Self Assessment

2015 - 2015 - Final NURS - 208 Course Learning Outcomes (201509)

NUR 208 Practical Nursing Practice 4 (PN, 06-Sep-2015 - 31-Dec-2015)
Student :
Clinical Teacher/Preceptor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Description :
Period :
Student hours :
Required Hours :
Validated hours :

Kushanvir Gill
Elaine Willard
Judy Martin
William Osler Health Centre/Etobicoke General
Hospital
Agency
8E Orthopedics
Surgical Unit
06-Sep-2015 To 31-Dec-2015
168
168
168

I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes

Student Rating
1. COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK
Satisfactory
Comply with regulatory standards, relevant legislation and the practice settings policies and procedures.

Teacher Rating

Satisfactory 1. 1

K.G. : I have followed the nursing standards of the profession and the policies and procedures of the orthopedic unit as well as the
practice setting. I followed the Bowel Enhanced Recovery After Surgery (BERAS) on the orthopedic unit to follow the postop procedures
and I have prepared the patient for special tests such as gallium test and ERCP.

Satisfactory

Satisfactory

1. 2 Act in a responsible, ethical and accountable manner.

K.G. : I make hourly checks on my patient and update my nurse and teacher about the clients condition. I inform my nurse before going on
the breaks. Before going into my clients room I collect essential data and write it on my organizational plan. When my patient had gallium
test and ERCP I made sure that my patient is NPO.

Satisfactory

Satisfactory 1. 3

Determine how the three factor and practice decision-making frameworks influence client care.
K.G. : I always provide privacy to my client. Eg: I stepped out when one of the clients had their priest for the prayer service. I always keep
in my mind my limits in the nurse-client relationship.

Satisfactory

Satisfactory

1. 4 Use evidence informed practice and a theory-based approach to care.

K.G. : I look into the evidence based resources for the diagnosis and clinical manifestation of the disease. I apply my knowledge from the
theory and pharmacology courses into my practice. EG: I checked the level of potassium before giving my patient KCL and I also check the
INR levels before giving warfarin.

Satisfactory Satisfactory 1. 5
Carry out safety-based practices and risk management principles to ensure client safety and a safe environment.

K.G. : I always ensure my clients safety: by applying brakes on the wheelchair, bed-rails up, safe medication administration and observing
the signs and symptoms after the administration of the medication, and by checking the IV site for the signs of inflammation or phlebitis.
Eg: Twice in the clinical setting I detected the signs of phlebitis in the patient, nursing intervention such as discontinuation of the IV and
observing the signs and symptoms of redness and tenderness around the IV was observed.

Satisfactory

Satisfactory 1. 6

Ask questions and clarify the plan of care, unclear orders or directions, and whenever uncertain.
K.G. : I always clarify the orders with the my teacher or the nurse. I never assume things and follow orders as they are documented in the
Kardex. If I have questions on how to mix certain drug in the D5W or NS I look into Lexi-comp for the compatibility.

Satisfactory Satisfactory 1. 7
Demonstrate professional behavior by seeking assistance in situations in which there is unsafe, unacceptable and/or
unprofessional behavior.
K.G. : I always get immediate assistance from my teacher and the nurse when my patient had signs of phlebitis. I always seek for
assistance when, I am unclear on my concept in order to prevent errors.

Satisfactory

Satisfactory

1. 8 Demonstrate understanding about the role of the nurse within health care.
K.G. : I have tried to provide my client with the safe and competent care. I do health teachings Eg: Patient with hip fracture, post op
exercises- such as deep breathing, coughing and ambulation and importance of physio. I communicate with the families and answered
their questions if they had any concerns.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
As seen from her examples from clinical practice, Kushanvir has consistently practiced safely and competently within the policies and
procedures set out by the surgical ward.

2. ACCURATE AND RELEVANT COMMUNICATION

Satisfactory

Satisfactory

2. 1 Participate in team sharing and discussions.

K.G. : I have developed on my communication skills over time. I participate more in the post conference. I help my peers with the
documentation in the MediTech and answer the questions if they have any. I also invite my peers if I have any procedures that they would
like to watch.

Satisfactory

Satisfactory 2. 2

Document clearly, accurately, concisely in a timely manner using written and electronic methods.
K.G. : I do my documentation clearly, accurately, concisely and in a timely manner on MediTech. I do my assessments are required Eg: I do
my physical assessment in the morning and do q4h assessments as required.

Satisfactory

Satisfactory

2. 3 Report relevant information to the appropriate personnel.

K.G. : I always update my teacher and nurse about my clients condition if there are any concerns and any situation that requires immediate
attention.

Satisfactory
Use communication techniques with the client and the inter-professional health care team.

Satisfactory 2. 4

K.G. : I communicate through a respectful, caring and compassionate manner. I show respect to the inter-professional health care team as
well as the client. I always approach my client with the positive attitude while interacting with them.

Satisfactory
Ensure privacy and confidentiality according to the Personal Health Information Protection Act (PHIPA).

Satisfactory 2. 5

K.G. : I will always ensure that I provide my client with the privacy, I take their consent and I make sure that their information is confidential
with me.

Satisfactory

Satisfactory 2. 6

Use technology to retrieve and share information including research, data and other information.
K.G. : I use William Osler Net to obtain information on medications from Lexi-Comp and E-cps. I also use Pyxis to obtain information on
the medications and to look up compatibility. I look up for doctors notes, physio and OT notes.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Kushanvir has developed accurate and relevant communication skills throughout this clinical experience by her use of the Meditech for
documentation, reporting appropriately and ensuring the privacy of her clients at all times.

3. CARING RELATIONAL PRACTICE

Satisfactory

Satisfactory

3. 1 Use effective communication techniques.

K.G. : Did health teaching on ambulation, deep breathing, coughing, calf-exercise and hip precautions. Communication with the doctor and
pharmacist to ask relevant questions about the diagnosis and medication respectively. Always answered client's question.

Satisfactory Satisfactory 3. 2
Establish therapeutic caring, compassionate, and culturally safe relationships with clients and health care team members.
K.G. : I always respect my clients culture and beliefs and respect their needs. Eg: If my patient is vegetarian I made sure that, they have
their vegetarian meals. I respect my clients religion and beliefs. I worked in a multi-cultural environment, I have shown respect to the
beliefs and culture of the other health professionals.

Satisfactory

Satisfactory

3. 3 Demonstrate therapeutic use of self to foster client well-being.

K.G. : I always reflect back on my knowledge, skills and practice. If I am doing any procedures for the first time, I make sure I ask my
teacher to assist me or watch me to rule out errors that would effect clients well-being. Eg: I watched videos to review the sterile technique
for dressing.

Satisfactory Satisfactory 3. 4
Use self-awareness to identify the effects that beliefs, values, and personal experiences have on relational practice.
K.G. : I never pose my opinions or beliefs on my client. I respect their beliefs and accept their values even if they differ from my beliefs and
opinions.

Satisfactory
Collaborate with clients and members of the inter-professional health care team and consult appropriately.

Satisfactory 3. 5

K.G. : I always talk to my client and ask them about their concerns. I make hourly checks on my client if they need anything and respond to
their call bell in timely manner. I seek assistance from the nurses or my teacher to look for resources. Eg: Talking to the resource nurse and
seeking help for the re-insertion of the IV catheter.

Satisfactory

Satisfactory

3. 6 Support the diversity of clients and the inter-professional health care team.
K.G. : I show respect to the clients and the inter-professional health care team from the different diverse groups. I show respect to their
beliefs and values.

Satisfactory Satisfactory 3. 7
Display sensitivity and respect for clients cultural, religious, and other beliefs and values influencing their choices and decisions.
K.G. : I show respect towards clients culture, religion and beliefs. I ask them for their choices Eg: I accepted the feedback from the family
of the patient who had dementia in order to provide the client with therapeutic care

Satisfactory

Satisfactory

3. 8 Provide effective client education.

K.G. : I have managed to do health teachings on hip fracture and ineffective breathing. I also educated my client after ERCP on his clear
fluid diet and how it would benefit him.

Teacher comments for CARING RELATIONAL PRACTICE :

Kushanvir has demonstrated therapeutic caring, compassion, and cultural sensitivity at all times throughout this clinical experience. She
provided her clients with excellent and appropriate health teaching.

4. LEADERSHIP AND ADVOCACY

Satisfactory

Satisfactory

4. 1 Apply appropriate conflict resolution skills in therapeutic client and other interactions.
K.G. : I can respond to the conflicts by making a calm and effective approach. During my conflict with the nurse I was calm and made an
effective approach.

Satisfactory

Satisfactory 4. 2

Evaluate and refine leadership skills to develop solutions and create a positive work environment.
K.G. : I never let the conflicts affect me or affect my day. I put forwards my opinions and respect the opinions of my teacher and peers. I
collaborate with my nurse and other health professional to provide the client with the therapeutic care.

Satisfactory Satisfactory 4. 3
Provide feedback to peers and accept feedback from peers and members of the interprofessional health care team.
K.G. : I did Peer evaluation, in which I provided feedback to my peer and accepted feedback from my peer in a positive way and developed
a learning plan on how to improve my nursing skills.

Satisfactory

Satisfactory

4. 4 Advocate for clients, self, others, and quality practice environment.

K.G. : I do health teachings and provide my client with the safe and competent care. Eg: when my client experienced phlebitis I held the IV
meds and reported the nurse and took appropriate interventions.

Satisfactory

Satisfactory

4. 5 Support clients rights for self-determination and choice.

K.G. : Client have the right to make their own decisions. Eg: When my client refused to take their meds I document it on Meditech and
Kardex. I always ask my client about their preferences.

Satisfactory

Satisfactory

4. 6 Respond appropriately to unsafe, unacceptable, and unprofessional behaviours.

K.G. : I respond calmly to the unprofessional and unacceptable behaviour of the nurses. There are times when nurses have a bad day, but
staying calm and reaching out to them in an appropriate manner is helpful.

Satisfactory Satisfactory 4. 7
Collaborate and consult when implementing health care and nursing practices that are in the best interests of the public and
protect the public through collaboration and consultation.
K.G. : Collaboration with the physio and OT is beneficial for the post-op patient. Encouraging the patient to attend physio and OT and
explaining the importance of it and how it will benefit them.

Satisfactory

Satisfactory

4. 8 Contribute to the creation of quality practice solutions and strategies.

K.G. : I submitted two care plans with nursing diagnosis, expected outcome and nursing interventions to contribute to the quality practice.

Teacher comments for LEADERSHIP AND ADVOCACY :

Kushanvir has demonstrated her excellent leadership abilities with her examples from her clinical practice. She always responds well to
feedback and her calm demeanor contributed to a positive working environment.

5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES
Satisfactory
Incorporate the clients unique needs and expected outcomes into holistic and clientcentred plans of care.

Satisfactory 5. 1

K.G. : I keep in mind my clients rights and needs. I analyse and interpret data from my clients assessments in order to provide my client
with the holistic and client centred care. I always ask my clients about their preferences.
Satisfactory

Satisfactory

Satisfactory

Satisfactory

5. 2 Develop theory-based plans of care that are holistic and client centered and are
articulated competently in writing and orally.
K.G. : I submitted two care plan with all the assessment data included in it.

5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.
K.G. : I use my knowledge, skills and judgement while assessing the client and while prioritizing their needs. Eg: Client with no urine
output from last 4 hours in the foley. Irrigated the catheter and patient returned on the normal output of the urine.

Satisfactory

Satisfactory

5. 4 Collaborate in the evaluation and modification of plans of care.

K.G. : After I get report from my nurse about my client from last night. I evaluate and modify my plans of care. Eg: When client had 5BM's a
night before, laxatives were held in the morning and checking BP before giving Beta blockers.

Satisfactory Satisfactory 5. 5
Safely and competently implement and evaluate nursing assessments and nursing interventions in a manner that demonstrates
knowledge and skill.
K.G. : I do my nursing assessment and ask my teacher to evaluate it. Eg: I asked my teacher to do respiratory assessment on one of the
client with me, to confirm the presence of wheezes.

Satisfactory
5. 6 Use the Three-Factor and practice decision-making frameworks to guide practice.

Satisfactory

K.G. : I do my assessments thoroughly and inform the clients about their vitals. I make sure that my clients have the right to refuse to any
procedure and I should respect their decision.

Satisfactory
Prioritize nursing care and nursing interventions in order to manage workload, time, and physical resources.

Satisfactory 5. 7

K.G. : I was able to manage my workload and time in an appropriate manner when I had two patients.I even managed to take my client for
the his ERCP procedure.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Kushanvir has consistently met her client's needs through mutually agreed expected outcomes. Concept maps were done well. Kushanvir
was able to thoroughly care for two clients with good time management and organization.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

Satisfactory Satisfactory 6. 1
Collaborate with clients and members of the inter-professional health care team to assess clients, determine health needs, and to
achieve mutually agreed expected outcomes.
K.G. : Collaborate with the physio and OT to assess clients walking ability and activity tolerance. I also collaborated with the doctor when
my patient agreed to get his ERCP done. I asked doctor about the benefits and the risks of the procedure.

Satisfactory Satisfactory 6. 2
Contribute as a member of the inter-professional health care team to respond to the changing needs and expected outcomes of
clients.
K.G. : I did health teachings in order to meet the changing needs and expected outcomes of the client. EG: After ERCP my patient felt
nauseated which was the expected outcome after the procedure.
Satisfactory
6. 3 Seek out assistance and consult with members of the inter-professional health care team.
K.G. : I asked medication related questions to the pharmacist and procedure related questions to the doctors.

Satisfactory

Satisfactory
6. 4 Use teamwork, consensus building, and conflict resolution skills to meet expected clientoutcomes.

Satisfactory

K.G. : I follow directions well. I accept feedback and opinions of others in a positive way. I have demonstrated effective communication
skills during my clinical practice.

Satisfactory
Use effective, collaborative, and consultative strategies to meet clients needs within a changing environment.

Satisfactory 6. 5

K.G. : Collaboration with the physio and OT to meet the clients needs. Eg: To make physio effective, administration of pain meds to relief
the patient from the pain during physio

Satisfactory

Satisfactory 6. 6

Interact with members of the health care team respecting their unique role and competencies.
K.G. : I interact with Doctors when they come to visit my patients. Eg: Interacted with doctor when he came to visit my client with VAC
dressing. I interact with the pharmacist and ask relevant questions. I respect their role on the unit, as they are important source of
information about the drug compatibility and dosages.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Kushanvir has demonstrated good understanding of this outcome by her clinical examples. She worked well with all members of the
surgical team, asking for their advice as needed.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

Satisfactory Satisfactory 7. 1
Act in the best interests of clients and protect clients from harm through collaboration and consultation with members of the interprofessional health care team and through competent and safe practice.
K.G. : I collaborated with my teacher and nurse, when one of the client had clogged catheter. Collaboration and nursing interventions were
taken to provide the client with the competent and safe practice.

Satisfactory Satisfactory 7. 2
Engage in ongoing reflective practice to identify strengths, areas for improvement; and, integrate feedback into practice.
K.G. : I reflect on my practice from what I know and look for areas I need improvement on. I respect the feedback I get from my peers and
teacher and I take feedback in a positive way to improve my nursing skills and practice.
Satisfactory
7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance
program (CNO).
K.G. : I have submitted my learning plan from this semester and will implement and evaluate my skills

Satisfactory

Satisfactory
Satisfactory
7. 4 Seek out learning opportunities and feedback that foster professional development; and, integrate these into practice.
K.G. : I attended huddles for infection control on the unit. I always look for opportunities to explore and learn. Eg: I took opportunity to
remove staples, Saw JP being removed, did dressings and watched NG tube feeds, inserted foley catheter and took my patient for the
gallium scan and ERCP procedure.

Satisfactory

Satisfactory

7. 5 Use nursing research to foster professional development.

K.G. : If I need to review on certain procedure I watch videos and do little research before coming into the clinical setting. Eg: Watched
videos for catheterization, management of IV therapy and sterile technique for the dressing change.

Satisfactory

Satisfactory

7. 6 Use a theory-based approach and evidence-informed practice.

K.G. : I look up my medications before administering them to the client in order to be informed about the side effects and contradictions.

Satisfactory Satisfactory 7. 7
Apply knowledge of changes to the health care system, technology, and in society as these affect nursing practice.
K.G. : I was updated about following the BERAS procedure post-op and doing full physical assessment instead of individual assessments
on the MediTech.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Kushanvir has many clinical examples above to demonstrate successfully meeting this outcome. She completed a learning plan, self and
peer review. She has always taken feedback well from her clinical teacher and then implemented the changes the next week.

8. USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING

Satisfactory
Use critical thinking and problem-solving skills to inform decision-making in all aspects of nursing care.

Satisfactory 8. 1

K.G. : Used critical thinking when the clients catheter was clogged and resolved the problem by irrigating the catheter and when patient
experienced phlebitis, discontinued the IV.

Satisfactory Satisfactory 8. 2
Use critical thinking, problem-solving and decision-making skills to assess clients and to determine nursing diagnoses, expected
outcomes, nursing interventions, and evaluative
criteria.
K.G. : When the client experienced phlebitis, I observed the site for redness, swelling and tenderness. The IV site was discontinued and
applied warm compress at the site and checked the site.

Satisfactory
Evaluate critical thinking, problem-solving, and decision-making skills and design a plan to improve these.

Satisfactory 8. 3

K.G. : I reflect back on my critical thinking, problem solving and decision making skills to evaluate what else could have been done in
order to improve the clients condition. I make drug cards to know the adverse effects and contradictions of the medication to prevent the
client from facing any interactions.

Satisfactory Satisfactory 8. 4
Integrate knowledge from a variety of nursing, health, and other theory into nursing practice to provide safe and competent care.
K.G. : I provide my client with the safe and competent care. Eg: I check ID bands of my client and ask them for any allergies to prevent
errors.

Satisfactory

Satisfactory

8. 5 Prioritize effectively.
K.G. : I do priority assessments. Eg: Before administering Beta blockers I will do Cardio assessment.

Satisfactory 8. 6 Demonstrate professionalism and accountability.

Satisfactory

K.G. : I was always punctual and in complete uniform.

Satisfactory

Satisfactory

8. 7 Use the practice decision-making and the nurse-client-environment frameworks to inform

and guide practice.
K.G. : I provide my client with the client centred to develop an effective nurse-client relationship.
Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING :
Kushanvir has used her critical thinking skills throughout this clinical placement. She has given many examples from her clinical practice.
Prioritization has developed well with two clients. She has consistently been present and punctual for all clinical days.

Student Final Summary with Strategies for Continued Growth

I have adapted well to the surgical unit. I always ask questions to clarify the orders or the care required for the client. I feel more competent with my
SC injections, hip precautions and IV administration therapy.

Teacher Final Summary with Strategies for Continued Growth

Kushanvir has done exceptionally well during this surgical clinical placement. She is an organized, self-reflective student who does her best at all
times to meet her client's outcomes. Kushanvir has met all the requirements of this clinical. Keep practicing the way you have and you should
experience continued success. All the best to you and I have enjoyed having you in my clinical group. Elaine Willard December 16, 2015

Student's References
College of Nurses of Ontario. (2014). Entry-to-Practice Competencies for Ontario Registered Practical Nursing. Retrieved October 28, 2015.
http://www.cno.org/Global/docs/reg/41042_EntryPracRPN.pdf

Grade

Unsatisfactory

Satisfactory

Referred to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Program Coordinator Feedback

The Program Coordinator has reviewed the evaluation

No

Yes
Student Sign Off
I met with my Clinical Teacher/Preceptor and discussed my evaluation

No

Yes
In general this evaluation accurately reflects my performance

No

Yes
Student Comment
It was a good experience on the ortho unit. Elaine was a good resource. I have learnt so much from her and really appreciate her help.