NURS 3021H Clinical Practice Focused on Chronic Disease Management – Fall 2022

Mid-Term Evaluation X Final Evaluation      

Student: Brendan Morano

Clinical Instructor: Naomi Cailes

Clinical Placement Hospital: PRHC Unit: D2

Date: December 9, 2022

Missed Clinical Hours: 0 Missed CLC Lab Hours: 0

 NURS 3021H Clinical Practice Evaluation
Program Goals 3000 Level Outcomes
Students graduating from this program will be: On completion of 3000 level courses students will be
able to:
1. Prepared as generalists entering a self-regulating Fully understand how to practice in a self-regulating
profession in situations of health and illness. profession.
Analyze clinical situations and reflect on individual roles of the
nurse as it impacts upon patients and the nursing profession.
Rationalize the link between health and illness.
2. Prepared to work with people of all ages and genders Understand the complexity adults, of all genders, to achieve
(individuals, families, groups, communities and optimal health.
populations) in a variety of settings.
3. Expected to have an enhanced knowledge of the program Use a critical perspective in applying the foci to nursing
foci: indigenous, women's and environmental health and knowledge and practice.
aging and rural populations.
4. Prepared to learn to continuously use critical and scientific Integrate critical reflective evidence-informed care using
inquiry and other ways of knowing to develop and apply multiple ways of knowing.
nursing knowledge in their practice.
5. Prepared to demonstrate leadership in professional nursing Develop and embody leadership at the point of care.
practice in diverse health care contexts. Expand awareness of leadership in nursing.
Identify strategies to develop leadership potential.
6. Prepared to contribute to a culture of safety by Anticipate, identify and manage risk situations.
demonstrating safety in their own practice, and by Demonstrate awareness of resources related to risk
identifying, and mitigating risk for patients and other management.
health care providers
7. Able to establish and maintain therapeutic, caring and Engages in deliberative personal centred relational practice to
culturally safe relationships with clients and health care assist individuals, families and communities to achieve health.
team members based upon relational boundaries and Acknowledge own potential to contribute to effective
respect. collaborative team function.
8. Able to enact advocacy in their work based on the Advocate for individuals, families, and communities
philosophy of social justice. recognizing the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.
9. Able to effectively utilize communications and Integrates and applies critical thinking to the use of
informational technologies to improve client outcomes. information technology and dissemination strategies as related
to clinical outcomes.
10. Prepared to provide nursing care that includes Critically assess the individuals, family and community health
comprehensive, collaborative assessment, evidence- status.
informed interventions and outcome measures. Collaborate to identify priority health needs.
Identify evidence informed interventions and health outcome
evaluation in complex care situations.
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.

Each objective should be awarded one of the following ratings:

Midterm:
Satisfactory Progress (SP): The student consistently demonstrates sufficient knowledge, and skill and ability to safely practice
or achieve the objective 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. 
 
Needs Development(ND): The student demonstrates sufficient knowledge and ability to safely practice or achieve the
objective,  but requires more 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.

Unsatisfactory Progress (UP): The student does not consistently demonstrate sufficient knowledge, or skill, or ability to safely
practice or achieve the objective, 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. 
Final:
Satisfactory (S): The student consistently demonstrates sufficient knowledge, and skill and ability to safely practice or achieve
the objective 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.

Unsatisfactory (U): The student does not consistently demonstrate sufficient knowledge, or skill, or ability to safely practice or
achieve expected objectives, even with constant or 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.
 NURS 3021H Clinical Practice Evaluation

Progress
Course Objective Evidence/Indicators Evidence/Indicators
MIDTERM FINAL
1. Demonstrate accountability and responsibility in Student:
the teaching-learning relationship.  Complete necessary preparation
Student:
work before labs pertaining to
Progress Midterm Progress Final clinical course
 Continued to complete necessary
 Complete simulation prep work
X SP  S drug cards before clinical shift
before simulations pertaining to
 ND  U (Week 7)
course
 UP  Took feedback from clinical
 Completed necessary drug cards
instructor on being more efficient
before med days at clinical (shift
with head-to-toe assessments
4)
 Attended OSCE preparation lab
 Seek feedback from clinical
before skills test
instructor and nursing staff
 Asked clinical instructor and staff
during charting review sessions
members questions regarding
and after performing nursing
palliative care and nursing skills to
skills
enhance knowledge of the unit/care
expectations and the practical
Clinical Instructor: Brendan has
application of nursing interventions
demonstrated accountability in the
respectively
teaching-learning relationship. As per his
examples above, Brendan consistently
comes to clinical prepared. He asks very
thoughtful questions and seeks out
assistance when appropriate. Brendan
Clinical Instructor:
has demonstrated accountability for
mistakes and applies constructive
feedback well.

2. Explain the experience of chronic illness in Student: Student:

individuals receiving care in chronic care  Provide client/family teaching on
settings positive effects on blood  Engaged with and provided
Progress Midterm Progress Final transfusions (shift 2) emotional support to the family of
 Participate in class debriefs post my patient who was sedated for
X SP  S clinical shifts palliation and passed away during
 ND  U  Completed weekly care plans clinical shift (Week 7)
 UP after clinical shifts  Formulated care plans after clinical
 Utilize knowledge gained from shifts with diagnosis and
clinical to formulate post clinical interventions as it related to the
care plans in analysis and patient’s hospital stay
rationale section  Engaged with the family of a
 Discussed importance of oxygen medical patient with dementia and
therapy with patients who had empathized with the challenges the
respiratory illnesses (shift 1 & 4) disease brings in regards to
personality changes and the new
Clinical Instructor: Brendan has learned caregiving role that the family
about the experiences of a variety of undertakes (Week 6)
patients receiving chronic care. Brendan
cared for one patient, for example, who
experienced a lot of anxiety and pain
with care and so was reluctant to allow
the staff to perform care on her. Clinical Instructor:
Brendan was able to reflect on the
ethical implications of this as he
empathized with the patient. Brendan
identified solutions such as giving the
patient analgesics prior to care,
emotional support, and moving through
care quickly to ease the patient’s
discomfort.

3. Interpret critical aspects of the person’s Student: Student:

experience of chronic illness in relation to the  Acknowledge stresses to both  Discussed how patient’s current
nursing process such as common signs and patient and families when it hospital stay had impacted her
symptoms, responses to treatment, patterns of comes to end of life/end of life feelings (Week 8)
coping, and impact on individual and family care (Shift 1&2)  Applied knowledge of disease
relationships.  Discussed coping strategies and process and pathophysiology on
Progress Midterm Progress Final probed feelings on death/dying care plans as it pertained to my
  S with patient who had end stage
X SP  U ILD (Shift 1)
 ND  Discussed patients’ feelings on
 UP palliative radiation therapy and
discussed benefits and
drawbacks with her (Shift 4)

Clinical Instructor: Brendan is able to

interpret critical aspects of chronic
patients
illness in relation to the nursing process.
 Engaged with families of patients
Brendan is developing his ability to think
about their loved one’s stay/illness
critically about his patients and to make
 Noted patients’ change in cognition
links between their medical diagnoses,
as a result of stronger analgesics or
his assessment findings, and appropriate
the initiation of palliative sedation
nursing diagnoses, goals, and
(Week 5, Week 7)
interventions through his care plans.

4. Identify symptoms and common medical Student: Student:

treatments of selected chronic illness.  Perform head to toe assessments  Performed musculoskeletal
of patient and document assessment on patient with spinal
Progress Midterm Progress Final abnormal findings as it relates to cord injury (Week 8)
my patient’s pathology  Noted skin temperature changes in
X SP  S  Build therapeutic relationship palliative patients as they got closer
 ND  U with clients and further learn to death (Week 5, Week 7)
 UP about the psychosocial  Noted adventitious lung sounds in
consequences of having a chronic patients with respiratory
and/or terminal illness (Shift 1 & pathologies (Week 6, Week 8)
2)  Charted wounds noting drainage,
 Discuss medications and size, and tissue characteristics based
therapeutic indications with on location and type of injury (Week
clinical instructor on medication 5, Week 7)
days (shift1 & 4)

Clinical Instructor: Brendan has cared for

patients with a variety of chronic
illnesses and is expanding his knowledge
 of different treatments and symptom
management. Brendan has
demonstrated his knowledge of
pathophysiology and pharmacology as
we discuss his patient’s diagnoses and
medications. Brendan also learned about
Clinical Instructor:
radiation therapy, a common treatment
for cancer patients, when he
accompanied a patient to her
appointment in the radiation suite.

5. Demonstrate select nursing and collaborative Student: Student:

interventions related to caring for the person  Performed respiratory  Administered medications for
with chronic illness such as specific assessment on patient with end patient who was undergoing
assessments, medication administration, stage interstitial lung disease palliative sedation (Week 7)
physical and chemical restraints, enteral  Monitor intake/output on  Changed dressings as ordered for
feeding & residual volumes, NG tube insertions, patients with indwelling patients with wounds (Week 5, 7)
wound care, patient-controlled medication
catheters (Shift 1, 2, & 3)  Emptied catheter bags at the end of
administration pumps.
 Performed wound care on shifts for intake/output calculations
patients with wounds (shift 2, 3 (Week 5, Week 7)
Progress Midterm Progress Final
& 4)  Started subcutaneous lines for
 Started a subcutaneous line on a patients for purposes of intermittent
 SP  S
 U patient for the purpose of medication administration (Week 7)
X ND
 UP administering fentanyl (shift 3)  Administered subcutaneous
injections (Week 7)
Clinical Instructor: As in the examples  Practiced sterile technique during
above, Brendan has had the opportunity dressing changes (Week 5, 7)
to provide a variety of nursing  Taught patient how to use incentive
interventions this semester. Brendan is spirometer and encouraged them to
very thorough and methodical in his use it during purposeful rounding
interventions, which can be an asset when appropriate (Week 6)
while learning these skills. As he takes
on a larger patient load this semester
and moving on to his future placements,
I encourage Brendan to become more
efficient in his work so as to manage his
 time effectively. One example, which we
have discussed in placement, is during
his head-to-toe assessments, which can
Clinical Instructor:
become more focused.

6. Identify potential consequences/complications Student: Student:

of select chronic illnesses and related  Discussed benefits and  Provided patient teaching to patient
interventions. drawbacks with palliative with bone cancer in how spinal
radiation therapy in patient with metastases/spinal column
Progress Midterm Progress Final lung cancer (shift 4) narrowing would affect her mobility
 Noted that a patient with and neuropathy (Week 8)
X SP  S compartment syndrome and  Noted reduced exercise tolerance in
 ND  U peripheral vascular disease patients with lung pathologies
 UP would have absent pulses (Week 6, Week 8)
affected limb and reduced pulse  Noted patients changes in
force in opposite leg (shift 2) cognition/orientation because of
 Cared for a patient with disease progression or palliative
metastatic bone cancer that led sedation (Week 5, Week 7)
to a femoral fracture. Post op,  Noted pressure ulcers on patient’s
the surgical wound got infected, coccyx as a complication of poor
leading to the placement of a bed mobility and reduced skin
wound VAC (shift 3) integrity/wound healing as a result
of diabetes (Week 7)
Clinical Instructor: Brendan has
demonstrated a good understanding of
potential consequences/complications
of select chronic illnesses and their
related interventions. Brendan has
become more comfortable with Clinical Instructor:
respiratory assessments and has been
learning to titrate a patient’s oxygen
therapy to achieve their target SpO2. As
he described, Brendan also made links
between a diagnosis of critical limb
ischemia and his assessment findings of
absent pedal pulses, cool extremity, and
 a non-healing wound.

7. Under the supervision of a Registered Nurse, Student: Student:

demonstrate safe, competent, evidence-  Engaged in family centred care  Discussed loss and grieving with
informed, holistic nursing practice with clients with a patient and his daughter family who’s patient passed away
with chronic illness who was a frequent visitor (shift during clinical shift (Week 7)
a. Use a wide range of effective 2)  Used critical thinking to discuss with
communication strategies and  Applied comfort care measures nurses regarding any additional
interpersonal skills to appropriately
to palliative patients involving interventions such as changes in
establish, maintain, re-establish and
non-medical/pharmacological medication/dosing to provide
terminate the nurse-client relationship
b. Demonstrate accountable, responsible interventions optimal therapeutic effect
and ethical practice  Changed dressing under  Discussed performance with clinical
c. Engage in respectful, collaborative, guidance of clinical instructor of instructor after performing
therapeutic and professional patient who had a chronic leg interventions
relationships wound (shift 2)  Provided patient-centred care by
i. Demonstrate therapeutic use of  Assisted with wound VAC change engaging with them during cares
self on patient who had a dehisced and respecting their being
ii. Create a culturally safe surgical wound (shift 3) regardless of
environment  Informed registered staff consciousness/cognition
d. Apply nursing models and theories members of patients’ complaints  Provided family centred care by
e. Demonstrate health promotion and supporting and engaging the family
illness prevention practices Clinical Instructor: Brendan has members of my patients
f. Demonstrate patient advocacy
demonstrated his ability to provide safe
g. Predict outcomes of nursing care
and holistic care to patients with chronic
h. Evaluate client response to nursing
care illness. Brendan has good bedside
i. Critically appraise own practice in manner and is learning to develop
relation to nurse-client/family therapeutic relationships with his
interactions and as a member of the patients and their families. Brendan Clinical Instructor:
health care team identifies thoughtful ethical issues in his
care plans, such as grappling with his
Progress Midterm Progress Final patient’s desire to stop radiation
treatments although they will improve
X SP  S her pain and symptoms. I encourage
 ND  U Brendan to begin advocating for his
 UP patients more; for example, he could
take his patient’s concerns about her
 radiation treatment to the bedside
nurse, who may then choose to notify
the MD or charge nurse to have a larger
discussion with the patient and her
family to reassess plan of care.

8. Critically appraise own practice in relation to Student: Student:

nurse-client/family interactions and as a  Reflect on interventions and  Discuss ethical challenges/dilemmas
member of the health care team assessments during post clinical during clinical week in post clinical
care plans care plans
 Complete midterm evaluation,  Learned about the role of palliative
noting areas of improvement for social workers and resources
future practice provided by hospice (Week 7)
Progress Midterm Progress Final  Discuss interaction with patients  Continued to discuss interactions
and family during debrief with patients and family members
X SP  S sessions with clinical group during clinical debrief sessions
 ND  U where appropriate
 UP Clinical Instructor: Brendan forms good  Complete clinical evaluation and
therapeutic relationships with his portfolio discussing personal
patients and their families and is also an strengths and weaknesses from the
active member of the health care team. experience
Brendan shows excellent initiative in
clinical placement and is always seeking
out new learning experiences. Brendan
assists his student colleagues, and
guided one of his fellow students in
completing a dressing change that he Clinical Instructor:
had done himself the day prior. Brendan
also actively helps the staff around the
unit. I have received good feedback from
the staff on Brendan’s initiative. During
the rest of the semester, Brendan could
begin to learn about the roles of
different interdisciplinary team
members such as PT, OT, and social
work, and engage with them while at
 clinical.

9. Participate in professional development based Student: Student:

on reflective practice and critical inquiry  Continue to ask for feedback  Requested an additional meeting
from clinical instructor in areas I with clinical instructor to discuss
Progress Midterm Progress Final feel I require improvement progress and areas for improvement
 Complete post lab and simulation  Participated in OSCE preparation
X SP  S reflections noting areas of session to further enhance skills in
 ND  U improvement for future practice catheterization and tracheostomy
 UP
 Discuss simulation challenges care
post end of life care simulation  Reflected on areas to improve on in
practice in final placement
Clinical Instructor: Brendan has evaluation and the corresponding
participated in professional portfolio
development based on reflective  Discussed nursing skill application
practice and critical inquiry. Brendan with clinical instructor and staff
asks questions and actively seeks out members
feedback. He is reflective in his practice,  Engaged with staff members to
for example producing thoughtful care enhance knowledge on palliative
plans. Brendan is developing his critical care and how to enhance my
thinking skills, and actively participates competency
in group debrief sessions. Brendan
showed initiative during our last clinical
shift when he elected to take on the care
of a second patient.

Clinical Instructor:

This section to be filled out by the Student Areas of Strength Student Areas of Strength
student.
1. Engaging patients during cares 1. Providing health
and learning about who they teaching/education where
are appropriate for patients and their
families
2. Performing thorough head to
 toe assessments 2. Taking feedback from clinical
instructor and applying it into
3. Formulating accurate nursing practice
diagnoses in post clinical care
plans 3. Applying knowledge of
pathophysiology and
Student Areas for Future pharmacology in clinical practice
Development
Student Areas for Future
1. Identifying lung sounds during Development
respiratory assessments
1. Continuing to develop skills as it
2. Continuing to improve pertains to wound care and
medication administration sterile technique
skills and checks
2. Continuing to improve efficiency
3. Being more time efficient and with charting and interventions
with my charting and making
sure my information is both 3. Learning appropriate times to
relevant and correct advocate for patients and
improving my ability of the skill in
question

Clinical Instructor Summative Comments:

Midterm: Brendan shows great initiative in clinical and is developing a good basis of knowledge and skills. Brendan forms good therapeutic
relationships with his patients and their families. Brendan is a team player, helping out his student colleagues and engaging with staff on the unit.
Brendan is very thorough, but sometimes to his own detriment as it can get in the way of completing tasks such as charting in a timely manner.
Moving forward, I encourage Brendan to continue to develop his time management skills.
Clinical Practice Attendance (8 Hours Per Shift)

Shift 1 Shift 2
Week 1 8 8
Week 2 8 8
Week 3 8 8
Week 4 8 8
Week 5 8 8
Week 6 8 8
Week 7 8 8
Week 8 8 8

Total number of clinical practice hours absent: 0

Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory Unsatisfactory

Clinical Learning Centre

Total number of clinical simulations completed 3/3

Total number of labs completed 3/3

Clinical Learning Centre Outcome (completed by Course Lead): Satisfactory Unsatisfactory

Signature of Course Lead: __________________________________Date: _____________________

Signature of Clinical Instructor: ______________________________Date: October 28, 2022

Signature of Student: ______________________________________Date: October 23, 2022