UNB-Humber Collaborative BN Program

FinalCollaborative Assessment of Student Abilities (CASA) for NRS.218

Student Name: Natasha Singh
Instructor:
Maternal Health
Dates:
Clinical Hours Missed:
Nature of Experience :( type of experience, length of time, etc.)

Una Clennon

Clinical Area:

Legend (S = Satisfactory, ND = Needs Development, U = Unsatisfactory)

Ability

student/

instructor
1. Knowledge and its Application
Outcomes:
1.1 With guidance,

incorporates relevant information (e.g. course resource material and appropriate technologies) to
provide safe nursing care for clients and their families.
.

Student:
While working in obstetrics section at the hospital this semester, one of the teachings for postpartum mothers is how
to properly strap their baby into a car seat. While following my receptor, I noticed she gave out a package to the
families before leaving the hospital on how to correctly do so. I took it upon myself to read a booklet from the
package so that when my receptor asked me to discharge a family, I would explain the correct information to them.
This made use of appropriate resources to provide safe nursing care for the family.
1.2 Applies knowledge and skills from year I and year 2 when assessing, planning, implementing, and evaluating
safe, competent nursing care. (e.g.) therapeutic communication techniques; nursing problemsolving process; vital
signs; basic comfort and hygiene; Code of Ethics; individual wellness, health promotion strategies including nutrition,
sleep, hygiene, stress management; suicide crisis intervention techniques; family developmental theory in relation to
transition, determinates of health etc.)
Student:
This outcome was met with every patient that I was assigned as well as the patients that I helped my partners take
care of. As taking the vitals, I encouraged therapeutic communication by talking to them about their families and
their feelings about their new baby so that I would decrease their stress level; Some patients seemed to be reluctant
to have a student take care of them which may have skewed the results of their vitals slightly. I reminded the
families that they should not drink alcohol if breastfeeding as well as never to have the baby in an environment

where they are exposed to second hand smoke. I encouraged the support of the family for the mother in her time of
need for help and rest. This is an example of the important information that needs to be relayed to the patient for
safe ethical care that was taught in the first 2 years.

Ability
student/Instructor
1. Knowledge and its Application
(e.g. integrates Best Practice
Guidelines, Canadian Nurses Association Code of Ethics (CNA), and provincial guidelines) within the context of
primary health care, while recognizing ones own developing nursing role and the role of the interdisciplinary team.
1.4 With guidance, incorporates into nursing practice relevant standards of care

Student:
I thoroughly incorporated the Best Practice Guideline on breastfeeding while working with client alongside the
lactation specialist. For example, explaining to the patient that the babys nose should face away from the breast for
breathing purposes, teaching that the bottom lip should cover more of the areola than the top, and placing the finger
into the mouth to break the latch. This is an example of how I successfully applied my knowledge from the RNAOs BPG
into my developing nursing role while working with the interdisciplinary team.
Instructor comments on Knowledge and its application:

Ability

student/Instructor
2. Communication
Outcomes:

2.1 With guidance, documents in a clear, comprehensive manner using clinical terms appropriately.
incorporates educational aids; appropriately provides informal teaching in a timely manner and at a
developmentally appropriate level).

Student:
After following my receptor and my clinical instructor for the first 2 days on the unit, I was able to document in a
clear and comprehensive manner. For example, while documenting on the progress notes of the mother and baby,
I used terms such as approximated to describe the healing of the C-section wound. This demonstrates
appropriate use of terminology for my level of studies as well as good judgment on what to document on while
writing the progress notes.

2.2 Uses elements of effective oral communication to enhance client/family learning (e.g. appropriately
incorporates educational aids; appropriately provides informal teaching in a timely manner and at a
developmentally appropriate level).
Student:
To incorporate the use educational aids to provide informal teaching, I used the booklets that the hospital
provides to help me teach my clients on subjects such as care seat safety and breastfeeding. This allowed me to
use a visual aid which may have helped the patient better understand what I was saying. Also, a very effective
element of enhancing oral communication with the family and client is using terminology that they understand.
Its important to realize that not all patients have the same knowledge as you do, so dont use terms that they are
unfamiliar with. This is especially important to do when dealing with families that speak another language.

2.3 With guidance, engages in therapeutic relationships with clients, families and health care professionals by
intentionally utilizing therapeutic communication techniques.
Student:
I sincerely learned how important it is to have a therapeutic relationship with your clients while working on this
rotation because these patients are trusting you with the infants and with their own health to help nurse them
back to a healthy, stable mother. Being in an environment such as a hospital can be especially nerve-racking to
some patients and so walking around the unit and talking with them is a great way to encourage that therapeutic
relationship while at the same time getting them to ambulate to prevent DVT in their legs. Also, when I had free
time I would check my patients to make sure they had everything they needed to be comfortable which also
intentionally aids in a therapeutic relationship.

----------------------------------------------------------------------------------------------------------------------------------------------------------Instructor comments on communication

Ability

student/Instructor

3. Critical Thinking/Skills of Analysis

Outcomes:
3.1 With guidance, articulates a variety of best nursing practice strategies and articulates the rationale for the
chosen interventions in order to develop a safe plan of care with assigned clients and families.
Student:
Strategies I used while practicing safe nursing varied. When giving injections, it is important to have the MAR
sheet with me by the bedside before administering the medication. This is a safe practice for nursing as well as a
strategy I followed. I had the gauze rolled up and ready with a piece of tape already cut so that when I removed
an IV, the patients blood wouldnt project out to cause a mess. While in the labour and delivery unit, I re-checked
the CPAP and O2 equipment to make sure everything was working fully in case of an emergency. The smaller
details also matter, such as carrying gloves with me at all times and being fully prepared with the materials
needed before approaching a task like a baby bath. These strategies all aided in a safe plan of care for the
patients.

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3.3 With guidance, critiques and reflects on different approaches and modifies the plan of care in accordance
with the clients response to previous nursing interventions.
Student:
After following my receptor, I noticed she did a lot of teaching on the importance on breastfeeding and pointers on
how to successfully breastfeed. Because I felt confident in my knowledge of this topic, I felt I would do well when
informing about breastfeeding as well. Unfortunately, my first assigned client did not want to breastfeed due to
bad experiences with is prior. This resulted in me modifying my approach to teaching about feeding her baby. I
then used a chart to show her how big the babys stomach was and how much formula the baby should intake
accordingly. I also taught her about the amount of diapers to expect as well as the behaviours the baby will have
when formula-fed such as sleeping longer and how to expect the soiled diapers to appear and smell.
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Instructor comments on critical thinking/skills of analysis:

Ability

student/Instructor

4. Professional Identity/Ethics
Outcomes:

4.3 With guidance, begins to build upon personal leadership attributes to enhance group team work and develop
professional relationships with the health care team.
.
Student:
Personal leadership includes taking charge of my own responsibilities and how to appropriately take on my role as
a student nurse. This outcome has been met by expressing my abilities as a second year nursing student. For
example, when working with a client, I complete the tasks I have been taught to do as well as educate on the
topics I am knowledgably on. When I reach something I dont know, I meet with my team or receptor and let them
continue. Working with my team in this manner develops professional relationships while also helping me build
upon my personal leadership skills. Professional relationships are also built during down time at the nursing
station when my receptor and I usually meet to talk about what the next step is for the client.
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4.5 Recognizes gaps in ones knowledge of nursing and related fields, and with guidance, develop and uses
strategies to address learning needs.
Student:
I fully understand why I need to recognize my gaps in knowledge and appreciate the need to address it as soon as
possible. One example of how I met this outcome would be when I instructed my client to start walking with an
explanation of why and instructed her to try coughing. She asked me why I was encouraging her to cough and I
was not able to answer her at that moment because I was not sure. I then went back to my instructor to inquire as
to why she needs to do that and once I had an understanding, I was able to go back and educate my client on
what I found out.
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4.6 Begins to recognize behaviours that enhance professional identity and accountability.
Student:
On my second last day of this rotation, I was assigned to completely assess and document one client. I was asked
to take a break with my group before charting my progress notes and when I returned to chart, I found another
nurse had charted already. But because of accountability purposes, I re-assessed my clients vitals and charted
them as a late entry. Also, I used my professional judgment while taking vitals on a client that was with the
midwife to take vitals on the baby while the midwife finished with the client before moving on to the client. My
basic behaviours that enhanced professional identity included fully introducing myself to the client before working
with them as well as confirming that the patient was content with me do my assessments in front of her visitors
instead of just doing it without her permission.

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Instructor
Instructor comments on professional Identity/ethics:

Ability

student/Instructor
5. Social Justice/Effective Citizenship
Outcomes:

5.1 Has a beginning awareness of personal values and biases and how they may affect their nursing practice.
Student:
Throughout the rotation I have become aware of my personal values and biases and how they may affect my
nursing practice. There was an incident where my clients husband had his wife sitting on a chair trying to
breastfeed her colicky baby while he lay sleeping on her bed. This angered me because I personally believe that
the father should be well involved in what is happening with the mother of his baby as well as his baby.
Fortunately, this particular situation did not affect me as much, but if could have potentially affected my nursing
practice if it bothered me to the point that I was distracted from helping the mother latch the baby to feed.
Personal values and biases mainly can cause distractions leading the nurse to not fully care for the patient.
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5.2 With guidance, considers perspectives of social justice to provide culturally competent and safe nursing
care.
Student:
This is an interesting outcome to write on for me because during this rotation, I experienced a very negative
situation where the anesthesiologist demonstrated the opposite of this. A patient that was fairly new to the
country and did not speak English was preparing for an epidural. The anesthesiologist pushed and pulled on the
patient instead of keeping her translator in the room with them. It was very apparent from her facial expressions
and body language that the patient was unhappy, in pain and in distress. While the anesthesiologist explained the
pros and cons of the epidural to the patient whom did not understand English, the patient may have made an
uninformed decision that could have potentially killed her. This experience was almost traumatizing to watch and
so I fully appreciate the importance of social justice and providing culturally competent care. Our job as nurses is
to educate our patients so that they can make informed decisions on their health; Everyone has the right to
decisions and culture can play a big role in developing and executing a care plan.
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5.3 With guidance, compares and contrasts differences in health outcomes based on a beginning understanding of the
determinants of health and relationship to the environment (ecological, economic, global, etc.) for individuals and
families
Student:
Relating to the rotation we are on, the determinants of health in relationship to the environment can play a

significant role in raising a baby and nursing a mother back to good health. Im beginning to see the difference
between patients that are wealthier from those that are not. For example, the patients that demand private rooms
due to the fact that they want to rest better usually indicates that they are financially able to do so. This leads to
having more income to help raise the baby keeping up with an adequate supply of diapers, food, clothing ect.
Some clients say they have no family in the country with them which affects their social support system. During
this time, the mother needs as much support as she can get and this can put a drain on that need for help also
causing the mother to have unneeded stress. How educated the parents will definitely play a major role in how
they raise their baby. For example, some cultures believe that wrapping up a baby tightly will diminish its fever
where as an educated mother on this topic knows that over-heating the baby can be fatal. Luckily in Toronto
health centers are located all over as well as 24 hour call centers for the mother use if she needs help.
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5.4 Begins to recognize disparities and power dynamics within the health care system.
Student:
Going back to the situation with the anesthesiologist, I watched as the nurse that was aiding in the epidural
administration tended to that patient. Although the anesthesiologist was so unprofessional, harsh, and
uncompassionate, the nurse was able to make up for it with her caring, nurturing, compassionate care. This goes
to show the disparities within the health care system and how the power dynamics can tie it all in together to
provide care. Although, in this particular situation the patient was not given complete, ethical, safe care from the
entire health care team.
----------------------------------------------------------------------------------------------------------------------------------------------------------Instructor comments on social Justice/effective citizenship

10

Midterm Summary with Strategies for Continued Growth:

Student comments:
As you indicated previously, I tried my best to keep my paragraphs short and to the point. I understand that excess information is
unnecessary and I am working on condensing my ideas to fit your criteria. I thoroughly enjoyed this rotation and Im sure that was very
apparent. Thank you for a wonderful rotation and thank you for sharing your knowledge with me. I found you to be a very helpful
instructor.

Instructors Response:

credit

non-credit

Instructor: _______________________
_November25th,2011_

Student: _Natasha Singh_

11

Date:

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