UNB-Humber Collaborative BN Program

Final Collaborative Assessment of Student Abilities (CASA) for NRS.218

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

Clinical Area: Rehabilitation

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:
I have met this outcome while administering medication alongside my clinical instructor because I was
quizzed on every medication that I had to give. I was allowed to use a drug guide to help me. This
taught me to fully understand why I was administering the medication to the specific client so that I
could in turn be a better nurse as oppose to blindly giving the medication because the MAR told me to.
I also learned the importance of checking vitals before giving certain medication as I witnessed my
nurse having to hold a medication because the blood pressure was too low. Blindly giving this
medication could have possibly killed the patient. This allows me to provide safe nursing care for the
patient.
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:
I have definitely been able to apply my knowledge and skills from previous years in the nursing

program such as the ability to assess vital signs on a client. This has become instinctive to do from the
time I first receive my patient in the morning, to prior to giving their medication, as well as to monitor
the medication effects. Year 1 has taught me how to properly provide basic care to help my patients
efficiently get ready for their day by showering them, feeding them, and in some cases positioning
them in a comfortable and timely manner. It has become natural to not discuss personal elements of a
patient when using their name, which is taught to us in the code of ethics in first year. I always check to
make sure my patients are well rested from the night before because I know the importance of sleep
and health. And as part of rehabilitation, I always push the patient to do as much as they can before
doing things for them to help their recovery process. I have also built a therapeutic relationship with all
the patients I work with and they trust me, as a student, to care for them because of this. I have been
complimented many times of the genuine care I give to my patients which makes me feel I am making
their quality of life better as I know unfortunately some nurses do not do so.

Ability

student/Instructor

1. Knowledge and its Application

1.4 With guidance, incorporates into nursing practice relevant standards of care ((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.
Student:
I believe I am meeting this outcome because I provide safe, compassionate, competent and ethical care
when working with all patients. As part of the RNAO, one of the best practice guidelines is on
documentation. I am fully capable of documenting the interventions and interactions between the
patient and I after I am with them. If I dont know something, I always ask to make sure that Im not
documenting incorrect, invalid, or inappropriate information. When something changes or is new with
the patients health, I am sure to make note of it as well as discuss it with my nurses because caring for a
patient is not an individual task but is done by a team of health care providers. I interact well with the
health care team and I believe I am doing my role as a developing nurse as best as I can. I understand I
always have room to improve and feel that I have improved a lot since the midterm.

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:
I believe I am meeting this outcome because I do document in a clear and comprehensive manner.
With the guidance of my clinical instructor as well as the nurses on the floor that I follow, I am able
to document clearly on the information that needs to be documented. I have learned that at credit
valley hospital their policy is to document by exception and was taught how to do so by the nurses. I
try to provide informal teaching to my clients whenever possible. For example, I had to explain to
one patient why she should eat as much of her meal as possible because she needed the energy to
help her participate during her physiotherapy. I also explained to my patient why I had injected the
LMWH heparin into a different part of her abdomen to prevent bruising and hardening of the skin.
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:
I believe I am meeting this outcome because I have had a client that did not speak any English but
always had his wife with him. She also did not speak much English. I was able to teach them both
how to transfer him [the patient] into his chair safely by using small, clear words and lots of visuals
such as hand motions and touching different parts of my body to help them understand where I was
talking about. For example, touching my knee and making it go limp to show that it was my weaker
limb, and putting it closer to the chair so they knew to put the chair on the weaker side of the
patient. Another example would be when I was reinforcing the teachings from my primary nurse to a
patient that needed to learn to empty his drainage bag. Using a urinal, I showed the difference of
locking the ends securely before attaching it to his leg bag to show that it could leak out and make a
mess if it was not done correctly. I did this as I was showering him. This demonstrated me informally
teaching my patient in a timely manner and appropriate level to enhance client/family learning.

2.3 With guidance, engages in therapeutic relationships with clients, families and health care professionals
by intentionally utilizing therapeutic communication techniques.

Student:
I have proudly reached this outcome during one main experience I had with a client who was very
irritable, anxious, and appeared very angry towards all the other nurses. This was an assigned
patient to one of the other students in my group but was able to help her assist with him. After
engaging him into a conversation that had not left him feeling the center of attention in a negative
way, he became bright and happy again. He stated he didnt like the attention he was being given
because it wasnt good attention. We talked for a while about different restaurants that he liked
and topics that made him happy such as the way colours can affect your mood. This made him
happier and he then let us transfer him into his chair with his help and participation. The other
nurses had not been able to achieve this type of therapeutic communication with him at that point. It
was that moment that I fully understood how much a therapeutic relationship could help with patient
care. A more recent example would be when a new admission patient had many inquiries as to what
and why he was taking the medication he was being given. Thanks to the quizzing of medication from
my instructor, I was able to explain to him and his daughter why he was taking every medication. He
was grateful for this as the primary nurse (who is also a 4 th year Humber pre-grad student) did not
fully answer his questions.
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
S
the chosen interventions in order to develop a safe plan of care with assigned clients and families.
Student:
At this point of clinical, I still have not written a plan of care for a patient. Although, I have made
some strategies for interventions with my patients. For example, I now know that if my patient is
feeling uncomfortable in a certain area of their body that I can take a look and if there appears to be
a problem then I can clean it with normal saline and put a bandage on it, being sure to document and
inform the other nurse. I also learned the importance of time management because I always start

with the patients that have the most difficulties with their ADLs and/or have the earliest therapy
times. I also make sure I allot time to physically watch my patients take their medication as I know
many nurses do not do so and it can be very dangerous if the patient is not taking them.
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:
I have met this outcome during my clinical placement thus far. On the last day I was at the hospital, I
sat with my nurse and revised our patients profile/Plan of Care sheet and reflected and changed the
clients needs to what was appropriate to her now at that time. She was doing much better than
when I first received her on January 15th 2013 so I changed the nursing interventions from needing a
2 nurse assist to needing a 2 wheel walker. This was all done under my nurses supervision and with
her input as well. A more recent example would be when my insulin-dependent diabetic patient was
being discharged home. He refused to take his check his blood sugar and take his insulin before his
meal. This patient had always been compliant with his medication regime but because he was going
home he did not want to follow it any longer. Because he was refusing it at the hospital, the nurse
said he would not be taking the fast-acting insulin throughout the day at home. The nurse then
stated it would be okay to let him refuse the fast-acting insulin this time as his body would need to
get use to using the long-acting insulin.
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:

I have definitely met this outcome so far because after being assigned a patient to myself on the
second day at the hospital, I was able to assist with patient care for the other patients my nurses
was assigned as well. Thus by the third day I was taking care of a few patients in the area even
though I was only assigned to one. Once I knew that my patient was taken care of, or did not need
care at that moment, I would move on to the next patient to see how I could assist them. This led my
nurses to leave good comments for the main Rehab charge nurse as well as my clinical instructor
because I was very helpful and was taking initiative to do what had to get done to help.
4.5 Recognizes gaps in ones knowledge of nursing and related fields, and with guidance, develop and uses
strategies to address learning needs.

Student:
This is one outcome that I feel I will always be working towards because this is the outcome that
leaves room for the most improvement. I do however feel that I meeting this outcome at the moment
because of my initial lack of complete knowledge on medications. After working with the instructor
and nurses and asking many questions as well as reading the literature, I was able to learn a lot
about the drugs that I was administering. I realize the importance of having some type of drug guide
on hand to access information so that I am not blindly giving it without know fully what it does and
what its adverse effects are. I learned that I can learn a lot about my patient from the medications
they are on and that information that I learn can better help me assist them with care. I also learned
that if I have questions about medications I can use helpful websites or apps such as Lexicom which
are readily available for nurses to use on the unit. And when in doubt on how to perform a procedure
I can always ask another nurse or the educator on the floor.
4.6 Begins to recognize behaviours that enhance professional identity and accountability.
S

Student:
One of the biggest fears I had beginning clinical was documentation. I am well aware of the nurses
accountability and how they are liable for any and everything they document on a patient. I learned
to relax and feel more confident when documenting to prevent this fear from overcoming me. With

guidance and practice, I am able to document confidently and accurately now. I also feel that being a
student nurse, some patients are reluctant to let me care for them and so building a therapeutic
relationship is that more important so that they trust me and trust my knowledge and skill level. I
continue to carry myself as a professional. Also, I realized that although I am a student, some of the
patients still look at me as an equal health care provider for them and therefore I must act as one
and understand that I am accountable for my actions.
Instructor
Instructor comments on professional Identity/ethics:

Ability
5. Social Justice/Effective Citizenship

student/Instructor

Outcomes:
5.1 Has a beginning awareness of personal values and biases and how they may affect their nursing
practice.

Student:
I believe that I do have some personal values and biases working with patients in rehabilitation due
to my surroundings and my past experiences working with patients in the same situations but I am
aware of them and I do know that as a professional nurse I need that it is my responsibility to
advocate for these patients and put aside any values or biases I may have that may inhibit my ability
to provide ethical and compassionate care. More recently I had a patient of Indian descent that
offered me something sweet. He explained that it would make him happy if I took it as he saw me as
his daughter because I am also of Indian descent. After taking it, he told me thank you. It was
apparent he appreciated that I accepted his culture and I can see that it positively affected my
interactions when caring for him then on.
5.2 With guidance, considers perspectives of social justice to provide culturally competent and safe nursing
care.
Student:
I have not encountered a situation where culture has restricted me in any kind of way with respect to

providing care therefore I am yet to fully reach this outcome. However, while reading this outcome I
imagine a patient of a different culture wearing a hijab that has a male nurse and does not want to
take off their hijab to do an assessment. I recognize that this person might need to be assessed in a
more private environment and that perhaps a male health care provider may not be allowed for them
so offering to switch to a female care provider could be of help. This is how I would approach the
situation.
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:
I was assigned a client whose familys financial status was higher than the neighboring patient based
on the fact that they had hired a PSW to stay with the patient in the hospital every day. With more
one on one help from the PSW, the patient became stable very quickly and was never unhappy with
her treatment whenever I asked her how everything was going when I would see her in the mornings.
Her roommate on the other hand had no extra help from a paid PSW and the recovery process was
much slower. This could be due to the determinants of health of financial status. Also, while
comparing the two patients, I had asked one lady about her home-life and she said she lived in a
house with her son. Perhaps this was blocking her motivation to get better to go home again where
she would have to travel up and down the stairs to get to and from the kitchen or different parts of
her house. This is not an assumption, but instead they are possibilities of why the health outcomes
that these two patients were achieving were so different.
A few weeks ago I had 2 patients sharing a room who were both from different cultures. One patient
was excited to go home to his family as the other one stated that he had no one to go home to. He
was living alone and did not look forward to going back. He stated that at least he had company at
the hospital. This was disheartening but also was good information to use to compare the outcomes
of the two patients. The one who said he had no one to go home to had to leave the hospital early
because he was not improving during his time spent there. The decline of his functioning could have
related back to his lack of relationships and social support.
5.4 Begins to recognize disparities and power dynamics within the health care system.
S

Student:
I came across a situation where a patient was complaining of drainage coming from a wound on his
coccyx and he wanted to the nurse or doctor to take a look at it so that someone could do something
about it so that it would stop leaking onto his bed and clothes. The primary nurse for him did not
want to address the situation so she told him a physician will come in and look at it when they got
the chance and she did not bother to put a simple dressing on it in the mean time. I feel that she did

not want to make this decision because she was an RPN and probably felt that she would not be
permitted to do so without a doctors order. Although an RN came to check it out right after and put
a simple dressing on the wound to stop the drainage. This shows the disparities and power dynamics
within the health care system.
Instructor comments on social Justice/effective citizenship

10

Midterm Summary with Strategies for Continued Growth:

Student comments:

Instructors Response:

Satisfactory

Needs development

Instructor: _______________________
2013__________________

Unsatisfactory

Student: Natasha Singh_____________

11

Date: April 7th