NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Mid-Term Evaluation
Student: Melissa Amos
Clinical Instructor: Melissa Farrow
Clinical Placement Hospital: PRHC
Missed Clinical Hours: 0

Unit: C2

Missed CLC Lab Hours: 0

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 Mid-Term Evaluation

Course Objective
1. Explain the experience of chronic illness in individuals
receiving care in acute settings

Progress
Evidence/Indicators
Week 1- Completed a pre & post clinical assignment
describing the experience of chronic care for a
patient that was total care, non verbal and was
unable to maintain their own airway
Week 5- Cared for patient that had been on the unit
for many years, this patient had a strict routine that
was different from that of the staff on the floor.
Adapted to the needs and desires of the patient. As
the patient had lived on the unit for an extended
period the focus was on following the routine that
she desired as opposed to the hospital routine.
Week 2- Dialysis
Was able to experience/ witness how patients
undergo dialysis, how they have adapted to the
program, how it impacts their life, and how the staff
attempts to help them maintain control. Was able to
witness patients canulating themselves and hear
about their own experiences with the process.
Provided a more throughout understanding of
treatment process.
~ Pre and post clinical assignments
have continued to be submitted in a
timely fashion; showing evidence of
research and increased knowledge
gained
~ Melissa is continueing to link
together diagnosis and nursing
interventions to care required for
each patient she cares for and the
rational for this requirement
~ She is caring for 2 patients each
clinical shift independently, and

Satisfac
tory

Unsatisfac
tory

2. Interpret critical aspects of the persons experience of

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

completing tasks in a timely fashion

Week 4- Interacted with a patient that had recently
received an ileostomy, interpreted the need for
additional support that the patient required due to
the major life change that occurred. Took additional
care to check on patient due to signs of distress
present during assessments, and staple removal.
Week 2- Dialysis
Interacted with patients who were undergoing
dialysis. Learned about common symptoms of
dialysis treatments, was able to interact with
patients, and their loved ones to better understand
the effect their condition had on their lives. Able to
better understand how various patients cope with
the diagnosis. Some were able to maintain control
over their care while others had minimal control over
their situation.
Week 2Cared for patient with a lap restraint. This patient
also did was aggressive verbally. This may have
been a result of the medical condition or an
emotional development due to the hospital
environment. Dealt with restraints, improper coping
and inappropriate behavior from the patient.
~ assessments of patients
completed in a timely fashion
~ Melissa has continued developing
assessment skills and concentrating
on details; her assessment forms
show evidence of this
~ Melissa is observant and
considerate in the care she provides
~ Melissa's charting has continued to
improve and is completed on time to
leave the unit
~ Progress notes are progressing to
the third year level, and is requiring
less and less adjustments

3. Identify symptoms and common medical treatments of

selected chronic illness and disease process in individuals
receiving medical, rehabilitation or long term care.

4. Demonstrate selected nursing and collaborative

interventions related to palliative approach, clinical
pathways, health promotion and self-management,
functional assessment, nutritional assessment,
musculoskeletal assessment, respiratory assessment,
head/neck/eyes/ears assessment, wound care and end of
life care.

Week 6- administering medications to a patient,

understanding that common medications given in
the chronic unit, and why they are being prescribed
for the particular patient.
Week 4- post clinical assignments investigating the
various forms of ostomies, why they are used, and
why some may be chosen over others.
Week 1-6: Regular and routine flushes, and G tube
maintenance. Understanding the need to have
patient in semi-fowlers when feed is on, and when to
turn the feed off when performing care
Week 6- Auscultated a patients lungs in order to
hear crackles, and understand what they sound like
in a realistic environment so that I may be able to
identify them at a later date, should my patient have
them.
~ great medication pass, well
prepared and knowledgeable of
medications, ensured the 3 checks
and 5 rights
~ Melissa is independent in caring for
feeding pumps, tubes and hydration
flushes
Week 4- Helped to perform end of life care on a
patient that passed on the floor. This included
confirming identity, and preparing and transferring
them to the morgue.
Week 4- helped to perform wound care, and
removed 30 staples from abdominal incision.
Documented wound site, dressing changes, any
other pertinent information.
Weeks 1-6: perform routine head to toes
assessments, focusing on areas of concern for that
specific patient. If they are bed or chair fast skin
integrity assessments are conducted, neurological
assessments are done for each patient to determine

5. Identify potential consequences/complications of chronic

disease process and related interventions.

a baseline level in order to determine possible

changes that may occur during the shift.
~ Melissa is continuing to hone in on
assessment skills, she is rarely
seeking clarifications and second
checks as her confidence is
increasing
~ I feel Melissa is putting together
the clinical pieces and is
collaborating a variety of nursing
models and theories, and utilizing the
knowledge she has gained thus far in
the program
~ We invited Shelley the Respiratory
Therapist department lead to 2 of our
post conferences. The first she
reviewed oxygen therapy, and the
second she reviewed tracheostomies.
She shared wonderful clinical
examples, uses and applications of
each device. An increased knowledge
and comfort was gained from these
experiences.
Week 6- Researched and increased understanding
of side effects associated with neurological
damage/disorders. Identify how neurological
diseases my progress, and what may be able to be
done to slow the progress of disease.
Week 1- worked with a patient with contractures,
understanding the effects of both disease
progression and the effects of delayed interventions.
The patient may have been able to maintain better
range of motion had physiotherapy been involved. I
was able to think critically about the consequences
of putting off interventions.
Week 5Cared for a patient that had minimal feeling in her
foot. This was due to previous injury. I discussed the

6. 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
Self management
Motivational interviewing
Addictions
Palliative approach
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

level of feeling that she had remaining with her,

when it occurred, her pain levels and how she felt
about it. The patient as undergoing physiotherapy
appointments in an attempt to help her regain
function and/or feeling in her foot. Watching her
progress through the process and the joy she
experienced when she was able to feel her foot,
even when she felt pain demonstrated the
effectiveness of the intervention for this patient.
~ Melissa reports abnormal findings/
assessments and behaviors to nurse
and instructor
~ able to predict outcomes and
foresee consequences (increase
secretions of trach requiring suction,
advocating for her patients in regards
to pain medications, and personal
care)
~ continuing to comprehends risks
related to patients and adjusts
practice accordingly ( HOB elevated
with feeding tubes, side rails, risks
related to tracheostomy tubes, lift
polices)
Weeks 1-6:
Did weekly preparations of patient information.
Researched conditions that patient had, possible
side effects and complications that may occur in
combination with these conditions. Researched
medications, and any other skills I may feel I needed
to care for the patient that week.
Week 5- provided emotional support to a patient that
was distressed because of impending bad news
from her son. I was able to use my presence to
provide comfort and to let her talk through her
concerns, allowing her to process the circumstance.
Week 6- I acknowledged that my patient had
become distressed while sitting in the activities

f. Predict outcomes of nursing care

g. Evaluate client response to nursing care

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

room, in order to adapt to his changed mood, I

attempted to move him to the hallway by the nurses
station, when this further proved to not improve his
state I returned him to his room, and bed. While the
patient typically remained in the activity for majority
of the day I recognized that he had become
distressed, and therefore needed to be returned to
his room, to improve his mood.
~ Professional behavior on the unit
for the majority of the time
~ applies multiple nursing models in
practice and addresses them in post
clinical assignments
~ good time management skills, as
Melissa's confidence increases, as
does her ability to manage a heavier
patient load
~ Melissa has experienced both
verbal and nonverbal patients and
has managed the challenges of
communication
and
therapeutic
relationship development well
~ helpful around the unit, always
willing to assist team members and
staf
Weeks 1-6: I have listened to the morning reports
on patients. This has helped me to understand what
is currently happening with the patient, concerns that
the staff or patient may have and how to approach
the patient for care. This is beneficial especially if I
have never had the patient before.
Week4,5,6: I have interacted with the
physiotherapist, and sat in on some activities in
order to better understand what is being done with
patients. This helps me to better understand the
physical needs of my patients and work in
conjunction with what the physiotherapist deems
appropriate to provide the best care possible for the

8. Participate in professional development based on reflective

practice and critical inquiry

patient.
Week1-6: I have worked with my peers, my
instructor and the nursing staff. I have introduced
myself to the nurse who is caring for my patient and
inquired about any pertinent information regarding
the patient that I may need to know. I have reported
off any information that I feel may be impact the
patients care at the end of shift, and documented in
progress notes.
~ Great reviews from her day spent
in dialysis; Melissa took advantage of
the opportunity and went well
prepared and gained an increased
understanding of the chronic disease
setting within these areas and how
they impact the patient
~ professional uniform and attire
~ introduces self to staf and
patients; does well reporting of to
peers and staf before breaks
Week 1- Wrote a reflection on the practices on the
unit. This helped me to develop my own care of
patients as I am now more consciously aware of the
limitations of the unit, and attempt to improve my
own skills in order to help improve the quality of
patient care overall.
Week 6- administering medications to a patients,
researching their purpose, possible side effects and
possible off label uses beforehand to understand the
medications before administering, and questioning
possible uses.
Week 6- Administering sliding scale insulin. Using
the blood glucose level recorded, to determine the
appropriate number of units to administer, have
values double checked, and administering insulin.
~ Evidence is sufficient in Melissa's
post clinical assignments that she
reflects on each patient she has and

the day spent with them providing

care
~ Melissa's reflection on care
required and care received was
adequate. More thought and research
is required for the second reflection
please.

Clinical Instructor Comments (All areas marked as unsatisfactory must have a

comment)
Melissa is a delightful addition to our C2 clinical group and pleasant to instruct. She is
increasing her knowledge, skills and comfort with total care patients along with her
independence and scope of practice. Melissa is eager to learn new skills and help out on
the unit. Keep up the good work Melissa!

Signature of Instructor:

Signature of Student:

Date:

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