NURS 3020H Clinical Course Evaluation
Evaluation
Student: Melissa Jenkins
Clinical Instructor: Cindy Davidson
Missed Clinical Hours: 0 Missed Lab Hours: 0
NURS 3020H Clinical Course Mid-Term Evaluation
Program Goals
Third Year Outcomes
Students graduating from this program are prepared as
generalists entering a self-regulating profession in situations of
health and illness.
To be developed
Students graduating from this program are prepared to work with
people of all ages and genders (individuals, families, groups,
communities and populations) in a variety of settings.
Students graduating from this program are prepared to work with
people of all ages and genders (individuals, families, groups,
communities and populations) in a variety of settings.
Graduates will learn to continuously use critical and scientific
inquiry and other ways of knowing to develop and apply nursing
knowledge in their practice.
Students graduating from this program will be prepared to
demonstrate leadership in professional nursing practice in diverse
health care contexts.
Graduates will be prepared to 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
Students will demonstrate the ability to establish and maintain
therapeutic, caring and culturally safe relationships with clients
and health care team members based upon relational boundaries and
respect.
Graduates of this program 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.
NURS 3020H Clinical Course Mid-Term Evaluation
Progress
Course Objective
Evidence/Indicators
Satisfactory
Unsatisfactory
1. Explain the experience of chronic illness in individuals in
chronic care settings
Wk1: I helped care for four patients. Each one had a different
diagnosis and reason for being there. I cared for one patient who
had a stroke and leg amputation that was receiving comfort measures
and was a total feed. I also cared for a patient who was fairly
independent. She was able to do many things for herself with some
assistance. These patients indicated to me the range of need of the
patients on the floor.
Wk2: I cared for the fairly independent patient. She was had a
bad on Thursday and stayed in bed all day. This made it hard to
have therapeutic conversation about her chronic diseases, of which
she had many. Having a bad day is typical of having many chronic
diseases. Due to her bad day I could sense that she was frustrated
so I listened to her concerns and reassured her that everyone has
good and bad days and sometimes need more assistance.
Wk3: I cared for a patient who had suffered a left hemispheric
stroke of the thalamus resulting in right sided weakness. He was
also under contact precautions as a carrier of c. diff. For this
patient it was easy to see the frustration that being isolated and
unable to do a lot of things for himself was causing, however
listening to his concerns and being patient with him enabled the
generation of a therapeutic relationship.
Melissa had the opportunity to care for a variety of patients in
weeks 1, 2 & 3 with different chronic conditions and was able
to articulate the experience of these individuals in the long term
care setting.
Wk5: I cared for a stroke patient this week that I had
previously cared for. Having developed a relationship with the
patient in the prior weeks helped the patient open up to me about
what it was like to experience a stroke in the acute phase. He told
me without his dog sensing that something was wrong and alerting
his wife it is quite possible he might not have made it.
Wk5: I helped care for a patient who was diagnosed with
Parkinson’s. The progression of his illness had led to his
hospitalization and subsequent inability to return home. His
dyskinesia makes him unable to perform many of his ADLs such as
hygiene and feeding. He is currently awaiting a LTC bed.
X
2. Interpret critical aspects of the person’s experience of
chronic illness in relation to common signs and symptoms, responses
to treatment, patterns of coping, and impact on individual and
family relationships.
When picking patients for each week I ensure that I thoroughly
review their charts to get a good sense of their past medical
history, current diagnosis, and current treatments so I can further
research these at home prior to caring for them the next week.
Wk2: I was able to apply what I had learned in previous courses
about medications and disease process to accurately assess my
patient before giving medications as well as understand her risk
for falls.
Wk1: I interacted with the husband of the patient who was
receiving comfort care. It seemed that he was having a hard time
adjusting to the level care she was receiving and was very
inquisitive of how much food/liquids she had and whether she had
her pain medications. Being able to answer his questions made me
feel like I was providing him with peace of mind that his wife was
still reviving good care.
Wk3: My stroke patient had just received news from his wife that
she wanted to place him in a nursing home rather than allowing him
to return home like he anticipated. When talking to the patient it
was clear that he was upset by this decision and in some denial. As
someone on the outside it is easy for me to see that this decision
is probably for the best but makes it hard to comfort a patient who
is not willing to openly discuss it and is in denial.
Melissa, had the opportunity to care for several patients during
week 1, 2 & 3 with a variety of chronic illnesses and is able
to interpret various aspects of the person’s experience of chronic
illness in relation to common signs and symptoms, responses to
treatment, patterns of coping, and impact on individual and family
relationships.
Wk4: I cared for a patient who had a diagnosis of CVA of the
left MCA and NSTEMI. This patient also had a past medical history
of laryngeal cancer that resulted in the placement of a
tracheostomy. Due to the severity of her CVA the patient is right
hemiplegic and bedridden. Having the tracheostomy also makes her
aphasic. She also a G-tube. I believe this patient to not be coping
well with her current condition as she keeps pulling at her
tracheostomy tube and G-tubes thus had to be restrained, however as
she is unable to make her wishes clear it is her POA decision on
whether to continue care and what type of care to provide.
Wk5: This week I cared for a stroke patient I had previously
cared for that had been on isolation. He had recently been removed
from isolation and was struggling with the lack of activities and
stimulation on the floor. He mentioned that he often went to church
before and was of the Catholic faith so we went to the Catholic
Church services. He mentioned to me he really enjoyed leaving the
floor and attending church as his faith is important to him.
X
3. Identify common medical treatments of selected chronic
illnesses
Wk2: I researched many medications both scheduled and PRN for my
patient. After learning the medications she's on and administering
them I also observed the nurse giving medications to the other
patients under her care. Through this process it became evident
that many patients experience some of the same chronic diseases
therefore the same treatments. For example many patients have
hypertension and diabetes. Most of them revive beta blockers and or
ace inhibitors as well as oral antihyperglycemics.
Wk2: I also observed physiotherapy working with many patients
and reviewed their notes on my patient to understand the types of
exercises they do to help improve strength for many of the patients
on the floor. Many of the exercises focus on improving mobility
with the hopes of supporting greater independence.
Wk3: My patient this week had several co-morbidities that were
being treated with medications. Of interest was his RA/OA being
treated with an antimalarial.
Melissa has had the opportunity during weeks 1, 2 & 3 to
identify common treatments for various chronic illnesses as
indicated above.
Wk4: I cared for a patient who had a tracheostomy and a G-tube.
The G-tube was put in place after the patient was assessed as
unable to swallow foods or fluids. The G-tube provides enteral
nutrition directly into the stomach, bypassing the mouth and
esophagus. This lowers the risk of aspiration and choking. In this
patient the G-tube is likely to be a permanent solution however
this is not the case in all clients. The tracheostomy was placed as
a result of laryngeal cancer damaging the airway. The tracheostomy
supports the airway as well as provides an outlet in the neck for
air exchange.
Wk5: I cared for a patient who had a hemorraghic of the left
thalamus and surrounding tissues. When working with physiotherapy,
the patient was focused on his weak (right) side. The PT mentioned
that this is common with this type of stroke. The patient becomes
focused of strengthening the weakened side but the unaffected side
is not strong enough to do what is required of it and is not
getting the attention it needs. PT mentioned that it is then
important to retrain the brain to function to the best of its
ability given its limitation, and that they do this through
strength and coordination exercises.
X
4. Demonstrate selected nursing and collaborative interventions
related to caring for the person with chronic illness, such as
medication administration, physical and chemical restraints,
enteral feedings, residual volumes, NG tube insertion, wound care,
colorectal screening, patient-controlled administration pumps,
neurological assessment
Wk2: I successfully administered scheduled medications for one
patient. The medications treated chronic diseases such as
depression, hypertension, spasticity (d/t spinal stenosis), and
type 2 diabetes. I also performed a respiratory assessment and an
assessment of my patient’s throat as she was complaining of pain
d/t a pill getting stuck in her throat the previous day. Though her
throat was red, her chest was clear indicating no damage.
Wk1&2: While assisting the nurse in morning care,
specifically showers, I observed the patients for redness or other
signs of pressure ulcers on the common pressure points (coccyx,
heels etc.). One patient had some redness on her heel so the nurse
and I applied a heel boot to prevent further breakdown. We also
applied barrier spray to her back and coccyx before applying a
brief as she was bedridden.
Wk3: I helped care for a patient who had had one arm restrained.
The restraint was placed as the patient kept removing her
tracheostomy tube. The patient was restrained in the morning and I
was asked by the nurse to remove the restraint so that we could
perform morning care. We did not reattach her restraint. The next
morning I read report on the patient and noticed that they had to
restrain her shortly after shift change because she had again
pulled out her tracheostomy.
Melissa was able to demonstrate a variety of nursing and
collaborative interventions for several different patients she
cared for with diverse chronic illnesses including medication
administration, restraints and head to toe assessments.
Wk4: Care for my patient with a G-tube and tracheostomy this
week involved the care of these as well as the use of physical
restraints. To care for the G-tube I inspected the site to ensure
that there were no signs of inflammation and to ensure that it was
still intact. I also flushed the G-tube with water at designated
intervals to ensure proper hydration of the patient and patency of
the tube. I also changed the feed bag and tubing. The tracheostomy
required little care other than suctioning and placing a dressing
around the site. This patient was also restrained by a wrist
restrained. As part of caring for this patient I removed the
restraint at regular intervals to check the ROM of the extremity as
well as for any bruising. I also assessed the patient for
agitation, behavior, respirations, and any skin breakdown as part
of the documentation required for the use of restraints.
Wk4: I observed a nurse administer lorazepam to an agitated
patient in attempt to calm them. When the nurse noticed that the
current prescribed dose of lorazepam was having no effect on the
patient, I observed her discussing increased dosing and other
medications with the nurse practitioner.
X
5. Demonstrate selected nursing and collaborative interventions
related to clinical pathways, peri-operative care, IV medication
administration, cardiac assessment and rhythm strips, neurological
assessment, wound care, blood component therapy, TPN and central
lines, pulmonary care including chest tubes and tracheotomy,
initiating IVs, rapidly changing conditions, and resuscitation.
Wk3: I cared for a patient that had a tracheostomy tube and a G
tube. I observed the nurse suctioning secretions out of the
tracheostomy and helped with tracheostomy care (cleaning). I also
observed the nurse administering medications through the G tube as
well as flushing it.
Wk3: I also cared for a patient who had a biliary drain. As part
of the care for this patient the biliary drainage was emptied from
the collection bag and measured. The drain was also flushed daily.
I both drained and flushed the biliary drain.
Melissa had the opportunity to care for a patient in week 3 with
a tracheotomy and observe the nurse doing suctioning. Able to flush
and drain biliary drain.
Wk4: I was able to care for a patient who had a trach and a
G-tube. With this patient I was able perform trach suctioning to
remove thick mucus secretions. I was also able to flush an IV line
to ensure that it was patent.
Wk4: I was a part of the code team and able to respond a code
blue. Though the code was just a syncopal episode the experience
taught me a lot about how to respond in the situation.
Wk4: I was also present in the room during a respiratory arrest.
I was able to observe to code team in their resuscitation efforts.
During the code I observed intubation, initiation of a central
line, as well as fluid resuscitation.
X
6. Identify potential consequences/complications of chronic
illness
Wk1: I helped the nurse care for a patient who had an above the
knee amputation d/t PVD secondary to diabetes and smoking. Both
diabetes and smoking impair peripheral circulation which can lead
to venous stasis and clot formation. Clot formation impairs gas
exchange in the tissues resulting in cell death and necrosis. If
the process is not managed and/or reversed amputations are
common.
Wk2: I cared for a patient who suffers from spinal stenosis and
rheumatoid osteoarthritis. These diseases cumulated to cause the
patient to fall at home breaking her femur, which resulted in her
hospitalization. Her spinal stenosis was also treated with surgery
to relieve the pressure on her spinal cord to relieve some of her
pain. In all she is only semi-mobile, able to transfer herself to
and from her wheelchair where she spends most of her time. Being
wheelchair bound means that she is unable to return home and is now
awaiting LTC.
Wk3: I worked with patients that had suffered strokes that were
attributed to uncontrolled hypertension. One of the patients had
suffered an MI in addition to her stroke which was also attributed
to uncontrolled hypertension and possible hyperlipidemia.
Melissa, has been able to identify potential
consequences/complications of chronic illnesses as indicated above
and in the clinical setting as appropriate.
Wk4: I helped care for a man who had been brought to the
hospital by ambulance after he was found unconscious by his family.
On arrival to the hospital a toxicology scan was done and showed
him to have opiods, alcohol, and marijuana in his system. He then
subsequently suffered from withdrawal. Tests were also done to
determine whether there was any damage to his liver or other organs
from his chronic alcohol use. Also given his substance abuse, his
family said that he could not return home, so the patient was to
remain in hospital until other arrangements were made and he was
well enough to leave.
Wk4: I also helped care for a patient who had cirrhosis due to
alcohol abuse. His cirrhosis was complicated by esophageal varices
which had led to GI bleeding. Ultimately the complications of his
cirrhosis led to hypovolemic shock.
X
7. Under the supervision of a Registered Nurse, demonstrate
safe, competent, evidence-based, holistic nursing practice with
clients with chronic illness
a. Apply nursing models and theories
b. Demonstrate therapeutic use of self
c. Engage with patients in an ethical and culturally sensitive
manner
d. Demonstrate health promotion and illness prevention
practices
e. Demonstrate patient advocacy
f. Predict outcomes of nursing care
g. Evaluate client response to nursing care
h. Demonstrate accountability and reliability
Wk2: I was able to advocate for my patient to the staff nurse
during this week. My patient was complaining of headache, but was
not due for Tylenol for a couple hours after her initial complaint.
When she was able to receive more Tylenol, I assessed the patient’s
pain and reported to the nurse that I thought that the patient
should receive more pain based off of my findings. The staff nurse
seemed hesitant to administer the medication, stating that the
patient often complains of headaches. I restated my findings,
explaining that the patient seemed to be in actual pain and adding
that headache was a common side effect of many of her other
medications.
I documented my assessment findings in the patient’s chart for
both my clinical shifts. I also filled out the shift change report
for both days. I also ensure that I am protecting myself and my
patients through hand washing, the use of gloves, and the proper
use of PPE.
Wk3: I cared for a patient who was under contact isolation for
being a carrier of c. diff. In order to care for this patient I
donned a gown and gloves. Also as part of the care for this
patient, we were required to shower him daily and strip his bed and
room for cleaning by housekeeping. This is done to remove spores
from the patient and room in order to limit the spread.
Melissa has the all of the elements of safe, competent and
evidence-based, holistic nursing practice. Melissa is extremely
accountable and reliable, practices in an ethical and culturally
sensitive manner and is a strong patient advocate.
Wk5: I was able to discuss my patient’s faith with him and take
him to church. I attended church with my patient as I could not
leave him alone. We have different faiths but I was able to be
open-minded and supportive of the patient during the discussion and
church service.
Wk4: I cared for a patient that has a tracheostomy and required
suctioning due to the buildup of thick secretions. Removal of these
secretions by suctioning helps to maintain a patent airway and
facilitates breathing. I also encouraged the patient to clear as
much of the secretions through deep breathing and coughing though
this was difficult for her. In addition to suctioning I ensured
that the head of the bed was always elevated slightly to help
facilitate breathing.
Wk4: I used Orem’s theory of Self-care in practice for a stroke
patient that was wholly compensatory for all areas of self-care
(universal, developmental, and health deviation). Knowing that the
patient was wholly compensatory allowed me to plan my care to
include each aspect of self-care, such as hygiene, making sure her
airway was patent, making sure her feed was hooked up through her
G-tube, and performing assessments.
X
8. Critically appraise own practice in relation to
nurse-client/family interactions and as a member of the health care
team
Wk2: In post-clinical we share information about the patients on
the floor in order to familiarize ourselves with the patients for
future clinical encounters. In doing this I was able to pass my
patient along to another student for care during wk3. After
expressing her interest in my patient we discussed what was in her
chart as well as the additional information I had gathered about
her from providing care.
Before shift change I complete report on my patients in order to
inform the oncoming shift of any pertinent information. I also make
sure to report off to the staff nurse at breaks to make sure my
patients are cared for while I am gone, should they need
anything.
Melissa is able to critically her own practice in relation to
the client/family and health care team.
Wk4: I have continued to use the kardex as a means of
communicating information from the previous shift with the next
one. I have also documented each day on my patient per the hospital
forms. I also made a progress note to document my observation of a
macupapular rash in the armpit of my patient.
X
9. Participate in professional development based on reflective
practice and critical inquiry
Wk1: During post conference we explored the topic of death
within the hospital of a palliative patient. This discussion helped
me to reflect on how I would handle the death of a patient under my
care.
Wk2: While preparing for the care of patients, I thoroughly
review their medical chart to get a good picture of their medical
history as well as on-going treatments. In pre-clinical I relate
treatment to disease process, researching any treatment/disease I
am unfamiliar with.
Wk3: I completed my first reflection on the use of multiple
medications in the elderly population. Though medications are
necessary to treat many chronic diseases, research shows that
decreasing the number of medications from a regime could help
decrease negative outcomes in this population.
Melissa has demonstrated professional development based on
reflective practice through journals and reflection/sharing in
clinical. She shows evidence of critical inquiry with knowledge of
medications/chronic diseases/plan of care.
Wk5: I completed my second reflection on nursing students
feeling unprepared and/or uncomfortable in performing certain
skills in the clinical setting. This is something I felt when
suctioning a tracheostomy. An experience that is much different
when compared between doing it on a mannequin in the lab setting
and on a real human in the clinical setting.
Wk4: While observing a nurse caring for an alcoholic patient who
had the potential to be released from the hospital within a few
days after experiencing withdrawal, I questioned the method of
treatment for the patient. He had been admitted for an acute issue,
unconsciousness and pneumothorax, and then began to experience
withdrawal. The withdrawal process complicated his situation
resulting in a longer length of stay then needed to treat the acute
issue. Knowing that he would likely leave the hospital and return
to his previous state of alcoholism, I thought it was unnecessary
to force the patient through withdrawal and wondered if there was
an additional treatment that could be tried, however, there was
not.
X
Student Areas of Strength
1. Independence & Confidence
2. Time Management
3. Leadership
Student Areas for Future Development
1. Initiative
2. Therapeutic relationships
3. Confidence
Clinical Instructor Comments (All areas marked as unsatisfactory
must have a comment)
Melissa has met all of the objectives for clinical as evidenced
by the examples provided above.
Melissa, it has been a pleasure having you in clinical this
rotation. You are an extremely compassionate and caring nurse. You
have excelled in all areas of clinical, are extremely intuitive and
take advantage of all learning opportunities. You are aware of your
strengths and weaknesses. Keep up the great work during
preconsolidation.
Attendance
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Total number of clinical hours completed 160
Clinical Component
Satisfactory Unsatisfactory Please circle the appropriate
outcome
Clinical Learning Center Completed (if applicable) done
Signature of Instructor______________________________________
Date_______________________________
Signature of
Student______________________________________Date_____________________________
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