and the instructor. Even be able to communicate with the physician about the

client's situation.

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

T.C. : Active listening with a client to show my attention. Effective communication with other care providers. Ensure extra need for an effective

communication.
Satisfactory Satisfactory
2. 5 Ensure privacy and confidentiality according to the Personal Health Information Protection Act

(PHIPA).

T.C. : Be accountable and didn't explore any personal information to people out of the circle of care. Follow PHIPA and CNO documents. be careful

with social media use. Committed to clients' privacy safety and maintain trust.

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

T.C. : Be able to use proper resources to support my action and behavior for care or group works (e.g. presentation with video play, use online

resources for medication search, etc.)

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Tina continues to develop and improve her communication skills, both verbally and in writing. Having a better understanding of the
electronic charting, she is able to now document in a more timely manner. Her questions and contribution to group discussion are usually
spontaneous and thought provoking. She promptly reports significant findings,not only to the teacher, but also to the primary nurse. She is
better able to retrieve needed information both from the clients'binder as well as the electronic chart.

3. CARING RELATIONAL PRACTICE

Satisfactory Satisfactory
3. 1 Use effective communication techniques.

T.C. : Be able to active listen to my clients and show my respect and attention. Maintained eye contact while was cultural sensitivity if the client

preferred not as the culture. Used body language when in any situation that can help a better understanding. Assessed the additional needs that can

facilitate a communication.

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

health care team members.

T.C. : Always reflected my own culture and compare with the client culture to aware how these affect my actions, Always showed respect and

communicated with clients to maintain a therapeutic relationship. For example, one day a client's family requested an immediate bedbath while my

colleague who had time is a male. The client's family preferred another female nurse. Therefore, I showed my respect and explained the situation to

allow them to think and decide. Finally, they were okay to let me work with the male nurse.

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

T.C. : Active listening was really helpful especially in a complex unit such as nero that the pts are more stressed and anxious. Once a client was on

isolation and complained pain. I checked his vitals and history there was no specific indication showed pain. I talked with him, with PQRSTU,

communicated with him. Later on when I left he told me he had no pain. Sometimes the patient need extra attention might emotionally felt pain and

when I use therapeutic methods which can improve the well-beings

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

relational practice.

T.C. : During my care, I always introduced myself. I also evaluated my own beliefs and its implications on client care. Previous experience in LTC

helped me realize the seniors are more vulnerable and isolated, so this would bring me more sense when I cared senior client in the unit.

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

appropriately.
T.C. : I would seek or confirm with the physiotherapist and my nurse preceptor about transferring and positioning if the client is high risk for fall.

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

T.C. : Addition to above, I would also talk with nutrition therapist/client/family member for any diet preference. I would also respect any concern of the

patient. I would work with language interpreter if any language barrier, etc.

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

influencing their choices and decisions.

T.C. : For some religion issue, they would not accept the blood transfusion. In this case, I would like to present the benefits and risk factor and my

recommendation. However, I would still respect their decision and try to find another way to maximize the care that the client can receive.

Satisfactory Satisfactory
3. 8 Provide effective client education.

T.C. : For some patient have diabetes while wanted some high sugar or sodium food. I would do some more education and to collaborate with the

family members. If they refuse to change, I would communicate to promote the education plan or seek assistance.

Teacher comments for CARING RELATIONAL PRACTICE :

Tina's care delivery is with compassion and selflessness. Often she would forgo her personal needs to meet those of her clients. She is
sensitive and kind and is able to readily bond with not only the clients but also the families. Her ability to communicate is spontaneous,
warm and safe, as she is able to maintain the boundaries of professionalism. .

4. LEADERSHIP AND ADVOCACY

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

T.C. : One day I was helping my patient while the patient next to my pt was asking help. By the time there was no one to response her (she didn't use

call bell, just yelling). I answered her and asked if she was okay, she said she need water and very thirsty. I explained to her that I am cleaning my pt

and it's unsafe to leave the pt in half way. She can wait for me to finish or she can use call bell. The point was to show the attention and attitude to

assist.

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

environment.

T.C. : Effective communication with care providers. Maintained accountability and responsibility to clients, professions and myself. Use feedbacks

from people to reflect own actions and values, etc.

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

professional health care team.

T.C. : Always communicated with people, ask for advice. Used k4y as feedback references to self-evaluate. Also, I would like to share my ideas with

people.

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

T.C. : Performed appropriate care to clients to maintain safety and meet needs. Be able to reflect own behavior and actions and to improve my own

practice. Followed policy and kept hygiene. Ensured a safe environment for both staffs and clients.
Satisfactory Satisfactory
4. 5 Support clients rights for self-determination and choice.

T.C. : Effectively conducted culture assessment, therapeutic communication. Encouraged them to make decisions and supported the autonomy.

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

T.C. : A patient's BP was abruptly high and it was time to change incontinence pad, while it was unsafe with this high BP. I decided to pause

everything and reported to preceptor for further interventions.

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

best interests of the public and protect the public through collaboration and consultation.

T.C. : Reported to the preceptor or the manager If any elements that would harm the client. Always checked the MAR for any discontinued med and

clarified the order.

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

T.C. : Followed the policy, CNO standards. Performed effective communication and collaboration. Used consultations from other care providers,

Referred credible resources to support the care, etc.

Teacher comments for LEADERSHIP AND ADVOCACY :

Tina is able to advocate for herself, her peers and clients. She takes responsibility for her own actions. for example an experience with a
near miss medication error. She was able to identify the source of the potential risk and learned a positive lesson regarding the three point
check. She leads by example. Is always gainfully engaged, self directed and focused. She contributes to a positive work environment and
through collaboration is very supportive of the group. Is a team player.

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

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

plans of

care.

T.C. : For example, I will concern pt who has language barrier would be more risk in isolation. Therefore, I would like to communicate more with them

just to show my attention.

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

competently in writing and orally.

T.C. : Based on the MAR, assessments, and the client's request, I will use a concept map to plan my care and try to maximum support the client.

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

T.C. : Last time my pt appeared tachypnea and she asked to change the diaper immediately (it was dry), I explained the situation and reported to the

instructor. Then we checked the order gave prn med and reassessed. Then I reconfirmed if the client still needs to change.

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

T.C. : Continue the above, the prn med was to give q6h, so after 6 hr I still checked vitals even though it was stable. Then the breathing rate was

normal so I didn't give any more and just gave schedule med on time.
Satisfactory Satisfactory
5. 5 Safely and competently implement and evaluate nursing assessments and nursing interventions

in a manner that demonstrates knowledge and skill.

T.C. : Under the guideline of the preceptors, I have been learning to use knowledge and skills effectively with a continuous evaluation. As I talked, I

am able to perform a proper plan and action based on the change of the conditions.

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

T.C. : Based on the client's needs, hospital policy, and nursing standards, I always create, review, and update care-plan for clients conditions and

know what to prioritize.

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

resources.

T.C. : Effectively reviewed the documentation of the client, used more proper worksheet for data collection, be able to teamwork and use access for

resources for a safety care. In this way, I have more idea and confident to deliver a proper care, and will be more eficient.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :

Through weekly data collection and client assessment, Tina was able to develop client centered, theory based care plans with a holistic
approach.Through this process she was able to develop and reflect a satisfactory level of knowledge,skills and judgment. Through
problem solving and prioritizing she was able to use her critical thinking skills to create nursing diagnoses and interventions, She has
recognized the need to further develop her workload and time management. She fully understands and appreciates the value of the three
factor framework and how it impacts practice and ultimately client outcomes.Her adaptability to stressful and changing situations is
developing.She was able to witness how quickly a client's condition deteriorated to the point of arresting. This happened during having his
breakfast. This proved to be a learning opportunity.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

Satisfactory Satisfactory
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.

T.C. : Talked with physicians or other therapists and participated the nursing round, Also, performed effective communication with clients and the

family.

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

needs and expected outcomes of clients.

T.C. : one time my patient's IV site was leaking, after fixed by the nurse, there was a therapist for ROM, so I told her might need more attention for

the site at antecubital.

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

T.C. : A patient who was urged to exercise, so I actually talked this with preceptor first and then I got chance to meet the physical therapist.

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

outcomes.

T.C. : Always performed teamwork no matter for my patient or my peers' patients. Used therapeutic communications skills to deal with conflicts.
Satisfactory Satisfactory
6. 5 Use effective, collaborative, and consultative strategies to meet clients needs within a changing

environment.

T.C. : Time managed to make sure all the medication can give properly if the patient has any test that would leave the floor.

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

T.C. : Communication, learning, and questioning, they are all great ways to learn and interact with people.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Tina was able to observe and interact with the inter professional team by attending weekly bullet rounds and huddles. She has gained
insight and a greater sense of how each member of the team brings to the table a specific and unique level of competency that impacts
client care through consultation and collaboration. The aim is to set goals and develop ways of meeting these goals that will ultimately
foster better client outcomes. She has gained a greater sense of the importance of the nurses role in identifying clients' needs, not just
physical, but also psycho social needs.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

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

consultation with members of the inter-professional health care team and through competent and safe

practice.

T.C. : As I mentioned, the client who wanted to walk while her condition seemed not competent. I talked to the therapist see if there is anty way that

could help the client to solve this,

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

feedback into practice.

T.C. : Effectively used k4y for feedbacks and delf-reflection tools. Participate the post conference, etc.

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

(CNO).

T.C. : Used k4y for self-improvement. Searching and readings to build up knowledge. Ensured the safety of clients and the care that I provided.

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

integrate these into practice.

T.C. : Similar to above, with a consistent learning plan, I will be orgab=nized to know the resources for learning and how I can evaluate my work. If I

feel this is really helpful, I will apply the idea to the practice.

Satisfactory Satisfactory
7. 5 Use nursing research to foster professional development.

T.C. : Be able to use the hospital resources. Searched medications with proper resources, read CNO documentations for self-regulation. They all

develop profession knowledge.

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

T.C. : Regarding the data (initial and updated) and knowledge, I will implement my care plan more safe and helpful for clients.
Satisfactory Satisfactory
7. 7 Apply knowledge of changes to the health care system, technology, and in society as these

affect nursing practice.

T.C. : Sometimes if the vitals appeared abnormal while the patient seemed fine, especially in many patients, I would manually assess to confirm.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Through ongoing self reflection, peer review, and feedback, Tina was able to identify her strengths and areas of her practice that needs to
be further developed by creating a learning plan. Time and workload management, and knowledge development were identified as learning
goals. She expressed concern regarding her readiness for her pre grad rotation. She is encouraged to continue to seek out new learning
opportunities that will enhance her level of competence and thereby her ability to cope with the increased demand that she will experience
moving forward.

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

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

care.

T.C. : First of all, I think critical thinking and problem-solving skills are key pieces to nursing that need to be continuing to develop in life-long, while I

did see my improvement throughout the semester. One instance, a patient only scheduled one diabetic oral med at 1000. Consider the BS was

slightly high compared to previous(still in normal), critical thinking, I gave the med right after she finished meal at 0900

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

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

T.C. : Continue above, after this, the priority for my client is LOC and BS. Critical thinking, the pt is high risk in fall because she can walk, she needs

extra instruction.

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

improve

these.

T.C. : Always reviewed my action and data by documentations and reflect my own care. The way I design to improve is using a concept map to guide

my next care.

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

provide safe and competent care.

T.C. : I still need to develop to build up my knowledge base while I did learn a lot through the semester such as administering med by NG tube, etc.

Satisfactory Satisfactory
8. 5 Prioritize effectively.

T.C. : Prioritization is still a skill that I will work on in my career while there is a progress. As shown previously, I can deal with multiple clients and

multiple tasks and know how to prioritize them.

Satisfactory Satisfactory
8. 6 Demonstrate professionalism and accountability.

T.C. : Followed the policy, nursing standards. Maintained safety for client, nursing and environment. Applied proper action and knowledge in different

situations. Culture respect.


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

guide practice.

T.C. : One method is post conference that we can review the care we provided and improve it.

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

In as much as Tina has made much progress in this area, it is one that can not be exhausted. Hence further development is needed through
ongoing research and knowledge acquisition. Her concept care mapping reflects a satisfactory ability to assess, identify and prioritize
problems through critical thinking. She is able to create nursing diagnoses, determine expected outcomes and nursing interventions.

Student Final Summary with Strategies for Continued Growth

Time management: I want to be more organized and more controlled. I eventually can adapt the workload while I would expect that I can have extra
time left just for anything that might need extra time (extra education, family members talk etc.)
Critical thinking and decision making (prioritization): I would expect myself be more independent and confident in my plan. So far I still would like to
double check to confirm my next step with them sometimes.
Knowledge base: Even it's the third semester, while I feel that I still need to learn a lot. I need to plan for some review study and also more readings.
Overall, it was a great learning experience and I got lot help and inspires from my instructor, the nurses, and my peers. Thanks for everything.

Teacher Final Summary with Strategies for Continued Growth

Tina has completed this course satisfactorily. She has made much strides in her ability to plan and organize her client care. She has improved on the
consistency of her research effort, creating concept care maps and in general better able to adapt to the needs of her clients. She shows readiness for
her pre grad rotation in that she is able to practice safely and to some extent dependently.

I do suggest you continue:


Ongoing knowledge development through research.
Be guided by self reflection and ongoing feedback.
Ask when in doubt.
Keep current with CNO and maintain continuing competency.

Student's References

CNO, WHO, Canadian functional nursing, 5th Edition

Grade Satisfactory Unsatisfactory

Referred to Clinical Excellence Committee (CEC)

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

Thanks for the great help from my instructor throughout the semester and I will keep working hard.

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