Student Name ____Samuel John_________________ Date _______11 April 2016_______

N360 Weekly Self Evaluation

1.

Considering your patients current status, list potential complications and strategies for
prevention and early recognition.

Potential complications for my first client r/t to bilateral ankle surgery are infection, impaired
perfusion to lower extremities (e.g. Compartment syndrome), bleeding and issues related to
post-op surgical procedure (immobility increases chance of thrombi, pneumonia, constipation
r/t opioid pain management treatment). Strategies for prevention and early recognition are
frequent neurovascular checks, assessing surgical site for bleeding, pin site and condition,
proper pin care if ordered, deep breathing/coughing and IS, prevention of constipation (highfiber foods, increased fluids, stool softener, bowel stimulant), monitoring labs. Potential
complications for my second client r/t severe sepsis, if not resolved, include AKI, shock,
MODS, eventually progressing to death if not properly addressed. Strategies for prevention
and early recognition include assessing clients condition for any deterioration or change in
LOC and V/S, monitoring lab values especially WBCs, kidney function indicators (BUN, Cr,
Serum Chem), lactic acid and trough levels of prescribed IV antibiotics, in this case,
vancomycin, and continuing diligent adherence to antibiotic regimen to treat septic condition.
2.

Am I getting more comfortable with the use of the nursing process to plan and evaluate
nursing care? (Give examples of how it is better now or problems that still bother you).

Yes I am. This week I continued to refine my data collection skills and organization of that
data on to paper. Using this paper as a guide, I was able to better visualize and plan my shift
and care accordingly. This allowed for performing appropriate interventions and efficient use
of my time as well as proper evaluation and adjustments as necessary. I still can benefit from
improving my data collection skills from the chart, patients and other healthcare team
members by noticing and selecting relevant data, asking patients select and appropriate
questions and soliciting more information from other health-team members, especially
nurses.
3.

Were my nursing diagnosis and plan of care individualized for my patients? (Give
examples of how you did this.) Do I have difficulty in this area? (Explain).

I believe my nursing diagnoses and plans of care were individualized. I did this by using the
physicians notes as a foundation, then based on my own assessment and evaluation of the
clients condition via data gathered in the chart, attached my own priorities and
recommendations. Finally, to complete the task, I spoke with and assessed my clients own
concerns and wants and assimilated those into the care plan. The difficulty I still have in this
area is fully including the client in his/her own care, though I am making progress in this
regard.
4.

How are my assessment skills developing? Am I being as thorough as I need to be?

What areas are still difficult for me and what am I doing to improve? (Be specific).

My assessment skills continue to develop. This week I was much more thorough than
previous weeks though I think I can still be even more so. It is still difficult for me to
sometimes assess areas I perceive to be bothersome, painful or uncomfortable for clients as
I feel they have already been assessed here and I would rather not bother them
unnecessarily. However, I recognize that this is a block in my own logic and actually not
conducive to the client, in fact, possibly detrimental. So, what I have been doing and will
continue to do is to push past this conception and instead replace it with the understanding

that a thorough and complete assessment is necessary for my clients health and wellbeing
as well as requirement of a competent and effective nurse.
5.

What new skills did I implement this week? How did I do? What could have helped me to
improve? Did I ask for help when I needed it?

This week I gave heparin and regular insulin via subcutaneous injection, a skill I have
performed before but not in awhile, so it felt new. I feel I did okay considering it had been
such a long time since I had performed the skill, but I also know I can improve substantially,
mainly by increasing the speed with which I complete the task and thoroughness in
preparation (gathering necessary supplies, selecting right needle, drawing up med, recapping needle properly). I did ask for help when needed, on several occasions, and found it
both very helpful and insightful.
6.

How is my time management progressing? What areas of difficulty have I found and what
can I do to improve? How do I monitor my time management while in the clinical area?

My time management continues to get better and better. I feel I am getting a handle on the
time needed to complete certain things and finding a rhythm and groove that works for me. I
have found it difficult sometimes to incorporate unanticipated changes in my workflow, i.e.
shuffle things around. For instance, a patient asks for something or shares information that
requires reprioritization of planned interventions. This sometimes trips me up, but I am finding
that by allowing time in my shift schedule for unexpected developments such as these, it
helps me be more flexible and able to adapt, so that I can stay on-track and on time. I monitor
my time by drafting a timeline on paper and checking my watch often.
7.

Was I involved in making referrals for my client in any way? How could the nursing role in
this process have been strengthened?

Yes, I helped with a referral. In this case, it was for RT to come assist a patient with a
breathing treatment. However, for another patient, I could have strengthened the referral
process by following up with social work on his behalf.
8.

List the specific interventions, in order of priority, for two of your clients and explain how
you determined which interventions took precedent.

My interventions for my first client were: Pain Management, Assessing and monitoring for
potential complications r/t the surgical procedure to his ankles, applying ice and maintaining
elevation of his lower limbs and reinforcing teaching regarding calling for assistance with
ambulation, deep breathing and IS. I chose these because pain and its management were his
most frequent request (understandably). Close to this was making sure his perfusion was
adequate and no complications r/t surgery were present as that is so important to catch early
on. Initiating interventions to help prevent these complications included ice application and
extremity elevation, as well as teaching on respiratory health and ambulating with assistance.
My interventions for my second client were: Assess and monitor clients status for any
changes or signs & symptoms signaling complications r/t sepsis, Pain management and
timely administration of all medications. Ensuring that sepsis was being treated effectively
was priority because complication from this can quickly become a medical emergency. Pain
management is also important to help the client heal and be comfortable. Timely
administration of all medications to maintain appropriate levels of drugs was integral for the
successful treatment of this client.
9. Client-centered Care: Did I reserve judgment until I had enough information to make a
decision?

For me this week the answer to this question is yes and no. I knew my client was in a lot of
pain as he had just fractured both his ankles and undergone surgery to repair them. As such,
his need for pain medications was high. However his primary nurse suggested (prior to my
own assessment) that he might be seeking narcotics. This implication did not sit right with me
on the one hand, but I also had to consider it on the other. At certain points in my shift I am
ashamed to say I interpreted my clients requests for pain meds more as narcotic-seeking
behavior than desire for effective pain relief due to extreme pain. However, this interpretation
did not sit right with my intuition, recognizing that this behavior was a normal response to his
situation. As such I made a point to give him the benefit-of-the-doubt, in essence practicing
the principle of pain is whatever the client says it is. After gathering and analyzing more
information and input (from the primary nurse, client, and later on my clinical instructor), I
realized it was my responsibility to treat him in a non-judgmental manner, regardless of if he
had a substance abuse problem or not.