NURS 4021C Clinical Course Evaluation FINAL EVALUATION Nov 2014 Student: Jody Dawson Preceptor: Tanya Neilsen Clinical Instructor: Wendy Fucile Placement: Woodstock Hospital – Surgical Unit

PROGRESSCourse Objective Evidence/Indicators Satisfactory Unsatisfactory1. Synthesize and apply relevant concepts from nursing models, theories, and frameworks when making clinical decisions

Student:Midterm

I consistently utilize knowledge of theories and frameworks as rationale for the clinical decisions I make. For example,

I believe that Sister Callista Roy’s Adaptation model is very applicable for our surgical recovery floor. According to this model, the goal of nursing is to foster successful adaptation. I have observed this to be a central focus of our nursing priorities on the surgical floor, as many patients are adapting to changes (ie. a hip replacement, knee replacement, the formation of an ostomy, etc). With these changes it is important to promote integrated adaptation. In some situations, it is critical to recognize when adaptation is compromised, for example, if a patient develops post-surgical complications such as an infection or DVT. Nurses need to be aware of these potential complications so that we can help the patient utilize compensatory actions to prevent them.

I believe that using virtue ethics as a framework for decision-making promotes the most holistic and ethical care. A virtuous person is characterized by their compassion, discernment, trustworthiness, integrity, and conscientiousness. I believe that these virtues pervade all aspects of moral excellence and developing a moral community. The aspects of this theory encourage me as a nurse to reflect on the values I have and whether they are

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consistent with those of the nursing profession. By valuing these traits I believe I can promote sincere respectful practice based on unconditional positive regard.

Final:

I have continued to incorporate models, theories, and frameworks when making clinical decisions. For example, after caring for a patient with dementia, it came to my attention that there were particular challenges associated with caring for patients with dementia in the acute care setting. In acute care settings, the time spent with patients and families is compacted and likely to occur during periods of heightened stress from a health crisis. After this experience I researched the best practices for engaging with patients with dementia in an acute setting. I came across the Montessori method in an article from the Nursing 2014 journal, which was distributed to our floor. The Montessori method can be used to help engage adults with dementia by stimulating the mind with activities that use fine motor skills and build self-esteem. For example, providing the patient with responsibilities such as folding towels, providing welcome kits that include items that the patient can engage with at the bedside such as cards, poker chips, simple books, paper and coloured pencils and shapes. These types of interventions optimize participatory involvement and patient-centered care.

Preceptor:

Jody takes a creative approach in applying multiple nursing theories and frameworks while planning, and caring for her patients. This allows for a more individualized patient care plan.

2. Consistently apply the nursing process (assessment, diagnosis, goals, interventions and evaluation) in the holistic care of

Student:

Midterm:

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all patients.The following are examples of how I use the nursing process in the care of all patients.Pt with orthopedic surgery

Assessment – vital signs, neurovascular assessment (pedal pulses, CMS)

Diagnosis – ie .impaired physical mobility r/t pain, discomfort Goals –ambulate effectively with ambulating device,

independence, effective pain management Interventions – pt teaching re: effective ambulating

techniques, getting out of bed, using a walker, administer PRN pain medication

Evaluations – document progress of ambulating, update activity (ie patient may progress from needing two people to assist to one), evaluate pain relief with NRS.

Pt with general abdominal surgery Assessment – Vital signs, focused abdominal assessment –

tenderness, bowel sounds, + flatus, last BM Diagnosis – ie. Nausea related to gastrointestinal distention

and medication anaesthesia Goals – Reduce episodes of N/V, no interference with post-op

recovery Interventions – advance diet as tolerated to prevent

gastrointestinal distention, administer antiemetics as indicated

Evaluations – continue to monitor for episodes of N/V, document

Final:

Since the midterm, I have continued to use the nursing process in the holistic care of all patients. The following are examples of how I have used the nursing process on select cases:

Pt recovering from mastectomy Assessment – patient had large amount of sang drainage from

incision site. Low levels of hemoglobin and hematocrit, increased fatigue, pallor

Diagnosis – ineffective tissue perfusion r/t blood loss during surgery

Goals – obtain hemodynamic stability Intervention – administer blood products as ordered by

physician. Obtain BP from non-operative side. Evaluation – pt demonstrates no S/S adverse reaction to

transfusion. Pt’s Hgb and Hct levels return to normal. Pts skin returns to normal colour. Pt able to carry out goals with minimal fatigue/SOB.

Pt with perforated appendix Assessment – patient febrile, WBC elevated Diagnosis – risk of infection r/t perforation of appendix Goals – minimize/prevent complications Intervention – Administer prescribed antibiotics, monitor for

S/S of infection (redness, swelling), monitor vital signs and changes in mentation.

Evaluation – pt’s WBC returns to normal, patient afebrile

Preceptor:

The assessment data we gather as nurses is by far the most important component within the nursing process. It guides the formation of all the following components including the nursing diagnosis, goals, interventions and evaluation. Jody continues to exceed in performing head-to-toe assessments. She is well on her way to recognizing patterns and "what to expect" vs. what is abnormal, or unusual based on the patient's surgery, and/or condition.

3. Effectively synthesize patient Student: ✔

data while using multiple sources of knowledge in the development and implementation of prioritized nursing care.

Midterm:

My Preceptor Patients returning from surgery require focused assessments

and monitoring in order to promote optimal functioning and to prevent post-surgical complications. My preceptor has been the most important source for helping me to learn the most critical aspects of a focused post-surgical assessment, which varies depending on the type of surgery and the patient.

The Patient When prioritizing nursing care, the patient is the most

important source of knowledge. By completing a holistic assessment of the patient, I have learned how to identify when it is important to take action on abnormal findings, and when it is appropriate to continue to monitor. For example, when I have a patient whose blood pressure is very elevated, I assess whether the patient is symptomatic, whether they take a blood pressure pill at home, whether the dose of that pill has been altered, whether they have just completed a strenuous task.

Final:

I have continued to utilize data from multiple sources of knowledge in the development of prioritized patient care. For example,Knowledge from the physician

I read physician’s consultation and surgical reports to inform myself of the patient’s history. I update the patient’s individual care plan and complete interventions according to the physician’s orders re: vital signs, diet, activity, IV therapy, wound care, medications, pain control, input/output, etc.

Knowledge from laboratory/diagnostic reports

For patients preparing for surgery, I monitor values such as INR to ensure they are not at risk for bleeding.

For patients returning from surgery, I monitor lab values such as hemoglobin and hematocrit to assess their hemodyamic stability.

In general, I monitor patient’s CBCs, electrolytes, BUN, and creatinine levels to ensure their levels are within normal limits.

Knowledge from the patient In my head to toe assessments I gather information to make

sure the patient is progressing well and not experiencing post-operative complications.

Knowledge from my Preceptor Every shift I continue to learn new things as every patient has

a unique history requiring specific interventions. My preceptor prompts me to determine how to prioritize my care according to patients’ stability and individual needs.

Knowledge from Woodstock Hospital’s Resources Woodstock Hospital has a wonderful learning resource for

staff known as The Artery. The Artery was developed for the hospital’s intranet. It provides a variety of clinical resources, medication resources, as well as access to Potter and Perry text.

I use the Ottawa Hospital Parental Drug Therapy Manual when completing intravenous drug therapy administration to determine appropriate rates of infusion, how to reconstitute meds, etc.

Preceptor:

Jody continues to excel in gathering multiple sources of patient information. She is not only recognizing abnormal findings, but furthermore, is able to verbalize multiple reasons why these findings may be present.

Jody is a phenomenal researcher and a critical analyst, and continues to openly discuss her observations, findings and any questions she has. With these skills, she is able to compile her information in order to gaina broader picture of her patients and their immediate needs.

4. Provide consistent, safe, competent, and ethical nursing care that reflects the principles of relational practice and critical thinking.

Student:

Midterm:Consistent

By documenting all of the care I provide and keeping clear, complete, accurate health records, I promote consistent care of patients. I have learned how to update each patient’s care plan and how to add physician’s new orders to the care plan so that I can promote consistent care from shift to shift.

Safe In order to ensure the safety of the patients I care for, I

consider patient safety in every aspect of my practice. For example, when entering a room I follow the principles of hand-hygiene, and identify whether my patient has allergies and is identified as a fall risk by assessing their ID band and whether they have a “falling star”. When transferring patients I ensure they have proper footwear and I keep rooms tidy. When leaving a patient’s room I make sure the patient’s call bell and important items are within reach, I keep their bed in the lowest position, and again use hand-hygiene.

When medication administration I protect the safety of patients by verifying the 7 rights of the patient

When completing dressing changes I use clean/sterile techniques.

If I am unsure about a task, I make sure that I ask my preceptor for a demonstration or her supervision.

Competent I maintain the necessary knowledge, skills and judgments

required to practice safely and competently as a registered

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nursing student. For example, I research the medications I am providing so that I know their purpose, mechanism, and potential adverse affects so that I can use this knowledge to determine whether the medications are appropriate, and use critical inquiry when responding to adverse events. I research the special procedures and skills I have seen that I am unfamiliar with (ie. CBI, chest tubes, hemovacs, JP drains, TPN, suctioning) so that I can provide knowledge-informed care to each patient.

Ethical I preserve the rights, dignity, and safety of my patients by

ensuring that I act within the ethical standards of our profession. For example, I consider the beliefs and values of the patient so that I can provide culturally competent care. I embrace diversity, facilitate patient’s choices, and reflect on how my own values and beliefs impact my relationships so that I can strengthen the quality of care that I provide. I protect each patient’s right to confidentiality by ensuring the proper disposal of nursing papers and by only discussing questions about patients to nurses within the patient’s circle of care.

Final:

I have continued since the midterm to provide consistent, safe, competent, and ethical nursing care that reflects the principles of relational practice. To me, relational practice is being attentive to the unique needs of every patient and responding with intentionality. For example,

I have learned to use knowledge of potential complications of certain procedures to help me recognize when a typical goal is not being met. For example, the ability to ambulate safely following surgery, the ability to void following surgery, the ability for the patient to tolerate their prescribed diet and

activity, etc. I have learned how to prioritize care according to detection of patient’s change of status. For example, when my patient with CAD began complaining of chest pain, we obtained her vital signs, an ECG, and administered her prescribed nitroglycerin and closely monitored her until she returned to a stable condition.

Since the midterm I have continued to research medications, conditions, and procedures so that I can maintain necessary knowledge, skills and judgments required to practice safely and competently as a registered nursing student. By using knowledge of my patient’s status and the medications they are receiving, I have been able to identify times where certain medications may be appropriate or inappropriate. For example, I ensure that I give medications such as digoxin, ACE-inhibitors, and insulin within the parameters indicated by the physician as opposed to just giving them without considering the patient’s physiological condition.

Preceptor:

Jody's competency continues to improve in relation to her increased knowledge base and the experiences she has obtained throughout her practicuum. She consistently provides safe care by ensuring she is adhering to hospital policy and CNO guidelines, and by always verifying anything she is unsure of.

5. Within the nursing student's scope of practice, assume the responsibility and care of assigned patients. By midterm, the student should be managing a full and reasonable nursing assignment or workload (expected of a novice staff in the assigned practice area).

Student:

Midterm

Every shift I accompany my preceptor and complete tasks within my scope of practice. These tasks on a day shift include, but are not limited to:

Taking report at change of shift Assisting with am care for patients (assisting with personal

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hygiene, dressing, toileting), Assessing and documenting patient’s blood glucose levels, Assessing and documenting patient’s vital signs, Assisting with preparing patients for rehabilitation therapies, Administering medications, Assessing dressings and changing them as per physicians

orders, Reviewing patient care plans, Catheter maintenance, IV maintenance, Documenting all assessments, filling out change of shift

reports Giving report at change of shift

These tasks on a night shift include, but are not limited to, Taking report at change of shift Introducing myself to all of my patients Assisting with HS care for patients (assisting with personal

hygiene, dressing, toileting) Administering HS medications Completing “chart checks” – checking charts for new orders

within the last 24 hours, ensuring new entries are in the ICP Stocking supplies at nursing stations Repositioning patients Catheter maintenance, IV maintenance Documenting all shift tasks and filling out change of shift

reports Giving report at change of shift

Final:

Since the midterm I have continued to complete nursing tasks within my scope of practice, and have gained a lot of independence in assuming the responsibility and care of patients. Each day there are new things to learn and I always document what I am learning and ask

questions so that next time I can do the task independently. At this time, I am completing focused assessments with specific nursing interventions, medication administration, and documentation for each patient assigned to my preceptor.

Preceptor:

Jody has continued to provide nursing care within her scope of practice. At this time she is managing 75-100% of a regular assignment, consisting of 4-6 patients. Her time management skills have significantly improved, and she is demonstrating that she can prioritize and organize her assignment based on each patient's current status and/or needs.

6. Effectively use "self" in the initiation, maintenance and termination of both professional and therapeutic relationships.

Student:

Midterm:

Every time I meet a new patient, I introduce myself by telling them my name and my designation as a nursing student.

I honour each patient’s right to have control over personal decisions. I promote autonomy by involving patients in every decision regarding their care plan and daily goals and by promoting independence.

By respecting patient privacy, valuing trust and confidentiality, and preserving patient's dignity, I establish therapeutic and caring relationships

I attend to the needs of not only patients but also their families. Families frequently need information, support, comfort, assurance, and accessibility. I provide current information about patient’s progress including trends in vital signs, wound healing progress, rehabilitation progress, and I orient them to routines of our floor and care procedures to help engage them in their loved one’s recovery process.

I contribute to the culture of our floor that is very focused on

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helping eachother as a team by showing passion in my work and motivation to learn from the expertise of the staff. I strive everyday to contribute to the great dynamic they have created by answering call bells and offering my help wherever I can. I am very grateful for the wisdom and guidance they share with me.

Final:

I have continued to effectively use "self" in the initiation, maintenance and termination of both professional and therapeutic relationships. In establishing therapeutic relationships, I try to always be available to my patients so that they can feel comfortable in talking to me and knowing they can depend on me. In professional relationships, I try to always be available to my nursing colleagues so that we can share the workload evenly. I always express gratitude when nurses go out of their way to teach me knew knowledge and skills. In return, I love to help the nurses balance their workload by using the skills they have taught me to help them with their own tasks.

Preceptor:

Jody continues to identify her name and role to each of her patient's during her first interactions with them. She furthermore explains to her patients what they may expect during her shift, and promotes their independence and autonomy by involving them in their care. She collaborates with other health care professionals to ensure patient safety and needs are being met and always shows initiative to assist fellow nurses .

7. Apply principles of advocacy in client centered care.

Student:

Midterm:

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I recognize the importance of critical thinking, action and advocacy in all domains of practice. With each relationship that inspires individual healing and self-actualization, I have the opportunity to advocate for human rights. By respecting patient privacy, valuing trust and confidentiality, and preserving patient's dignity, I can ensure that the care I provide is professional and accountable. I apply principles of client centered care by documenting the name that the patient prefers to be called, and by keeping the patient involved in their care plansby reviewing and updating the patient’s goals on their whiteboard, and updating their white board with the name of their nurse, the date, and their mobility requirements.

Final:

Since the midterm, I have continued to apply the principles of advocacy in client-centered care. I recognize the importance of critical thinking, action and advocacy in all domains of practice. For example, my instructor has taught me how to advocate for patients to receive valuable support from resources such as CCAC following surgery, dietary consultation following bowel diversion, geriatric assessment to support specialized care of older patients, etc.

Preceptor:

Jody continues to advocate for her patients by listening to their concerns and/or wishes, and addresses these with the moost responsible physician. She is recognizing when there may be gaps in a patient's plan of care, and alerts myself, the charge nurse, or the physician to these.

8. Maintain professional conduct in accordance with legislation and the standards of practice as outlined by the College of Nurses of Ontario.

Student:

Midterm:

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As a nursing student, I recognize my knowledge, skills and judgment, limits of responsibilities, and supervision requirements. For example,

I ask for help or extra guidance in skills I am not completely comfortable in completing. Ie, my first time giving injections, my first time doing dressing changes with tunneling that required packing

I report all abnormal findings to my preceptor. For example, if a patient has excessive dressing drainage, uncontrolled pain, etc.

I use clear, accurate and effective communication skills in professional interactions. For example,

At change of shift I provide a comprehensive report to the oncoming nurse to relay all important patient information.

I document all required information regarding the patient’s physical assessments, and any nursing tasks completed

If I answer a call bell for a patient that I am not assigned to, I relay any important information to the nurse responsible for that patient’s care.

I follow my agency’s policies, procedures and principles. For example, I complete a comprehensive head to toe assessment at the

beginning of every shift, and take vital signs per protocol depending on the patient.

I complete change of shift gemstar flow sheets with a registered nurse.

I understand and clarify my role in the provision of care with the educator/preceptor – I do this by updating them on my scope and skill-sets, and every time I work with a new educator I inform them of the tasks I am capable of doing, and what I may need help with.

I follow the protocol for moving patients as designated by the physiotherapists, ensuring that I transfer patients with the proper amount of assistance.

Since the midterm, I have continued to maintain professional conduct in accordance with legislation and the standards of practice as outlined by the College of Nurses of Ontario. For example,

▪ I recognize my knowledge, skills and judgment, limits of responsibilities, legislative authority and supervision requirements – I do this by always asking for assistance with tasks I am not proficient in, and not completing tasks not permitted of students at Woodstock Hospital, such as IV insertion.

▪ I contribute to the development of objectives for the experience – for example, I discuss my goals with my preceptor and seek feedback from her so that I can evaluate my accomplishment of goals I set out for.

▪ I understand and clarify my role in the provision of care with the educator/preceptor – I do this by updating them on my scope and skill-sets, and every time I work with a new educator I inform them of the tasks I am capable of doing, and what I may need help with.

▪ I use clear, accurate and effective communication skills in professional interactions – I do this by completing accurate documentation and by filling out report sheets for the oncoming staff that accurately reflect each patient’s individual care plan

▪ I identify the need for, and acts to obtain, appropriate supervision – for example, I ask my preceptor to double check any high alert medications I administer.

▪ I am accountable for the quality of care Iprovide within the established objectives – I do this by being thorough with my documentation and by documenting only on the tasks that I have completed.

▪ I follow my agency’s policies, procedures and principles. For example, I respect their policy that nursing students are not

to complete IV injections. I use the Ottawa IV therapy manual for any questions related to the IV meds I am administering. I update patient’s ICPs whenever new orders from the physician are received.

Preceptor:

Jody has arrived at every scheduled shift on time and in proper uniform. She maintains professionalism in all of her modes of communication. She refrains from "surfing the web" or using her cellphone while on the floor working.

Please provide comments for each of the Competency areas below. When commenting on, please also provide evidence including specific details to support your comments (e.g. example of students’ behaviour)

Professional Responsibility and Accountability

Please comment on the Trent BScN student’s ability to demonstrate actions that reflect accountability and responsibility in your practice environment. This entails: 1) demonstrating respect for your practice area (patients, staff, organization, and community), 2) demonstrating leadership skills by taking initiative and working collaboratively with others, and 3) practicing within the policies and procedures of your agency/organization. This component of the student’s practice also includes their ability to organize themselves and their work, to critical and creatively think, to exercise good judgment, and be accountable for their use of their time.

Student:For the duration of my placement at Woodstock Hospital, I have remained professionally responsible and accountable for all aspects of care I have provided. I have remained committed to meeting the standards of this competency as outlined by the CNO. For example,

(CNO ETP 11) – I promote current evidence informed practices. Woodstock Hospital provides staff with current literature on best practices. These have included documents on current best practices for caring for patients with dementia, patients with chest tubes, etc. I enjoy reading the documents they provide in order to maintain competent on the latest evidence and research.

(CNO ETP 14) - I question and take action on unclear orders. For example, I recognized when a physician transcribed orders under the wrong patient’s file. My preceptor helped me to clarify the orders by phoning the physician.

(CNO ETP 20) – I organize my workload and develop time-management skills for meeting responsibilities. For example, at the beginning of each shift I make a time schedule outlining all critical times to remember, ie. medication administration, gemstar checks, etc. Prior to my head-to-toe assessments I familiarize myself with the patient’s history and note what I need to focus on and remember to check. After completing each activity I check it off, and document all work I have completed.

Preceptor: Jody consistently maintains professionalism with all of her interactions with staff members and patients. She demonstrates leadership by providing guidance to the year two RPN students, and in turn, appreciates any transfer of knowledge and skills, she receives from other colleagues.

Clinical Faculty:

Knowledge-based Practice

Please comment on the Trent BScN student’s: 1) demonstrated knowledge of your patient population and issues of relevance to this population, 2) contribution of their nursing and health related knowledge and skills to the practice setting 3) communication skills; and 4) their ability to effectively collaborative to identify and take actions to address health related needs and issues.

Student:For the final duration of my placement at Woodstock Hospital, I have remained committed to knowledge-based practice for all aspects of the care I have provided. I have remained committed to meeting the standards of this competency as outlined by the CNO. For example, - (CNO ETP 36) – I use appropriate assessment tools and techniques in consultation with clients. For example, in addition to head to toe assessments, I use the assessment forms provided by Woodstock Hospital to document specific, patient-focused assessments. These forms include neurovascular documentation forms, gemstar documentation forms, input and output forms, etc. - (CNO ETP 37/CNO ETP 49) – I facilitate client engagement in identifying their health needs, strengths, capacities, and goals, and anticipate potential health issues for clients and their consequences and initiate appropriate planning. For example, patients who are returning from surgery after receiving an anesthetic are at risk for complications such as DVT, pneumonia, aspirations, etc. I teach my patients the importance of DB+C, ambulation, calf pumping, slow diet progression after abdominal surgery, and I encourage the use of tools such as incentive spirometers and pneumatic stockings in order to help avoid post-op complications. - (CNO ETP 52) – I collaborate with other health care team members or health-related sectors to assist clients in accessing resources. For

example, I address the need for CCAC for patients being discharged, I address the need for dietary consultation following bowel diversion, I address the need for geriatric assessment to support specialized care of older patients, etc.

Preceptor: Jody has gained tremendous knowledge surrounding orthopaedic and general abdominal surgeries during her consolidation on the inpatient surgical unit. She understands the care plan pathways involved in each surgery, and what is expected of her in her role as a nurse caring for these patients.

She is always eager to expand her clinical knowledge base and demonstrates this by seeking out opportunities to learn. For instance, Jody has attended information sessions held at WGH that cover various topics geared towards educating and improving nursing care.

As previously mentioned, Jody effectively collaborates with all members of the health care team to address any issues/concerns pertaining to her patients. Eg. she reports any abnormal bloodwork, or a change in patient's condition/status to the physician (low urinary output, uncontrolled pain issues, change in vital signs, large increase in amount of dressing drainage).

Clinical Faculty:

Ethical Practice

This area of competence relates to the student’s ability to practice ethically and engage with the ‘community’ (patients/clients/residents, staff, organization, community) in ways that recognize, respect, and work to preserve rights, dignity, and personal safety. Please comment on the Trent BScN student’s action related to establishing and maintaining appropriate professional boundaries with clients (individuals, families and/or partners) and other team members (health care and non-healthcare, student colleagues) in your setting. Please also comment on any actions taken by the student that demonstrated support and advocacy for clients.

Student:For the duration of my placement at Woodstock hospital I have remained committed to ethical practice and meeting the standards as outlined by the CNO entry to practice guidelines. - (CNO ETP 81) I ensure that informed consent is provided as it applies to multiple contexts. For example, I obtain informed consent from the patient prior to administering blood transfusions. - (CNO ETP 85) I use ethical frameworks and evidence-informed decision making to address situations of ethical distress and dilemmas. For example, in order to avoid having to use restraints on a patient who continued to attempt to leave the unit, we collaborated with his family to determine the cause of his behaviour. In doing so we identified the value of family visits for his positive ability to cope in the unfamiliar acute care setting. The family were happy to visit often which was very helpful and enabled us to avoid the use of a soft restraint. Also, nursing staff collaborated by helping his wife visit him from the unit she was on.

Preceptor: Satisfactory

Clinical Instructor:

Service to the Public

This area of competence focuses on the student’s ability to understand the broader historical and current contexts (e.g., health policy, political and other systems issues, and social issues) which impact your practice area and the patients/clients/residents in your setting. This area of competency also includes the student’s awareness and appropriate use of agency and university policies and procedures and their understanding of and ability to promoting healthy and safe work environments. Please provide a comment if this area applies to your setting and/or the activities the student has been involved in.

Student:Throughout my placement I have demonstrated an understanding of the concept of public protection and the duty to provide and improve health care services in collaboration with other members of the health care profession. For example,- (CNO ETP 89) – I demonstrate leadership in the coordination of health care by delegating and evaluating the performance of selected health care team members in carrying out delegated nursing activities. For example, when I have RPN students assigned to my patients, I provide assistance with the tasks that are outside of their scope, such as completing gemstar checks, and I advocate for them to have practice with the skills that are within their scope, such as head to toe assessments, medication administration, etc. - (CNO ETP 90) – I participate and contribute to the nursing and health care team development by building partnerships based on respect for the unique and shared competencies of each team member. I contribute to our team’s functioning by offering assistance and completing tasks that help out the team. For example, when a nurse gets an admission there are a lot of extra tasks associated with this. I assist by helping to complete some of these tasks such as obtaining vital signs, obtaining MRSA + VRE swabs, completing the patient admission, adding the patient’s orders to their individual care plan, etc. This assistance from myself as well as members of our nursing team helps prevent a single nurse from being overloaded and contributes to the team-nursing culture on our floor. The respectful and helpful culture of our floor builds partnerships and positive interactions. - I have informed myself of Woodstock Hospital’s policies and procedures in order to promote safe and healthy work environments. For example, Woodstock Hospital’s intranet, The Artery, has all of Woodstock’s policies on it. I have read these documents and informed myself of Woodstock’s policies and clinical practice protocols for specific tasks such as blood therapy, care of a patient with a chest tube, CVAD care, Gemstar therapy, Insulin therapy, etc.

Preceptor: Jody promotes a safe and healthy work environment in several ways including:

- Doning proper PPE to prevent the transmission and spread of infection.

-Consistently engaging in health promotion from a preventative and holistic perspective. This in turn helps to decrease the amount of readmissions to hospital.

-Obtaining her "Project uplift" certification which enables her to compentently and safely operate lifting devices used for patient transfers. This helps prevent work-related injuries and ensures patient safety measures are being met.

Clinical Faculty:

Self-Regulation

This competency area focuses on the Trent BScN student’s understanding of and participating in professional self-regulation. Demonstrating competence in this area requires the student to be able to : 1) practice safely within the parameter of the course expectations and limitations, the partner agency/organization expectations and limitation, and their own level of competence; 2) actively engage in self-reflection and identify their learning needs; 3) clearly communicate learning needs to their preceptor, 4) take initiative and seek out opportunities to meet learning needs; 5) seek feedback from others and incorporate feedback into their practice; 6) seek help from others when it is appropriate; and 7) critical thinking about their actions and the potential impact they may have on others. Please comment on the student’s demonstrated abilities in this area.

Student:I have demonstrated an understanding of professional self-regulation by advocating in the public interest, developing and enhancing one’s own competence, and ensuring safe practice. For example,

- (CNO ETP 99) – I articulate the significance of continuing competence requirements within professional self-regulation. I participate in continuing competence initiatives held by Woodstock Hospital. For example, I attended an information session regarding current research on malnutrition in Canadian hospitals. Attending these sorts of sessions and familiarizing myself with recent research enables me to remain knowledgeable on the current health care issues and best practices.

- (CNO ETP 100) – I demonstrate continuing competence and preparedness by reflecting on my individual competence and learning needs. Every week I summarize what I have learned and research the diagnoses and interventions for the clinical cases I have seen so

that I can understand the logic behind the patient’s plan of care. This has enabled me to identify patterns in care plans based on specific diagnoses and surgical/medical interventions. It has also enabled me to inquire further into the concepts I don’t understand by asking my preceptor or using my textbooks and current literature as resources. For example, I noticed that some patient’s returned from surgery requiring telemetry, but I could not figure out why some patients did and others did not. My preceptor helped me to identify which situations warranted the use of telemetry, and where I could find this information in the future.

- I have taken initiative and seek opportunities to meet learning needs. For example, whenever I know that a patient requires a catheter insertion, TPN care, colostomy care, or any task I don’t have as much practice with, I always ask the nurse if I can help her, as well as the patient’s permission if I can assist in completing the task.

- I seek feedback from my preceptor after completing new skills, after giving transfer of accountability reports, and when deciding what to include in clear and concise documentation of completed work. My preceptor also gives me feedback after each set of shifts and we discuss my progression and what my goals to set out for in the next week should be.

Preceptor: Satisfactory.

Clinical Faculty:

Summary Comments: (include steps to improve areas of identified weakness)

Student:I have thoroughly enjoyed my placement at Woodstock Hospital. I have had the privilege of working with a large variety of patients with varying diagnoses, surgical interventions and medications, which has broadened my scope of practice and knowledge considerably. I have been blessed with a preceptor and fellow nursing staff who have been very kind, informative, given me constructive feedback, and have been patient with me and my learning needs. I feel that I have come a long way this semester because of their guidance and mentorship. I am very thankful for the experience I have had at Woodstock Hospital! Going forward, I know I still have a lot of learning ahead of me and I look forward to this in my upcoming experience as a new-grad. In order to continue to improve my knowledge and skills, I will volunteer myself as a new grad to complete tasks for nurses that I would like more practice with. I will solidify many concepts I have come across this semester as I prepare for the NCLEX examination. As an RN, I will remain committed to life long learning and seek opportunities to enroll in courses such as ACLS.

Preceptor:Jody has made great strides this semester, particularly with her time management skills, and organizing her patient assignment. She is displaying more confidence and proficiency in her delivery of care, and remains dedicated to her patients safety and ensuring their needs are met.

She has a sincere, and warm personality, and displays eloquence in her conversations with others. This aids her in developing trust, which is highly important in her nurse-patient relationships, as it is with her colleagues.

Of further note, Jody has displayed competence and leadership in her abilities with teaching and providing mentorship to the RPN students.

I would conclude that she shows the necessary skills and knowledge base to begin her career as a entry level nurse.

Clinical Faculty: