NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Final Evaluation
Student: Ainsley Kinch
Clinical Instructor: Karissa Soetens
Clinical Placement Hospital Northumberland Hills Hospital
Inpatient Rehabilitation

Unit

Total Hours Completed: 144

Date: Monday, March 21st, 2016

Satisfactory

Unsatisfactory
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NURS 3021H Clinical Practice Mid-Term Evaluation

Program Goals
Students graduating from this program will be:
1. Prepared as generalists entering a self-regulating
profession in situations of health and illness.

2. Prepared to work with people of all ages and genders

(individuals, families, groups, communities and
populations) in a variety of settings.
3. Expected to have an enhanced knowledge of the program
foci: indigenous, women's and environmental health and
aging and rural populations.
4. Prepared to learn to continuously use critical and scientific
inquiry and other ways of knowing to develop and apply
nursing knowledge in their practice.
5. Prepared to demonstrate leadership in professional nursing
practice in diverse health care contexts.
6. 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
7. Able to establish and maintain therapeutic, caring and
culturally safe relationships with clients and health care
team members based upon relational boundaries and
respect.
8. Able to enact advocacy in their work based on the
philosophy of social justice.
9. Able to effectively utilize communications and informational
technologies to improve client outcomes.
10. Prepared to provide nursing care that includes
comprehensive, collaborative assessment, evidenceinformed interventions and outcome measures.

3000 Level Outcomes

On completion of 3000 level courses students will be
able to:
Fully understand how to practice in a self-regulating
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.
Understand the complexity adults, of all genders, to achieve
optimal health.
Use a critical perspective in applying the foci to nursing
knowledge and practice.
Integrate critical reflective evidence-informed care using
multiple ways of knowing.
Develop and embody leadership at the point of care.
Expand awareness of leadership in nursing.
Identify strategies to develop leadership potential.
Anticipate, identify and manage risk situations.
Demonstrate awareness of resources related to risk
management.
Engages in deliberative personal centred relational practice to
assist individuals, families and communities to achieve health.
Acknowledge own potential to contribute to effective
collaborative team function.
Advocate for individuals, families, and communities
recognizing the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.
Integrates and applies critical thinking to the use of
information technology and dissemination strategies as related
to clinical outcomes.
Critically assess the individuals, family and community health
status. Collaborate to identify priority health needs.
Identify evidence informed interventions and health outcome
evaluation in complex care situations.

NURS 3021H Clinical Practice Final Evaluation

Course Objective
1. Demonstrate accountability and responsibility in the
teaching-learning relationship.

2. Explain the experience of chronic illness in individuals

receiving care in chronic care settings

Progress
Evidence/Indicators

Satisfac
tory

Unsatisfac
tory

Throughout this clinical placement, I

believe I have exuded accountability
and responsibility through all of my
actions. For example, I fell ill and
knowing I would put my patients at
risk if I came to placement, I made
the decision that I was in no condition
to attend. Even though I would be
missing valuable clinical hours, I
made sure that I promptly notified
both my clinical instructor and course
lead via the appropriate methods to
inform them of my absence. Within
the hospital setting, I ensure that I
approach my co-assigned nurse and
ask if there's anything I can assist
with or observe to gain new learning
experiences and attempt to broaden
my clinical skills.
I believe I have been successful in
identifying and communicating to my
patients about the experience of
living with a chronic illness. For
example, I had one patient who was
nearing their predetermined
discharge date and lacked an
extensive amount of knowledge
surrounding self-care and how to
effectively perform self-management
relating to ostomy care. I took the
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3. Interpret critical aspects of the persons experience of

chronic illness in relation to the nursing process such as
common signs and symptoms, responses to treatment,
patterns of coping, and impact on individual and family
relationships.

initiative to provide client teaching

and offered to address any concerns
my patient had; their main fear
related to lack of awareness about
how to empty an ostomy bag. I then
demonstrated how to empty the bag
and then had the patient
demonstrate it with my supervision to
ensure they were adequately
informed. Bowel resections are just
one example of how chronic care
differs from acute care due to the fact
that the goal in a chronic setting is
effective self-management rather
than treatment of a disease
Chronic illness is a lifelong process
that requires adjustments to be made
to achieve adequate selfmanagement. The majority of our
patients were diagnosed with
diabetes and most were not
managing effectively. Either due to
lack of education or inability to
perform self-care, the consequences
of diabetes manifested. Since I have
immediate family members with the
disease, I was able to effectively
identify complications of the disease
and provide education to both the
patient and their family on how they
can better manage the disease.
Having a support system is crucial,
just like with any other chronic
illness, as it has enormous benefits to
enhance quality of life and provide
help with self-care.
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4. Identify symptoms and common medical treatments of

selected chronic illness.

5. Demonstrate select nursing and collaborative interventions

related to caring for the person with chronic illness such as
specific assessments, medication administration, physical
and chemical restraints, enteral feeding & residual
volumes, NG tube insertions, wound care, patient
controlled medication administration pumps.

6. Identify potential consequences/complications of select

chronic illnesses and related interventions.

A new chronic illness that I had never

encountered before this placement
was a patient who had chronic
immune thrombocytopenia. This
disease creates a deficiency in the
level of platelets within the blood that
lasts longer than 6 months.
Symptoms associated with the
disease include excessive bruising,
superficial bleeding, prolonged
healing, and fatigue. The medical
treatment this patient would receive
on a monthly basis was
immunotherapy consisting of
intravenous immune globulin. This
medication consists of pooled plasma
from approximately 1000 blood
donors and, in this situation, was
administered over a period of 8
hours.
I have demonstrated select nursing
interventions including:
- Safe and competent medication
administration
- Ostomy care, wound care,
incontinent care, respiratory care
- Comprehensive head-to-toe
assessments
- Assistance with catheterization
- Conducting a bladder scan
- Proper use of physical restraints
For the majority of my assignments,
my patients have ranked high as a
fall risk. With diagnoses related to
fractures, neurological deficits, or
strengthening, I make sure I
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continually assess my patient's ability

before performing any lifts or
transfers. One of the complications I
ran into frequently was that my
patient, who was a minimal 2 person
assist, didnt have a transfer belt
available to them. This deeply
troubled me because I didn't want to
pose a risk to both the patient and
myself if I tried to perform any action
without a belt. Therefore, I would
ensure that I contacted either my
nurse or a member of the physio
team to either locate a belt for my
patient or question why they didnt
have one.
7. Under the supervision of a Registered Nurse, demonstrate Nursing practice tasks I have
safe, competent, evidence-informed, holistic nursing
completed include:
practice with clients with chronic illness
- reporting to the assigned nurse
a. Use a wide range of effective communication
when I notice abnormalities with their
strategies and interpersonal skills to appropriately
patient
establish, maintain, re-establish and terminate the
- Perform constant assessment and
nurse-client relationship
evaluation when providing care for
b. Demonstrate accountable, responsible and ethical my patients (i.e. using the PQRST tool
practice
for pain assessment and evaluate the
c. Engage in respectful, collaborative, therapeutic and efficacy after administering a pain
professional relationships
reliever)
i. Demonstrate therapeutic use of self
- Advocate for my peers to perform
ii. Create a culturally safe environment
certain skills if I have already had the
d. Apply nursing models and theories
opportunity and they have yet to
e. Demonstrate health promotion and illness
have that experience (i.e. I was
prevention practices
assigned two catheter insertions and I
f. Demonstrate patient advocacy
inquired if I could let my peer conduct
g. Predict outcomes of nursing care
one of them considering they have
h. Evaluate client response to nursing care
not had the opportunity)
i. Critically appraise own practice in relation to nurse- - Be upfront about my concerns in my
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client/family interactions and as a member of the

health care team

8. Critically appraise own practice in relation to nurseclient/family interactions and as a member of the health
care team

9. Participate in professional development based on reflective

practice and critical inquiry

own clinical abilities and critically

reflect on how I can further develop
upon
my
areas
that
need
improvement with guidance from my
clinical instructor
- Inform all my patients about the
importance of hand washing in
disease prevention, espeically within
a hospital setting
Client/family interactions are a key
aspect in providing care in a chronic
setting. When providing care for my
patient in the presence of family, I
ensure that I properly identify myself
in a professional manner and make
myself available if there is any
concerns about the care their loved
one is receiving. I have answered the
phone numerous times when a family
member is inquring about the status
of the patient; I ensure that I uphold
confidentiality, identify the member
of the team that is best fit to answer
the call (i.e. the assigned nurse or
member with which they wish to
speak), and provide alternatives if
that member is not available.
As previously mentioned, my weekly
pre-clinical assignments allow for
critical thinking and gives me a
chance to first prepare for my clinical
shift by identifying my focused
assessments for my patient. The
clinical reflections also gave me the
opportunity to reflect on my actions
and analyze how I either did well in
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the situation, or areas I would need to

improve upon if I face the same
encounter again. An opportunity my
group had that I really enjoyed was
having a member of the physio team
provide a SMART moves inservice to
demonstrate a safe way to effectly lift
and transfer patients. This will benefit
me throughout my clinical practice to
preserve my own health as well as
the health of my co-workers.

Areas of Strength Identified by Student

1. Safely performing wound care
2. Effective use of time management (identifying priority tasks)
3. Conducting safe and competent medication administration relative to the best practice
guidelines
Areas for Future Development Identified by Student
1. Work towards developing a better understanding of pharmacology
2. Continue to build upon my therapeutic communication skills
3. Continue to develop self-confidence in my clinical abilities
Clinical Instructor Comments (All areas marked as unsatisfactory must have a
comment)
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Clinical Practice Attendance (8 Hours Per Shift)

Week
1
Week
2
Week
3
Week
4
Week
5

Thu Fri
rs
X
X

Fri

Week 6

Thu
rs
X

Week 7

Week 8

Week 9

Week 10

Total number of clinical practice hours completed: 112 /128 Hours

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Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory

Unsatisfactory
Clinical Learning Centre
Total number of clinical replacement simulation hours completed 14 / 14
Hours
Total number of lab hours completed 22 / 22 Hours
Clinical Learning Centre Outcome (completed by Course Lead): Satisfactory
Unsatisfactory
Signature of Course Lead:

Date:

Signature of Clinical Instructor:

Date:

Signature of Student:

Date:

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