NURS 3021H Clinical Practice Focused on Chronic Disease

Management

Mid-Term Evaluation
Student: Ainsley Kinch
Clinical Instructor: Karissa Soetens
Clinical Placement Hospital: Northumberland Hills Hospital
Rehab
Date: February 22nd, 2016
Missed Clinical Hours: 0

Missed CLC Lab Hours: 0

Unit:

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

Progress
Evidence/Indicators

I have been able to demonstrate accountability during

my clinical placement in multiple areas such as being
punctual , having all required assignments done on
time, and ensuring I administer safe, competent, and
ethical patient care. I have also taken responsibility for
all my actions and remained honest with my coassigned nurse when asked to perform a task that is
outside my scope of practice as I would be held
accountable.
Ainsley has completed all required written work. She is
able to care for a two patient assignment including
patient care and documenting. She completes physical,
neurological, and CSM assessments each shift. She has
administered medication, changed dressings, and
assisted with patient hygiene and transfers.
2. Explain the experience of chronic The rehab floor in this clinical setting I have found very
illness in individuals receiving care similar to my NURS 1020 placement in long-term care
in chronic care settings
as they both involve caring for patients with a chronic
illness. In relation to my acute placement on an
orthopaedic floor, the commonality that I found
between the two settings is that patients typically have
multiple comorbidities. This clinical area is slower
paced than others however, that doesn't negate the
amount of care RN's provide to their patients. The main
focus in providing care to our patients is to encourage
the process of recovery to allow for a level of mobility
and/or independence (relative to the patient) so they
are able to achieve their set goals for discharge. The
purpose of providing care in a chronic setting is, unlike
acute care which is focused on treatment and curing an
ailment, but rather encouraging self-management and
maintaining a focus on prevention and health
1. Demonstrate accountability and
responsibility in the teachinglearning relationship.

Satisfac
tory

Unsatisfac
tory

3. Interpret critical aspects of the

persons experience of chronic
illness in relation to the nursing
process such as common signs
and symptoms, responses to
treatment, patterns of coping, and
impact on individual and family
relationships.

4. Identify symptoms and common

promotion. Patients diagnosed with a chronic illness

incur many difficulties in areas of their lives such as
physical (decreased mobility/self-care), social,
psychological (loss of independence), financial
(insurance/medication costs), and practical (coping
skills, change in living arrangements).
Ainsley is able to discuss the implications for patients
who have been admitted to hospital including potential
discharge to an ALC setting versus returning home. She
is able to identify short term and long term impact of
falls that lead to joint replacement or repair on a
patients lifestyle. She is able to recognize when
patients may need encouragement vs. physical
assistance and is familiar with the routines of the unit.
In a rehabilitative setting, there is a wide array of
medical diagnoses that I encounter. Patients commonly
are in rehab due to a fracture or break of the bone that
resulted from a fall. These patients also typically have
multiple chronic conditions such as diabetes, COPD,
dementia, CVA ,etc. When I am working with stroke
victims, is is essential to consider and understand their
limitations and be able to provide accomodations when
performing care. Suffering a stroke creates a huge
impact on both the individual and family members as it
can result in a huge loss of function and mobility in the
immediate stages and possibly long term. The post
stroke conditions that may affect an individual could
include hemiparesis, aphasia and cognitive deficits
which can result in the patient having feelings of
frustration and despair when engaging in rehabilitation.
Ainsley has developed rapport with a number of
patients on the rehabilitation unit. She assists patients
she is caring for as well as patients who request
assistance. She is able to assess a patients pain, as
well as their reaction to cardiac meds via vital signs
and physical assessments.
A chronic illness I have encountered numerous times is

medical treatments of selected

chronic illness.

5. Demonstrate select nursing and

collaborative interventions related
to caring for the person with
chronic illness such as specific
assessments, medication
administration, physical and
chemical restraints, enteral
feeding & residual volumes, NG
tube insertions, wound care,
patient controlled medication
administration pumps.

diabetes. My first patient was admitted to help maintain

their diabetes as it was uncontrolled and causing
damaging side effects. Common symptoms of diabetes
include: polyuria, polydipsia, polyphagia, sudden weight
loss, and impaired wound healing. The common
medical treatments prescribed for diabetes can differ
due to the type of diabetes the patient is diagnosed
with. Type 1 diabetics are always prescribed insulin
therapy to help maintain blood glucose levels while
type 2 diabetics either can maintain their diabetes
through healthy eating and exercise, supplment insulin
in addition, and/or take oral medications to help
maintain blood glucose levels.
Ainsley has discussed a variety of chronic illnesses in
her preclinical work including:
CVA, COPD, hypertension, and arthritis. She has clearly
demonstrated knowledge of medications related to
pain, cardiac dysfunction and diabetes management
during medication administration.
I have adequately demonstrated select nursing and
collaborative interventions relevant in a chronic care
setting such as:
- Comprehensive head-to-toe assessments (including
neuro checks and vitals)
- Pulmonary care (encouraging deep breathing and
coughing when O2 sats are less than normal,
maintaining supplemental oxygen)
- Medication administration (completing three checks,
conducting research into unknown medications,
obtaining vitals before administering certain
medications such as antihypertensives)
- Wound care (assisting in dressing changes, conducting
staple removal, assessing incision sites for proper
healing)
-Restraints (ensuring proper use of physical restraints,
consulting chart for recommendations)
Ainsley has cared for patients who have had restraints
used. She is able to provide appropriate care and

6. Identify potential
consequences/complications of
select chronic illnesses and
related interventions.

7. Under the supervision of a

Registered Nurse, demonstrate
safe, competent, evidenceinformed, holistic nursing practice
with clients with chronic illness
a. Use a wide range of
effective communication
strategies and
interpersonal skills to
appropriately establish,
maintain, re-establish and
terminate the nurse-client
relationship

document the use of this restraint. She has

administered oral and subcutaneous medications. She
has assisted in staple removal and wound care. She
has proved herself proficient in a variety of
psychomotor skills.
Chronic illnesses I have commonly seen as listed above
can render many complications. Dementia is
particularly dangerous when considering the extent of
the disease and related confusion. Patients can lose the
ability to perform self-care, suffer diminished social
interaction, loss of orientation and are more susceptible
to infection. Reorientation is a key nursing intervention
that can be achieved through labeling of personal
belongings (placing a sign navigating a patient to their
room), providing assitive devices, allowing patient to
mention their own name and names of close family
members, and restablish current time, person and
place.
Ainsley has discussed outcomes of patients who have
diabetes, rheumatoid arthritis and neurological deficits.
She has cared for patients who have a brain injury and
was able to share with the group how this changed the
patients ability to decision make in post-conference.
She led a post-conference on rheumatoid arthritis and
reflected on how this impacted patients lives.
I have demonstrated safe, competent, evidenceinformed, holistic nursing practice with clients with
chronic illness through:
- Receiving and giving report to my peers and coassigned nurses
- Using my critical judgment when identifying abnormal
results and consulting with my co-assigned nurse of
clinical instructor
-Provide patient teachings and answering patients
questions about their care within my scope of practice
-Performing all required checks before administering
medications within the patients rights for safe
administration

b. Demonstrate
accountable, responsible
and ethical practice
c. Engage in respectful,
collaborative, therapeutic
and professional
relationships
i. Demonstrate
therapeutic use of
self
ii. Create a
culturally safe
environment
d. Apply nursing models and
theories
e. Demonstrate health
promotion and illness
prevention practices
f. Demonstrate patient
advocacy
g. Predict outcomes of
nursing care
h. Evaluate client response
to nursing care
i. Critically appraise own
practice in relation to
nurse-client/family
interactions and as a
member of the health
care team
8. Critically appraise own practice in
relation to nurse-client/family
interactions and as a member of
the health care team

- Acquiring all vital information before completing any

procedures or assisting in ADLs (ex. identifying
patients mobility status and constantly assessing
patients
mobility
during
lifts,
transfers,
and
ambulation)
- Applied Roys adaptation model during clinical
practice
Ex. considering patients environmental factors that
might impact (positively or negatively) a patients wellbeing and promotes the concept of adaptation
Ainsley works within her scope as a third year nursing
student, she seeks assistance with new tasks, or
specific skills she knows require supervision. She
spends time visiting with patients when they are lonely,
or discussing their concerns. In previous weeks a
patient was very concerned about getting to an
appointment, when she could not clearly arrange
transportation Ainsely spent time allowing her to
express her concerns, and comfort the patient. She
utilizes nursing theories to reflect on her care in her
post clinical work each week. She advocates for
patients when they are in pain or require a change in
their care. She is able to assess effectiveness of her
care.

I have found over the past few weeks that I am growing

in my abilities and gaining confidence in my therapeutic
communication skills. Chronic care involves the
incoporation of family-centered and client-centered
care as family plays a pivotal role in my care. I always
conduct myself in a professional manner through
proper introduction and identification of my role as well

9. Participate in professional
development based on reflective
practice and critical inquiry

as explain any procedures or methods of care I

administer before hand so the patient and family
members (if present) are adequately informed.
Over the first portion of this clinical, Ainsley has shown
progression in her critical thinking and her ability to
interact with patients. She works well with the coassigned nurses who often seek her to assist in tasks.
She has expressed a willingness to learn and to seek
new experiences and the nurses on this unit appreciate
that.
When faced with abnormal findings, I always use my
critical thinking skills as to why it would occur. My first
response, if not a critical situation, is to try and use my
current basis of knowledge to understand how it is
caused and if I can do my best to alleviate the cause.
The weekly post-clinical assignments allows for the
opportunity to engage in critical self-reflection of my
experiences and gain a deeper understanding of my
actions to identify where I can improve and what my
strengths are going forward.
Ainsley has completed weekly pre and post clinical
work. She has submitted her first reflection. She has
self-reflected on her praxis in her midterm evaluation.

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

comment)
Ainsley is enthusiastic and open to feedback. She seeks new experiences and works on the unit as a
team player. She has cared for patients with a variety of diagnosis, and comes to clinical well prepared with
pre-clinical work each week. She works within her scope as a third year student, seeking assistance for tasks
she is unable to complete without supervision i.e. medication administration, blood glucose testing. She has
lead a post-conference on rheumatoid arthritis, with associated documentation and handouts. She was able
to actively involve the group and to disseminate a care plan for a patient with this illness. She can continue
to refine her assessment skills related to chronic illness. She can participate in family conferences and with
allied health care professionals such as OT/PT. She has one more reflective paper to complete before final.

Ainsleys inquisitiveness and enthusiasm for knowledge makes the teaching-learning relationship simple to
facilitate.
Signature of Instructor:

Date: Feb 22, 2016

X
Karissa Soetens
Clinical Instructor

Signature of Student:

Date: