Clinical Evaluation Process Nursing 3020

Transcription

1 Instructions Clinical Evaluation Process Nursing 3020 The Mid-Term Evaluation will be completed by students at the mid-point of the clinical placement to assist students to take inventory of their current development and assist them to make plans for future clinical practice. The student will use a reflective process to help assess progress in meeting established program, year, and course objectives. The student will submit an electronic copy of the Mid-Term Evaluation document to the clinical instructor prior to the formal mid-term student evaluation. Because the document is to be completed electronically, the student and instructor can take as much space as they need to provide appropriate evidence and feedback. After receiving the student s Mid-Term Evaluation, the clinical instructor will complete the comment section providing feedback and evaluation of the student s progress. The clinical instructor will provide suggestions for improvement. The instructor will place a check in the S column if progress is satisfactory, and in the U column if progress is unsatisfactory. If a student demonstrates unsatisfactory progress at mid-term, the student and instructor will develop a Learning Plan outlining strategies in which the student will engage, along with clear expectations that must be met for the successful completion of the course. The course professor may be involved in developing the learning plan. The student and instructor should save and print a copy of the mid-term evaluation. Printed copies must be submitted to the course professor within a week of completion. At the end of the rotation, students will complete a Final Evaluation. Students will use a new copy of the evaluation template to archive their achievements and areas for future development. The student will submit an electronic copy of their final evaluation to the instructor; this will help the instructor complete an assessment of the student. In order to complete the final evaluation, the clinical instructor will provide additional evidence by completing the comment section, providing feedback and evaluating the student s progress. The clinical instructor will collect evidence in the form of the student self-assessment, comments of the health care team members, patient input, student submissions (including portfolios) and observations. A summary of achievement as well as implications for future learning should be included in this 1

2 document. The attendance section and record of completed hours is to be filled in completely. The completed document is to be printed, shared with the student and signed. The signed copy must be returned to the TFSON within 10 days. The Year Lead, lab instructor, and/or course professor will assess the completion of the Learning Center Component, if applicable. Students and instructors will complete both the mid-term and final clinical evaluation documents electronically. An electronic copy of the completed (student and instructor) final evaluation should be submitted to the course professor within 48 hours of the final evaluation delivery. A printed and signed copy should follow within 10 days of the evaluation meeting. 2

3 NURS 3020H Clinical Evaluation (Check one) Midterm (x) Final Student Name: Chloe Clark Clinical Instructor: Jennifer Massimo Missed Clinical Hours: 0 Missed Lab Hours: 0 3

4 Program Goals Graduates are generalists entering a self-regulating profession in situations of health and illness. Graduates are prepared to work with people of all ages and genders (individuals, families, groups, communities and populations) in a variety of settings. Graduates continuously use critical and scientific inquiry and other ways of knowing to develop and apply nursing knowledge in their practice. Graduates will demonstrate leadership in professional nursing practice in diverse health care contexts. Graduates will contribute to a culture of safety by demonstrating safety in their own practice, and by identifying, and mitigating risk for patients and other health care providers Graduates will establish and maintain therapeutic, caring and culturally safe relationships with clients and health care team members based upon relational boundaries and respect. Graduates will be able to enact advocacy in their work based on the philosophy of social justice. Graduates will effectively utilize communications and informational technologies to improve client outcomes. Graduates will be prepared to provide nursing care that includes comprehensive, collaborative assessment, evidence-informed interventions and outcome measures. 4

5 Objectives 1 Explain the experience of acute illness in individuals receiving care in acute setting Progress Indicators/Evidence 1) Jan 11 th Pt with recent leg amputation: I aided this pt to the bathroom and noted to myself how independent she still was. She also talked to me about her feelings about having to stay in hospital for a month which was stressful for her to think about. S U 2) Jan 15 th Pt with new ostomy: this pt explained to me what it was like to be staying in the hospital since he was out of surgery. He felt like he had only gotten 5 minutes sleep since he d been on the floor. People were always checking on him and disturbing his sleep which was irritating to him. Adjusting to the new space can be difficult. 3) Jan 16 th Visitor in line at Time Horton s: in line at Tim Horton s the person standing behind me struck up a conversation about his girlfriend in the ICU. He told me that she had been there for 16 days and would not be coming home. He told me that he had been by her side every day and he seemed very exhausted. It s so important for family members and friends to have support when coping with the changes. Chloe demonstrates a good understanding of what a patient experiences while in an acute care setting. Chloe is able to imagine herself in that person s situation and use this technique to provide therapeutic and professional presence. 2 Interpret critical aspects of the person s experience of acute illness in relation to common signs and symptoms, responses to treatment, patterns of coping, and impact on individual and family relationships 1) Jan 11 th Pt with left leg amputation: had visitors over and made friends with the person she shared a room with. When I first went in to aid her with getting to the bathroom, she was quite unhappy. When I came back to help her back to her bed she struck up a conversation with her roommate and her mood dramatically changed, as she joked around with her and even joked about her roommate having sexy legs. Making light of her new situation was helping her cope. 5

6 3 Identify common medical treatments and potential consequences/complications of selected acute illnesses 2) Jan 15 th Pt with new ostomy bag: he explained to me that since his retirement he had been in hospital for multiple surgeries. He told me how he had expected this surgery to have the same amount of pain as the last few. Unfortunately, this one was causing him more pain which was harder for him. It is important to talk to patients about how surgeries differ and to encourage them through times of discomfort. 3) Jan 16 th Pt with 2 nd -5 th toe amputation: this patient was disappointed that he was still on bed rest. He had an amputation in the past and explained that this time felt like the recovery was taking a lot longer. He had visitors in the afternoon that encouraged him that he would be up and moving the next day. His family helped support him through his disappointment. When family is supportive they can be very helpful with coping. Chloe uses information obtained through assessments to understand a person s experience. She is able to utilize previous experiences to recognize patterns within similar diagnoses and patient and family experiences. She applies therapeutic approaches to her nursing care. 1) Jan 11 th Pt with epidural: this pt was given enoxaparin therefore we needed to wait before we could remove the epidural or there would be a risk for bleeding into the epidural space. 2) Jan 15 th Pt with new ostomy: has been on IV PCA which lowered his SpO 2 stats. We attempted to raise his levels with deep breathing exercises but this did not help. After looking at his chart, we re-administered 2L of oxygen to raise his stats. 3) Jan 15 th Jen walked us through a CBI and explained how it works. She told us what was normal and what things looked like when an issue arose. If a clot were to block the line at any point, the person s bladder could fill up with fluid rather quickly. It is 6

7 4 Demonstrate selected nursing and collaborative interventions related to clinical pathways, peri-operative care, IV medication administration, cardiac assessment and rhythm strips, neurological assessment, wound care, blood component therapy, TPN and central lines, pulmonary care including chest tubes and tracheotomy, initiating IVs, rapidly changing conditions, and resuscitation important to monitor frequently for blocks and to see what is being passed through. Chloe is able to identify common medial treatments for diagnoses as well as understand rationale for these treatments. She is able to critically think about treatments and recognize possible complications or nursing concerns. She uses clinical knowledge to apply when performing head to toe assessments to understand acute illness. Chloe is competent and efficient in assessments and able to accurately identify abnormalities and how this is related to acute illness. 1) Jan 11 th Pt with epidural: I witnessed and talked to one of the nurses while they collaborated with the anesthetist on a new plan for the removal of this pt s epidural. The pt had been given enoxaparin therefore was at a greater risk for bleeding within the epidural space if the epidural was removed. The collaboration between disciplines is extremely important to see things from different sources of expertise. 2) Jan 15 th Pt with new ostomy: I helped the OT/Physiotherapist convince this pt to go for a short walk. He was 2 days post-op and hadn t been moving and much at all so we were worried about his risk for developing clots. He was agitated and didn t feel as though we were hearing him out. We allowed the pt to talk and explain his feelings and then he listened to our concerns about him. Eventually he chose to come with us for a walk. 3) Jan 25 th : I had the chance today to help a patient with deep breathing exercises in order to raise the patient s SpO2 stats. If the patient s stats did not increase then we would have had to discuss the use of oxygen therapy. Chloe understands the importance of multidisciplinary interventions and collaboration of professionals in the care of an individual. She understands the importance of helping out colleagues with patient care to act as part of 7

8 the health care team. Chloe is able to use critical thinking to trouble shoot with different therapies-for example trouble shooting IVs when IV pumps continue to beep. Chloe also is proficient with different types of wound dressings, providing therapeutic care while providing knowledge-based techniques. 5 Under the supervision of a Registered Nurse, demonstrate safe, competent, evidence-based, holistic nursing practice with clients with acute illness 1. Apply relevant nursing models, philosophical frameworks, theories and evidence 2. Demonstrate therapeutic use of self 3. Engage with patients in an ethical and culturally safe manner 4. Understand and anticipate emerging bio-psychosocial needs of persons with acute illness and apply this knowledge to care: a. Plan appropriate nursing care b. Predict outcomes of nursing care c. Evaluate client response to nursing care 5. Demonstrate health promotion and illness prevention practices a. Engage with patients and families to identify health-related situational challenges b. Work with patients and families to create reasonable and effective solutions 6. Demonstrate patient advocacy 7. Demonstrate accountability 8. Demonstrate reliability 1) Jan 11 th : When shift change occurred, I helped one of the nurses flush IV lines and go through her head-to-toe assessments. One patient was confused about where she was and she wanted to go home. Without lying to her, we helped explain where she was and found out for her that her daughter was going to be coming the next day to visit. It s important to not lie to a patient just because they are confused. This is important in order to perform ethical care. 2) Jan 15 th : Today, I was taught to do glucose tests. Jen talked us through proper glucose levels as well as what to expect when patients have eaten and when they haven t. I spoke to Heather who had an insulin dependent patient however because they hadn t eaten since their surgery their diabetes was under control. This demonstrates the importance of doing your checks because you should never administer medication without a relevant reason. 3) Jan 25 th : with the supervision of one of the nurses, I removed a NS IV lok. I practiced proper sterile procedure and the patient was very happy to have to it removed. I then wrote a progress note recording the removal and state/location of the site. This demonstrates accountability and Nightingale s model of maintaining a clean environment. Chloe consistently prepared for clinical, demonstrating reliability and accountability for her practice. She is helpful to other nurses and nursing students, as well as to patients and their families. Chloe always advocates 8

9 6 Critically appraise own practice in relation to nurseclient/family interactions and as a member of the health care team 7 Participate in professional development based on reflective practice and critical inquiry for her patients, taking the time to speak with patients and understand their concerns. She demonstrates efficiency in documentation while maintaining detail and accuracy. 1) Jan 11 th I think I took it on myself to be available to all patients and nurse supervisors today by readily asking if someone needed help. I answered call bells as they occurred and looked around in the supply closet to get familiar with where things were. 2) I felt like I needed to look at my charts more today because I kept forgetting to do things like take temperature or find the pedal pulse. There seemed to be so much going on and I was trying to be extra careful not to agitate the patient. Eventually I realized though that some people are just going to be more agitated with students who are still learning proper techniques and that this was something to just push through. It s impossible to please everyone. 3) Jan 15 th I think taking on two patients today was great. I had the chance to take on more responsibility and work on my tie management skills. I enjoy having the opportunity to look at different treatments and surgeries. This also gave me the chance to practice more head-to-toe assessments and my progress note writing. Chloe is able to work with patients and their families to provide patientcentered care. She is always answering call bells, making sure to assist others when needed. She demonstrated understanding of her own practice in her detailed reflections and post-clinical discussions. 1) Jan 11 th : Today I took the time to look up calciphylaxis with Jen. It is a syndrome characterized by vascular calcification, as well as thrombosis and necrosis of the skin. It occurs typically in patients with kidney failure who are going through dialysis as treatment. 9

10 2) Jan 15 th : After preparing myself for 1.5hrs last night researching the pt s history, dx, sx, and tx, I showed up to find out my pt was going to be off the unit until 1700h. This was a little chaotic at first but I think I handled the change well by getting as much information on my new pt as possible and doing a head-to-toe assessment by 1430h. Nurses have to be ready for an ever changing day, we are lucky to know something about the pts prior to our shift; usually this is not the case. Being prepared for anything and being adaptable are good qualities to have. 3) Jan 16 th I finished my second head-to-toe and wrote out a rough draft of the progress note. Most students had already headed out for a break up to this point and considering we were getting close to our dinner break I thought I d better get my break in. I asked Jen and she reminded me that I needed to write out my progress note in the pt s chart before I went. Reflecting on this, I m glad she got me to do this because it s good practice to use. This makes sure I am accountable for what I ve done and also allows the nurses on the floor to know what the most recent assessment on the pt was if something were to happen while I was on break. Chloe s journals demonstrate her critical inquiry to her nursing practice. She is always reflecting on her patient interactions and understands this in the context of acute illness. She is able to identify strengths and weaknesses in her practice to further develop in the future. 10

11 Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment) At midterm Chloe is satisfactorily working towards the course objectives. She consistently demonstrates safe and competent patient care. Her documentation is efficient and accurate. She is becoming increasingly independent with her skills, while continuing to ask relevant questions to develop her practice. She understands the role of acute illness and its effect on the individual and their families. She works well with her peers and the health care team. Chloe is doing very well and continues to progress. Signature of Instructor Signature of Student Date Date 11

12 Attendance Day 1 Day 1 Day 1 Day 2 Week 1 8hrs 8hrs Week 6 8hrs 8hrs Week 2 8hrs 8hrs Week 7 Week 3 8hrs 8hrs Week 8 Week 4 8hrs 8hrs Week 9 Week 5 8hrs 8hrs Week 10 Total number of clinical hours completed Clinical Component Satisfactory Unsatisfactory (Please circle the appropriate outcome) Clinical Learning Center Completed Not completed 12

13 Signature of Instructor Date Signature of Student Date 13