NURS 253 STUDENT SELF-ASSESSMENT

NATASHA SINGH
EVALUATION OF PERFORMANCE OCCURS AT WEEK 4 and/or ongoing (if required), WEEK 7 (Midterm), Week 11 AND WEEK 15 (Final)
NOTE: Students who are experiencing difficulties that could result in an unsatisfactory in Week 7 or Week 15 will be expected to do a self-evaluation and receive
a preceptor and faculty evaluation in Week 4 and/or week 11, and as required.

PLEASE CIRCLE

S = SATISFACTORY

COMPETENT AND SAFE PRACTICE WITHIN A LEGAL

AND ETHICAL FRAMEWORK
1. Model safe, competent, and ethical practice in
compliance with legal and regulatory frameworks
and the policies and procedures of the practice
setting.
i.
ii.
iii.

iv.
v.
vi.
vii.
viii.

Comply with regulatory standards, relevant legislation

and the practice settings policies and procedures.
Act in a professional, responsible, ethical and
accountable manner.
Use the three factor and decision making frameworks
to determine strengths and limitations and when to
collaborate and consult with other professionals.
Integrate evidence-informed practice and a theory
based approach into nursing care.
Assess practices and risk management principles and
take action to ensure safety of clients, self, and others.
Question and clarify unclear orders or directions and
when uncertain.
Question, clarify or challenge questionable orders,
decisions or actions by others.
Respond in a professional manner to situations in
which there is unsafe, unacceptable or unprofessional

Week 4

ND = NEEDS DEVELOPMENT
S

U = UNSATISFACTORY

Comments

vii. I always question, clarify or challenge orders when I am unsure of an order or the action
of others. For example, when transcribing new orders, I have other nurses or the pharmacist
clarify if I can't understand the writing. I challenged a doctor by alerting him to my patient's
allergies so that he could discontinue the medications he had her on.

Week 7

Comments

ii. I believe I always behave in a professional, responsible, ethical and accountable manner.
For example, I always check wristbands before giving medications, I watch the patient's
take their medications, I document accordingly, and communicate with the nurse about any
relevant information.

Week 11

Comments

v. I am able to assess practices and risk management principles and take action to ensure
safety of my clients, self, and others. For example, when performing care on clients, I raise
the bed rails for patient safety as well as raise the bed for my own safety.

ix.

behavior.
Demonstrate understanding about the role of the nurse
within health care.

Week 14

Comments

ix. I demonstrate an understanding about the role of the nurse within health care. as a
nurse, I'm there to help my patient first and foremost to return to, or maintain optimal health
while working alongside my health care team.

Week 4

Comments

ACCURATE AND RELEVANT COMMUNICATION

6. Communicate using strategies and technology to
effect accurate and timely information sharing
including data, research, and other information.
i.
ii.
iii.

iv.

v.
vi.

Contribute to team sharing and discussions.

Document clearly, accurately, concisely in a timely
manner using written and electronic methods.
Use effective communication techniques when
reporting relevant information and providing feedback
to the appropriate members of the interprofessional
heath care team.
Evaluate and refine techniques used to communicate
and share information with clients and the
interprofessional health care team.
Ensure privacy and confidentiality.
Use technology to retrieve information including
research and other date and to obtain and forward
information both within and outside the practice setting.

i. I contribute to the team by discussing information during shift report and team huddles
where I share relevant information of a patient in front of the attending doctors, OT, PT,
SLP, discharge nurse, charge nurse, and the PSW's.

Week 7

Comments

iv. During team huddles, I now make notes of the important information that I need to share
with the team so that the information I give them is clear and concise. This is an example of
how I've refined my communication techniques.

Week 11

Comments

ii. Using the constructive feedback I recieve from nurses, I am able to document clearly,
accurately, concisely in a timely manner using the electronic method. And if for any reason
my documenting is incomplete, I know it is my responsibility to stay and complete my
documentation before leaving the unit.

Week 14

Comments

v. I maintain privacy and confidentiality by sharing information about a patient with the team
members that are directly involved in the patients care, by not speaking about the patient in
front of anyone, and by properly discarding paperwork with patient information on it.

CARING RELATIONAL PRACTICE

7. Engage in relational practice that is caring,

compassionate and respectful.
i.

ii.

iii.
iv.

Establish therapeutic caring, compassionate, and

culturally safe relationships with clients and health care
team members.
Establish a caring environment that supports clients in
meeting their needs and outcomes, managing their
illness, or experiencing a peaceful death
Demonstrate therapeutic use of self to foster client
well-being.
Utilize relational knowledge and skills, and ethical
principles to support clients and to interact with health

Week 4

Comments

I know I'm able to establish a therapeutic, caring, compassionate relationship with my patient's and
team because of the amazing feedback I receive from my preceptor, the staff, the patients, and the
patient's families.

Week 7

Comments

vi. Before working with a patient, I collaborate with the client and read the charts to understand
how the patient likes to be cared for or how they transfer. Also, if I notice something new that a
patient can or cannot do, I communicate it with the team during huddles.

Week 11

Comments

ii. I am able to establish a caring environment that supports the clients in meeting their
needs and outcomes and managing their illness which is observed through my entire
practice on the floor.

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Week 14

Comments

iii. I am able to demonstrate therapeutic use of self to foster client well being when I take time out
to sit with my patients and engage in therapeutic conversations when they start to feel depressed.
I've received a lot of positive feedback with this technique.

Week 4

Comments

LEADERSHIP AND ADVOCACY

8. Act as a leader and an advocate to empower
clients, self, the interprofessional health care team
and to further the profession.
i.

Evaluate and refine leadership skills to develop

solutions, resolve conflict, create a positive work

v. I am able to respond appropriately to unsafe, unacceptable, and unprofessional

behaviours. For example, when the nurse dropped the medications on the floor, she
asked me to switch the medication cups and give the patient. I respectfully declined and
explained that it was unacceptable.

ii.

iii.
iv.
v.
vi.

vii.
viii.

environment and organizational culture, and to

strengthen advocacy role.
Provide feedback to peers and accept feedback from
peers and members of the interprofessional health care
team.
Advocate for clients, self, others, and quality practice
environment.
Support clients rights for self-determination and
choice.
Respond appropriately to unsafe, unacceptable, and
unprofessional behaviors.
Demonstrate public protection and acting in the
interests of the public through collaboration and
consultation with other members of the
interprofessional health care teams.
Contribute to the creation of quality practice strategies
and solutions.
Assign, supervise, teach as appropriate, and provide
feedback to unregulated care providers (UCPs) in
collaboration with the interprofessional health care
team.

Week 7

Comments

iii. I definitely advocate for my patients. For example, when the T.V's broke, I called for
repairs and advocated for the patients to not be charges since they were not receiving
the services. Also, when my patient was on medications that she was allergic to, I
advocated to have them discontinued because she was becoming ill.

Week 11

Comments

i. I have definitely learned to refine my skills by using helpful feedback for organization, and
developing solutions as well as avoiding unnecessary conflict while still being able to
advocate for myself as well as my patients.

Week 14

Comments

ii. When my peers are having difficulties with a task or are unable to cope in their situation, I
provide helpful feedback. As well as when I am having difficulties, I accept all the feedback I
receive. For example, every nurse has their idea on the best way to give an injection. When
they give me feedback, I incorporate all their techniques. Hence, I am able to provide and
accept feedback from peers and members of the team.

COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH Week 4 S

Comments
PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY
Week 4 S
Comments
CARE TEAMS
AGREED EXPECTED OUTCOMES
vi. I respect the unique role and competencies of all members of the interprofessional
iii. I use clinical judgment to assess clients, prioritize needs, outcomes, and nursing
1. Collaborate and consult with clients and the
health care team. I never undermine their authority.
interventions. For example, if a patient is in pain and a patient needs to be toileted, I
9. Integrate
the nursinghealth
process
into
all to
aspects
of
interprofessional
care
team
provide
nursing
care and across
diverse
practice
comprehensive
and holistic
health
caresettings.
in a complex will give the patient pain medication first then tend to the patient that needs to be
toileted in order to prioritize their needs.
and changing environment.
i.
Formulate clinical judgments that meet clients unique and
i. changing
Collaborate
clients
members
of the and overall
healthwith
needs
andand
priorities,
outcomes,
interprofessional
healththese
care team
to determine
Week 7 S
Comments
condition
and incorporate
into evolving
plansneeds,
of care.
mutually
agreed health outcomes,
approaches
to care,and
and Week 7 S
ii.
Devise
evidence-informed
plans of care
that are holistic
Comments
to evaluate
client
centered.care.
i. During huddles and rounds, I give my input and share my questions or thoughts with
Contribute
as a member
of theclients,
interprofessional
and health
iii. ii. Use
clinical judgment
to assess
prioritize needs,
the team
while evaluating
care. refinement and modification of plans of care
iv. I always
collaborate
in the evaluation,
care
teams
to
respond
to
changing
client
needs
and
outcomes, and nursing interventions.
outcomes.in the evaluation, refinement and modification of by making by making necessary notes on patients and communicating them to the
iv.
Collaborate
iii. plans
Consult
with and seek out assistance from members of the appropriate team members during huddles and rounds.
of care.
interprofessional
health
care team.
v.
Safely
and competently
perform
treatments and use
iv. techniques,
Use teamwork,
consensus
building, and and
conflict
and technology autonomously
in resolution
and leadership skills to meet expected client outcomes.
collaboration with clients and members of the
Week 11 S
Comments
v.
Integrate effective, collaborative, and consultative strategies
interprofessional health care team.
to meet clients needs within a changing environment.
vi.
Collaborate with the clients across the lifespan and with
iii. I 11
consult
seek out assistance from members of the interprofessional health
S with and Comments
vi.
Respect the unique role and competencies of all members Week
members of the interprofessional health care team to create
care
team
when
needed.
For example, when I was feeling uncertain about a
of the interprofessional health care team.
a client centered plan of care that is articulated with
the that
procedure
and asked
theand
nurse
for assistance.
vii.
Collaborate as a member of the interprofessional health
i. I am female
able to catheterization,
formulate clinicalI revised
judgments
meet clients
unique
changing
competence
in writing
and orally.
The
task
was
completed
successfully.
care team both
to respond
to changes
in nursing knowledge and
health needs and priorities, outcomes, and overall condition and incorporate these
vii.
Use
awareness
ofthe
ownhealth
knowledge
and skills, the three
practice
and in
care environment.
into evolving plans of care. For example, when my patient begins to ambulate
factors of nurse, client and environment and the practice
again,14theirS needs change and
therefore the plan of care changes with them.
Week
Comments
decision-making framework to guide practice.
Activities such as self-toileting and Activities of Daily Living become the next goal
viii.
Manage workload, time, and physical resources to provide
and
forth.
v.
I amsoable
to demonstrate my ability to integrate effective, collaborative, and
effective, efficient and ethical care.
consultative strategies to meet clients needs within a changing environment by
Week 14
S
Comments
collaborating
with the nurse
to share the workload during the outbreak to complete
patient care while in their isolated rooms. This strategy makes it possible to
v. I am complete
able to safely
and in
competently
perform
treatments
and
use techniques,
all tasks
a timely manner
while
using and
discarding
PPE at and
a
technology
autonomously
and
in
collaboration
with
clients
and
members
of the
minimum.
interprofessional health care team. For example, I triple check medications and
orders for my nebulizer treatments, place the mask on the patient first, and then
slowly increase the oxygen rate to ensure safety as well as ensuring the full dose
of medication is administered.

Week 4
QUALITY ASSURANCE: CONTINUE AND IMPROVE
COMPETENCE

ND

Comments

This is an ongoing process.

10. Engage in Quality Assurance consistent with the

regulatory framework.
i.

ii.

iii.
iv.

v.

vi.

Act in the best interests of clients and protect clients

from harm through collaboration and consultation with
other members of the interprofessional and health care
teams and by through competent and safe practice.
Commit to Quality Assurance practice to identify
strengths and areas for professional growth and in
accordance with the regulatory framework (CNO).
Create, implement, and evaluate a learning plan
consistent with the Quality Assurance program (CNO).
Assume responsibility to seek out feedback for
colleagues and peers and learning opportunities that
foster professional development.
Consistently review nursing research and information
about health care to improve competence and to
support clients
Develop professional responses to health care system
changes resulting from advances in research,
technology, and changes in societal and political
forces.

Week 7

Comments

iii. I created a learning plan to giving a successful report during shift changes. I now give all
reports when the shift is over by making notes of the necessary information that needs to be
passed on. My preceptor's feedback is that my shift reports are done well at this point.

Week 11

Comments

iv. Throughout my entire rotation, I have demonstrated responsibility to seek out feedback
for colleagues and peers and learning opportunities that foster professional development by
taking initiative and asking/reserving tasks to be left for myself and my preceptor to
complete so that I gain as much experience as possible.

Week 14

Comments

v. I consistently review nursing research and information about health care to improve
competence and to support clients by reading CNO's Best Practice Guidelines and
standards as well as recent articles pertaining to practice and new medications. However,
quality Assurance is always an ongoing process.

USE CRITICAL THINKING, PROBLEM-SOLVING and

DECISION-MAKING EFFECTIVELY

Week 4

11. Use critical thinking, problem solving and decision

making skills to meet the health care needs and
expected outcomes of clients.
i.
ii.

iii.
iv.

v.
vi.
vii.

Use critical thinking to inform decision making in all

aspects of nursing care.
Use clinical judgment to assess and refine
assessments in collaboration with the interprofessional
health care team, formulate nursing diagnoses, plan
nursing interventions, and outline evaluative criteria.
Evaluate and refine critical thinking, problem solving,
and decision-making skills.
Integrate knowledge from variety of nursing, health,
and other theory into nursing practice to provide safe
and competent care.
Prioritize effectively.
Demonstrate professionalism, responsibility, and
accountability.
Use critical thinking, the practice decision-making
framework and the nurse-client-environment framework
to inform clinical judgments and practice.

Comments

iv. I most definitely integrate my knowledge from a variety of theory to provide care. For
example, I always check my patients blood pressure and pulse rate before administering
hypertension medication so that I know if I should give the medication or hold it. If I have to
hold it, I have data to show my nurse to reinforce my decision.

Week 7

Comments

vi. I demonstrate professionalism, responsibility and accountability at all times throughout

my placement. For example, when my preceptor was on break, another nurse approached
me and began to yell at me for something my preceptor did. I respectfully explained to her
the reasons behind my preceptors doing, finished my paperwork and told my preceptor
about the discussion that occurred. I did not instigate the nurse's anger as I seen she had a
difficult day, and eventually she came to apologize. The feedback I received from the
nurses that witnessed the event said that they were impressed with the way I handled the
situation and that I was very professional.

Week 11

Comments

i. I am able to think critically while making decisions. For example, whe my patient
developed a blister on their heel, I chose a foam adhesive to help relieve pressure while
they push themselves on the wheelchair using their heel.
Week 14 S

Comments

v. I am able to prioritize effectively after weeks of finding techniques and strategies that work
for me and practicing them. I am able to complete all my tasks successfully and in a timely
manner.

Student signature ___________________

Date ________________

Preceptor signature _____________________

Date _________________