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NURSING 4020/21/22 Clinical Evaluation – MIDTERM

NURS 4020/21/22 Clinical Evaluation: Midterm

Student: Alicia Jeffery Preceptor: Pina Boni

Faculty Advisor: Jaime Sims Clinical Practice Site: KHSC- Kidd 6

Nature of Clinical Practice (Check all that apply) Practice hours completed _____140________

The setting is: The population is primarily:

__x___Hospital/Inpatient Unit _____Adults with medically-related health needs


_____Hospital/Ambulatory or Day Program __x___Adults with surgery-related health needs
_____Hospital/Critical or Emergency care _____Children or adults with mental health needs
_____Community/Community Health _____Intrapartum families/mothers and newborns (not NICU)
_____Community/Home Care _____Older adults requiring support
_____Community/Long Term Care _____Healthy adults
_____Industry/Occupational Health _____Families/Neonates requiring critical care
_____Other _________________ _____Adults requiring intensive or critical care
_____Persons requiring emergency care
_____Children with medically or surgically related health needs

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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.

Before completing the evaluation form, students and preceptors should review the objectives and sub-objectives. While students and
preceptors should comment on each of the seven course objectives, it is not necessary to write comments about each sub-objective. It is
better to provide specific and detailed comments about a few sub-objectives than to write broadly about many.

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Assessment for Midterm Evaluations:

Satisfactory Progress (SP): The student demonstrates sufficient knowledge, and skill and ability to safely practice or achieve a competency with an
average level of teaching support and guidance; or the level of performance is what the instructor would expect of an average student at that level
and point in time; and the instructor reasonably anticipates that if the student continues at the current pace of practice and achievement, the student
should be able to fully meet the objective at the end of the course.

Unsatisfactory Progress(UP): The student does not demonstrate sufficient knowledge, or skill, or ability to safely practice or achieve a competency,
even with constant, intensive teaching support and guidance; or the level of performance is far below what the instructor would expect of the
average student at that level and point in time; and the instructor reasonably anticipates that if the student continues at the current pace of practice
and achievement, the student is not likely to meet the objective at the end of the course.

Needs Development(ND): The student demonstrates sufficient knowledge and ability to safely practice or achieve a competency, but requires more
than average teaching support and guidance; or the student demonstrates knowledge but needs more practice to achieve the competency; or the
level of performance is below what the instructor would expect of the average student at that level and point in time; and the instructor reasonably
anticipates that if the student focuses his/her learning in the required area, and gains sufficient practice, the student has the potential to meet the
objective at the end of the course.

Objectives Progress
Indicators/Evidence S UP U
1 Within the scope of practice and knowledge of a fourth - During shifts, when I discover something I do not know
year BScN student, continually demonstrates professional enough about, I write the topic down and later research 
conduct in accordance with CNO standards for nursing those topics/skills
practice and ethics: - Introduces self to patients before assessment, explains what I
a. Critically appraises own interactions with clients will be doing, re-introduces self when patients appear
and team members confused/have forgotten who I am
b. Demonstrates accountability and accepts - Displays initiative by being willing to learn and agreeing to
responsibility for own actions and decisions perform skills that I feel I am competent enough to perform
c. Demonstrates a professional presence and models - With each shift that I complete, I am feeling more
professional behaviour comfortable with skills and more comfortable on the floor
d. Consistently identifies self by first/last name and and around the patients in general
student designation to clients and team members - Each clinical shift, when I come across a topic that I do not
e. Displays initiative, self-awareness, and with time, know about, I write this topic down on a list. Examples of
increasing levels of confidence in role things I have put on my list: certain medications, certain

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f. Demonstrates effective and collaborative problem- surgeries, certain illnesses, and certain drug reactions. Later, I
solving research these topics so that the next time I encounter them,
g. Uses effective approaches to managing conflict I will have more knowledge and be able to provide better
h. After critically reflecting on learning needs, care
a. Recognizes individual competence within - I made learning goals and developed a timeline to address
scope of practice and seeks support and how to meet these goals. I am progressing towards my goals
assistance as necessary of improving my assessment skills, applying dressings, skills-
b. Participates in professional development based techniques and IV medication administration. I am also
exceeding my goal for the number of patients I am safely able
to care for.

Preceptor: Alicia has demonstrated significant progress on her clinical


skills. When she first started, she looked so terrified and quite honest
that she doesn’t have sufficient skills. i.e setting up secondary IV meds,
initiating feeds, applying wound dressings and the like. But she showed
her willingness to learn and listened to suggestions given. She observed
for the first and seconds shifts, asked questions and clarifications and jot
down notes. Made readings and researches about the diagnosis of our
patients/type of surgeries they had, so she can develop plan of care.
Alicia always introduces herself prior to providing care to patients. She
made her learning goals and is continually working on achieving them.

2 Within the scope of practice and knowledge of a fourth - When I found a confused patient in the hallway, without 
year BScN student, continually demonstrates that the pants on, I quietly and calmly covered her up and assisted her
primary duty is to the client, to ensure safe, competent, back to her room, to maintain the dignity and privacy of the
ethical nursing care patient
a. Advocates and intervenes, as needed, to ensure - I always checked arm bands for identifiers and confirmed
safety of the person requiring nursing care name and DOB with the MAR before administering
b. Uses effective strategies to maintain a patient's medications
privacy and autonomy - Disposes of all paper with patient-identifiers on it before
leaving the unit. Maintains patient privacy and confidentiality
- Followed the 10 rights of medication administration
- I always wear the correct PPE with correct donning and
doffing technique. For example, when caring for a patient

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with MRSA, I donned and doffed a gown and gloves with


correct technique.
- I practice the 4 moments of hand hygiene
- I promptly document all care I provided in the progress notes
section, Kardex, MAR and/or tick sheet as per hospital policy

Preceptor: I have observed Alicia and I agreed to her self evaluations


above. She always use patient identifiers every time she delivers care
esp. when giving meds and when sending patients off the unit for
procedure. She maintains patients’ confidentiality by keeping the charts
closed in the wall unit. She also makes sure that she always provides
patients with privacy by closing doors/curtains. To site an example, she
had a patient admitted to the floor but who had to stay in the hallway
temporarily on a stretcher while waiting for a bed to become available.
The patient had incontinent stools, so she asked assistance to wheel him
down to the sunroom, covered the glass windows with bedsheets and
eventually cleaned him up. My only suggestion is for her to try hard to
document initial assessments promptly in the progress notes esp. that
there are lots of healthcare team members using the chart, as much as
possible late entries should be avoided.

3 Within the scope of practice and knowledge of a fourth - Evaluated competence and level of confidence at beginning of 
year BScN student, demonstrates safe, competent and semester and acknowledged that I did not have enough
ethical nursing practice in the area of relational practice: experience or knowledge to safely care for patients
a. Engages in critical self-reflection independently. Also recognized that all equipment and supplies
a. evaluates own emerging competence in the used at this site are different than those I had been trained to
area of relational practice use. Discussed this with preceptor and independently made a
b. identifies personal, professional and timeline to address when I would increase the number of
systemic barriers to development patients I cared for. Also researched the supplies and equipment
c. prioritizes learning in the area of relational and completed the mandatory learning packages.
practice - Works with preceptor each shift and asks questions when I am
b. Effectively uses self to initiate, maintain and unsure and assists preceptor with other patients when needed.
terminate relationships Answers call bells for other nurses’ patients.
a. creates therapeutic, caring, and culturally - Introduces self to patients during each assessment and re-
safe relationships introduces self when necessary. Always introduces self to patient
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b. uses principles of supportive counselling family members as well. I always update the patient’s white
and motivational interviewing to help boards
clients set goals, identify problems, find - Listened and empathized with a patient who expressed sadness
solutions after waking up from surgery with a permanent ostomy when
c. Demonstrates she thought she would be able to have a temporary ostomy. I
i. empathy listened to, asked questions and allowed the patient to vent her
ii. attentive listening and sensitive feelings.
questioning
iii. mutuality and reciprocity in Preceptor: Alicia can safely provide/deliver nursing cares to all her
relationships patients. She asks questions and support regarding the proper usage of
iv. advocacy unfamiliar equipment or for any skills that she’s not comfortable doing.
c. Works collegially and in concert with other health She deals with patients and families professionally, tries to answer their
professionals to facilitate appropriate, timely care queries and directs them to staff/preceptor if unable to deal with. Alicia
also fosters a therapeutic, caring and culturally safe environment in the
unit. She takes time to listen to patients and provides emotional support
if needed. She is very quiet and I suggest her to work collegially to other
health care members for better and effective delivery of care. Ie: physio,
PCA, RT, unit clerks and other nurses. Ex. If pt needs to mobilize with
physio, ask them what time they plan to do it so she can provide
meds/analgesia at least 30 minutes ahead so patient can do better with
mobilization, or coordinate with PCA when they’re doing a shower for pt
so she can plan to prepare supplies needed for dressing changes and
have time to request from stores if not available. Help to answer call
bells for other nurses to have opportunity to know other patients.

4 Within the scope of practice and knowledge of a fourth - Completes journals each week. Takes a considerable amount of 
year BScN nursing student, demonstrates safe, competent time to reflect on the week in order to complete the journals.
and ethical nursing practice in the area of clinical decision- - Administers all narcotic medications under the supervision of my
making: preceptor and ensures proper disposal of narcotics if necessary
a. Informed by the discipline of nursing, integrates - Disposes of all sharps and biohazardous waste in the correct
nursing knowledge with knowledge from the basic areas
sciences, health sciences, humanities, research, - I applied Abdellah’s 21 Nursing Problems theory to the care I
and ethics completed on a patient for one of my weekly journals
a. Applies models, theories, and frameworks - Applies Johnson’s 7 subsystems to patient care. An example from
from the discipline of nursing practice: the patient’s affiliative subsystem consisted of her
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i. Chooses appropriate models for sister, her husband and a few close friends who visited her in the
specific client situations and clinical hospital and provided support. These individuals would also be
settings doing her care after discharge. The patient’s dependency
b. Continuously demonstrates critical inquiry, included the need for education and tracheostomy care. The
scientific inquiry, and clinical reasoning as patient was able to meet her ingestive and eliminative needs
evidenced by: independently. The subsystem of achievement also needed
a. Using new understanding to identify nursing interventions. The patient and her family stated they
problems, propose solutions, find evidence were feeling overwhelmed with performing the tracheostomy
for and against proposed solutions, and care so my preceptor and I helped to guide the sister through
evaluate proposed solutions performing it and helped when necessary. The needs of each
b. Challenging the status quo subsystem should be met in order to attain balance and stability
c. Performing focused reflection, connecting (aka health), according to Johnson.
new experiences to existing knowledge,
thinking creatively, using nursing judgment
Preceptor: Alicia was able to provide effective health teachings to pt and
family who are ready for discharge and needing to do own care at home
(like trach care and dalteparin injections). She was able to explain and
demonstrate them in the proper way and in return ask and observe them
do it.

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5 Within the scope of practice and knowledge of a fourth - Recognized a potentially dangerous situation when a patient’s
year BScN student, demonstrates safe, competent and feeds had become disconnected and leaked during the night.
ethical nursing practice in the area of planning, Patient indicated he felt that he had low blood glucose levels and
implementing and evaluating nursing care: was symptomatic, so I got the help of my preceptor to test his
a. Uses the nursing process to blood glucose levels and initiate the hypoglycemia treatment
a. recognize, gather and analyze data from pathway. Documented all care and continued to monitor after.
multiple sources to develop a plan of care - Identified that decreased staffing and increased patient loads are
b. recognize actual or potential life- stressors affecting the interprofessional team
threatening situations - Documents all assessments, input and outputs, IV fluids, 
c. implement appropriate interventions to medication administration, PRN administration. Spent time
prevent complications during initial shifts to look at the methods of documentation
d. document and communicate assessment used on the unit so that I would be able to complete
data, plan of care, interventions and documentation independently and correctly
patient responses or outcomes - Always evaluates effectiveness of PRN administration to ensure
e. teach the client, consistent with the acuity, symptoms are managed effectively. For example, I administered
complexity, readiness, ability and needs of gravol for nausea and vomiting. About 30 minutes later, I
the patient and family evaluated its effectiveness by asking the patient if their
b. Integrates own knowledge with the client’s symptoms had subsided. The patient stated less nausea and
knowledge and preferences, and factors within the vomiting and was feeling better. I evaluated this as effective and
health care setting, to plan, implement and documented this.
evaluate care - When taking vital signs, many patients’ blood pressures have
a. identifies gaps in own knowledge been high. I evaluate this by first assessing if the patients have
b. Identifies client’s knowledge and symptoms, asking them if they usually have high blood pressure
preferences and looking through their chart to see if they have a history of
c. Seeks and evaluates new evidence to hypertension or lf their blood pressure has been high the past
support nursing action couple shifts. I also look and see if they have antihypertensive
d. Uses many kinds of evidence to inform medications ordered. I document all of these assessments and
nursing actions alert my preceptor if I feel there is an issue or if I need help
e. Recognizes the resources and limitations of assessing this
the health care setting
c. Appraises outcomes of nursing care Preceptor: Alicia has been doing proper assessments, able to recognize
d. Demonstrates collaborative action within the and report actual and potential life-threatening situations and provide
nursing and health care team proper interventions. Example: patient with high blood pressure and
hypoglycemic patients. She knows the sequence of providing nursing

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a. Collaborates with other providers to assess interventions to such, evaluates her nursing actions and documents them
outcomes of health care in the chart.
b. Identifies environmental, physical and
psychosocial stressors affecting the inter-
professional team
6 Within the scope of practice and knowledge of a fourth - Read learning package about special diet and implications after 
year BScN student, demonstrates enhanced knowledge of bariatric surgery. Completed a paper about the marginalization
nursing and health related to indigenous populations, of bariatric patients for another course, which required research
women's and environmental health, aging and rural into the subject. I will now be able to apply this knowledge with
populations, and other marginalized populations: future bariatric patients.
a. Identifies gaps in care delivery - I completed a discussion post about the marginalization of
b. Challenges status quo approaches to caring for patients with ostomies for another course. This required
marginalized populations research and reflection on my previous practice. I can now
c. Recognizes the unique pathophysiology of disease understand the experience of this marginalized population.
states and implications for care of special - Cared for an older man with dementia. I frequently re-oriented
populations including those with prolonged lengths the patient to the hospital and frequently re-introduced myself. I
of stay, bariatric patients and older adults asked the patient simple, answerable questions. I gave the
d. Consistent with student role and novice patient some time and space when he became agitated, but
practitioner, recommends and initiates changes in ensured he was safe from a distance.
practice - During one shift, I was assigned the care for an older man who
only spoke Cantonese. Since he did not speak English, it was
difficult to communicate with him. I used simple words and
gestures in order to assess him and his pain. The patient was able
to communicate this way. I also recognized resources such as
using a hospital-provided translator if this was necessary. I
recognized that the language barrier could have been a barrier to
his care

Preceptor: Alicia is flexible and able to provide individualized care to


indigenous, aging and marginalized populations. She was able to provide
effective care to a patient with a language barrier, a patient with
dementia and patients with ostomies and VAC dressings.

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7 Within the BScN student's scope of practice and - Made timeline addressing how I would progress with increasing
knowledge, assumes the responsibility and care of patient load. By week before midterm I have worked up to a 4-5
patients: patient load on days and a 6 patient load on nights. Completing
a. Demonstrates safe and effective care of patients: all care and documentation with moderate guidance and help
a. Initially, and with a high level of supervision from preceptor
and support from the preceptor, the - Shadowed preceptor and assisted with full patient load first two
student will manage an assignment of two- shifts. Then had one heavy patient that I did care on with high
three clients level of support and supervision. Now I am caring for up to 4-5
b. By midterm, the student will be managing patients on days and up to 6 on nights.
at least 2/3 (e.g. approximately 3-4 on day - Completes head-to-toe assessment, vitals and documentation
shift) the preceptor’s client assignment with with no to minimal assistance. Administers oral medication with
frequent support and guidance by the no assistance, administers medication through G-tube/J-tube
preceptor with minimal support, administers IV medication and feeds with
c. By the conclusion of the practicum, the minimal support, administers subcutaneous injections with little
student will independently and with needed support. At the beginning of this clinical placement, I
minimal supervision by the preceptor, required maximal assistance for all these tasks. With time, I have
manage an assignment equivalent to 2/3 become more independent.
the preceptor’s usual assignment. - Uses username and password to log into the Omnicell to get
b. A fourth year nursing student is able to carry out medications. Prepares medications before administering
the following nursing activities: - Primes and sets up primary and secondary IV lines with little
a. Assessment assistance. Sets up feeds with little assistance.
i. Biopsychosocial, head-to-toe, - Uses the hospital’s online resources to look up IV drug
focused, mental status, pain compatibility and administers the IV medications in the correct
ii. Vital signs: TPR, BP, SaO2 way as per this resource
iii. Situational stressors and coping - Takes bloodwork via venipuncture with maximal assistance
pattern - Researches patient medications before administration
iv. Medication administration - Gives report to nurse who is covering my patients while I go to
v. Basic knowledge of the medications break. Writes report on Kardex at end of shift with little
prescribed assistance
vi. Classification - Always comes to clinical shifts prepared, in uniform and on time
vii. Purpose - Is always prepared and willing to learn. Asks preceptor for
viii. Possible side effects clarification and support. Encourages preceptor to watch me
ix. Adverse effects complete skills and asks for feedback
x. Interactions with other drugs

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xi. Appropriate dose/route - When administering medications, I always check the patient’s
xii. Implications for nursing care wrist band with the MAR and ask the patient to state their name
b. Health Teaching and date of birth before administering medications. I engage in
i. Identify client/family learning needs patient + family teaching about medications. A patient's family
ii. Collaborate with team to develop member asked what pantoprazole was and I explained it’s uses
plan to meet client’s learning needs and how it worked to the family member.
iii. Implement aspects of plan within - Completed a discharge. I removed IVs and went over the
scope of practice as a learner discharge summary paperwork with the patient, educating him
c. Psychosocial/Relational Practice about care for his laparoscopic sites in the community and
i. Recognize and acknowledge client answering questions he had about pain medications. Recognized
distress as it arises a potentially dangerous situation and told patient not to drive
1. Demonstrate empathy, while taking narcotics. I also ensured his wife was picking him up
active listening, sensitive from hospital due to administering narcotics earlier in the day.
questioning - Completes all documentation with little assistance
2. Apply principles of - Took report from a nurse on another unit for a patient we were
motivational interviewing receiving
3. Offer support - I assist patients with ADLs such as helping them to the bathroom,
4. Engage in problem-solving as changing briefs, repositioning patients, etc. I assist patients and
required, in collaboration other staff members to ambulate and transfer patients. Have
with others as needed assisted to transfer a patient with a slider board.
ii. Team Communication - After each shift, I reflect on my performance. For example,
1. Discuss any abnormal during the fourth week of my placement, I took time to reflect on
findings related to the how much I had improved in comparison to what I was able to do
patient assessment with during my first shift
preceptor, staff nurse,
physician, team member Preceptor: Alicia has been handling a full patient assignment since after
2. Seek assistance/ask her second week of clinical shifts. She only requires assistance from
questions before doing preceptor if patient’s acuitiy rises/changes and if there are new nursing
procedures for the first time, skills that she’s not familiar with. She’s been taking 4-5 patients on day
or for anything about which shifts and 5-6 patients on nights. She only needs minimal supervision in
is uncertain. basic nursing cares, sometimes need reminders but most of the time,
3. Report to team leader/staff delivering cares on time. She acknowledged that she still needs
nurse when leaving the floor assistance with venipunctures, so I suggest her to volunteer herself to do
bloodwork for other nurses especially on night shifts to have more

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and arrange for coverage of practice. Also work with other nurses to inform them that she’s willing to
patients help esp. if there are new/exciting skills such as insertion of foley
d. Basic Nursing Care/Activities of Daily Living catheter, initiation of heparin infusion, blood transfusion, etc.
i. Hygiene, skin care
ii. Nutrition, elimination, intake/output
iii. Ambulation/transfers
e. Nursing and Collaborative Therapeutic
Interventions
i. Determine which interventions are
required, what resources, including
support and supervision are
required, and schedule interventions
in consultation with the client
ii. Complete interventions as
appropriate and within scope of
learner practice
f. Relationships
i. Work with the staff to learn and
deliver excellent patient care
ii. Maintain a professional manner in
dress, behaviour and conversation
iii. Assist others with patient care as
time and scope of practice permit
iv. Welcome all opportunities to learn
and practice new skills
g. Evaluation and Documentation
i. Document vital signs and
assessments in the appropriate
areas of the chart for assigned
patients, accurately and concisely,
ASAP after assessment
ii. Use institution’s system of
documentation for nursing process
and patient progress

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iii. Reflect on own performance


independently during and after each
shift
iv. Reflect on and seek clarification of
any feedback from the instructor,
who may receive feedback from the
staff.

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Student and Preceptor Comments


Student: Overall, I think I have progressed significantly since the start of this placement. I am now more comfortable on the unit
and can provide most care independently for a full patient assignment. I will continue to ask for help and supervision when
necessary for new skills, higher acuity patients and for bloodwork/venipuncture and IV insertions. For the final month of this
placement, my goals are to: 1) Continue to practice and perfect my assessment skills, with emphasis on respiratory assessment
and the assessment of wounds; 2) Work with other healthcare team members to not only build professional relationships, but to
also get help and volunteer myself to help with new skills and skills I need practice with; 3) Focus on practicing venipuncture and
IV insertions; 4) Continue to improve my knowledge of different surgeries and medications by researching them.

Preceptor: I am happy with how Alicia is doing. I can see that she has gained more confidence and is comfortably delivering care
to a full patient assignment. She just needs to continue what she’s doing and continue to work on the areas that she thinks she
needs more practice with and don’t hesitate to ask questions and clarifications. Always take initiative to every learning
opportunity on the unit.

Faculty Advisor Comments (All areas marked as unsatisfactory must have a comment)

Signature of Preceptor_____________________________________________________ Date______________________________

Signature of Student_____________________________________________________ Date ______________________________

Signature of Advisor_____________________________________________________ Date _____________________________

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