NURS 3021H Clinical Practice Focused on Chronic Disease Management – Fall 2021

Mid-Term Evaluation Final Evaluation      

Student: Erin Collins

Clinical Instructor: Rebecca Johns

Clinical Placement Hospital: PRHC Unit: A2

Date: November 30, 2021

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. Fully understand how to practice in a self-regulating

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. Understand the complexity adults, of all genders, to achieve

(individuals, families, groups, communities and optimal health.
populations) in a variety of settings.

3. 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. 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. 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. 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 health management.
care providers

7. 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. Advocate for individuals, families, and communities recognizing

of social justice. the influence of public policy on health.
Recognize contextual influences on persons lived experiences
within the health care system.

9. Integrates and applies critical thinking to the use of

 technologies to improve client outcomes. information technology and dissemination strategies as related
to clinical outcomes.

10. 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. Student:
Progress Midterm Progress Final I demonstrated accountability and
responsibility in the teaching-learning
◻ SP ◻ S relationship by always remaining
◻ ND ◻ U accountable for what I do and do not Throughout the rest of my clinical
◻ UP know, making sure to communicate that placement, I demonstrated accountability
to either my clinical instructor or one of and responsibility in the teaching-learning
the other nurses. This ensures that I do relationship in multiple ways. I ensured I
not complete a skill or task that I am not was accountable for all my actions and
able to properly or confidently do on my skills throughout the clinical shifts. This
own, remaining accountable and meant reporting back to my CI or MRP
responsible for my own actions. Also, I anything that I had completed or that I
make sure to report back to my clinical may have needed assistance or guidance
instructor or other nurse after with. I ensured that I remained
completing tasks or if I have any accountable for what I do and do not
abnormal or concerning assessment know, including skills that I am confident in
findings, ensuring that I remain and those that I am not as confident in.
accountable for the tasks that I complete This confirms that I am remaining
for the patients. accountable to my own skill set and scope
of practice as a 3rd year nursing student,
providing the best quality of care to my
Clinical Instructor: patient as possible.
-
accountability. Always checking
on your patients and
communicating with myself and
members of the team.
- Clinical Instructor:
CI or the staff nurse in a timely
manner.

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

individuals receiving care in chronic care The experience of chronic illness in After clinical this semester, I was able to
settings individuals receiving care in chronic care see first-hand how the experience of
Progress Midterm Progress Final settings is different for every person, as it chronic illness in individuals differs in
is a very subjective experience. But, different chronic care settings. For
◻ SP ◻ S receiving chronic care in a setting like the example, I was able to learn about the
◻ ND ◻ U hospital is also much different than that experience of those living with a chronic
◻ UP of an environment like a LTC home or in disease on a chronic care/rehab floor in a
the patient’s own home. I think that the hospital. What I learned is that two
illness experience of the patient, like we individuals with the exact same disease
are learning about in NURS-3001, is physiologically may have a completely
dependent on the person and numerous different experience than one another.
other factors. One patient might have a Like I said before, I believe everyone’s
much different outlook on their chronic experience with chronic illness is very
illness than that of another patient. For subjective. Knowing this now for my future
example, the patient that I was paired practice, I now know to treat every patient
with for our first clinical weekend was uniquely, even if physiologically their
extremely eager to be independent, to diseases may be similar. I think that
do the work with physiotherapy and to chronic care in the hospital setting looks
get home and back to their life. But there much different in ways than other settings
were other patients on the unit that saw such as LTC or retirement. I believe that
their experience in the chronic care this impacts the individuals experience as
setting very differently in that they did well, as it has an impact on the illness
not have that same eagerness and experience.
positivity to make the most out of their
illness, in a sense. So, I think it is difficult
to explain the experience of chronic
illness in individuals receiving care in
chronic settings when every individual’s
experience is much different than others. Clinical Instructor:

Clinical Instructor:
-
a genuine understanding of
chronic illnesses. I appreciate
 therapeutic relationships you
form with your patients.
3. Interpret critical aspects of the person’s Student: Student:
experience of chronic illness in relation to the Some critical aspects of people’s There are numerous aspects of an
nursing process such as common signs and experience of chronic illness include their individual’s experience of chronic illness
symptoms, responses to treatment, patterns of responses to treatment, patterns of that are related to the nursing process.
coping, and impact on individual and family coping, and the impact on individual and One of the main aspects includes the
relationships.
Progress Midterm Progress Final family relationships. Individual’s patient’s response to treatment, including
response to the treatment and the plan their willingness to follow through/adhere
◻ SP ◻ S of care impacts their care and the to the treatment plan. How the patient
◻ ND ◻ U outcome that it has. Especially in a floor responds to the treatment and the
◻ UP like A2, where it is a rehab-based floor, treatment plan has a big impact on the
the patients drive and willingness to nursing process and the patient’s
work at the plan/treatment will make a outcome, especially in a chronic/rehab
big difference in their treatment unit. Another aspect of the person’s
outcomes. Another critical aspect of the experience of chronic illness includes the
patient’s experience is the patterns of impact on individual and family
coping that they have, depending on if relationships. With chronic illness being a
they have healthy and positive coping life-long illness in most cases, the
mechanisms, or maladaptive ones. For individuals’ relationships and family
example, the patient that I was with this relationships can be altered and driven to
past weekend was a stroke victim, an adapt/adjust. Many of the patients that I
experience that is very unexpected and worked with over my clinical placement
frightening to experience. My patient had strong familial relationships and
had very positive patterns of coping, support systems. This could impact their
wanting to learn about their condition, chronic illness experience positively in
why the stroke may have happened, many ways, as it could motivate them to
ways to manage their health better, keep working/adhering to the treatment
keeping themselves busy playing word plan and goals. Although on the other
games on their iPad and so on. Lastly, the hand, there were some patients who did
impact that chronic illness can have on not seem to have the same supports that
not only the individual, but the family other patient had. This could negatively
relationships is a critical aspect of chronic affect the patients experience with their
illness. For example, the patient that I chronic illness.
primarily worked with had a seemingly
good relationship with their family
member, as they were in all day for both
days, asking questions, inquiring about
their care and so on. Although, being in
the hospital chronic care setting for a Clinical Instructor:
long period of time could most definitely
 become very overwhelming and draining
to both the individual and their family
relationships, as it is a major adjustment
to all of their lives.

Clinical Instructor:
-
patient and her illness.
-
the family is affected too.
4. Identify symptoms and common medical Student: Student:
treatments of selected chronic illness.
Progress Midterm Progress Final Some common symptoms of an ischemic Another chronic illness that I witnessed in
stroke follow the “FACE” acronym. This clinical quite a lot was hypertension. Most
◻ SP ◻ S stands for facial drooping, arm weakness, people who are experiencing hypertension
◻ ND ◻ U speech difficulties and time. have no symptoms, but those who do
◻ UP Furthermore, the patient that I worked could experience headaches, SOB,
with this past weekend had multiple nosebleeds, and so on. One of my patients
pulmonary embolisms, with which they was diagnosed with hypertension, but also
described their symptoms to be SOB on had other infections including endocarditis
exertion, but not the other typical and other heart problems which could
symptoms seen with PE such as a feeling affect their blood pressure. The patient
of “impending doom”. This brought light was also suffering from pitting edema
to how the symptoms that we learn predominantly in their lower extremities,
about in class are not always that which could also affect their blood
prevalent in the patient and can be quite pressure. Some common treatments
vague to the point where the patient include dietary changes including heart-
does not think anything of it. Also, while healthy diets (low sodium), regular
many patients may describe their signs physical exercise, maintaining a healthy
and symptoms one way, another patient weight or losing weight if necessary, and
may not experience those at all. I learned limiting alcohol consumption. The patient
that it is important to look at each was overweight, but due to the extreme
patient’s signs and symptoms edema, it was causing their weight to be
individually, and that even though they even more increased. When their diuretics
may not have all of the “textbook” were adjusted, they lost some weight due
symptoms, it does not mean that they to lessening edema. There are many blood
are not experiencing that illness or pressure medications to control
condition. Common medical treatments hypertension as well, including diuretics,
following a stroke include taking some ACE inhibitors, ARBs, and calcium channel
form of anticoagulant as more of a blockers.
prophylactic measure to prevent further
strokes, and lots of rehabilitation to work
to get the function lost back. Although, it
depends on the person, the area of the
brain that was impacted by the stroke,
and the degree to which that area was Clinical Instructor:
 impacted.

Clinical Instructor:
-
for stroke for those eligible.
-
extract the clot from the artery it
released into.
5. Demonstrate select nursing and collaborative Student: Student:
interventions related to caring for the person Specific assessments that are related to Some specific nursing and collaborative
with chronic illness such as specific caring for a person with a chronic illness interventions related to caring for a person
assessments, medication administration, include head to toe assessments, as it is living with a chronic illness include lots of
physical and chemical restraints, enteral feeding important to see how the disease assessments. Like previously stated, there
& residual volumes, NG tube insertions, wound process is changing (improving, are a lot of head-to-toe assessments to
care, patient-controlled medication worsening, remaining the same). keep an up-to-date assessment on the
administration pumps.
Especially on a rehabilitation floor like disease process, looking for any changes
Progress Midterm Progress Final A2, it is important to track the progress (positive or negative). Another nursing
or lack thereof, that the patient is intervention that can be related back
◻ SP ◻ S experiencing. For stroke victims, a CNS chronic illnesses include physical
◻ ND ◻ U assessment is frequently done as well. restraints. For example, one of the
◻ UP For medication administration it is patients on our unit was suffering from
important to assess and think about the delirium for our entire clinical placement.
patient’s swallowing abilities, especially if They were a very high fall risk and thus,
the patient experienced a stroke or was placed with physical restraints
dysphagia of some kind. The patient’s including restraint belts and wheelchair
swallowing abilities may change, belts for their safety. Lastly, we got a lot of
impacting the nurse’s medication practice with medication administration,
administration or interventions with learning how to safely administer
eating and so on. medication to different patients. This
included preparing IV medications, giving
SUBCUT injections, and lots of PO
Clinical Instructor: medications. With chronic illnesses, many
- of the patients had polypharmacy, taking
administration. She ensures she many medications at once.
checks the rights of medication
administration.
-
CNS assessment with guidance
from peers or CI.
Clinical Instructor:
6. Identify potential consequences/complications of Student: Student:
select chronic illnesses and related Some potential consequences of chronic Some potential
interventions. illnesses, for example, a stroke, include consequences/complications of the
Progress Midterm Progress Final the patient stroking again, choking (due chronic illness hypertension include, heart
to dysphagia), chronic hemiplegia, and a attack or strokes, aneurysm, HF, weakened
◻ SP ◻ S high risk of falls due to one sided blood vessels in the kidneys, metabolic
◻ ND ◻ U weakness. It is important that the patient syndrome, memory problems and even
◻ UP be monitored and assessed frequently to dementia. Interventions for hypertension
try to ensure that they do not have can include education around living a
another stroke, or that if they do, the healthy lifestyle and how it can positively
proper interventions are in place to affect their blood pressure. Other
lessen the complications. For example, it education could include education
is important to educate the patient and surrounding medication adherence and
their family or support systems on signs how it is very important they take their
and symptoms of a stroke so that they medication regularly and as prescribed.
can be aware and follow the proper Another intervention could include
interventions as well if the patient were educating the patient on monitoring their
to stroke again. Choking or swallowing blood pressure daily to ensure the other
issues is another big issue when it comes interventions are effective and their blood
to a chronic illness like a stroke, as many pressure is being maintained at a safe
patients experience dysphagia. Ensuring level.
that the patient has the proper
assessments completed (i.e., swallowing
assessment) and the proper
documentation regarding their choking
risk is important to lower their risk of
choking and to ensure that the proper Clinical Instructor:
interventions are put into place if they
do. Due to many stroke victims
experiencing hemiplegia, this puts them
as a high fall risk. Some nursing
interventions include lots of education
regarding transferring and asking for help
when needed, ensuring that it is
indicated to all healthcare staff that the
patient is a high fall risk so that they have
the proper interventions in place, and so
on. It is important that the proper
consequences and complications are
known and understood for the chronic
illness of the patient, including the
proper interventions that the nurse
would take if those complications were
to arise.

Clinical Instructor:
-
stroke patients. This can be a
serious complication and lead to
aspiration PNA and possibly
death.
-
consequence of many patients
who are hospitalized. This is
especially true with strokes.
Stroke patients usually have one-
sided paralysis and poor
judgement at times.
7. Under the supervision of a Registered Nurse, Student: Student:
demonstrate safe, competent, evidence- I demonstrated safe and competent care I ensured that I demonstrated safe,
informed, holistic nursing practice with clients by always making sure to follow best competent, and evidence-informed
with chronic illness practice guidelines when provided care nursing practice with patients with chronic
a. Use a wide range of effective to the patients. I made sure that if I were illness. I used a wide range of effective
communication strategies and completing a task that I was not communication skills including effective
interpersonal skills to appropriately completely confident in, that I would ask listening and therapeutic communication. I
establish, maintain, re-establish and
another nurse to come with me and appropriately established, maintained, and
terminate the nurse-client relationship
supervise to ensure that it was done as terminated the nurse-client relationship
b. Demonstrate accountable, responsible
and ethical practice best practice as possible. For example, with each patient I encountered. I
c. Engage in respectful, collaborative, when using the ADU, I did it alongside my demonstrated accountable, responsible,
therapeutic and professional clinical instructor, ensuring that I was and ethical practice by following best
relationships taking all of the proper steps to properly practice guidelines, only doing what was in
i. Demonstrate therapeutic use of complete the medication administration my scope of practice as a nursing student,
self process. I used therapeutic and by ensuring that I was completely
ii. Create a culturally safe communication to establish a confident in a skill before performing it. If I
environment therapeutic relationship with the patient. was not completely confident, I would ask
d. Apply nursing models and theories I ensured that I was actively listening and for assistance from my CI or another nurse
e. Demonstrate health promotion and communicating with the patient, on the floor to ensure it was done to the
illness prevention practices listening to their experience(s) and their best standard of care. I also ensured to
f. Demonstrate patient advocacy needs. I effectively terminated the nurse- engage in respectful, collaborative,
g. Predict outcomes of nursing care client relationship by saying goodbye to therapeutic, and professional relationships
h. Evaluate client response to nursing care
the patient on my last shift. with all staff and clinical group members. I
i. Critically appraise own practice in
ensured that I was professional and
relation to nurse-client/family
interactions and as a member of the respectful with all other team members on
health care team the unit, using effective therapeutic
techniques with them as well.
Progress Midterm Progress Final

◻ SP ◻ S Clinical Instructor:
◻ ND ◻ U - Effectively communicates with
◻ UP staff when leaving the unit.
- Checks on patients frequently and Clinical Instructor:
advocates for concerns with
patients.
- Active listening has been
demonstrated throughout
conversations.
- She makes great therapeutic
relationships.
8. Critically appraise own practice in relation to Student: Student:
nurse-client/family interactions and as a member I believe that I effectively formed a Throughout this clinical placement, I
of the health care team nurse-client therapeutic relationship, believe I formed nurse-client therapeutic
ensuring to use therapeutic relationships with numerous patients. I
communication and effective listening made sure that I was using therapeutic
techniques. I also ensured to speak with communication, which included actively
Progress Midterm Progress Final the family using the same techniques, listening to them and using effective
ensuring that they felt heard as well and communication techniques. For example, a
◻ SP ◻ S answered any questions that they may patient of mine told both me and one of
◻ ND ◻ U have. I worked as a member of the my group members some dark information
◻ UP healthcare team by helping other nurses regarding their past and things that had
or other clinical group members happened to them. We ensured that we
whenever possible. I also ensured to were actively listening to the patient and
report back to the nurse of my patient responding effectively. This included
anything abnormal or any tasks that I empathizing with the patient and
completed. While working on the unit, I validating their experience and feelings.
saw first-hand how important teamwork When speaking with the families or
is and how integral it is to nursing as a support systems present, I ensured that I
whole. used therapeutic communication with
them as well. I ensured I was polite,
Clinical Instructor: respectful, and professional during all
- interactions. Working on this unit showed
relationships with patient’s, me the importance of teamwork. I ensured
family, and other members of the I was helping wherever possible, reporting
health care team. back to my CI or nurse whenever
- necessary.
-
experience to create these
relationships.

Clinical Instructor:
9. Participate in professional development based Student: Student:
on reflective practice and critical inquiry I will participate in professional I will continue to participate in
Progress Midterm Progress Final development by reflecting on my own professional developing throughout my
practice after each clinical shift, reflecting nursing school career and future practice. I
◻ SP ◻ S on certain aspects I could improve on in will continue to reflect after each clinical
◻ ND ◻ U my practice. This will help me to guide shift on things that I did well and areas
◻ UP my professional development, as I will where I could have some improvement. I
consistently be learning and trying to will maintain a reflective practice by
improve my practice. This is very always having goals of areas that I would
important, especially in the nursing like to improve in, continuing to learn and
profession, as I will constantly be grow as my practice continues. I will
learning and working on new things. It is continue to work on and improve my
important to be accountable for what we critical thinking skills. Remaining
do and do not know in practice, so we accountable throughout your nursing
can further improve. Furthermore, it is practice is important, knowing what you
important to be accountable for any are confident in and what you need more
mistakes that we make while learning or learning in as well. This includes being
throughout our careers as well, all accountable for any mistakes that are
assisting in professional development made, reporting them immediately and
and the ongoing reflective practice of being accountable for any consequences
nursing. that come from it. Consequently, it is
important to always be reflecting on your
Clinical Instructor: nursing practice and practicing critical
- inquiry, to ensure the best quality of care
nursing practice. Continue to as possible.
perform this throughout your
future. It helps with your critical
thinking skills!

Clinical Instructor:
This section to be filled out by the Student Areas of Strength Student Areas of Strength
student.
1. Communication – I believe that 1. Therapeutic relationships with
communication is one of my patients – I believe that this is
strong suites, as I am always an area of strength for me, as I
trying to use therapeutic always strive to communicate
communication and active well and create therapeutic
listening skills. relationships with patients and
their families
2. Organization – I am organized 2. Professionalism – I continued to
as I follow due dates, keep all maintain a professional
my documents in order, and manner, always making sure
ensure that everything is that I am at least 15 minutes
accounted for and in the early, wearing my proper
proper place. uniform and PPE (i.e., eye
protection and masks), and that
3. Professionalism – I maintain a I speak to all other members of
professional manner, ensuring the health care team with
that I always come to clinical in respect.
the proper uniform, show up 3. Interpersonal relationships – I
15 minutes early for each shift, believe this was an area of
and ensure that I speak to both strength for me, as I believe I
my other clinical members and worked well as a member of
clinical instructor with respect. the healthcare team and with
my other clinical members
Student Areas for Future
Development
Student Areas for Future
1. Leadership role – I would like Development
 to improve by taking more of a
leadership role, rather than 1.
sticking to being more of a I am much more confident in
follower. Even though I have my assessment skills and in my
improved on this a bit, I would skills in general. But I would
like to be even more confident always like to work on this
taking a leadership role this aspect and improve my skills.
year. 2.
though I was starting to get the
2. Assessments and skills – I hang of this within the hospital.
would like to be more But I would like to keep
confident in my assessments working on this aspect as well
and skills, making sure to take 3.
every opportunity to practice skill I am always trying to
them whether in practice or at improve/work on. I will
home with my lab kit. continue to work on this
throughout the semesters and
3. Time management – I would my future nursing practice.
like to improve my time
management skills, especially
in practice. Nursing is a very
busy career sometimes, so it is
important that I am able to
prioritize and manage my time
so that all tasks are completed.

Clinical Instructor Summative Comments:

 Erin, you are a great student. You are prompt, thoughtful and great with the patients. Your critical thinking skills
are developing well. I notice the connections you are making in clinical practice. Keep up with your assessments skills
and practicing them.

Clinical Practice Attendance (12 Hours Per Shift)

Shift 1 Shift 2
Week 1 12 12
Week 2 12      12     
Week 3 12    12

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     2 / 2

Total number of labs completed 53 / 5

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

Signature of Course Lead: __________________________________Date: _____________________

Signature of Clinical Instructor: __________________________________Date: _________________

Signature of Student: ______________________________________Date: November 30, 2021