Académique Documents
Professionnel Documents
Culture Documents
Kristina Milaniak
Sylvia Wojtalik
John Stone
Halton Healthcare Oakville
Agency
151-2
OTMH - HALTON HEALTH SERVICES
2 EAST - NEPHROLOGY UNIT
30-Apr-2015 To 02-May-2015
168
168
168
I declare that this is my original work and the sources used are acknowledged.
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.
K.M. : I comply with the standards, legislation, and the policies and procedures that the CNO and Humber College has set out for me as a
student nurse. I use these standard in my clinical practice to provide patients with a therapeutic and holistic experience in their time of
needs.
Satisfactory
Satisfactory
K.M. : During my clinical and simulation practice I have shown that I am responsible, accountable and ethical in the actions I make. For
example, I try to exhibits following policy and protocol that OTMH has outlined when doing transfer of care during a shift-change, with
proper bed side reporting.
1. 3 Determine strengths and limitations and when to consult and seek assistance from other
Satisfactory
Satisfactory
professionals.
K.M. : I use the tools that I are available to me when I am in a clinical setting and simulation lab. I know where my strengths are and when I
need assistance I ask my clinical practice leader, Sylwia Wojtalik, primary nurse or the interprofessional healthcare team for help.
Limitations allows for opportunities for learning, and I value these things.
Satisfactory
Satisfactory
K.M. : I use evidence informed practice and theory- based approaches that have been taught in simulation and clinical labs for NURS 151
and 152 courses. Also along with that, empirical knowledge learned from the nursing textbooks have been used as supporting tools to be
used in the care that I provided to my patients within clinical placement.
Satisfactory
Satisfactory
K.M. : I ensure that client safety is of number one importance in providing care. Making sure that the environment is up to Occupational
Health and Safety standards within the healthcare setting is one of the ways to ensure client safety. Along with advocating for the right
patient care, and appropriate medication administration also ensure that I have created a safe environment for patient care.
1. 6 Ask relevant questions to clarify understanding of the plan of care and whenever
Satisfactory
Satisfactory
uncertain.
K.M. : Whenever uncertain or needing clarification on plan of care, I always ask the primary nurse or clinical teacher for further
information. In clinical, I found it challenging to translate certain orders in the kardex and had to penmanship clarified. Also any
interventions that I was second guessing, I had supported with the clinical team.
1. 7 Identify ethical and unsafe situations and seek appropriate assistance to resolve these.
Satisfactory
Satisfactory
K.M. : As CNO practice guidelines state, as a nurse you have the right to disagree/ question with a patient's plan of care. I definitely feel
that if in a situation where ethics may be involved, advocating for the best therapeutic outcome for the patient would be my nursing
priority.
Satisfactory
Satisfactory
K.M. : As a student nurse I have definitely learned from what it means to be a nurse "being" rather than a nurse "doing". I know that
throughout my clinical practice at 2 East I have my own strengths and limitations. I know that I am still learning but the important part of
being a student is making sure you are learning the practices and guidelines right. I believe the clinical environment fosters a great
learning environment when collaborative inter-professional healthcare team work is evident, that myself being a student, benefits from.
Teacher comments for COMPETENT AND SAFE PRACTICE WITHIN A PROFESSIONAL, LEGAL, AND ETHICAL FRAMEWORK :
Kristina has successfully completed Practical Nursing Practice, Nurs 151 1 in the Winter and was evaluated based on the College of
Nurses Standards of Practice (CNO/SP) within the dimension of direct practice (weekly) at Halton Health Services , Nephrology Unit.
Kristina demonstrates responsibility for her conduct and accountability to herself, clients and profession by engaging in the learning
process and self-evaluation as a learner. Much interest and enthusiasm were shown throughout this semester. She has demonstrated
evidence of accountability by being present; punctual for lab /clinical. Her attendance has been excellent and she has met all the course
objectives.
Satisfactory
Satisfactory
K.M. : Clinical daily debrief foster great reflective practices that reinforce quality assurance that is required from the CNO. I believe that I
have been very involved in sharing and participating in team discussions.
2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic
Satisfactory
Satisfactory
methods.
K.M. : I have tried to the best of my ability to document all assessments, medication administration, interventions, and findings when
providing care to the patients as to Halton Healthcare policy. I have documented within patients' files, kardexs and eMAR profiles.
Satisfactory
Satisfactory
K.M. : I have communicated with appropriate personnel when reporting relevant information that needs to be addressed. For example, I
inform the primary care nurse of all care that I have done along with any interventions or implementation actions that need to be taken. In
post conference, I let Sylwia know of all care and documentation that has been done, and this is reinforced on a week to week basis.
2. 4 Utilize communication techniques with the client and inter-professional health care team.
Satisfactory
Satisfactory
K.M. : I learned how imperative it is to utilize communication techniques with the HCP team. Tools such as eMAR, PCS, kardex, and patient
charts, inform all interprofessionals of 2 East on patient care status.
Satisfactory
Satisfactory
2. 6 Use technology to retrieve information including research, data and other information.
Satisfactory
Satisfactory
K.M. : Prior to coming to clinical, information about diagnoses and patient care is researched through SLS learning modules, nursing
clinical books, MAR, PCS, kardex, and inter-professional assessment notes. These tools allow to be prepared for aspects of care, and
further competent care.
Satisfactory
Satisfactory
K.M. : I use effective communication techniques when interacting with my clinical practice leader, HCP team, and the patient in regards to
all imperative/ relevant information that needs to be shared.
Satisfactory
Satisfactory
3. 3 Apply knowledge of therapeutic use of self and identify its effect on client well-being.
Satisfactory
Satisfactory
K.M. : Being able to relate to the patient's situation will allow one to have empathy and enhance clients well being. It is important to have
that open interaction and effection communication with the patient to understand what is in the best interests of the clients' well-being.
3. 4 Use self-awareness to identify the effects that beliefs, values, and personal experiences
have on relational practice.
Satisfactory
Satisfactory
K.M. : It is important to remember that incorporating individual beliefs, values, and personal experiences should be irrelevant to clientcare. The plan of care should always revolve around the patient, and not the nurse's personal views. Relational practice, however can be
beneficial, but the patient should still be the main focus. The client should receive care that is connected to their beliefs, values and
cultural experience, and is imperative to gaining trust in the nurse-client relationship.
3. 5 Interact with clients and members of the inter-professional health care team; and, consult
Satisfactory
Satisfactory
appropriately.
K.M. : Being able to understand patient's needs and concerns allows or the ability to form appropriate care. This will allow to incorporate
and implement interventions within the plan of care that concerns the patient. Consulting with the HCP team, client, and family (if the
patient wishes), allows for holistic care planning. Consultation will allow for collaborative thinking and will ultimately benefit the patient.
3. 6 Apply knowledge of practices and systems that support the diversity of clients and the
Satisfactory
Satisfactory
3. 7 Apply knowledge of clients cultural, religious, and other beliefs and values as these
Satisfactory
Satisfactory
Satisfactory
Satisfactory
K.M. : It is important that during care when implementing interventions and upon discharge planning, client education is imperative to
maintaining patient safety and health. For example, when providing bolus feeds, it is important to have the patient in a supine position to
prevent aspirations and promote digestion.
Satisfactory
Satisfactory
K.M. : From recent experience, I believe that it is important to recognize conflicts at hand and possible strategies for resolution. There are
many opinions that filter throughout a clinical setting, from the family/patient opinions, to the doctors recommendations. I believe that it is
important to communicate why certain decision are being made and to incorporate other opinions, so that everyone involved in care is
content and patient health outcome is successful.
4. 2 Demonstrate leadership skills that foster group work and a positive learning environment.
Satisfactory
Satisfactory
K.M. : I believe that when I am in a group setting, I am able to organize my day, by prioritizing all care that needs to be made for the clients
that are in my care. I am able to take a leadership role and give support to my peers, where I can. As a leader, I would like to come to a goal
that the clinical team as a whole is comfortable with. Therefore, it is important to hear and advocate for every person of the group, this
fosters positive learning and collaboration. A healthy team environment, should have conflict, because that fosters learning for everyone,
however, it is important to hear all pros and cons of a situation to come to a decision.
Satisfactory
Satisfactory
4. 4 Provide feedback to peers and accept feedback from peers and members of the inter-
Satisfactory
Satisfactory
Satisfactory
Satisfactory
K.M. : Any care provided should be given consent prior to any intervention. Even when the patient is unconscious, it is important to still
speak to the patient. Obtaining patient consent to unconscious patients is usually retrieved from a POA (power of attorney) or deciding
family member. There when obtaining consent, making sure all information is included is imperative, and it is within the patient's rights. It
is important that when administering medication, to follow all medication administration patient rights. The patient ultimately has the right
to refuse meds, treatment, and that is why informed practice should always be incorporated.
Satisfactory
Satisfactory
K.M. : I know that it is mandatory to protect patient's safety. Therefore, if I witness inappropriate, unsafe, unethical, or unprofessional care
that I address the issue. It is a CNO regulation that I document and fill out an incident report regarding these situation. Advocating for a
patient reinforces patient safety complies to the standards and guidelines of the CNO.
4. 7 Consult and collaborate when carrying out health care and nursing practices that are in
Satisfactory
Satisfactory
the best interests of the public and protect the public through collaboration and consultation.
K.M. : Healthcare incorporates many multidisciplinary approaches to providing care. By using the collaboration from other HCPs such as
physiotherapists, occupational therapists, SLPs, PALs, PSWs, MDs, and other specialties, will ultimately provide and cater to client care.
Collaboration has been evidenced to lead to successful healthcare outcomes.
5. PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES
5. 1 Incorporate the unique needs and expected outcomes into individual clients plans of
Satisfactory
Satisfactory
care.
K.M. : I make sure that I keep in mind that every patient is different, and that each organizational plan of care must be individualized. This
fosters the therapeutic nurse-client relationship. This makes the nurse a "nurse-being" and not a "nurse-doing".
5. 2 Develop theory-based plans of care that are holistic and client centered and are
Satisfactory
Satisfactory
5. 3 Use knowledge, skill and judgment to assess clients, prioritize needs and outcomes.
Satisfactory
Satisfactory
K.M. : I believe that i use my skill and knowledge, and judgement to make sure that the care I am providing is the right care.
5. 4 Provide information that contributes to the evaluation and refinement of plans of care.
Satisfactory
Satisfactory
K.M. : Providing additional information to a patient fosters client education. Providing pamphlets, medication instructions/information, and
rehabilitation exercises are all example of how providing information benefits patient healing. Reinforcing health promotion and health
teaching throughout care will allow to be more beneficial in elderly or young child populations, because small amounts of information
repeated frequently tends to educate more successfully.
5. 5 Safely and competently carry out nursing assessments and nursing interventions that are
Satisfactory
Satisfactory
5. 6 Carry out nursing care that reflects the practice decision-making framework.
Satisfactory
Satisfactory
K.M. : Concept mapping fosters my decision-making framework and allows for prioritizing the intervention that need to be taken for each
patient.
Satisfactory
Satisfactory
timely manner.
K.M. : It is important that the nursing intervention and responsibilities are carried out and completed within a nurse's shift. Although every
nursing shift i different, it is important to utilize the team environment that I am in. It is appropriate to as for the help when necessary. This
ensures that I as a nurse, am providing competent and safe care of a patient.
Teacher comments for PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED EXPECTED OUTCOMES :
Kristina has cared for clients with myriad of diagnoses; few of them being: Diabetes, Liver,CHF, OA, CAD,Depression Thyroid Dysfunction,
Renal Failure, , Diabetes, Aphasia, Osteoporosis, Hypertension, and Dysphagia. She demonstrates good knowledge of these diagnoses
when caring for clients and collaborating with staff about client related care. Furthermore, her weekly Step1 & Step 2 Assessments
reflected her strong ability to categorize her client information using the Roys model, identifying nursing diagnoses and suggesting
appropriate nursing intervention. Her medication research have been adequate and she is encouraged to apply pharmacoolgy
knowledge to client assessment and care.
6. 1 Work with clients and members of the inter-professional health care team to assess
Satisfactory
Satisfactory
clients, determine health needs, and to achieve mutually agreed expected outcomes.
K.M. : I agree with this statement and find myself satisfactory in this regard. I believe that I collaborate with the primary nurse every clinical
shift. I believe that certain working environment is necessary in a hospital setting because of the multidisciplinary approach taken.
Satisfactory
Satisfactory
6. 3 Seek out assistance and consult with members of the inter-professional health care team.
Satisfactory
Satisfactory
K.M. : Whenever I am unsure or in doubt, I always seek assistance or take initiative to look up information to provide appropriate
competent care based on evidence- based knowledgeable practice.
Satisfactory
Satisfactory
K.M. : I believe that I possess the skills that foster a teamwork learning environment amongst my peers and clinical leaders.
6. 5 Describe effective, collaborative, and consultative strategies to meet clients needs within
Satisfactory
Satisfactory
a changing environment.
K.M. : Strategies that describe effective care and collaborative works which meets the client's needs within a changing environment:
- Utilizing the Three Factor Framework: the nurse, client and environment document provided by the CNO provides information on how
care should be given
- Appropriate documentation ensures all information is resent to make informed and collaborative strategies
- Consultation with other HCPs regarding what appropriate care is needed
- Transfer of Accountability standards and regulation with effective bed-side reporting during a shift change amongst nurses
- Organizational structures, supports, and philosophies that encourage new ways of working together and using empirical therapy to use in
care
- Interpersonal skills and attitudes within the team foster a willingness to collaborate and creates trust, respect amongst the team.
6. 6 Interact with members of the health care team respecting their unique role and
Satisfactory
Satisfactory
competencies.
K.M. : Communication is important among the nursing team and within healthcare which I believe I do when interacting and documenting
to acquire about patient needs. Using others for knowledge of different competencies they hold and use their uniqueness to enhance my
knowledge and provide even better care to my patients.
7. 1 Act in the best interests of clients and protect clients from harm through collaboration
Satisfactory
Satisfactory
and consultation with members of the inter-professional health care team and through
competent and safe practice.
K.M. : I believe that I do act in accordance to the best interests of my clinical team and most importantly the patient by consulting and
learning from one another.
Satisfactory
Satisfactory
Satisfactory
Satisfactory
K.M. : Quality assurance is something that I believe I uphold and reflect on my day to day practice
7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance
program (CNO).
K.M. : Every shift at 2 East in OTMH, I make an organizational plan of care for the patients assigned to me. After my clinical day I reflect on
the positives and negatives of the day. I reflect on how I have been implemented and where my strengths and weakness lie from the day.
7. 4 Seek out learning opportunities and feedback that foster professional development; and,
Satisfactory
Satisfactory
7. 5 Utilize nursing, health and other theory and literature to improve nursing practice.
Satisfactory
Satisfactory
Satisfactory
Satisfactory
K.M. : I believe that I am satisfactory within this criteria of the quality assurance section.
K.M. : I believed that I incorporated theory based approaches and evidence informed practice by using the resources given to me from the
nursing program, research obtained from credible sources and using that intellect and critical thinking skills obtained from the nurses on
the team and used it within my clinical care.
8. 1 Utilize problem-solving skills to inform decision making in all aspects of nursing care.
Satisfactory
Satisfactory
K.M. : I do my best to utilize problem-solving and critical thinking to inform decision making in all aspects of nursing care to enhance the
therapeutic nurse-client relationship.
Satisfactory
Satisfactory
Satisfactory
Satisfactory
skills.
K.M. : Self-reflection is integral within this profession. Such as the reflection I am writing this moment, it is important to be able to identify
one's strengths and weaknesses. being able to address these issues allows for growth and development within this nursing profession.
Post-conference discussions were very insightful and beneficial to my learning. It allowed to decompress after stressful shifts, and to
empower each peer to do better.
8. 4 Utilize knowledge from variety of nursing, health, and other theory into nursing practice
Satisfactory
Satisfactory
Satisfactory
Satisfactory
K.M. : Prioritization is one of the most integral aspects of nursing- patient care. Prioritizing interventions have been engrained in all clinical
practice that I have had. For example, the three main priorities that must be intact for every patient is airway, breathing, and circulation.
These all must be within defined limits before prioritizing any other nursing intervention. Strategies such as these are necessary within a
nursing care plan.
Satisfactory
Satisfactory
K.M. : I address all of my teachers, leaders, peers and clinical community within my clinical placement and school with professionalism
and respect. I am accountable for the decisions I make and take full responsibility.
8. 6 Recognize strengths and limitations and seek appropriate assistance and support.
Satisfactory
Satisfactory
K.M. : I know what knowledge I possess and with skills I have acquired and in which I am confident in doing. I seek appropriate assistance
from my peers and clinical leaders when needed. I follow up with researching on skills or knowledge that I may need to further my clinical
practice when needed.
Teacher comments for USE CRITICAL THINKING, PROBLEM-SOLVING & DECISION-MAKING EFFECTIVELY :
Kristina actively participated in lab and clinical activities; used clinical time effectively and accessed appropriate resources to meet her
learning needs. Kristina sought out learning opportunities by getting involved with other activities on the unit after completing her own
assignment, such as IV therapy; wound care, client assessment. Kristina responded positively to constructive feedback for improvement in
caring for her clients.
She demonstrates critical-thinking and evidence based rationales when providing care or when engaged in a conversation with a teacher.
When necessary,Kristina knows where to access learning resources, policies and procedures on the unit. Daily assessment, plan,
interventions and evaluation of care have been demonstrated. She is able to modify the initial plan as needed, for example, looking up lab
work and deciding if specific medication needs to be given.
Student's References
Clinical Placement - learning experience on 2 EAST
Fundamentals of Nursing (Jarvis et al.,)
Medical - Surgical Nursing in Canada 3 Ed (Lewis et al.,)
CNO Practice Standards (CNO website)
RPNAO/ RNAO
Grade
Satisfactory
Unsatisfactory
Grade
Satisfactory
Yes
No
Yes
No
Yes
No