NURS 3021H Clinical Practice Focused on Chronic Disease Management

Mid-Term Evaluation: X Final Evaluation: n/a

Student: Alannah Hewitt

Clinical Instructor: Wendy Symons

Clinical Placement Hospital: PRHC Unit: D2

Date: Feb. 18, 2018

Missed Clinical Hours: 0 Missed CLC Lab Hours: 0


Course Objective
1. Demonstrate accountability and responsibility in
the teaching-learning relationship.
2. Explain the experience of chronic illness in
individuals receiving care in chronic care
settings
NURS 3021H Clinical Practice Evaluation
Progress
Evidence/Indicators SP/S ND UP/U
1) Each clinical shift I have completed a thorough and
comprehensive pre-clinical and post-clinical which demonstrates
my responsibility and commitment to my learning and making
connections in my patient care. Also demonstrates that I am making
connections between medications, diagnoses and patient
outcomes.
2) I arrive ahead of the time required before each shift to ensure
that I am prepared and have everything I need to have a successful
shift (i.e., my badge, stethoscope, pens, etc).
3) I engage in the discussion held in every post-conference and
actively listen to the experiences of my peers to be able to gain
knowledge and perspective of their experiences. X
4) I remain accountable for all of my actions as a student nurse by
reporting frequently to my primary care nurse, and always
documenting my actions through progress notes and
documentation sheets.
ALANNAH IS THROUGH WHEN SUBMITTING HER PRE AND POST
CLINICALS, SHE LISTENS TO SUGGESTIONS WHEN DISCUSSING HER
PATIENTS CARE BEFORE SHIFT, AND REVIEWS OBSERVATIONS AND
GUIDANCE IN THE POST CLINICALS. SHE IS PREPARED WHEN
ADMINISTERING MEDICATIONS, SEEKS ASSISTANCE WHEN
REQUIRED AND IN A TIMELY MANNER. SHE IS PUNCTUAL, NEAT,
TIDY AND INTRODUCES HERSELF TO HER PATIENTS AND THE
STAFF.
1) Chronic illness isn’t something that just impacts the physical
aspects of a person. It is very clear how one’s emotions and social
aspects are also effected. Patients have expressed a loss in their X
social norms and how their emotions have changed since their
chronic illness or being in the hospital.

3. Interpret critical aspects of the person’s
experience of chronic illness in relation to the
nursing process such as common signs and
symptoms, responses to treatment, patterns of
coping, and impact on individual and family
relationships.
2) It is also clear that chronic illnesses and being cared for in a
palliative (chronic) setting results in a change in identity in patients
as well as a feeling of powerlessness. Powerlessness over their
illness progression, their symptoms, what they’d like to do, etc.
ALLANAH EXPERIENCED A PERSON BEING TOLD THEIR DIAGNOSIS
AND PROGNOSIS IN HER FIRST SHIFT. SHE SAT QUIETLY WITH
THEM, HELD THEIR HAND DEMONSTRATING EMPATHY,
COMPASSION. SHE QUESTIONED HER ABILITY, WAS AFRAID SHE
WOULDN’T KNOW WHAT TO SAY OR DO. SHE DID EXACTLY WHAT
THAT PATIENT NEEDED, DEVELOPED A THERAPUTIC
RELATIONSHIP.
1) I have had the chance to see multiple stages of coping and
acceptance in patients. The majority of patients I have seen have
had the chance to adapt and cope with their chronic illness. For
example, they know what medications they need to be taking, or
have accepted what part of their illness they’re at. In other patients
its clear that they’re still in denial or have anger about their illness
which is evident through what they see, their mood, or through
how they talk about their illness/treatment. One patient in
particular I interacted with got very frustrated and angry when
discussing any aspect of their chronic illness.
2) I’ve also observed many different types of family dynamics; some
with a positive impact on the patients, and some with a negative X
impact. I have seen how a chronic illness can bring families together
as they show support, visit a lot, and provide emotional support. In
other instances, family relationships are more strained and can
cause stress on the patient. Chronic illness impacts family
relationships.
ALLANAH IS THROUGH IN HER POST CLINICALS ASSIGNMENTS
AFTER CARING FOR THE PATIENT. SHE IS BEGINNING TO
UNDERSTAND THE DIFFERENT TREATMENTS, LAB WORK, SCANS
AS THEY RELATE TO HER PATIENT.SHE IS INTERPRETING THESE
RESILTS AS WE DISCUSS THE NORMAL AND THE ABNORMAL.SHE
UNDERSTANDS WHY THESE TESTS ETC ARE ORDERED. SHE HAS

4. Identify symptoms and common medical
treatments of selected chronic illness.
5. Demonstrate select nursing and collaborative
interventions related to caring for the person
with chronic illness such as specific
assessments, medication administration,
physical and chemical restraints, enteral
feeding & residual volumes, NG tube insertions,
wound care, patient controlled medication
administration pumps.
ALSO OBSERVED THE INTERACTION BETWEEN PATIENTS AND
FAMILY MEMBERS, RESPECTING THEIR CHOICES.
1) During our third week, I had a patient with Congestive Heart
Failure and Bradycardia. I observed their shortness of breath,
markedly slow heartbeat, activity intolerance and fatigue which are
key signs and symptoms of CHF.
2) One of my assigned patients had terminal cancer and though
common treatment includes invasive procedures such as surgery or
chemotherapy, this was not the treatment plan chosen for the
patient. They instead chose pain and symptom control through
palliative care.
3) Another patient I had had hypothyroidism which was managed
through the administration and adherence to levothyroxine which
is a synthetic thyroid hormone medication to raise T4 and T3 levels
to normal levels. X
4) Pain control is a major treatment method for many of the
chronic illnesses on the palliative unit. The use of subcutaneous
lines and CADD pumps are common to provide constant infusion of
pain medications, such as hydromorphone, morphine, or fentanyl.
ALANNAH UNDERSTANDS THE PATHOPHYSIOLOGY OF THE
DIAGNOSIS OF EACH OF HER PATIENTS ASSIGNED.SHE DOES A
THROUGH ASSESSMENT, AND CAN ANTICIPATE POSSIBLE
COMPLICATIONS AND HOW TO RESPOND. SHE HAS WITNESSED
DIFFERENT FORMS OF PAIN, NAUSEA, CONSTIPATION, ANXIETY
CONTROL UTILIZED ON THE UNIT, AND HOW THESE
INTERVENTIONS HELP OR HINDER HER PATIENT.
1) I have completed two coccyx wound dressings using No-Sting and
Mepilex dressings on wounds that resulted from pressure ulcers.
2) Pulled up multiple medications (dilaudid, midazolam, Haldol) and
administered them to patients. One was a subcutaneous injection
in the thigh, while two were administered through a subcutaneous
line.
X
3) Observed the initiation of a subcutaneous line into the thigh of a
patient.
4) Observed primary care nurse managing CADD pumps and
monitoring them (i.e., how to check how many times the patient

6. Identify potential consequences/complications
of select chronic illnesses and related
interventions.
has clicked the PCA pump)
5) Observed the drainage of a pleurex chest tube. Was able to
observe the sterile techniques and the steps of this process.
ALANNAH REQUIRES SUPERVISION WHEN ADMINISTERING
MEDICATIONS AND IN NEW SITUATIONS. SHE PERFORMS THESE
WITH GUIDANCE, ASKS APPROPRIATE QUESTIONS AND
DOCUMENTS WELL. SHE REQUIRES MININAL ASSISTANCE WITH
HER ASSESSMENTS (WOUNDS), AND HAS THE CONFIDENCE TO
RELATE TO THE PRIMARY NURSE HER ASSESSMENTS.
1) One consequence of a lot of the chronic illnesses is a decrease in
mobility or complete bedrest. This presents a big complication for
the formation of pressure ulcers. To prevent this patients with X
decreased mobility or are immobile must be repositioned q2h and
have their skin assessed regularly.
2) Another complication of chronic illnesses is the emotional and
mental impact they have on individuals. It is common to see signs of
depression, decreased mood, or a negative affect in people with
chronic illnesses. Interventions for this include support from HCPs
3) Another common consequence of chronic illness that I have seen
in patients is a decrease in quality of life. People with chronic illness
receiving care in a chronic unit are not living their life the way they
used to be able to. I’ve had two patients express to me that they
have a decrease in their life satisfaction and quality.
ALANNAH IS BEGINNING TO UNDERSTAND THE KNOWLEDGE
REQUIRED TO MEET THE NEEDS OF COMPLEX PATIENTS, SEEKS
CLARIFICATION WHEN REQUIRED AND IS EAGER TO LEARN.
ALLANAH DEMONSTRATES THIS ALSO IN HER POST CLINICALS IN
THE THEORISTS SHE USES.
7. Under the supervision of a Registered Nurse,
demonstrate safe, competent, evidence-
informed, holistic nursing practice with clients
with chronic illness
a. Use a wide range of effective
communication strategies and
interpersonal skills to appropriately
establish, maintain, re-establish and
terminate the nurse-client relationship
b. Demonstrate accountable, responsible
and ethical practice
c. Engage in respectful, collaborative,
therapeutic and professional
relationships
i. Demonstrate therapeutic use of
self
ii. Create a culturally safe
environment
d. Apply nursing models and theories
e. Demonstrate health promotion and
illness prevention practices
f. Demonstrate patient advocacy
g. Predict outcomes of nursing care
h. Evaluate client response to nursing
care
i. Critically appraise own practice in
relation to nurse-client/family
interactions and as a member of the
health care team
8. Critically appraise own practice in relation to
nurse-client/family interactions and as a
member of the health care team
1) I have been able to apply multiple models to my care including:
Orem’s Self-Care Theory, and Ruland’s Peaceful End of Life Theory.
It has allowed me to critically think about what stage of illness my
patients are at, what they self-care abilities are, and what is needed
X
from me in order to provide the holistic care necessary for that
individual.
2) I have demonstrated my ability to evaluate client’s response to
nursing care and interventions. For example, after
the administration of an opioid to a patient, I ensured to monitor
this medication for efficacy after. I assessed the patients VAS before
and after the administration of the analgesic as well as non-verbal
signs of pain to see if the analgesics was effective.
3) I employ a multitude of therapeutic methods and techniques
with my patients, peers, and nurses on the unit. I incorporate
components of therapeutic communication such as active listening,
engagement and empathy to my patients. I remain professional
with my peers and health care providers on the palliative unit. I am
always respectful of those I interact with.
AS STATED ABOVE, ALANNAH DOES APPLY NURSING MODELS
AND THEORIES. SHE DOES ASSESS HER PATIENTS HOURLY, AND
DOCUMENTS HER ASSESSMENTS.SHE UNDERSTANDS THE VALUE
OF THE PPS SCALE ON THE PALLIATIVE CARE UNIT, AND IS ABLE TO
RELATE THIS INFORMATION.SHE IS ABLE TO EVALUATE THE
RESPONSE OF ANALGESICS, AND ADVOCATES FOR HER PATIENT IF
THE ANALGESIC IS OR IS NOT EFFECTIVE. SHE KNOWS WHO TO
REPORT TO, TO RELAY THIS INFORMATION.SHE HAS COME TO
CLINICAL WELL PREPARED FOR MEDICATIONS ADMINISTRATION,
AND WHEN ASKED, KNOWS THE MEDICATION AND SIDE EFFECTS.
1) I have been able to improve upon and form professional
relationships with the nurses on the unit. For example, keeping
open communication, asking questions, helping when needed, X
asking for assistance if I need it, and reporting key information to
my primary care nurse for the shift.

9. Participate in professional development based
on reflective practice and critical inquiry
2) I have observed how nurses on the unit interact and
communicate with the families of patients. It is clear that the
relationship a nurse has with the family is just as important as the
one they have with the client/patient.
ALANNAH IS BECOMING MORE COMFORTABLE WORKING WITH
THE PATIENTS AND THE FAMILIES. SHE IS MORE CONFIDENT IN
HER APPROACH TO THEM, AND INITIATES CONVERSATIONS. SHE
IS A GOOD LISTENER, AND SPENDS TIME NOT ONLY WITH HER
PATIENTS, BUT OTHERS. SHE SEEKS GUIDANCE WHEN REQUIRED,
AND TAKES ANY OPPORTUNITY TO LEARN.
1) Successfully completed a formal written reflection on supporting
a patient on the unit who had just received a terminal health
diagnosis. I reflected on the importance of providing emotional
support to patients and my personal feelings & values that came X
along with this.
2) I engage in informal reflection after each shift, or after important
interactions/experiences I have on the palliative unit. For example,
thinking about the actions of other nurses, why they did something,
how I felt about the experience and potentially what I think could
have been done differently. I even reflect on “simple” interactions
such as a nurse talking to the patient as I believe that I can learn
things from every experience, no matter how small.
3) I have expressed curiosity and a desire to critically enquire into
multiple experiences and actions that have taken place. For
example, I ask nurses when I am not sure the exact reason for a
patient to be on a certain medication, or when I inquired into why a
specific dressing was chosen for a patient as opposed to another
type.
ALLANAH ‘S REFLECTIVE JOURNAL DEMONSTRATED HER
THOUGHTS AND FEELINGS ON A TERMINAL PATIENT .SHE
IDENTIFED AND DEMONSTRATED HER STRENGHTS AND HER
WEAKNESSES.EACH WEEK SHE REFLECTS ON HER PRACTICE, AND
IS BECOMING MORE COMFORTABLE EACH CLINICAL.SHE
PARTICIPATES IN POST CLINICALS, OFFERS SOLUTIONS AND HOW
 SOMETHING COULD HAVE BEEN DONE BETTER OR DIFFERENTLY.

Areas of Strength Identified by Student

1. Building a therapeutic relationship and using therapeutic communication with my patients and showing patience and
understanding.

2. Following all the correct steps for medication administration and considering implications of the medications and
adverse reaction to watch for.

3. Have greatly improved on my skills of drawing up medications for parenteral administration and in my skills on
administering subcutaneous injections.

Areas for Future Development Identified by Student

1. Communication with the family members of patients and improving on my comfort in interacting with them.

2. Practice/improvement on my sterile technique (i.e., a catheter insertion, or sterile wound dressing)

3. Continuing to work on my progress notes and thinking through which components of assessment should be included.

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

ALLANAH IS SATISFACTORILY ACHIEVING THE OBJECTIVES OF THE COURSE. SHE IS ACCOUNTABLE, DEMONSTRATES
EVIDENCE BASED RATIONALE FOR HER CARE, SEEKS ASSISTANCE WHEN REQUIRED. SHE IS BECOMING MORE CONFIDENT IN
HERSELF AND HER APPROACH TO THE PATIENT, THEIR FAMILIES AND MEMBERS OF THE HEALTH TEAM. SHE IS WELL
PREPARED FOR CLINICAL, UNDERSTANDS THE COMPLEXITY OF HER PATIENTS DIAGNOSIS AND THE TREATMENTS.
ALLANAH IS PROGRESSING AS EXPECTED.
Clinical Practice Attendance (8 Hours Per Shift)

Thurs Fri Thurs Fri

Week 1 8 8 Week 6
Week 2 8 3.5 (SIM) Week 7
Week 3 8 8 Week 8
Week 4 8 8 Week 9
Week 5 8 3.5 (SIM Week 10

Total number of clinical practice hours completed: 71 /128 Hours (at midterm)

Clinical Practice Outcome (completed by Clinical Instructor): Satisfactory X Unsatisfactory

Clinical Learning Centre

Total number of clinical simulation hours completed: 7 / 14 Hours (at midterm)

Total number of lab hours completed: 14 / 22 Hours (at midterm)

Clinical Learning Centre Outcome (completed by Course Lead): Satisfactory Unsatisfactory

Signature of Course Lead: Date:

Signature of Clinical Instructor: Wendy Symons RNBScN Date: Feb.23/18

Signature of Student: Date: