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 :

Lara Pabandero-de Lasan

Emillie Etcubanez
Judy Martin
William Osler Health Centre/Etobicoke General
Hospital
Agency
10W Resp
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.
L.P.L. : I comply with regulatory standards, relevant legislation and the practice settings policies, procedures, student guidelines from
Humber College and also the William Osler Health Centre/Etobicoke General Hospital policy as well.

E.g. Everyday I arrive on the floor on time, with proper uniform, Id Badge, white toe covered shoes with no holes, no hoop earrings, etc. As
per Humber College policy, we have to bring an analog watch to clinical/sims however, the hospital prefers if we don't wear watches for
infection control so I remove any jewelry on my wrist and fingers and keep the watch in my scrub pocket. Also one example of following
practice setting policy is documenting my nursing interventions within the required timeframe (1hr), formally filling out a medication
request form to fax to the pharmacy so that my pt can get the required medication needed etc.

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

Satisfactory

Satisfactory

L.P.L. : I act in a responsible, ethical and accountable manner by coming to the unit on time, letting the primary nurse and break partner
know when I am leaving and coming back from break and giving them information needed so they can cover for me safely while I am gone.
When taking down client information, I only take information I need for the care for that day, do not talk about my patients to personnel so
are not authorized or outside of the unit and not take other information that can identify them to other people. I do not discuss the client
information with others, and all information stays at the unit. I keep passwords for the med cow, meditech safe and always log out when I
leave the computer.

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

Satisfactory

Satisfactory

L.P.L. : As an RPN I can work autonomously, however when there is a change of my pts status and they suddenly become very unstable,
it is vital that I have been communicating with my primary nurse the interventions that I am providing and knowing when my knowledge
and experience are limited and need help and/or collaboration with the primary nurse or transfer the pt to my primary nurse.

I had an experience where the pt wasnt mine, however I was asked by the charge nurse to help out the agency primary nurse. The pt
was vomiting black ground coffee emesis and had a liquid consistency, black stool. At first I gave her the kidney basin because she said
she felt like throwing up. I gave her some time before I went in to change her incontinence pad. A few moments later she was throwing up
and having loose BM at the same time. That is when I called for help with my fellow classmates to help me change her however the pt
didnt stop vomiting and having BM. At that time we were looking for the primary nurse for at least 10 minutes. When the primary nurse
finally came, we collaborated with her on the plan of care.

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

Satisfactory

Satisfactory

L.P.L. : I used evidence informed practice and theory-based approach to care each time I interact with my pt, entering and leaving the
room, changing gloves, ect. are the times I need to do hand hygiene. Evidence proves that it is the single most important intervention for
infection control. Another example is while giving SC injections, drawing IV, using all my theory based knowledge to approach those skills
for the safety of my pts and myself.

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

Satisfactory

Satisfactory

and a safe environment.

L.P.L. : I ensure pt safety and safe environment by carrying out safety-based practices and risk management principles for each pt by
putting up the side rails when the client is in bed, putting at arms reach the items they need so that they do not have to reach for things
(e.g. call bell within reach, tissue box, table beside them, water etc.) Orienting pts to the call bell so that when they need to get up or need
something, I am there to either provide it to them or supervise them to go to the washroom.

Mrs. C was able to walk to the washroom, so I oriented her that she needed to press the call bell when she needed to go to the washroom
because it was important to have her shoes on and that I assist her to go to the washroom for her safety and to prevent injury of falls.

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

Satisfactory

Satisfactory

uncertain.
L.P.L. : Whenever I am unclear about something, I seek assistance from my clinical instructor or the nurses on the floor. I came back from
lunch and I went to check on my pts chart and MAR to see if there are new doctors orders. Sometimes it is very hard to read the
physicians writing, and at times I feel frustrated because I am not able to read what the doctor wants. I asked one of the nurses how they
can read the orders and she said sometimes you just have to get used to how the doctor writes. You learn and get used to each doctors
penmanship. If I am uncertain about the changes in the plan of care I make sure to clarify it with my primary nurse and/or my clinical
instructor.

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

unsafe,
unacceptable and/or unprofessional behavior.

Satisfactory

Satisfactory

L.P.L. : My patient this week, I noticed that his bed was a little high even when the nurse had left him already, from nursing literature and
from work experience (PSW) I am used to leaving the patient in the lowest level possible so that if they were to have a fall, the height of the
bed would be very low. I mentioned that to my nurse if I could lower the bed when we were about to leave him at the beginning of the shift
and she said yes that would be preferred, but she justified the nurse from the previous shift that there was a very small falls risk for him
because he was not able to move, (he was unresponsive at one point in the early morning) so that was not a priority. The bed was also
hard to work with, but whenever I had finished doing my assessments or any type of care for him, I tried to leave the bed at a lower level for
his safety.

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

Satisfactory

Satisfactory

L.P.L. : My patient this week, I noticed that his bed was a little high even when the nurse had left him already, from nursing literature and
from work experience (PSW) I am used to leaving the patient in the lowest level possible so that if they were to have a fall, the height of the
bed would be very low. I mentioned that to my nurse if I could lower the bed when we were about to leave him at the beginning of the shift
and she said yes that would be preferred, but she justified the nurse from the previous shift that there was a very small falls risk for him
because he was not able to move, (he was unresponsive at one point in the early morning) so that was not a priority. The bed was also
hard to work with, but whenever I had finished doing my assessments or any type of care for him, I tried to leave the bed at a lower level for
his safety.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
Lara had excellent attendance and she was consistently prepared for clinical. In addition, she is able to manage her two patient
assignment independently and when she is uncertain or needs help she has asked for clarification and assistance in a timely manner.

2. ACCURATE AND RELEVANT COMMUNICATION

2. 1 Participate in team sharing and discussions.

Satisfactory

Satisfactory

L.P.L. : The opportunity is given to us to participate, every post conference to share and discuss the interesting things that we learned or
encountered during each shift. It helps me, personally because I am able to share the plan of care (suctioning, packing and cleaning
wound, priming an IV, injections) that excites me as a nursing student that I will be doing on a regular basis. Also other information that
the unit nurses want to get across to the students such as the documenting time limit of within an hour, or documenting on Meditech the
Diabetic medications especially if a pt is receiving insulin on a sliding scale, or on standing order.

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

Satisfactory

Satisfactory

methods.
L.P.L. : After this clinical rotation, I am confident to document electronically using Meditech, my first time using it. I document on a timely
manner clearly, accurately and concisely each clinical day. I am very empowered when my clinical instructor trusts me, whenever I show
her my documentation she used to go through every single thing I did to make sure I documented correctly. But since shes seen how I
document, I believe that she is confident it is being done correctly. After midterms she now just asks as a reminder if documentation has
already been done, which the answer is always yes this shows that she is satisfied with the way I document correctly. However when I
need guidance with documenting something I have not done, I do not hesitate to ask for help.

2. 3 Report relevant information to the appropriate personnel.

Satisfactory

Satisfactory

L.P.L. : I report relevant information such as food/fluid intake, urine output (when necessary), and care given to appropriate personnel,
even though I already charted it, I still verbally report it to the primary nurse.

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

Satisfactory

Satisfactory

team.
L.P.L. : I use communication techniques with the client and the inter-professional healthcare team on a regular basis. Such as touch, eye
contact and soft spoken voice to pts and one communication technique I used with the inter-professional healthcare team is the
medication request form when one of the medication dose of my patient was increased by the doctor, the dose on the med cow was now
incorrect. I used that form to communicate accurately what was needed and the medication was given in due time.

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

Satisfactory

Satisfactory

Protection Act (PHIPA).

L.P.L. : When I take client's information from their Kardex, I do not include anything that would distinguish who they are. No name,
address, or anything specific to him. Just the medication, diagnosis, medical history etc. In addition to that, I keep my password for the
computers in the unit to myself and do not share it with anybody.

When a procedure is being done, I make sure that the curtain is drawn to ensure patient privacy.

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

Satisfactory

Satisfactory

information.
L.P.L. : I use the computer in the unit and go on Meditech to research the client's care plan, diagnosis, medication etc. to help me with my
plan of care. Also when there is a new addition to the medication list on the MAR, I go on the computer and use the Lexi Comp, or when no
computers are available I use my cellphone to use the drug app to help me find information about the new medication and put the phone
away when all research is done.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Lara frequently participated in post conference by sharing new experiences attained during the clinical experience and by initiated
discussion by asking questions. Also, she documented the vital signs of her assigned patients within 1 hour and ensured that all
assessment documentation was complete prior to lunch break. All necessary information was reported to primary nurse and covering
student nurse before breaks and at the end of shift. Lara became proficient in retrieving patient lab report, using lexi-comp for IV
administration research and reviewing consultation notes for a thorough health history of the patients. Furthermore, she is able to
communicate abnormal findings with the primary nurse and collaborate with the primary nurse to identify possible nursing interventions to
be completed with her scope.

3. CARING RELATIONAL PRACTICE

3. 1 Use effective communication techniques.

Satisfactory

Satisfactory

L.P.L. : Communication techniques from the CNO, Therapeutic Nurse-Client Relationship, (2006), such as announcing myself, my name
and stating that I am the nursing student that will take care of the resident for that shift, addressing the client by the name and title they
prefer (e.g. their first name instead of their surname or vice versa) because that is what they feel comfortable to be called with.

Starting with these techniques for each new client assignment helps to the client to become more comfortable with a new face that they
haven't seen before, and acknowledging that they are in charge of their care, that they have the right to know who is caring for them and
the procedure to be done for them or to them.

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

Satisfactory

Satisfactory

L.P.L. : I establish therapeutic caring, compassionate & culturally safe relationships with clients and health care team members so that a
holistic nursing care is given to patients. Like when I had a client who wore a bandana on her head to cover her hair, she had it off and on
the chair during the night shift, I noticed it and asked the client if she wanted to wear it after I provided her with the morning care. She
really appreciated that I asked her and I noticed that she felt safe and comfortable having the bandana on her.

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

Satisfactory

Satisfactory

L.P.L. : The therapeutic use of self to me that would relate to my client is explaining to my client each step that I would do so that he knew
what was happening with his care. (I will turn you over now, you might feel some bumps under you because of the diaper change, etc.) I
believe that it helped with the client well-being because he knew what was being done for him. One pt I observed that he was more at ease
whenever I explained the procedure being done to him and everytime there would be position changes I would inform him.

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

Satisfactory

Satisfactory

have on relational practice.

L.P.L. : For me, I was aware that if I told the patient what happens during care he was more compliant and willing to help when he can.
Because I know for myself when I go to the doctor's office I am thankful when they tell me what is happening throughout the whole
procedure so that there are no surprises. Explain the procedure and the steps throughout the care, giving client choice and a chance for
their preferences. I can relate to this when my mom when for a knee surgery, she was shy to ask what the nurse was doing to her
everytime the nurse came in, the nurse would just do the skill/procedure (post op unit) and leave without explaining or telling the rationale
for each plan of care. When she got home I was the one changing her wound dressing and explaining to her the importance of around the
clock scheduled pain meds, she was very proud and happy at the same time that I could explain it to her, made her feel more comfortable
and confident in the nurse (me) taking care of her.

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

Satisfactory

Satisfactory

consult appropriately.
L.P.L. : I collaborate with the members of the inter-professional health care team like the speech therapist, she is very approachable and is
happy to explain the procedures she is doing with the patients. I was there when she observed and assessed my pt on her swallowing, to
change her diet getting ready for discharge, so that it can be documented from NPO to puree and thin liquids because the client was very
verbal and will let the HCP know when she is ready to swallow.

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

Satisfactory

Satisfactory

L.P.L. : For the staff in the unit like the Nurses (RN, RPN, maintenance, the people in charge of giving the trays for the clients etc.) I have
had a chance to interact with them in the unit, it is always nice to get along with everybody even though there are differences in culture or
ethnicity or title. I observed how the diversity of clients and the healthcare team can create a therapeutic relationship especially for the
clients with language barriers. I had a client who did not speak English however, when her neighbour talked to her in their language, I was
able to explain that it was safer for her to use the call bell when she needed to go to the washroom because she was a falls risk patient.

3. 7 Display sensitivity and respect for clients cultural, religious, and other beliefs and values
influencing their choices and decisions.

Satisfactory

Satisfactory

L.P.L. : Please see above point 3.6 and

I display sensitivity and respect for clients cultural, religious and other beliefs and values influencing their choices and decisions because
each client is different, they have different needs and specific ways of going about their day and care and that needs to be incorporated in
their care. Whatever their beliefs maybe, it needs to be respected and their choices and decisions should be supported. E.g. refusing to
eat meat because it is prohibited by their religion etc. so then other means of protein can be administered through fluid supplements like
isosource with fiber or vegetables rich in protein can be offered.

3. 8 Provide effective client education.

Satisfactory

Satisfactory

L.P.L. : For each patient, whenever I administer medication I state what that medication is and what it is for. Mrs. M had about 20
medications and for each one she asked me what they were for, educating pts effectively for example about their medication, it involves
them be part of the plan of care, and become more knowledgeable about their health.

Teacher comments for CARING RELATIONAL PRACTICE :

Lara effectively communicates with the patients, members of the patients family and the health care team by demonstrated genuine
empathy and caring presences. In addition, she uses self-awareness to identify areas of improvement which has been demonstrated in her
learning plan.

4. LEADERSHIP AND ADVOCACY

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

Satisfactory

Satisfactory

L.P.L. : I applied appropriate conflict resolution skills in therapeutic client interactions when I was with a client who was very confused and
was very combative when giving care and verbally abusive especially early in the morning at the start of shift. I first checked on my pt and
received bedside report. She was already loud and restless, she did not know she was in the hospital and was always looking for her
husband. I approached her and introduced myself to her, she was happy to have somebody stop and listen to what she wanted to say.
With that, she was calmed a little bit and I addressed her worry, which was where is my husband. I just kept on asking her questions and
prompted her to find out more of her thoughts. She believed she was still in the nursing home and looking for her husband, all she wanted
to do was to see her husband. I reassured her that I would look for her husband and when I saw him I would let her know right away. She
let me do the morning care, however she did not want her incontinence pad to be changed and started being very aggressive. So I put the
side rails up, covered her up with the blanket so she doesnt get cold, left the bed on the lowest level and walked away to give her some
time to calm down. I stayed out of eyesight but I was just behind the curtain so that I could still monitor her. I gave her time and that
worked, when I came back her mood changed and I again introduced myself and carried on with morning care. I addressed her worry
about her husband while changing her diaper and that seemed to ease her worries.

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

Satisfactory

Satisfactory

environment.
L.P.L. : As the weeks go by I constantly evaluate and reevaluate and refine my leadership skills to develop solutions and create a positive
work environment. I am very open to having my peers look at a new dressing or a different procedure being done. This week it was the
whole group who saw and assisted me to pack a wound that was stage IV. With my enthusiasm and leadership skills, it is helping create a
positive work environment where everybody could learn and refine their skills.

4. 3 Provide feedback to peers and accept feedback from peers and members of the interprofessional health care team.

Satisfactory

Satisfactory

L.P.L. : I provided feedback to my peers and accepted feedback when we had to submit the self evaluation forms to the clinical instructor.
Giving feedback and accepting feedback lead to reflect on skills that I excel in and some that still need improvement such as speaking up
and being confident and not second guess myself when I have to speak to a doctor.

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

Satisfactory

Satisfactory

L.P.L. : I advocate for clients, myself and others and quality practice environment like when I noticed the suctioning canisters being full, I
advocated for myself and my peers for a quality practice environment on a new learning practice of the unit policy or preference of
documenting in the Meditech along with the insulin are the diabetic medications given, even though it has already been signed in the MAR.
(New information for my classmates and I).

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

Satisfactory

Satisfactory

L.P.L. : Supporting clients' rights for self-determination and choice like giving them the choice of not eating the food tray because her
husband brought her favourite egg sandwich made from home. She still ate her lunch just not the hospital lunch that was provided, she
had a better lunch in her point of view, which I would agree with.

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

Satisfactory

Satisfactory

L.P.L. : One patient I had was taken out into the hallway but she was very agitated in the hallway and wanted to go back to her room
however the room was being cleaned and the floor was still wet and unsafe to walk on. So I reassured and tried to calm her down that the
floor was wet and we needed to wait for it to dry. I tried to distract her with activities and talking to her so that she would forget even for a
little while to want to go back to her room.

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.
L.P.L. : Protecting the public and my family when I remove the scrubs I had on in the unit before going home. To prevent infection and for
bacteria to be passed around on the TTC and I put my uniform in the was right away so that my family is also prevented from contacting
anything that got into my uniform (specially with contact precaution residents that I care for).

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

Satisfactory

Satisfactory

L.P.L. : Quality practice such as hand washing when hands were visibly soiled and rubbing sanitizer whenever I enter and leave a patient's
room or whenever I put on and remove my gloves to contribute to the creation of quality practice strategies of infection control.

Teacher comments for LEADERSHIP AND ADVOCACY :

Lara has demonstrated her ability to constructively provide and receive feedback through her accurate completion of the peer and selfevaluation.

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 clientcentred plans of
care.

Satisfactory

Satisfactory

L.P.L. : I incorporate the clients unique needs and expected outcomes so that a holistic nursing care is given to patients. Like when I had
a client who wore a bandana on her head to cover her hair, she had it off and on the chair during the night shift, I noticed it and asked the
client if she wanted to wear it after I provided her with the morning care. She really appreciated that I asked her and I noticed that she felt
safe and comfortable having the bandana on her. It was as if she needed it to get better, it was her belief and unique need to have it beside
her or on her, which I provided.

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

Satisfactory

Satisfactory

articulated competently in writing and orally.

L.P.L. : Submitted the concept map to the clinical instructor and it was a theory-based plan of care that was holistic and client centered,
articulated competently in writing and orally about one of my clients diagnosis, pneumonia.

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

Satisfactory

Satisfactory

L.P.L. : Prioritizing and planning out my day was important so that everybody is able to go on break, everything done on a timely fashion
etc. Able to plan my day e.g. Assessing the client at the beginning of the shift, giving am care then breakfast & wait 30 minutes at least
before putting the head of the bed at a lower position after meals.

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

Satisfactory

Satisfactory

L.P.L. : I collaborate with the nurse and my CI in modifying my plan of care for my client to achieve a holistic plan of care for my pt. I
discuss my plan of care with the nurse and then implementing. When my client was complaining of nausea and she kept asking why it
wasnt prescribed to her, I collaborated with my primary nurse and we found out that her diagnosis contraindicated medication such as
Gravol. Or another pt where she was in a lot of neuropathic pain, she had a standing order of hydromorphon but was still in a lot of pain
because of her cellulitis, I looked in the plan of care, she had PRN meds of more pain medication, and right on time the doctor was on her
way to see the pt, so after meeting with the pt, her Lyrica medication was increased with positive effects.

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

Satisfactory

Satisfactory

interventions in a manner that demonstrates knowledge and skill.

L.P.L. : With the same pt as point 5.4 after administering the newly changed dose of pain medication, I monitored her pain by using the
pain scale, her vitals and patients perspective and facial expression, to see the therapeutic effect of the medication. Also after providing
medication, was when I did the wound dressing change so that the medication would have been given enough time to work, because even
just touching her legs she would be grimacing. She was very thankful and relieved after the dressing change.

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

Satisfactory

Satisfactory

L.P.L. : As an RPN I can work autonomously, however when there is a change of my pts status and they suddenly become very unstable,
it is vital that I have been communicating with my primary nurse the interventions that I am providing and knowing when my knowledge
and experience are limited and need help and/or collaboration with the primary nurse or transfer the pt to my primary nurse.

I had an experience where the pt wasnt mine, however I was asked by the charge nurse to help out the agency primary nurse. The pt
was vomiting black ground coffee emesis and had a liquid consistency, black stool. At first I gave her the kidney basin because she said
she felt like throwing up. I gave her some time before I went in to change her incontinence pad. A few moments later she was throwing up
and having loose BM at the same time. That is when I called for help with my fellow classmates to help me change her however the pt
didnt stop vomiting and having BM. At that time we were looking for the primary nurse for at least 10 minutes. When the primary nurse
finally came, we collaborated with her on the plan of care.

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

Satisfactory

Satisfactory

physical
resources.
L.P.L. : To manage workload, time and physical resources it is important to prioritize nursing care and interventions or simply planning
when to do the care is important. I had an ISOLATION case this week where I had to remind myself to prioritize and think of a plan so that
once I was in the room, I did not need to leave the room and regown again. This way it was not time consuming and it did not tire me out
going in and out of the room (putting PPE on and off). E.g. gathering all the equipment for am care, and meds checked by my CI so going
in and out of the room would not be cumbersome. Gave perineal care before changing the wound dressing and provided morning care
before changing the Gtube dressing etc.)

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Lara has progressed very well in her management of her two patient assignment by completing necessary assessments, providing am
care, and medication administration in a timely manner, while also identifying and completing other nursing care such as wound care, foley
catheter management and insertion, monitoring feeds, providing trach and g- tube site care as needed.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

6. 1 Collaborate with clients and members of the inter-professional health care team to assess

Satisfactory

Satisfactory

clients, determine health needs, and to achieve mutually agreed expected outcomes.
L.P.L. : I collaborate with the nurse and my CI in modifying my plan of care for my client to achieve a holistic plan of care for my pt. I
discuss my plan of care with the nurse and then implementing. When my client was complaining of nausea and she kept asking why it
wasnt prescribed to her, I collaborated with my primary nurse and we found out that her diagnosis contraindicated medication such as
Gravol. Or another pt where she was in a lot of neuropathic pain, she had a standing order of hydromorphone but was still in a lot of pain
because of her cellulitis, I looked in the plan of care, she had PRN meds of more pain medication, and right on time the doctor
(collaboration) was on her way to see the pt, so after meeting with the pt, her Lyrica medication was increased with positive effects.

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.

L.P.L. : I contributed as a member of the inter-professional health care team and responded to the changing needs and expected outcomes
of the clients when my client was experiencing a lot of pain, after noticing that her pain medication dose increased, I carried out the order
and monitored my patient for the therapeutic effect of the pain meds, I also gave the medication time to be absorbed before providing
dressing change so that she wouldnt be in a lot of pain while doing the procedure.

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

Satisfactory

Satisfactory

L.P.L. : When doing transfers with the ceiling lifts I would seek out assistance with the unit staff. Or if I needed some assistance with
something I ask for help and consultation with the nurse or my CI. The unit nurses are very generous with their knowledge and most are
more than happy to help especially with clients who have preferences. Knowing patient preferences help with providing safe and
compliant care, and helps in a therapeutic client nurse relationship.

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

Satisfactory

Satisfactory

L.P.L. : I help my peers with what they needed when I was able to for teamwork and concensus building and to avoid conflict (e.g. when I
need help they would be willing to help me out as well because I helped them when they needed someone). When giving a bed bath with a
heavy resident, I would ask if they needed an extra set of hands and hope that vice versa they would do the same. (Common courtesy)

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

Satisfactory

Satisfactory

changing
environment.
L.P.L. : One client is always being moved from one room to another, he is just waiting for a room in a long-term care facility. I would go
and visit him, because I believe that he knows my face, because everytime I have a chance I would go and visit him for a few minutes, most
of the time in a different room with all of the equipment in the opposite side as from the last room etc. The daughter expressed her
appreciation when she saw me visiting her dad. She thought that it made him more confused because he was always confused because of
the room changes and she was grateful that I would come to say hello even though he was not assigned to me.

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

Satisfactory

Satisfactory

competencies.
L.P.L. : I note to myself who is who (rpn or rn, administrator etc.). Also interacted with the OT when he was conversing with my pt in the
hallway because my patient has been bedbound and restrained . The tray deliverers, the maintenance all help to provide a holistic health
care approach to the residents. However, I would avoid talking to the secretary, and would use other resources that I can to find out what I
needed.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Lara is a team player she offers assistance to her fellow nursing students and coordinates her care with her patients based on her
assigned patients preferences. She also collaborates and consults with the primary nurse and clinical instructor when she is learning a
new skill and when assessment findings for a patient is abnormal.

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.
L.P.L. : Same as point 6.2, I acted in the best interest of my client, waiting for the medication to work before providing the painful dressing
change that had to be done daily, which shows competent, safe and holistic nursing care.

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

Satisfactory

Satisfactory

integrate feedback into practice.

L.P.L. : I engage in ongoing reflective practice to identify strengths, areas for improvement and integrate feedback into practice using the
Quality Assurance program from the CNO website, and received feedback from my peer and integrate it into my QA to be handed in same
as this week

7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance
program (CNO).
L.P.L. : Learning plan consistent with QA program is also due to be handed in this week.

Satisfactory

Satisfactory

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

Satisfactory

Satisfactory

integrate these into practice.

L.P.L. : By being vigilant and observant I was able to seek out learning opportunities and feedback that foster professional development
and integrate it into practice. (Changing the suction containers, first time to do that, seeking out if IV lines need to be primed or 2ndary
lines to be changed and also primed etc.)
Also had the opportunity to prime primary IV line, D/C catheter and more.

7. 5 Use nursing research to foster professional development.

Satisfactory

Satisfactory

L.P.L. : I was able to utilize nursing, theory and literature to improve my nursing practice when I did my scholarly paper about pediatric
cystic fibrosis this semester. (E.g. nursing research such as our ebooks to research for our concept maps on a specific medical diagnosis
of a patient and prioritizing nursing interventions)

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

Satisfactory

Satisfactory

L.P.L. : I was able to utilize nursing, theory and literature to improve my nursing practice when I did my scholarly paper about pediatric
cystic fibrosis this semester. (E.g. nursing research such as our ebooks to research for our concept maps on a specific medical diagnosis
of a patient and prioritizing nursing interventions)

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

Satisfactory

Satisfactory

these affect nursing practice.

L.P.L. : Always educating myself and reminding myself that there are changes to the health care system, technology and society as it
affect nursing practice. (Meditech software, being used in the unit for documentation etc.)

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Lara consistently sought out learning opportunities by assessing her patients needs and identifying nursing interventions documented in
the plan of care while also asking other floor nursing for other possible learning opportunities.

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.
L.P.L. : Using a care plan as a tool, helps me complete my care responsibilities and nursing interventions in an organized manner. It
helped me utilize my problem-solving skills to inform decision making in all aspects of nursing care by helping me to point out the
ineffective or maladaptive aspect of the client's progress.

E.g. Knowing to administer pain meds before performing a painful wound dressing, and evaluating that the increased pain medication dose
has a therapeutic effect.

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.

Satisfactory

Satisfactory

L.P.L. : Using a care plan as a tool, helps me complete my care responsibilities and nursing interventions in an organized manner. It
helped me utilize my problem-solving skills to inform decision making in all aspects of nursing care by helping me to point out the
ineffective or maladaptive aspect of the client's progress.

E.g. Knowing to administer pain meds before performing a painful wound dressing, and evaluating that the increased pain medication dose
has a therapeutic effect.

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

Satisfactory

Satisfactory

to improve
these.
L.P.L. : I engage in ongoing reflective practice to identify strengths, areas for improvement and integrate feedback into practice using the
Quality Assurance program from the CNO website, and received feedback from my peer and integrate it into my QA to be handed in same
as this week.

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

Satisfactory

Satisfactory

practice to provide safe and competent care.

L.P.L. : I was able to utilize nursing, theory and literature to improve my nursing practice when I did my scholarly paper about pediatric
cystic fibrosis this semester. (E.g. nursing research such as our ebooks to research for our concept maps on a specific medical diagnosis
of a patient and prioritizing nursing interventions). Also with in-services at work such as infection control, proper ROM when providing
care and CPR at work and in class help me provide safe and competent care.

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

L.P.L. : Using my care plan and being able to change and modify it throughout the day to accommodate the client and their needs. I am
able to prioritize effectively incorporating the time that I need to go on my morning break, and the time I need to give medication and
morning care along and using my critical thinking skills in helping me decide what can be done after my break and what needs to be done
right away in the beginning of the shift.

8. 6 Demonstrate professionalism and accountability.

Satisfactory

Satisfactory

L.P.L. : I engage in ongoing reflective practice to identify strengths, areas for improvement and integrate feedback into practice using the
Quality Assurance program from the CNO website, and received feedback from my peer and integrate it into my QA to be handed in same
as this week.

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

and guide practice.

Satisfactory

Satisfactory

L.P.L. : As an RPN I can work autonomously, however when there is a change of my pts status and they suddenly become very unstable,
it is vital that I have been communicating with my primary nurse the interventions that I am providing and knowing when my knowledge
and experience are limited and need help and/or collaboration with the primary nurse or transfer the pt to my primary nurse.

I had an experience where the pt wasnt mine, however I was asked by the charge nurse to help out the agency primary nurse. The pt
was vomiting black ground coffee emesis and had a liquid consistency, black stool. At first I gave her the kidney basin because she said
she felt like throwing up. I gave her some time before I went in to change her incontinence pad. A few moments later she was throwing up
and having loose BM at the same time. That is when I called for help with my fellow classmates to help me change her however the pt
didnt stop vomiting and having BM. At that time we were looking for the primary nurse for at least 10 minutes. When the primary nurse
finally came, we collaborated with her on the plan of care.

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

Lara has progressively improved in her ability to prioritize her time and patient care needs effectively by administering medications on time
and documenting in a timely manner.

Student Final Summary with Strategies for Continued Growth

I will continue to do self reflection for continued growth using the CNO QA program to reflect and celebrate my strengths and improve on my areas of
development, at least once every 6 months and keep a record on my nursing portfolio.
I will continue to seek out opportunities for in-services, nursing grand rounds, seminars that are available to enhance and add on to my learning and
widen my knowledge as a nurse/person.
I will strive and do my best to review all my courses to get ready for the mock exam in January 2016, March 2016 so that I am more than ready for the
licensure exam in May 2016.

Teacher Final Summary with Strategies for Continued Growth

Continue to develop assessment skills and providing quality holistic care to patients and members of their family by enhancing critical thinking skills
through the use of concept maps.

Student's References
CNO, Culturally Sensitive Care, 2009 (https://www.cno.org/Global/docs/prac/41040_CulturallySens.pdf)
CNO, Therapeutic Nurse-Client Relationship, Revised 2006 (http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf)
CNO, Quality Assurance Learning Plan Form, 2015 (http://www.cno.org/Global/docs/qa/qa2014/QA%20Learning%20Plan%20form.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
Emillie, Thank you for your guidance and generosity of your knowledge and patience.