NURS 3020H

Clinical Evaluation
(Check one) Midterm ____X______ Final ____________

Student Name: _______Alannah Hewitt__________

Clinical Instructor: ____Holly Grieder___________

Missed Clinical Hours: __0___ Missed Lab Hours: __0___

 Program Goals
Graduates are generalists entering a self-regulating profession in situations of health and illness.

Graduates are prepared to work with people of all ages and genders (individuals, families, groups, communities and populations) in a
variety of settings.
Graduates continuously use critical and scientific inquiry and other ways of knowing to develop and apply nursing knowledge in their
practice.
Graduates will demonstrate leadership in professional nursing practice in diverse health care contexts.

Graduates will 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
Graduates will establish and maintain therapeutic, caring and culturally safe relationships with clients and health care team members based
upon relational boundaries and respect.
Graduates will be able to enact advocacy in their work based on the philosophy of social justice.

Graduates will effectively utilize communications and informational technologies to improve client outcomes.

Graduates will be prepared to provide nursing care that includes comprehensive, collaborative assessment, evidence-informed
interventions and outcome measures.
 Progress
Objectives
Indicators/Evidence S U
1 Prepared to provide 1) I have conducted a head to toe assessment at the beginning of each clinical shift. This is a collaborative
nursing care that assessment that requires multiple practical skills as well as critical-thinking. It involves skills of taking vitals (T,
includes comprehensive, P, R, BP, O2) and then using visual inspection, auscultation, and palpation to assess each of the body systems
collaborative
assessment, evidence- of the patient. It also includes gathering subjective data from the patient such as an pain levels they might be
informed interventions experiencing. It is important to conduct a head to toe assessment on each patient to gather baseline
and outcome measures. information and data that you can compare throughout your shift should there be any changes in the patients
status. A head to toe assessment also provides you as a nurse/nursing student an accurate and complete
picture of the patient to know what your priorities in care should be.
2) During the fourth week of clinical, the patient I had was experiencing significant pain. I quickly gathered
information from my patient to have a comprehensive idea of the severity, location, and description of the
patients pain. The patients pain was primarily in their back and surrounding a wound on their coccyx. I asked
a peer for their help in re-positioning the patient to one side and placing a pillow underneath their lower back
to relieve pressure off the wound. Repositioning patients is an evidence-informed practice for wound care to
both prevent pain and to promote healing of the wound by relieving any constant pressure on it. I then went
and talked to my nurse who gave my patient medication for pain relief. After 30 minutes I went back and
checked on my patient and asked their current pain levels to see if the interventions we used were effective.
3) During the second week of placement I demonstrated comprehensive care with a patient who was post-MI.
I completed my physical assessment of the patient gathering subjective and objective data, but I also realized
there was a psychosocial aspect of the patient that I should also be paying attention. It was clear that the
patient was showing signs of anxiety and stress over their upcoming catheter lab procedure as well as due to
the fact they had just had a heart attack. I asked the patient if they were experiencing any anxious feelings
which they said they were. I provided an opportunity for the patient to explain their concerns and worries. I
had the time at that moment to sit and chat with them and their family, so I did. The patient had a few
questions about the procedure of the catheter lab so I found my nurse, ensured I had the right
information/answers and then I went back to the patient to answer their questions. After this discussion the
patient stated their decrease in anxiety which I took as a positive outcome.
4) I have also demonstrated evidence-based practice through my administration of medications. Before it was
my day to administer meds, I made sure to research each medication so that I knew what I was giving to the
patient and any signs/symptoms I should be looking after administration. I always completed my 3 medication
checks before administering meds to ensure that I have the right patient, the right medication, the right dose,
the right time, and the right route. I also asked the patient for two identification identifiers (name and birth
date) before administering medications to make sure it was the right patient and to prevent any medication
errors. After administrating the medication, I correctly documented for it. I have also read through the Safe
Medication Administration policy that PRHC has which includes standards such as ensuring youre checking for
the 2 patient identifiers each time you give a medication.
2 Establishes and 1) I demonstrated my ability to create and maintain a therapeutic relationship as well use effective
maintains therapeutic, communication. During the most recent clinical week, I was able to have the same patient for both days that I
caring and culturally was in the hospital for. During both days I was able to build a therapeutic relationship with the patient. When
safe relationships
through effective giving the patient a bedbath the first day it was an opportunity to talk with the patient and start building trust
communication. and rapport with them. Talking to the patient while feeding them breakfast both days was also an opportunity
to communicate with my patient. Later in the day when the family came to visit I also had the chance to build
rapport with them as well. Through both verbal and non-verbal communication I was able to build a
therapeutic relationship. For example, sitting at eye level when talking, having open body language and even
through the use of humour as the patient use this a lot.
2) One patient that my nurse had needed a bed-bath as they were immobile and very weak, so a student peer
and myself went to give the bed-bath. The patient was very stressed about having a bed-bath and started
crying while we were gathering supplies. It was evident that the idea was very distressing to the patient. While
my peer continued to gather supplies, I talked to the patient. I asked them what they were worried about and
they expressed fear of pain and getting cold during the bath. I explained to the patient that it wouldnt be
painful, and we would do just one body part at a time and keep the rest of them covered to ensure they
wouldnt get cold. The patient calmed down significantly and said it was okay to bathe them. Through the
whole process I made sure to talk to the patient and explain each step we were doing to keep them calm and
to ensure they knew what was going on. Through effective verbal communication I was able to comfort the
patient and keep them calm.
3) I also make sure to communicate well with my peers and nurse that Im with. This ensures that my nurse is
aware of what I am doing and the status of her patient through the whole shift. By communicating with the
nurse I am helping to keep the patient safe and ensure that their status is stable, and if any change should
occur that my nurse promptly knows about it.
3 Applies the four ways of 1)An example of ethical knowing was when during a bed-bath I accidentally dropped the cloth I was using to
knowing and clean the patient on the floor. Instead of just picking it up and continuing to use it, I went to the hall and
informational grabbed a clean one. Even though it was more time-consuming to do this, it was the right thing to do to
technologies to
effectively care for prevent any dirt/germs from the floor to be put on my patient. I covered them with a blanket, lowered the bed
diverse, acutely ill and ensured they were in a safe position before going to get the cloth, and then coming back to finish the
patients. bath.
2) Another example of ethical knowing was when I took a patient from their room to the washroom. They said
they would be just a few minutes and would press the call bell when they were done. Instead of going to
another area and starting another task to do, I knew that if I left to do something else in the meantime, the
patient would then be waiting in the bathroom for me to come back and take them to their room for a long
time. I didnt think it was ethical to make the patient wait for a long time in the bathroom, so I simply waited
the two minutes for them, took them back to their room and then started another task.
3) Ive demonstrated personal knowing through the completion of both formal and informal reflections
throughout the semester. I have completed one formal reflection so far that has allowed me to look back on a
 specific learning experience of my first packing wound. I have informally reflected many times too after many
experiences, particularly new ones. For example, the first time I flushed a GI feeding tube I was able to reflect
on this new skill and also on the psychosocial impact this would have on the patient. My personal knowing has
also grown through the corresponding theory course for this clinical, NURS3000. My knowledge of acute
illnesses and providing acute care has grown significantly.
4) I have applied empirical knowing throughout clinical as well through evidence-based practice. For example,
when I had to complete a packing wound I knew I had to use sterile technique based on the location of the
wound. It was necessary to use sterile technique to prevent contaminating the wound with microorganisms
(ie, through the use of non-sterile material or just using clean technique). The process that I used for the
wound also came from empirical knowing, based on the procedure for wound packing. This involved using an
antimicrobial on a ribbon gauze to pack the wound, followed by a dry gauze dressing. This particular procedure
was done to promote healing from the inside to the outside and to prevent infection and moisture buildup
inside of the wound.
4 Adheres to professional 1) I displayed professionalism by arriving on time to clinical every shift. I always show up 10-15 minutes early
practice standards and to ensure I get on the floor on time and am entirely ready to work as soon as the shift starts.
organizational polices to 2) I also show professionalism by wearing my Trent nursing uniform properly to every shift. Im always in clean
contribute to a culture of
safety. scrubs with my name badge to every shift. I realize the importance of a professional appearance in providing
nursing care. I also always have my stethoscope with me as well as pen & paper so that I can effectively
complete assessments and document.
3) I display professional in my communication with my peers as well as with the nurses on the unit and the
nurse that I am working with each day. I introduce to my nurse each morning and communicate with her/him
what exactly I will be doing on the shift (ie, vitals, head to toe assessment, any charting, etc). I also
communicate with my nurse any abnormal findings on my patients, or if my patient needs something that is
beyond my scope to do on my own (ie, medications). At the end of each shift, I tell my nurse that Im leaving,
and ensure they know exactly what Ive done during the shift for the patient and what charting Ive done. This
also shows my accountability for my actions.
4) I contribute to a culture of safety by ensuring that any safety risks that I notice are fixed or brought to the
attention of someone who can fix them. If I see any bed that isnt at the lowest position then I will go into the
room and lower it, or if I notice any fall-risks such as items in the patients room/in their walkway then I will
move them to ensure they dont trip any patients.
5) I also demonstrate the professional practice standard of knowledge by completing my pre-clinicals and post-
clinicals each week. I fully research each patient I have beforehand to ensure that I understand the patients
diagnoses and the appropriate nursing interventions for the situation/patient. If theres something that I dont
know during clinical I will seek out the answer. For example, a patient needed a BP taken but had an IV in each
arm and I didnt know what to do so I found my nurse and asked for the correct way to obtain their BP.
5 Exercises leadership to 1) One experience that showed my leadership was during the first week of clinical that we were all assigned
enhance patient care, our own patients. There were two other students who had never given a bedbath to a patient before. With the
and support permission of each of their patients, I demonstrated a bedbath for them on one patient, and then stayed with
professionalism in
practice. them and talked them through a second bath which they worked together on to complete. I was able to take
knowledge that I had from previous experience in a long-term care facility in know how to do and feeling
comfortable in giving a bedbath and pass it on to two other students.
2) I have also shown leadership by collaborating with my student peers when taking care of patients. Being a
leader doesnt mean doing everything by yourself, it also means working effectively with the people around
you. I have helped my peers on many occasions to re-position patients, help mobilize patients, bathe their
patients, etc. In order to provide the best nursing care possible, it is necessary to collaborate and work as a
team to effectively ensure that each patient is being cared for in the best way possible.
3) I also demonstrated leadership by helping a peer to understand a Foley catheter and how to empty one.
This student had never seen a Foley catheter in practice and her patient had one but she was unsure of how to
empty it and what the procedure for that was like. As her patient was on ins & outs, I showed her where the
plastic urine measuring hats were in the supply room as measuring the urine in these is more accurate than
the bag. I showed her how to open the tubing/bag to allow the urine to flow out into the urinal hat and then
how to close back up the tubing and ensure its closed to prevent spilling. Though it was a fairly simple
procedure to explain, it was still an important one for the peer to understand how to do.

Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment)

Signature of Instructor___________________________________________________ Date _____________________________

Signature of Student__________ ___________ Date ______October 7, 2017__________