4th Year Theme: Integration of Professional Self into the Health Care System

Connecting Theory and Practice across NSE417, NSE418, NSE407, NUR 820/823/824/825/826
NSE 417 Student Self-Evaluation: Fall 2016
With Faculty Evaluative Comments
Final
Student Name:

Rosette Lenon

Preceptor Name:

Marina Lam

Faculty Advisor Name: Patricia Hynes

Clinical Practice Setting: Pediatrics (Michael Garron Hospital)

For Office Use Only:

Faculty:
End of term Review X
Mid term Review ____________

Student: Self Review with Preceptors signature X

Preceptor:

Mid term Feedback ________

End of Term Feedback X

Record of All Required Hours: X

Accountability
Students are accountable to the
public and responsible for
ensuring that their practice and
conduct meets legislative
requirements.

I demonstrated accountability by advocating on behalf of the client. I was

assigned a newborn admitted into the unit and I watched the mother attempt
to breastfeed the child and tried to help the mother with breastfeeding by
educating her on how to hold the baby while feeding, and how to use tactile
stimulation to keep the child from sucking. I recognize that I did everything
in my knowledge to help the family, and then sought for my preceptors
guidance in teaching the mother to breastfeed. She also contacted the
lactation consultant to assess her feeding, in order to educate the mother
better before she leaves the hospital. I was able to advocate for the patient by
connecting them to resources that meet their needs, and also was able to
recognize when I have a gap in my breadth of knowledge.
I continue to maintain accountability by refraining from performing
activities such as independently administering narcotics to children. When I
am required to administer narcotics, I always have my preceptor in the room
when I am drawing up the medication, and also have another nurse sign off to
double-check the medication. I also refrain from administering IV morphine
and communicate this to my preceptor accordingly. I let my preceptor know
that I am not allowed to administer such medications, and work together to
provide care to the patient.

Faculty Evaluative Comments

Pass
Rosette continued to have a productive semester and progressed as expected. She presented herself in a
professional manner, sought assistance in a timely manner from her preceptor and refrained from performing
activities for which she lacked knowledge, skill or judgment. She displayed initiative, self- awareness, and sought
to establish leadership competencies. In conference, Rosette shared her experiences with colleagues and
respectfully listened to others.
Continued Competence
Students must assume
responsibility for their ongoing
professional development in the
practice setting (progressive
improvement in knowledge, skills
and judgment).

I am able to demonstrate this standard by implementing a part of my learning

plan. For discharge teaching, I continued my competence by developing a
concept map on discharge teaching that includes information about what
asthma is, the signs and symptoms to watch out for, what parents can do
during an emergency situation, how to administer medications, and what
allergens to avoid. I also included extra information on exercised-induced
asthma, and how to communicate with the childs school about their childs
asthma. By developing my knowledge on discharge teaching, I felt that I had
a better grasp on asthma management for the pediatric population. I also feel
more confident in providing health education to families regarding asthma. I
consulted with my preceptor as she is an asthma educator, to ensure that the
information that I provided are relevant and accurate.
I was able to continue my competence by investing time, effort and other
resources to improve my knowledge on what occurs during a code pink on the
unit. There was a situation in my unit where I took part in a code pink on a
child with RSV, as the child was apneic and needed intubation. I felt that it
was overwhelming as everyone knew their role and were very organized on
their tasks and the order of a code pink. However, I felt that I lacked the
knowledge on what the process is like and the role of the nurses. After this
experience, I researched on the nurses role in a code pink to identify what
type of medications, and interventions are expected. By doing so, I will be
more confident in taking part in this emergent situation.

Faculty Evaluative Comments

Pass
Rosette demonstrated good clinical judgment and reflective capacity, approaching a level of performance that is
consistent with CNO entry to practice competencies. She knew where and how to access resources and evidence to
support the provision of safe, competent and ethical care and shared these resources to promote positive patient
outcomes.
Ethics
Students must understand, uphold
and promote the values and
beliefs described in the ethical
framework (1999). For example,
identification of ethical issues in
the practice setting and
identifying strategies, in
consultation with the health care
team, to resolve ethical issues.

An ethical issue occurred in placement when a newborn was admitted for

hypoglycemia. Initially, she was very calm and was able to advocate for her
own child. Later throughout the night, she is seen crying and refusing to be in
the room alone. I came into the room, and asked her what was wrong. She
stated that she feels very sad and depressed being alone in the room. She
states that she would like to go home. I felt unsure on the correct words to
say, and told her to call her husband to stay in the hospital with her to support
her, and continued to console her by stating that nurses are here to support her
as well. My preceptor communicated to her that she needs to stay as her
childs condition is not well enough to be sent home and that she needs to
learn how to care for her child before being discharged. In this situation, I
identified my personal values as I initially felt that she was not ready or
responsible for her childs condition. It was shocking to experience a mother
who was refusing to stay in the hospital and I felt that she was not mentally
prepared to learn how to care for the child. I reflected on this thought and
recognized that my thinking process is inappropriate as I should not be
jumping into conclusion or judging their behaviours. I also recognized that I
did not truly explore her personal experience and situation that may have led
up to his behaviour. I was able to recognize my personal values and ensure
that it did not conflict with my care and communication with the families. I
continued to be respectful towards her throughout my shift. From this
situation, I reflected on my personal values and recognized that it is
unacceptable to enact in my professional practice.

Faculty Evaluative Comments

Pass
Rosette demonstrated respect for patient / family choices within the unit routines. She promoted their well-being,
wishes and values while maintaining commitments to them as well as to her preceptor and the healthcare team.
Rosette upheld privacy and confidentiality at all times and ensured that her personal values did not conflict with
her professional nursing practice.
Knowledge
Students possess through basic
education and continuing
learning knowledge relevant to
their professional practice. For
example, being informed about
nursing and its relationship to the
health care system. Students
demonstrate the ability to provide
theoretical and evidence based
rationale for all decisions in the
practice setting.

In my placement, I was assigned a child diagnosed with NAS, which is

neonatal abstinence syndrome. This was my first time encountering a child
with this diagnosis and was able to find time to research on the interventions
regarding NAS. I was also informed by my preceptor about how we use the
NAS score to assess withdrawal symptoms. NAS score assesses their status
such as high pitched crying, sleep, muscle tone, myoclonic jerks, temperature
etc. which can be documented through the eChart. The rationale for
administering small dosages of morphine PO is to gradually wean off the
child daily to prevent severe withdrawal symptoms. I was also able to
recognize the collaborative effort of nurses assessing, and physicians titrating
the drugs from the nurses assessments. I was able to know to rationale
behind the dosages of morphine, and why it was decreased the next day.
Being in the circumcision clinic, I became informed about the roles and
objectives of nurses. I was able to help with assessing the weight of the

newborn upon admission. More importantly, I was assisting with the

circumcision procedure by placing the child on the surgery table, and promote
comfort by using sugar water and a sucker throughout the whole procedure. I
also had the opportunity to provide education to a family about what to expect
when they return home, and how to care for the penis. I educated the family
on the normal and abnormals signs and symptoms post-procedure. From this
experience, I was able to understand the role of a nurse and its relationship to
the health care team in that situation.

Faculty Evaluative Comments

Pass
Rosette demonstrated a body of knowledge that is approaching the scope of practice of a new graduate and related
to the contributions of registered nurse practice in promoting positive patient and family outcomes. She
demonstrated the ability to access a variety of learning resources when necessary which she used to ensure that the
care planned and implemented was evidence based, current, and in adherence to the policies of the agency and the
expectations of her preceptor.
Knowledge Application
Students continually improve
their application of professional
knowledge. Ensures practice is
based in theory, evidence and
meets all standards and
guidelines

In my nursing practice, I was able to manage three patients effectively which

had multiple interventions. During this shift, I was responsible for a newborn
jaundice patient that required continuous monitoring, a CBC to be completed
by the nurse, and reminding the family to feed and supplement with formula.
My second patient was also a newborn that had an NG tube, and required
monitoring to meet the total fluid intake each other. The infant also had three
medications to administer via IV push throughout the shift. My third patient
was a tonsillectomy post-op and required to be monitored as he has
obstructive sleep apnea. I was responsible for managing pain, and also
ensuring that the IV site in intact and running well throughout the shift. I was
able to meet the needs of all three clients by prioritizing my workload and
planning ahead to manage multiple interventions.
I was able to effectively use best-practice guidelines to address the clients
needs by conducting a lung assessment and recognizing wheezing and
crackles on all lobes. I consulted with my preceptor to see if there was
Ventolin via nebulizer available that promotes airway entry in order to
prevent further exacerbation of their symptoms. I was able to apply my
knowledge on airway management in children to recognize that it is an
abnormal finding, and their PRN medication will help in alleviating the
symptoms.

Faculty Evaluative Comments

Pass
Rosettes practice was theory -based, evidence informed, and was at all times in adherence to the policies and
procedures of the Michael Garron Hospital. She ensured the plan of care addressed patient and family needs
holistically and communicated abnormal responses to her preceptor and the health care team in a timely manner.
At the end of the semester Rosette demonstrated an ability to manage multiple nursing interventions
simultaneously.
Leadership
Students demonstrate leadership
by providing, facilitating and
promoting the best possible care
service to the public.

I demonstrated leadership by acting as a role model and mentor to students

that were shadowing the unit for the day. I noticed that they were interested in
how the newborn assessments were done. My preceptor allowed me to
educate them based on my knowledge as I felt experienced in this skill. I was
able to guide them step by step on how to find the apical pulse, and to count
for a full minute. I also instructed them that newborn respirations are often
counted more efficiently if their hand is on the abdomen. I let one of the
students take an axilla temperature, and to also listen to the apical pulse to
engage them into the learning. From this experience, I was demonstrating
leadership by sharing my current knowledge.
Throughout my whole nursing practice in the pediatric placement, I rolemodel professional values of a family-centered care. I was able to
communicate with families and incorporate them into my plan of care. An
example is enacting this is when I allow the mother to take part in the plan of

care by either letting them calm their child using sugar water during a blood
work procedure, or simply letting them give an oral medication to their child.
By doing so, I am allowing the parents to continue to show support to their
child. Another important aspect of family centred care is sharing information.
An example of this when I was assigned a post-op T&A, I always made sure
to communicate with the family the plan of care and managing pain. I let her
know that if the child experiences pain, vomiting, bleeding from nose or
mouth, or not drinking well, to let me know in order to intervene accordingly.

Faculty Evaluative Comments

Pass
Rosette role-modeled professional values, beliefs and attributes by working respectfully with other staff members
and adhering to collaborative and agency policies while working within the scope of practice of a nursing studentfourth year. She collaborated with the health care team to implement professional practice respecting the rights and
needs of her young patients and their families. She acted as a resource for more junior students and I encourage
her to continue to do this as it is a good way to contribute back to the learning environment.
Relationships
Students establish and maintain
respectful, collaborative,
therapeutic and professional
relationships.

In caring for children, I was able to develop a therapeutic relationship with

the family in order to ensure that the childs personal needs are met. A child
was admitted on the unit for constipation, and the mother and grandmother
was in the room. Instead of just doing my nursing tasks, I had a conversation
with the grandmother and mother about the childs history leading up to
constipation. From this, I was able to have a better understanding of the
childs school environment and also the stress it puts in the family. They told
me that the child goes over a month without a bowel movement. The
grandmother also expressed her feelings in the childs situation as she feels
very stressed and worried about his condition. I reassured the family that it is
concerning, and that is why they are admitted at the hospital. I told them that
the health care team has the same goal of reducing constipation in the child.
By developing a therapeutic relationship, I felt that it was enjoyable to
collaborate with the family, and also ensure that the child remains that main
focus of this relationship.

Faculty Evaluative Comments

Pass
Rosette consistently practiced according to the Therapeutic Nurse-Client Relationship practice standard and was
attentive to her responsibility to establish effective professional relationships. She collaborated to implement
agreed upon interventions for patients and families and was a contributing member of the health care team. She
gained knowledge of, and respect for, various team members roles and unique contributions as a result.
Areas for Growth and Development
An area for growth is to become more proficient in calculating medications. At a point of the semester, I was
having difficulty calculating medications using a vial in a powered form. I felt that it was due to anxiety, and my
lack of experience of using a powered vial. It was difficult to read the instructions on the label and find the one
relevant to the administration. I have been practising and feel that I am more competent in drawing up
medications. I plan on continuing to engage myself in reviewing medication administration questions to ensure
that I provide the correct dose to the correct patient.
An area of development in my practice is to promote collaboration within the health care team. In my clinical
placement, I felt that I did not communicate my care to the physician or another health care provider. This was due
to my focus being strictly clinical skills, and anxiety due to internalizing that they are the authority. Knowing that
this is my gap, I would like to actively seek an opportunity to communicate about abnormal findings, and become
autonomous in consulting and contacting a physician. In the future, I plan to integrate a portion of my future
learning plan into inter-professional collaboration.

Clinical Hours to date: 176

Final Written Work: Letter Grade for LP1: APortfolio: _________

LP2: B

Final Practice: PASS

RA: AFAIL

FOR FACULTY USE ONLY

OVERALL STATUS IN NSE 417: PASS _____ FAIL _____
Comments: It has been a pleasure to oversee Rosettes learning and I look forward to working
with her in her final semester.

Student Signature: ________________________ Date: ______________________________

Rosette Lenon
Faculty Advisor Signature: ________________ Date: ______________________________
Patricia Hynes