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 :
Period :
Student hours :
Required Hours :
Validated hours :

Hayley Nolan
Grace Jose
Judy Martin
Halton Healthcare Oakville
Agency
2E Med
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

Teacher Rating

1. COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK

1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies

Satisfactory

Satisfactory

and procedures.
H.N. : I abide with the standards created by Halton Healthcare, Humber College Institute of Technology (HCTAL) and Advanced Learning
and College of Nurses of Ontario (CNO). I ensure that I critically assess the expectations of the facility in which I am practicing in and the
expectations of Humber College. If I discover a conflict, I address my concerns with my clinical instructor for further guidance. I review
literature and resources provided by the facility, college and CNO (i.e. Humber College Practical Nursing Handbook, CNO practice
standards, etc.) if necessary. I ensure that I have adequate access to these resources when I am at the hospital and when I am reflecting on
my practice at school or at home.

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

Satisfactory

Satisfactory

H.N. : I act in a responsible, ethical and accountable manner outside and inside of the clinical setting. This includes being responsible for
my actions in regards to nursing care which includes documenting interventions and assessments. I ensure that I represent the values and
expectations of the facility, CNO and Humber College. I use my knowledge, skills and judgement to make clinical decisions that support the
well-being of the patient. I understand that I am responsible for my actions, therefore, I accept the potential consequences of my actions. I
demonstrate my competence with the guidance and supervision of a registered nurse and/or my clinical instructor.

1. 3 Determine how the three factor and practice decision-making frameworks influence client

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care.
H.N. : I understand that the CNO created the three-factor and decision making frameworks to assist nurses with making decisions about
care that foster positive outcomes and patient well-being. When accepting patient assignments with my clinical instructor, I utilize the three
factor framework (nurse, client and environment) to determine if the assignment is appropriate. I continuously assess my abilities and
limitations.

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

Satisfactory

Satisfactory

H.N. : I have learned from my current and prior clinical experience that evidence informed practice goes hand-in-hand with decision
making. I am aware that all good clinical decisions are guided by research. This research can be obtained from a variety of sources,
however, a thorough nursing assessment offers valuable information about patient condition. This information provides the rationales
needed to initiate, modify or stop nursing interventions.

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

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Satisfactory

and a safe environment.

H.N. : I use critical thinking and professional judgement to advocate for safety for all persons within the hospital including patients,
nurses, support staff, visitors, students, volunteers, etc. If I have concerns about the safety of the environment or patient I consult with my
clinical instructor for guidance on how to resolve the issue.

1. 6 Ask questions and clarify the plan of care, unclear orders or directions, and whenever

Satisfactory

Satisfactory

uncertain.
H.N. : If I am uncertain about an order or plan of care for a patient, I communicate directly with the patient's nurse and my clinical
instructor for guidance. In addition, I utilize other resources such as text books for further information. I ensure that I bring these materials
with me to clinical.

1. 7 Demonstrate professional behavior by seeking assistance in situations in which there is

Satisfactory

Satisfactory

unsafe,
unacceptable and/or unprofessional behavior.
H.N. : I employ an ethical framework when making decisions which demands that I protect the client's privacy, confidentiality, well-being
and choice. I understand that nurses are well respected, highly educated professionals. It is imperative that all registered nurses and
nursing students work together to protect the integrity of the profession. I ensure that I continuously reflect my own professional
behaviours and critically assess other nurse's and/or nursing students professionalism. If I have any reason to believe a nurse or nursing
student's behaviour does not align with the inherent core values of the hospital, CNO or Humber College I communicate my concerns with
my clinical instructor. I understand that if I do not advocate for the safety and well-being of all persons within the health care facility, I am
also liable for any consequences.

1. 8 Demonstrate understanding about the role of the nurse within health care.

Satisfactory

Satisfactory

H.N. : The nurse has many roles and responsibilities within the health care facility. The ultimate goal being positive outcomes and patient
well-being. However, a nurse must also be aware of the well-being of nursing staff, visitors, support staff and themselves. A nurse must be
aware of the expectations of the facility and the College of Nurses of Ontario. I also represent Humber College, therefore, I abide by
regulations created by the college. I understand that the role of the student nurse in the clinical setting is to further and enhance the
knowledge and skills learned in the classroom and prior clinical experiences. I work as a team with my clinical classmates in order to
facilitate learning. I am respectful of the facility and those who work in it. Although I am learning, I ensure that I maintain patient safety at all
times. This includes consulting with RNs, RPNs and my clinical instructor.

Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
Student consistently demonstrated accountability in nursing practice. Student was able to consistently demonstrate preparedness for
practice, assumed responsibility for learning, and actively participated in learning. Weeks 11- 14: Student was able to care for 2 clients
independently; medication, morning routine, wound dressing changes, ADL needs, and documentation.

2. ACCURATE AND RELEVANT COMMUNICATION

2. 1 Participate in team sharing and discussions.

Satisfactory

Satisfactory

H.N. : I actively participate in group discussion and sharing within the clinical setting. I more often than not take the initiative to initiate
discussions about relevant issues, questions or findings. In addition, if my patient requires a specific nursing intervention that could be an
opportunity to learn for other students I encourage them to participate and/or watch.

2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic

Satisfactory

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methods.
H.N. : I document events clearly, accurately and concisely by utilizing suitable documentation tools such Meditech and bed side shift
reports. I ensure that I document information and interventions within a reasonable time frame. I understand that this information can be
vital for other clinicians (i.e. NPs, MD, RTs, etc.).

2. 3 Report relevant information to the appropriate personnel.

Satisfactory

Satisfactory

H.N. : I familiarize myself with the nurse responsible for the care of the client in order to exchange important information. I understand that
I am not only responsible for reporting information pertinent information about my assigned patient's safety and well-being, but all
patient's I may encounter. I ensure that I relay appropriate information to the right professionals (i.e. pharmacy, charge nurse, respiratory
therapist, MD, etc.). Further, I ensure that I maintain regular communication about nursing skills, interventions and findings with my
nursing instructor.

2. 4 Use communication techniques with the client and the inter-professional health care

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team.
H.N. : When I communicate with nursing staff, instructors and students I employ appropriate nursing language learned in theory and lab
classes. I ensure that I am clear, concise and relevant when communicating information with other professionals. When I communicate
with clients and family, I use my nursing judgement to identify any possible communication barriers such as culture, language, education
and/or hearing impairments.

2. 5 Ensure privacy and confidentiality according to the Personal Health Information

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Satisfactory

Protection Act (PHIPA).

H.N. : I have familiarized myself with CNO standards for maintaining confidentiality and privacy which was created considering PHIPA. I
ensure that I am familiarized with shredders on unit to dispose of papers which may contain patient information. I ensure that I do not take
client information home such as names and/or diagnoses.

2. 6 Use technology to retrieve and share information including research, data and other

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Satisfactory

information.
H.N. : I have familiarized myself with the Meditech system which allows me to gain valuable information about clients from a variety of care
providers (i.e. MD, nursing staff, respiratory therapists). I use these systems to review patient history, diagnoses, medications and lab
results. I document vitals, interventions and assessments with the Meditech system. For example, during week 12 I had a patient with a firm
lower abdomen upon light palpation. I used the Meditech system to research when the patient's last bowel movement was. I discovered
that the patient's last bowel movement was 6 days prior. I used the Meditech system to research any PRN medications/interventions for the
patient. I discovered an fleet enema was listed. Once completed, I used the Meditech system to document my assessment, intervention and
evaluation so that other providers of care could see.

Teacher comments for ACCURATE AND RELEVANT COMMUNICATION :

Student communicated clearly, concisely, and correctly in the written, spoken, and visual forms that met the needs of the clients. Also,
student responded to relevant information in a manner that ensured effective communication.

3. CARING RELATIONAL PRACTICE

3. 1 Use effective communication techniques.

Satisfactory

Satisfactory

H.N. : I ensure that I assess for barriers to effective communication (i.e. hearing impairment, speech impairment, language, education level,
cognition, etc.) before initiating the nurse-client relationship. I try to be continuously aware of the tone, volume and speed of my speech. I
use appropriate terminology and language when communicating with nursing staff, instructors, students and other members of the interprofessional team. I convey a respectful and judgement free method of communication with patient's and their family.

3. 2 Establish therapeutic caring, compassionate, and culturally safe relationships with clients

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and health care team members.

H.N. : I support that all Canadians deserve reasonable access to quality, competent, non-judgemental and compassionate nursing
services. I consider core principles of therapeutic nurse-client relationship such as empathy, respect, professional intimacy, power and
trust (CNO, 2013) when initiating care. I consider the patient's psychosocial, physical, spiritual, religious and emotional needs when
creating a plan of care. I understand and respect that every patient is different, therefore, each patient's plan should be created with this
knowledge. I understand that individuals possess unique needs that reflect their culture which deserve to be acknowledged and actualized.
I do not limit these skills to patient interactions, but interactions with all staff and classmates. I value the insight and knowledge from other
cultures that are not my own.

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

Satisfactory

Satisfactory

H.N. : I understand that the use of self in nursing is a therapeutic agent. I offer unique knowledge, strengths and personality that can
facilitate positive changes in the patient's overall condition. I understand that the interaction I have with a patient can have positive or
negative consequences in regards to their day and/or long-term well-being. A nurse can encourage and empower patients to self-actualize.

3. 4 Use self-awareness to identify the effects that beliefs, values, and personal experiences

Satisfactory

Satisfactory

have on relational practice.

H.N. : A well developed nursing care plan is the reflection of knowledge of client. A plan of care should always be client-centred. I
understand that my beliefs, values and personal experience are unique and differ from the experiences of others. I acknowledge that the
beliefs, values and experiences of others are equal in importance. It is imperative to nursing care to understand the person beyond their
medical condition(s) which includes exploring their beliefs, values and personal experiences.I understand that knowledge can be obtained
from a variety of sources (i.e. friends, family members, medical history, other health professionals) and directly from the patient. It is
imperative to nursing care to understand the person beyond their past and current medical history, diagnose(s) and disease(s).

3. 5 Collaborate with clients and members of the inter-professional health care team and

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consult appropriately.
H.N. : I continuously interact with the patient, their family and other members of the inter-professional health team. I educate others about
the role of the student nurse in providing care. This includes the role I serve within the patient's plan of care, what year and program I am
enrolled. I answer inquiries about prior placements, experiences and competencies if necessary. In addition, I reassure patients that I am
under the supervision of a registered nurse and a clinical instructor appointed by Humber College. I convey that I am confident,
knowledgeable and capable of providing care. If I am unsure about my competence regarding a particular skill or intervention, I consult
with my instructor and/or nursing staff.

3. 6 Support the diversity of clients and the inter-professional health care team.

Satisfactory

Satisfactory

H.N. : I recognize the unique skills that each member of the team can contribute to care. I understand that providing patient care is a team
effort. The role of each member of the inter professional team serves an important purpose with the ultimate goal being positive patient
outcomes.

3. 7 Display sensitivity and respect for clients cultural, religious, and other beliefs and values

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influencing their choices and decisions.

H.N. : It is the responsibility of the nurse to support patients to make their own decisions with accurate information to do so. I understand
that these values may be different from mine. I support each patient's right to make decisions about their care that reflects their personal,
religious, spiritual and cultural beliefs. I attempt to understand the different positions that these differences in values create. I ensure that I
convey support without judgement. I support each patient's right to make decisions about their care that reflects their personal, religious,
spiritual, and cultural beliefs.

3. 8 Provide effective client education.

Satisfactory

Satisfactory

H.N. : I understand that teaching and nursing go hand-in-hand. I ensure that I assess any barriers to learning prior to initiating teaching in
order to make necessary accommodations. I ensure that I am continuously providing education throughout the day by answering
questions, sharing knowledge about interventions and medications. I also understand that each patient learns in a different way. I ensure
that I have access to more than one type of educational support such as brochures, websites, videos and group learning activities. I
confirm patient learning by asking the patient to reiterate the education I have provided.

Teacher comments for CARING RELATIONAL PRACTICE :

Student was able to establish sound relationships with peers, staff, clients, and teacher. Student consistently utilized well developed
communication and interpersonal skills.

4. LEADERSHIP AND ADVOCACY

4. 1 Apply appropriate conflict resolution skills in therapeutic client and other interactions.

Satisfactory

Satisfactory

H.N. : I understand that the nurse plays a vital role in the prevention, anticipation and reduction of possible conflicts. I am aware that
conflict can arise between the nurse-client, nurse-family and nurse-interprofessional team relationships. I have learned to remain calm and
prioritize client-centred care. I have learned this semester that conflict is likely to arise on a complex and acute unit. I understand that
nurses are under a lot of pressure and I must ensure that I remain calm. I have worked with my instructor to resolve conflicts in a manner
that promoted learning for future practice. In sum, the patient's health and well-being should always remain foremost.

4. 2 Evaluate and refine leadership skills to develop solutions and create a positive work

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environment.
H.N. : I actively participate and lead in various group discussions. I collaborate with other students to offer knowledge and understand
different perspectives to facilitate learning. I empower, support and encourage other students when providing direct care. I am always open
and willing to assist other students if I am able. I believe that I possess a naturally positive attitude, however, this can be challenging in an
acute/stressful environment. However, if conflicts are addressed as they arise this can be dramatically minimized. I have worked with my
instructor to reflect on stressful situations and how to better manage these situations in future.

4. 3 Provide feedback to peers and accept feedback from peers and members of the interprofessional health care team.

Satisfactory

Satisfactory

H.N. : continuously communicate with fellow nursing students inside and outside of the clinical setting to discuss nursing practice within
the clinical setting. I provide support and positive reinforcement when I believe that other students are doing a good job. Further, I provide
recommendations if a fellow student is concerned about their performance. I accept the same constructive criticism from other students.

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

Satisfactory

Satisfactory

H.N. : I advocate for myself, my fellow nursing students, the patient(s), nurses on unit and the nursing profession within the clinical
setting. I actively listen to the patient to gain an understanding of their needs and desires from care. I continuously assess the environment
to identify anything which may harm team members, families and patients.

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

Satisfactory

Satisfactory

H.N. : I encourage and support the patient's right to autonomy and directing their care. I understand that patient culture, spirituality,
religion and personal values may influence care. I provide education and additional resources so that the client may make the best
decision for their care. I understand that a patient's plan of care may differ from my suggestions, but I continue to convey non-judgement
and support. I consistently advocate for the patient's best interest.

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

Satisfactory

Satisfactory

H.N. : I understand that client-centred care remains the forefront of nursing. I ensure that I actively aim to prevent unsafe, unacceptable
and unprofessional behaviour. I familiarize myself with the standards of Humber College, CNO, Halton Healthcare Services and the unit. I
always critically assess the urgency of a situation in which I am concerned about safety, professionalism and acceptable behaviour. I
determine whether I can and/or should intervene immediately or consult with my instructor for assistance.

4. 7 Collaborate and consult when implementing health care and nursing practices that are in

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the best interests of the public and protect the public through collaboration and consultation.
H.N. : I collaborate and consult with various members of the health care team to further my knowledge and understanding. I educate
myself on the different contributions to care that other members of the health care team provide. When developing a care plan, I determine
if I can refer a patient to or collaborate with another health care professional (i.e. dieticians, respiratory therapists, social work, etc) to
promote positive patient outcomes. I understand that their specific training and knowledge can be beneficial.

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

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Satisfactory

H.N. : As aforementioned, I more often than not participate in discussing areas in which I believe patient care can be improved. I recognize
that the Ontario health system is publicly funded and it's imperative that tasks are delegated to appropriate team members to improve
utilization of resources. I offer solutions to my instructor and/or other members of the health care team.

Teacher comments for LEADERSHIP AND ADVOCACY :

Student was able to demonstrate leadership skills related to peer interactions. Student Consistently demonstrated professional nursing
behavior.

5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES

5. 1 Incorporate the clients unique needs and expected outcomes into holistic and clientcentred plans of
care.

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H.N. : I assess the patient's goals for care. I develop a plan of care that considers the emotional, spiritual, cultural and personal beliefs of
each person. I ensure goals are timely and realistic. I respect the patient's autonomy and right to self-determination of care. I understand
my role to provide the patient with the education to make informed decisions about their care. I provide support and convey non-judgement
regardless of a patient's decision. I advocate for the patient if their goals for care differ from their family and/or other health professionals. I
ensure that I do not influence the patient's decision based on my own values and beliefs. I understand that nurses treat people, not merely
a disease or diagnosis.

5. 2 Develop theory-based plans of care that are holistic and client centered and are

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articulated competently in writing and orally.

H.N. : I use credible resources when conducting research about medication, treatments and diagnoses. I ensure that I have access to
materials on the unit. If not, I bring my own resources from home to help create concept maps (i.e. drug guide, LPN notes, pathophysiology
text, cue cards from class notes, etc.). I ensure that I organize information appropriately and provide specifics (i.e. turn a patient with a
coccyx pressure ulcer Q2H). I ensure that my writing is clear and legible. I consistently communicate my actions with the patients nurse,
my clinical instructor and other members of the team. I use written and electronic documenting as necessary.

5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.

Satisfactory

Satisfactory

H.N. : When developing a plan of care, I ensure that I consider the whole person which includes their psychological, social and spiritual
well-being. I use knowledge obtained from independent study, in-class lectures, text books, prior experience and simulation labs in my
nursing practice. I develop my critical thinking and nursing priorities by consulting with my instructor. I evaluate interventions and make
adjustments if necessary. I use a variety of resources to conduct research about patients which are relevant to creating a comprehensive
plan of care including speaking with family, accessing past medical records, viewing multidisciplinary notes and communicating with other
care providers. I ensure that whether I use written or verbal communication that my message is understood.

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

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H.N. : I work closely with my clinical instructor and assigned nurse to evaluate/modify plan of care. I communicate interventions with my
instructor and provide rationales supported by assessments. I actively seek other members of the patients multidisciplinary team if there is
a particular issue, concern or question (i.e. in week 8, a patient with dysphagia requiring crushed medication had medication that could not
be crushed. I consulted with the pharmacist to determine if an alternative was available.). I review notes, recommendations and
interventions created by other members of the team. I ensure that I document interventions.

5. 5 Safely and competently implement and evaluate nursing assessments and nursing

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interventions in a manner that demonstrates knowledge and skill.

H.N. : I ensure that if I implement a nursing intervention that it is evaluated within a specific time frame. I understand that some
interventions can be evaluated quickly (i.e. implementing O2 therapy for a patient with low SpO2 sats, I/O catheter in a patient with urine
retention) and some must be evaluated over time (i.e. repositioning and turning in a patient with a stage 1 ulcer). I ensure that I am
knowledgeable about therapeutic and expected outcomes. Further, I am knowledgable about potential adverse effects/reactions. I tailor my
plan of care to monitor effectiveness of nursing interventions. I ensure that I communicate all interventions with the patient's nurse and my
clinical instructor.

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

Satisfactory

Satisfactory

H.N. : When accepting patient assignments with my clinical instructor, I utilize the three factor framework (nurse, client and environment)
to determine if the assignment is appropriate. I critically assess my knowledge, skills and judgement during this process. I continuously
consider the three-factor framework as I provide care in case one or more of the factors change.

5. 7 Prioritize nursing care and nursing interventions in order to manage workload, time, and

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physical
resources.
H.N. : I have learned that time management is critical in a acute/complex nursing environment. It's essential that I prioritize patient needs
when managing multiple assignments. I understand that remaining calm and focused is imperative to preventing errors and/or other
undesired outcomes. It's important to plan care in a manner that leaves time available if unanticipated complications arise. Further, I
understand the importance of working as a team on the unit with nurses and other care providers.

Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Student practiced within the ethical guidelines of the care facility, expectations of Humber College, and the CNO.

6. COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM

6. 1 Collaborate with clients and members of the inter-professional health care team to assess

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clients, determine health needs, and to achieve mutually agreed expected outcomes.
H.N. : I collaborate with multiple professionals in order to create a plan of care that reflects the clients needs and interests.I educate myself
about the resources and services available to provide quality care to patients. I utilize other members of the inter professional team such
as physiotherapist, respiratory therapists and speech language pathologists effectively. I encourage and take into consideration the
assessments from other professionals.

6. 2 Contribute as a member of the inter-professional health care team to respond to the

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changing needs and expected outcomes of clients.

H.N. : I understand my role as a student nurse in the clinical setting. I am able to spend more one-on-one time with the patient and gain
valuable information regarding the patient's condition and care. I ensure that I take the time to review the patient's chart,
notes/assessments made by other clinicians (i.e. pharmacy, social work, medicine) and develop thorough assessments. I ensure that I
communicate any discrepancies, significant findings and conflicts with the appropriate practitioners. I also communicate if I have reason to
believe that an issue may be anticipated. I ensure that problems are addressed within a reasonable amount of time related to urgency. I
document assessment, intervention and evaluation accordingly.

6. 3 Seek out assistance and consult with members of the inter-professional health care team.

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Satisfactory

H.N. : I ensure that I communicate with my clinical instructor and the staff nurses regularly/PRN while in the clinical setting. Further, I
assess if another practitioner needs to be utilized and/or notified. I assess my own knowledge, skills and judgment and ask for guidance as
needed.

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

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outcomes.
H.N. : I ensure that I establish an open and mutually beneficial relationship with other students on the unit to foster team work. I regularly
communicate with unregulated care providers (i.e. PALS, volunteers) and regulated health professionals (i.e. respiratory therapists,
occupational therapists, OT/PTAs). I build report with these other professionals. I ensure that each professionals perspective and
contributions are acknowledged. I understand that each member of the team has invaluable knowledge and expertise to contribute to the
well-being of the patient.

6. 5 Use effective, collaborative, and consultative strategies to meet clients needs within a

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changing
environment.
H.N. : I ensure that I continuously evaluate the patient's condition in order to identify if the assistance of another professional and/or a
change of location is required. I familiarize myself with the different resources and services available to the patient that are provided by
other members of the inter professional team. I collaborate and consult with these professionals to provide a more specific and quality plan
of care. I also consult with the patient to determine their wants and needs to facilitate client-centred care.

6. 6 Interact with members of the health care team respecting their unique role and

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competencies.
H.N. : I respect the knowledge, skills, experiences and contributions each member of the health care team provides to patient care. I
understand that each member of the team is working towards a common goal. I do not believe that one person's knowledge and expertise
is more valuable or less valuable. I collaborate and utilize the family when available.

Teacher comments for COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE TEAM :

Student developed strong relationships both with peers, hospital staff, teacher, and clients. Student utilized effective interpersonal skills
and therapeutic communication.

7. QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

7. 1 Act in the best interests of clients and protect clients from harm through collaboration

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and consultation with members of the inter-professional health care team and through
competent and safe practice.
H.N. : I continuously collaborate with nursing staff, patients, families, nursing students and instructors to ensure that the patient is
receiving the best possible care. I ensure that I advocate for care that meets the patient's social, emotional and physical needs. I provide
patients with the information they need to make decisions about their care. I continuously provide care that reflects patient-centred care. In
week 11, I administered 4 x the amount of a single dose of medication with my clinical instructor in the morning. Once I noticed the error, I
assessed the patient and notified the nurse/my clinical instructor. Although I was scared of possible repercussions, I knew it was my
ethical responsibility and duty to ensure the patient was safe. I prioritized effectively, I followed the protocols set by the unit, notified the
MD, documented, continuously monitored and fulfilled recommendations. I reflected on the incident with my clinical instructor and
assessed what happened and how to prevent recurrences. I use these strategies in my care now to promote safety and well-being of the
patients.

7. 2 Engage in ongoing reflective practice to identify strengths, areas for improvement; and,

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integrate feedback into practice.

H.N. : I continuously self assess my progress and ability to provide competent care. I use the criticism, advise and suggestions of the
collaborative team to improve the care I provide. I identify learning needs and create a goals based on these needs.

7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance
program (CNO).

Satisfactory

Satisfactory

H.N. : I am familiar with the QA program requirements and purpose. I recognize that nurses are responsible for demonstrating on-going
learning during their careers to promote client well being. I understand that self-assessment and reflection are important factors for
creating a QA program initiative. Further, I understand that using the feedback from other professionals allows a nurse to identify areas
which may need improvement but have failed to notice. I use SMART when creating goals within clinical practice.

7. 4 Seek out learning opportunities and feedback that foster professional development; and,

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integrate these into practice.

H.N. : I continuously seek out opportunities for learning on the unit at OTMH. I communicate opportunities for learning to my peers and my
instructor. Additionally, I participate in activities for learning that other students and/or my instructor communicates. I actively offer my
assistance when nurses are providing care to patients. I understand that gaining experience through hands-on-learning is the purpose of
clinical placement. I will continue to use the resources provided by my instructors, institution, facility and regulatory body to improve my
knowledge. I will ensure that I am competent by asking a respected and competent practitioner to evaluate my abilities.

7. 5 Use nursing research to foster professional development.

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Satisfactory

H.N. : I continuously familiarize myself with available resources and opportunities to advance my learning (i.e. websites, study aids, etc.). I
share these resources with other students. I ensure that I am familiar with these resources incase I need to use these resources quickly
while working. I keep up-to-date with the latest nursing techniques and skills. I will continue to explore other resources available to benefit
my current and future practice.

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

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H.N. : I have learned from my current and prior clinical experience that evidence informed practice goes hand-in-hand with decision
making. I am aware that all good clinical decisions are guided by research. This research can be obtained from a variety of sources,
however, a thorough nursing assessment offers valuable information about patient condition. This information provides the rationales
needed to initiate, modify or stop nursing interventions. I wish to continue developing my critical assessments throughout the semester
and during my pre-graduate experience. I will continue to work closely with experienced registered nursing staff to improve my
assessment skills. These skills include choosing the right assessment for the patient, completing the assessment in a timely manner,
continual assessments and ensuring that I obtain accurate results from these assessments. In addition to reviewing relevant nursing
theory-based material, I will utilize opportunities within the hospital to practice assessments on patients.

7. 7 Apply knowledge of changes to the health care system, technology, and in society as

Satisfactory

Satisfactory

these affect nursing practice.

H.N. : I combine information gathered from relevant course work such as ethical and legal practices, sociology and nursing theory to apply
to my clinical practice. In particular, I reflect on the role of the RPN in the hospital intra-professional team. I also reflect on the publics
perception of RPNs in the hospital setting. I ensure that I educate patients about the role, responsibilities, education and competencies of
the RPN. I also understand the influence of technology on health care including advantages and disadvantages. I ensure that I
continuously adapt to new technology and how they can benefit and/or compromise patient care.

Teacher comments for QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE :

Student consistently sought knowledge and provided evidence based rational for decisions. Student was able to use acquired knowledge
and apply it to practice. Student increased ability to organize and prioritize related to client care.

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

8. 1 Use critical thinking and problem-solving skills to inform decision-making in all aspects

Satisfactory

Satisfactory

of nursing care.
H.N. : I ensure that I apply nursing knowledge and professional judgement within the clinical setting. I use creativity, nursing knowledge
and personal experiences to come to solutions for problems. I take initiative to ensure potential and/or current issues are addressed in a
timely manner. I ensure that I critically assess all situations. I ensure I try to anticipate patient's needs. I use appropriate materials to
research and support rationales as necessary. I understand that critical thinking skills are imperative to quality nursing care. It is important
that I apply my nursing knowledge, skills and judgement to make accurate and informed decisions. I consult with various health care
professionals as needed.

8. 2 Use critical thinking, problem-solving and decision-making skills to assess clients and to

Satisfactory

Satisfactory

determine nursing diagnoses, expected outcomes, nursing interventions, and evaluative

criteria.
H.N. : I demonstrate the necessary skills to be a critical thinker, problem solver and decision maker on the unit. I use knowledge from prior
clinical experiences and theory to evaluate information obtained from assessments. I continue to use concept maps to organize nursing
diagnoses, expected outcomes, interventions and evaluations. I hope to continue developing my assessments so that they are more
focused, thorough and relevant to patient condition. Further, I will continue to critically assess what the patient's priority of care is.

8. 3 Evaluate critical thinking, problem-solving, and decision-making skills and design a plan

Satisfactory

Satisfactory

to improve
these.
H.N. : I continuously reflect on what care I provided, how I provided care and how I can improve my skills/knowledge to benefit the patient.
I work with my clinical instructor, fellow classmates and clinicians on staff to improve my practice. I will continue to use these strategies
with my preceptor in my pre-graduate placement.

8. 4 Integrate knowledge from a variety of nursing, health, and other theory into nursing

Satisfactory

Satisfactory

practice to provide safe and competent care.

H.N. : I combine knowledge from clinical experience, non-clinical experience and nursing materials in my clinical practice. I use a
combination of educated nursing knowledge and common sense to promote competent and safe care. I use self-reflection after
implementing a plan of care in order to assess where my strengths and weaknesses. I use the same problem solving and decision making
framework to make this assessment. I understand that I must continuously work to improve my problem solving and decision making skills
during my education and career.

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

H.N. : I use nursing knowledge, skills and judgment to prioritize patient needs. I ensure that I communicate my priorities with my clinical
instructor/nurse and support my priority with assessment findings. Further, I prioritize patients needs when managing multiple patient
assignments.

8. 6 Demonstrate professionalism and accountability.

Satisfactory

Satisfactory

H.N. : I continue to demonstrate professionalism and accountability while providing nursing care. I am responsible for documenting the
care I provide and inputing accurate values. I ensure that my actions represent the values and expectations of the facility, CNO and Humber
College. I use my knowledge, skills and judgement to make clinical decisions that support the well-being of the patient. I understand that I
am responsible for my actions, therefore, I accept the potential consequences of my actions. If I am uncertain about how to preform a
procedure, intervention or assessment I utilize the appropriate resources for clarification. In addition, I demonstrate my competence with
the guidance and supervision of a registered nurse and/or my clinical instructor.

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

Satisfactory

Satisfactory

and guide practice.

H.N. : I have familiarized myself with frameworks for decision making provided by the CNO including the three factor framework (nurseclient-environment) and ethical decision making. I understand that the CNO created the three-factor and decision making frameworks to
assist nurses with making decisions about care that foster positive outcomes and patient well-being. When accepting patient assignments
with my clinical instructor, I utilize the three factor framework (nurse, client and environment) to determine if the assignment is appropriate.
I continuously assess these three components after accepting an assignment. I consider these guidelines when practicing within the
clinical environment. I understand that it is my responsibility to be familiar and knowledgeable about these guidelines. I understand how to
access these guidelines if review is necessary.

Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING :

Student successfully cared for 2 clients for several weeks. Student was able to apply analytical, interpersonal, and technical skills to
implement a safe effective plan of care.

Student Final Summary with Strategies for Continued Growth

During my placement at Oakville Trafalgar Memorial Hospital (OTMH) I had the opportunity to apply learned knowledge, skills and judgment in a
complex and acute hospital environment. My critical thinking, problem-solving and decision making skills were challenged by caring for less
predictable conditions with a variety of patients from different populations (when compared to my placement last semester in a complex continuing
care unit). Further, I was expected to care for multiple patients on the unit during the twelve hour clinical rotation. This challenged and developed my
time management, stress management and prioritization abilities. I was exposed to and had the opportunity to practice more advanced nursing skills
including catheterization, PICC line removal, IV therapy maintenance, hemodialysis, staple removal, etc. I was able to work closely and collaborate
with a variety of clinicians such as pharmacists, physiotherapists, physicians, dieticians, etc. I familiarized myself with a variety of computer programs
and systems such as Meditech and Automated Dispensing Units (ADU) while on the unit which I will most likely use in future. I was able to practice
my assessments by completing a variety of thorough nursing assessments (i.e. cardiovascular, respiratory, etc.).
In future, I wish to continue developing and refining my assessment skills. I wish to create assessments that are more efficient, thorough and focused
assessments related to the client's condition. I will continue to review my checklists and use practice scenarios within the textbooks/online resources.
Further, I wish to continue to develop my confidence within the clinical setting. I believe I possess the knowledge, skills and judgment to be a strong
nurse. However, I believe that I hold myself back out of fear of making a mistake. I believe this will benefit stress and time management while
providing care. I have proven competence in the classroom and I wish to ensure this knowledge translates into my clinical practice. I will continue to
practice and refine my skills outside of the clinical setting and with my preceptor's guidance in pre-graduation experience. I will continue to review
relevant nursing materials provided by the college and from other resources.

Teacher Final Summary with Strategies for Continued Growth

You did an awesome job in clinical keep up the great work! Please continue to practice your nursing skills, develop your critical thinking by reading
your nursing theory books, and improve on your problem solving skills by communicating with the inter-professional team. Well Done!

Student's References
College of Nurses of Ontario Practice Standards and Guidelines, RNAO, Humber College, Canadian Fundamentals of Nursing

Grade

Satisfactory

Unsatisfactory

Referred to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Program Coordinator Feedback

The Program Coordinator has reviewed the evaluation

Yes

No

Student Sign Off

I met with my Clinical Teacher/Preceptor and discussed my evaluation

Yes

No

In general this evaluation accurately reflects my performance

Yes

No