Multi Rater Competency Assessment

2015 - 2016 - NURS 253 Practical Nursing Pre-graduate Experience MRA Mid (201508)
NURS 253 Practical Nursing Pregraduate experience (PN, 18-Jan-2016 - 07-May-2016)
Student :
Clinical Teacher/Preceptor :
Advisor :
Program Coordinator :
Location :
Placement Setting :
Unit/Office/Clinic :
Period :
Student hours :
Required Hours :
Validated hours :

Lara Pabandero-de Lasan

Renichia McIntosh
Mary McGrory
Judy Martin
Humber River Regional - Wilson
Agency
11W Surgery
18-Jan-2016 To 07-May-2016
200
200
236

Teacher comment for validated hours:

Earned.
Sick for 2 days.
I was informed about these hours as per protocol by Renichia.
I declare that this is my original work and the sources used are acknowledged.

Abilities and Outcomes / Learning Outcomes

Student Rating

Teacher Rating

1. Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies and procedures of the
practice setting.

1. 1 Comply with regulatory standards, relevant legislation and the practice settings policies and

Satisfactory

Satisfactory

procedures.
L.P.L. : I follow all student guidelines from Humber College and the Humber River Hospital policy as well. E.g. Uniform, Id Badge, white toe covered
shoes with no holes, no hoop earrings or rings on fingers, analog watch, etc. Practice setting policy such as codes, computer software being used
(Meditech) etc are being used as per protocol.

R.M. : Lara is dressed in her uniform and early on unit each morning.

1. 2 Act in a professional, responsible, ethical and accountable manner.

Satisfactory

Satisfactory

L.P.L. : I act in a responsible, ethical and accountable manner by arriving early and being on the unit at least 30 minutes before the start of the shift
so that I can check the daily patient assignment, get a Med Cow ready with the patient room numbers, and have time to do some research on the
patient information.

When taking down client information, I only take information I need for the care for that day, do not talk about my patients to personnel who are not
authorized or outside of the unit and not take other information that can identify them to other people. I do not discuss the client information with
others, and all information stays at the unit. I keep passwords for the med cow, meditech safe and always log out when I leave the computer. At the
end of the day, all paper are put into the shredder.

R.M. : Keeps patient information secure. Close computer when not in use. Discard other paper in shredder

1. 3 Use the three factor and decision making frameworks to determine strengths and limitations and

Satisfactory

Satisfactory

when to collaborate and consult with other professionals.

L.P.L. : As an RPN I can work autonomously, however when there is a change of my pts status and they suddenly become very unstable, it is vital
that I communicate that with my preceptor the interventions that I am providing and knowing when my knowledge and experience are limited and
need help and/or collaboration with the charge nurse or even transfer the assignment to the charge nurse or who she will assign it to.

We had a pt who had a tracheostomy, and using the three factor framework it was decided that this pt stable or not was not supposed to be under an
RPN's care, as per protocol of the hospital as well. We followed that decision making tool and the assignment was transferred to an RN.

R.M. : Takes initiative in getting work/ task done. Seeks help when needed.

1. 4 Integrate evidence-informed practice and a theory based approach into nursing care.

Satisfactory

Satisfactory

L.P.L. : I integrate evidence informed practice and theory-based approach into nursingncare each time I interact with my pt, entering and leaving the
room, changing gloves, ect. are the times I need to do hand hygiene. Evidence proves that it is the single most important intervention for infection
control. Another example is while giving sc/IM injections, wound dressings etc using all my theory based knowledge to approach those skills for the
safety of my pts and myself.

R.M. : Communicate with patient in professional manner.

1. 5 Assess practices and risk management principles and take action to ensure safety of clients,

Satisfactory

Satisfactory

self, and others.

L.P.L. : I ensure safety of patients, myself and others by assessing my practices carrying out safety-based practices and risk management principles
for each pt by putting up the side rails when the client is in bed especially a falls risk, putting at arms reach the items they need so that they do not
have to reach for things (e.g. call bell within reach, tissue box, table beside them, water etc.)

I assess each pt on their ambulating capacity, and if they have ambulation devices, I keep them nearby to the bed, orient them to the call bell so that
when they need to get up or need something, I am there to either provide help or supervise that they e.g. to the bathroom safely.

R.M. : Keeps patient safe at all time by ensuring side tails are up and if applicable bed alarms are on.

1. 6 Question and clarify unclear orders or directions and when uncertain.

Satisfactory

Satisfactory

L.P.L. : Whenever I am unclear about something, I seek assistance/clarification from my preceptor or the nurses on the floor.

When discharging a pt, there was a prescription in her chart that the doctor wrote out, (sometimes the prescription is typed out in the computer and
printed, at this instance it was manually written out, I was unclear about which medication it was so I asked my preceptor and she knew right away
which medication it was. I ask how they can read the orders and she said sometimes you just have to get used to how the doctor writes. You learn
and get used to each doctors penmanship. If I am uncertain about the changes in the plan of care I make sure to clarify it with my preceptor

R.M. : Lara ask for help when needed. Lara also helps others.

1. 7 Question, clarify or challenge questionable orders, decisions or actions by others.

Satisfactory

Satisfactory

L.P.L. : For one pt, she was ordered to to have her wound vac dressing every M,W,F. There have been an ongoing issue with the vac machine
where it would constantly beep but it is still vaccuming the drainage from the leg, each time the dressing would be changed, instantly the machine
would still make the beeping sound. However on this day, it was Monday and the pt was scheduled to have her foot amputated on Wednesday, so
the "wound dressing change" we questioned/clarified with the physician and also the wound vac team, we were not the experts of that kind of dressing
also because it was a little more complex than others because of the beeping sound that the machine made, even though it was changed numerous
times. Also another factor to be considered was that the pt was not careful when it came to movement with the leg that had the vac dressing, and one
of the theory was it could be the reason why the machine would keep beeping.

In the end, the physician still wanted the dressing to be the vac dressing, and the vac team expert gave us some pointers on how to make the
dressing more effective, especially with a client that would move frequently despite the dressing.

R.M. : Lara is very keen to new task. Improving on dressing changes.

1. 8 Respond in a professional manner to situations in which there is unsafe, unacceptable or

Satisfactory

Satisfactory

unprofessional behavior.
L.P.L. : There was a family member (wife) of one of the pt's in the unit (not my assigned patient). She looked as though she was very unsteady and
on edge. She was constantly yelling, and walked up and down the hallway where it came to a point where some of the neighbour patients were
looking out the door at her. Finally, one of the nurses had to call the security to calm her down. When I walked past her, she stopped me to say "I'm
not crazy" and that was the only interaction I had with her, but I responded politely and just smiled at her, and professionally where I closed the door
of my pt assignment to not agitate them as well.

R.M. : Lara communicates with staff and patients in professional manner at all times.

1. 9 Demonstrate understanding about the role of the nurse within health care.

Satisfactory

Satisfactory

L.P.L. : I am here to learn as much as I can in the unit to be able to go on and be prepared so that collectively, after the two years I am equipped and
able to practice my practical skills along with my knowledge from the lectures and literature and become a competent and knowledgeable nurse that
practices safely.

R.M. : Lara is on the unit early and prepare her work station. She is present at report and takes vital information for patient care.

Teacher comments for Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies
and procedures of the practice setting. :
Lara works well in a team and independently. Takes initiative for learning experiences and for patient care.

Advisor comments for Model safe, competent, and ethical practice in compliance with legal and regulatory frameworks and the policies and
procedures of the practice setting. :
Based on my visit, review and discussion with preceptor and student Lara is making steady progress and demonstrates a commitment to safe,
competent and ethical practice. Lara maintains a record of her clinical hours, keeps in contact with me and informs me of any changes or schedule
update all of which demonstrate her commitment to this clinical practice.

2. Communicate using strategies and technology to effect accurate and timely information sharing including data, research, and other
information.

2. 1 Contribute to team sharing and discussions.

Satisfactory

Satisfactory

L.P.L. : Daily morning bullet rounds I participate in along with my preceptor, it is a very fast paced environment because they have to go through 200
patients of the plan of care (discharge or not). However, during seminars when I have questions I contribute and ask about the specific topic. Also,
during shift report, I contribute to team sharing and discussions of the patient information and plan of care.

R.M. : Lara works well with staff and other multidisciplinary team members.

2. 2 Document clearly, accurately, concisely in a timely manner using written and electronic methods.

Satisfactory

Satisfactory

L.P.L. : I have the confidence to document electronically using Meditech in the unit whenever I finished a task that was part of the care plan. I also
now have the confidence to write a nursing progress note when provided care such as PRN meds for pain or wound care. When there is a discharged
patient, we need to make a discharge nursing note that I competently complete with the approval of my preceptor.

R.M. : Lara seeks help and clarification when needed. Fur example when writing patient notes.

2. 3 Use effective communication techniques when reporting relevant information and providing

Satisfactory

Satisfactory

feedback to the appropriate members of the interprofessional heath care team.

L.P.L. : I report relevant information such as food/fluid intake, urine output (when necessary), and care given to appropriate personnel, even though I
already charted it, I still verbally report it to the oncoming nurse or interprofessional health care team (doctor or physiotherapist etc).

R.M. : Lara communicates well with staff, patient and other team members.

2. 4 Evaluate and refine techniques used to communicate and share information with clients and the

Satisfactory

Satisfactory

interprofessional health care team.

L.P.L. : I use communication techniques with the client and the inter-professional healthcare team on a regular basis. Such as touch, eye contact
and soft spoken voice to pts and one communication technique I used with the inter-professional healthcare team is the medication request form when
one of the medication dose of my patient was missing from the MedCow, and the pharmacist was not on the unit at that time.

2. 5 Ensure privacy and confidentiality.

Satisfactory

Satisfactory

L.P.L. : When I take client's information from their chart or on the Meditech, I do not include anything that would distinguish who they are. No name,
address, or anything specific to him. Just the medication, diagnosis, medical history etc. In addition to that, I keep my password for the computers in
the unit to myself and do not share it with anybody, all information at the end of the day is put into the shredder before leaving the unit to go home.

When I enter the pt room I make sure that the curtain is drawn to ensure patient privacy.

R.M. : Lara closes Cow when not in use, to keep patient information protected.

2. 6 Use technology to retrieve information including research and other date and to obtain and

Satisfactory

Satisfactory

forward information both within and outside the practice setting.

L.P.L. : I use the computer in the unit and go on Meditech to research the client's care plan, diagnosis, medication etc. to help me with my plan of
care. Also when there is a new addition to the medication list on the MAR, I go on the computer and use the iHumber to research, or when no
computers are available I use my cellphone to use the drug app to help me find information about the new medication/diagnosis and put the phone
away when all research is done.

R.M. : Lara searches the Internet to find meaning if diagnosis and medication.

Teacher comments for Communicate using strategies and technology to effect accurate and timely information sharing including data,
research, and other information. :
Searches Internet for more information when needed.

Advisor comments for Communicate using strategies and technology to effect accurate and timely information sharing including data,
research, and other information. :
Lara is making steady progress with the use of on site technology to document and communicate. This clinical setting provides a good opportunity for
advancing these skills and with the direction of her preceptor her communication is developing well.

3. Engage in relational practice that is caring, compassionate and respectful.

3. 1 Establish therapeutic caring, compassionate, and culturally safe relationships with clients and

Satisfactory

Satisfactory

health care team members.

L.P.L. : I establish therapeutic caring, compassionate & culturally safe relationships with clients and health care team members so that a holistic
nursing care is given to patients. Like when I had a pt who was Jewish, he requested that his food be Kosher, he was adamant about his food so we
inquired in the kitchen that the feed he is given is Kosher, or if it wasn't like the sandwich he was given for lunch, we informed him and he opted to eat
the other food that had the COR symbol.

R.M. : Lara is very caring and speaks well with patient and family.

3. 2 Establish a caring environment that supports clients in meeting their needs and outcomes,

Satisfactory

Satisfactory

managing their illness, or experiencing a peaceful death.

L.P.L. : With each pt that I am assigned to each shift, I try to establish a caring environment that supports my patients in meeting their needs and
outcomes, managing their illness. With each pt that comes through either from the evening getting information from the previous nurse or from
surgery, it is my duty to know their needs and what the outcome for the careplan for that pt is.

For example, if the pt has been at the unit, usually the diet or their concerns are trying to be met already such as when is physio coming, their
wounds, when they can have or what they can eat etc. If the pt is from surgery, they may have their own concerns that needs to be met at the
moment and it is my duty to provide it as much as I can, depending on the doctor's order as well. I have learned that ice chips are very important to
pts, little things like checking something on the chart or the computer can settle and reassure the patients.

R.M. : Lara is ver caring and speaks well with patient and family.
Lara clarifies information before doing any task.

3. 3 Demonstrate therapeutic use of self to foster client well-being.

Satisfactory

Satisfactory

L.P.L. : I demonstrate therapeutic use of self to foster client well-being by being pleasant, listening to their needs, gentle and approachable to make
pts feel they can tell me any of their concerns and what I learned from my preceptor is, to avoid the multiple call bells, you need to establish a good
and trusting rapport from the beginning where you make sure that the pt knows you will come and pop into their room and ask if they need anything.
Checking in and doing rounds and showing your face to them, it reassures them that the nurse is there, they know the face and that "she will be back"
and most pts wait until I get into the room and then they tell me their concern. If you don't show that you are available for them, and have not been in
the room for a long time, that is when they start to pull the call bell more. Also, because you as the nurse go into the room, when the pt pushes that
call bell, you know that it is something important because you were just there a few minutes ago.

Also, The therapeutic use of self to me that would relate to my client is explaining to my client each step that I would do so that they know what was
happening with the care. (I will turn you over now, you might feel some bumps under you because of the draw sheet). I believe that it helps with the
client well-being because they know what was being done. I observe that they are more at ease whenever I explaine the procedure being done.

R.M. : Lara is ver caring and speaks well with patient and family and other team members. For example checking with pharmacist on unit if mess are
not in patients bin.

3. 4 Utilize relational knowledge and skills, and ethical principles to support clients and to interact

Satisfactory

Satisfactory

with health care providers.

L.P.L. : For me, I was aware that if I told the patient what happens during care he was more compliant and willing to help when he can. Because I
know for myself when I go to the doctor's office I am thankful when they tell me what is happening throughout the whole procedure so that there are
no surprises. Explain the procedure and the steps throughout the care, giving client choice and a chance for their preferences. I can relate to this
when my mom when for a knee surgery, she was shy to ask what the nurse was doing to her everytime the nurse came in, the nurse would just do the
skill/procedure (post op unit) and leave without explaining or telling the rationale for each plan of care. When she got home I was the one changing
her wound dressing and explaining to her the importance of around the clock scheduled pain meds, she was very proud and happy at the same time
that I could explain it to her, made her feel more comfortable and confident in the nurse (me) taking care of her.

R.M. : Lara is ver caring and speaks well with patient and family. Provide privacy for jayuent by drawing curtains before providing care.

3. 5 Use self-awareness to identify the effects that beliefs, values, and personal experiences have on

Satisfactory

Satisfactory

relational practice.
L.P.L. : For me, I was aware that if I told the patient what happens during care he was more compliant and willing to help when he can. Because I
know for myself when I go to the doctor's office I am thankful when they tell me what is happening throughout the whole procedure so that there are
no surprises. Explain the procedure and the steps throughout the care, giving client choice and a chance for their preferences. I can relate to this
when my mom when for a knee surgery, she was shy to ask what the nurse was doing to her everytime the nurse came in, the nurse would just do the
skill/procedure (post op unit) and leave without explaining or telling the rationale for each plan of care. When she got home I was the one changing
her wound dressing and explaining to her the importance of around the clock scheduled pain meds, she was very proud and happy at the same time
that I could explain it to her, made her feel more comfortable and confident in the nurse (me) taking care of her.

R.M. : Lara is ver caring and speaks well with patient and family.

3. 6 Collaborate with clients, members of the interprofessional and health care teams; and, consult

Satisfactory

Satisfactory

appropriately.
L.P.L. : In the unit, we collaborate in bullet rounds with the physiotherapists, social workers, nurse in charge, unit manager and consult appropriately.
Also, if there was a concern for the client such as change of diet it would be first consulted with the MRP (most responsible physician) for an order and
I would suggest for a speech pathologist or if the patient feels pain, we would consult that with the pain specialist team.

R.M. : Lara is ver caring and speaks well with patient and family. Follow up with jayuent by doing frequent rounding.

3. 7 Uphold practices and systems that support the diversity of clients and of the interprofessional

Satisfactory

Satisfactory

health care team.

L.P.L. : In the unit, we collaborate in bullet rounds with the physiotherapists, social workers, nurse in charge, unit manager and consult appropriately.
Also, if there was a concern for the client such as change of diet it would be first consulted with the MRP (most responsible physician) for an order and
I would suggest for a speech pathologist or if the patient feels pain, we would consult that with the pain specialist team. (This upholds practices and
systems that support the diversity of clients and the interprofessional team.)

R.M. : Present In bullet rounds and ask questions for clarification fir patients.

3. 8 Provide effective client education.

Satisfactory

Satisfactory

L.P.L. : During any time of the care with the pt, with each procedure, I will tell them what will happen each step of the way, if they have questions, I
provide effective client education. Such as what kind of medication they are taking, what it is for, what it does etc. One that is usually done is at the
time of discharge, any information is explained to them verbally and is written in the discharge information given to them. Such as symptoms
worsening, levels of activity that can be done, diet that can be had at home that pertains to their situation.

R.M. : Lara listens and answer questions if she us unsure she seeks assistant from me.

Teacher comments for Engage in relational practice that is caring, compassionate and respectful. :
Lara engages in patient and family by listening and answer questions appropriately.

Advisor comments for Engage in relational practice that is caring, compassionate and respectful. :
Lara is making satisfactory progress and based on my visit she has a well developed ability to connect with the clients and staff. Her preceptor
encourages her seek clarification and Lara has been doing this.

4. Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the profession.

4. 1 Evaluate and refine leadership skills to develop solutions, resolve conflict, create a positive work

Satisfactory

Satisfactory

environment and organizational culture, and to strengthen advocacy role.

L.P.L. : As the weeks go by I constantly evaluate and reevaluate and refine my leadership skills to develop solutions and create a positive work
environment. I try to be a leader for myself, trying to learn everything that I can, absorb as much as I can because I know that in a few months time, I
will need to be doing that for real and without a preceptor there to guide and back me up although I know that there will be help given when I ask for it.
With my enthusiasm and leadership skills, it is helping create a positive work environment for people that I encounter with be it the nurses on the unit
or the pts themselves.

R.M. : Takes the initiative to learning new things.

4. 2 Provide feedback to peers and accept feedback from peers and members of the

Satisfactory

Satisfactory

interprofessional health care team.

L.P.L. : I provided feedback to my peers and accepted feedback when we had to submit the self evaluation forms to the clinical instructor. Giving
feedback and accepting feedback lead to reflect on skills that I excel in and some that still need improvement such as speaking up and being
confident and not second guess myself when I have to speak to a doctor.

R.M. : Works well in the team. Very polite.

4. 3 Advocate for clients, self, others, and quality practice environment.

Satisfactory

Satisfactory

L.P.L. : I advocate for clients, myself and others and quality practice environment by voicing out their needs. Advocating for pts when they ask for
anything such as pain medication or someone from the interprofessional team that is not ordered yet by the doctor, the MRP's are one page away to
get an order for them.

One pt, she had an NG tube and IV on for several days. One night she pulled them both out. The next morning she was our assignment and we had
orders that day for her to be sent downstairs for her NG tube to be reinserted and a special team to reinsert her IV because her whole body was
swollen. When she came back, she was asking for ice chips, however it was ordered by the MRP that she was NPO so we explained that to her.
During AM care, I wiped her mouth with some water to moisten her mouth and later gave her some petrollium jelly for her dry lips. Later in the early
morning with another nurse, she pulled out her tubes again. We are theorizing that she was really desperate to have something through her mouth
because the whole day she was asking for ice chips. The next day we informed the MRP and he assessed her, then we advocated for her that maybe
the SLP can assess her if she could have something by mouth, and it was a good moment, the orders were being pulled through and by the end of
the day, the SLP said she could have thickened fluids fed to her, but we are waiting for the doctor to approve and order the diet.

R.M. : Lara follows up with information given on her client. By making sure Doctor is paged through locating.

4. 4 Support clients rights for self-determination and choice.

Satisfactory

Satisfactory

L.P.L. : One pt, she had an NG tube and IV on for several days. One night she pulled them both out. The next morning she was our assignment and
we had orders that day for her to be sent downstairs for her NG tube to be reinserted and a special team to reinsert her IV because her whole body
was swollen. When she came back, she was asking for ice chips, however it was ordered by the MRP that she was NPO so we explained that to her.
During AM care, I wiped her mouth with some water to moisten her mouth and later gave her some petrollium jelly for her dry lips. Later in the early
morning with another nurse, she pulled out her tubes again. We are theorizing that she was really desperate to have something through her mouth
because the whole day she was asking for ice chips. The next day we informed the MRP and he assessed her, then we advocated for her that maybe
the SLP can assess her if she could have something by mouth, and it was a good moment, the orders were being pulled through and by the end of
the day, the SLP said she could have thickened fluids fed to her, we were waiting for the doctor to approve and order the diet.

R.M. : Listen and communicates well to patients and their families.

4. 5 Respond appropriately to unsafe, unacceptable, and unprofessional behaviors.

Satisfactory

Satisfactory

L.P.L. : There was a family member (wife) of one of the pt's in the unit (not my assigned patient). She looked as though she was very unsteady and
on edge. She was constantly yelling, and walked up and down the hallway where it came to a point where some of the neighbour patients were
looking out the door at her. Finally, one of the nurses had to call the security to calm her down. When I walked past her, she stopped me to say "I'm
not crazy" and that was the only interaction I had with her, but I responded politely and just smiled at her, and professionally where I closed the door
of my pt assignment to not agitate them as well.

R.M. : Lara smiles when she is approached or spoken to in an inappropriate way.

4. 6 Demonstrate public protection and acting in the interests of the public through collaboration and
consultation with other members of the interprofessional health care teams.

Satisfactory

Satisfactory

L.P.L. : There was a family member (wife) of one of the pt's in the unit (not my assigned patient). She looked as though she was very unsteady and
on edge. She was constantly yelling, and walked up and down the hallway where it came to a point where some of the neighbour patients were
looking out the door at her. Finally, one of the nurses had to call the security to calm her down. When I walked past her, she stopped me to say "I'm
not crazy" and that was the only interaction I had with her, but I responded politely and just smiled at her, and professionally where I closed the door
of my pt assignment to not agitate them as well.

Protecting the public and my family when I remove the scrubs I had on in the unit before going home. To prevent infection and for bacteria to be
passed around on the TTC and I put my uniform in the was right away so that my family is also prevented from contacting anything that got into my
uniform (specially with contact precaution residents that I care for).

R.M. : Dresses appropriately each day.

4. 7 Contribute to the creation of quality practice strategies and solutions.

Satisfactory

Satisfactory

L.P.L. : Quality practice such as hand washing when hands were visibly soiled and rubbing sanitizer whenever I enter and leave a patient's room or
whenever I put on and remove my gloves to contribute to the creation of quality practice strategies of infection control. Using PPE whenever there is
precaution for that specific pt assignment

R.M. : Lara wages her hands before and after each patient care.

4. 8 Assign, supervise, teach as appropriate, and provide feedback to unregulated care providers

Satisfactory

Satisfactory

(UCPs) in collaboration with the interprofessional health care team.

L.P.L. : When a pt was going home with heparin injection daily, it was assessed that she was capable to do her own SC injections. She has seen me
give her the injection and she was knowledgeable each time I gave her the medication she would know which it was for that time. So on the day of
her discharge, we walked her the steps of doing her own injection in her lower abdomen, and she performed the injection herself.

R.M. : Follows up and advocates for her patients. Example helping other clients and if unsure ask the nurse for that jayuent before doing anything.

Teacher comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
Takes innitiayive to complete task.

Advisor comments for Act as a leader and an advocate to empower clients, self, the interprofessional health care team and to further the
profession. :
Lara is making steady progress. I encourage her to seek out opportunities to advocate for her clients, participate in discharge planning, communicate
with the team, join and participate in patient rounds, communicate with support staff and food services to ensure patients are receiving appropriate
care. On my next visit I will discuss with how she can seek and find more opportunities to develop in all areas. Keep up the good work!

5. Integrate the nursing process into all aspects of nursing care and across diverse practice settings.

5. 1 Formulates clinical judgments that meet clients unique and changing health needs and priorities,
outcomes, and overall condition and incorporates these into evolving plans of care.

Satisfactory

Satisfactory

L.P.L. : Formulated clinical judgement/assessment that meet client unique and changing health needs and priorities, outcomes and overall condition
and incorporate them into the plans of care. When a pt was going home with heparin injection daily, it was assessed that she was capable to do her
own SC injections. She has seen me give her the injection and she was knowledgeable each time I gave her the medication she would know which it
was for that time. So on the day of her discharge, we walked her the steps of doing her own injection in her lower abdomen, and she performed the
injection herself.

R.M. : Ask questions appropriately to get adequate information for patients safety.

5. 2 Devise evidence-informed plans of care that are holistic and client-centred.

Satisfactory

Satisfactory

L.P.L. : Submitted the concept map in class this semester and in previous semesters and it was a theory-based plan of care that was holistic and
client centered, articulated competently in writing and orally about one of my clients diagnosis

R.M. : Lara cares for the whole patient. Making sure pain killers are given before physiotherapist sees patient.

5. 3 Use clinical judgment to assess clients, prioritize needs, outcomes, and nursing interventions.

Satisfactory

Satisfactory

L.P.L. : Used clinical judgement/assessment that meet client unique and changing health needs and priorities, outcomes and overall condition and
incorporate them into the plans of care. When a pt was going home with heparin injection daily, it was assessed that she was capable to do her own
SC injections. She has seen me give her the injection and she was knowledgeable each time I gave her the medication she would know which it was
for that time. So on the day of her discharge, we walked her the steps of doing her own injection in her lower abdomen, and she performed the
injection herself.

R.M. : Lara teaches patient on questions that is asked of her.

5. 4 Collaborate in the evaluation, refinement and modification of plans of care.

Satisfactory

Satisfactory

L.P.L. : I collaborate with the preceptor in the evaluation, refinement and modifying plan of care for my client to achieve a holistic plan of care for my
pt. I discuss my plan of care with the preceptor and then implementing it.

One pt, she had an NG tube and IV on for several days. One night she pulled them both out. The next morning she was our assignment and we had
orders that day for her to be sent downstairs for her NG tube to be reinserted and a special team to reinsert her IV because her whole body was
swollen. When she came back, she was asking for ice chips, however it was ordered by the MRP that she was NPO so we explained that to her.
During AM care, I wiped her mouth with some water to moisten her mouth and later gave her some petrollium jelly for her dry lips. Later in the early
morning with another nurse, she pulled out her tubes again. We are theorizing that she was really desperate to have something through her mouth
because the whole day she was asking for ice chips. The next day we informed the MRP and he assessed her, then we advocated for her that maybe
the SLP can assess her if she could have something by mouth, and it was a good moment, the orders were being pulled through and by the end of
the day, the SLP said she could have thickened fluids fed to her, we were waiting for the doctor to approve and order the diet to implement the new
order of diet.

R.M. : Enquires and follow up on jayuent a care plans and appointment.

5. 5 Safely and competently perform treatments and use techniques, and technology autonomously
and in collaboration with clients and members of the interprofessional health care team.

Satisfactory

Satisfactory

L.P.L. : Safely and competently perform treatments and use techniques and technology autonomously and in collaboration with clients and members
of the interprofessional team. For example when I use the technologically advanced automated cuff to take the vital signs, the bladder scanner, the
vac dressing machine, the IV pump and I safely and competently perform those treatments. Treatments of changing the wound dressing safely is
also very important to avoid infection, using the right body mechanics for movement and teaching the same techniques to the pts are important to
avoid any injury.

R.M. : Provides care to patient in professional and competent manner. Ask for help when needed.

5. 6 Collaborate with the clients across the lifespan and with members of the interprofessional health

Satisfactory

Satisfactory

care team to create a client centered plan of care that is articulated with competence both in writing
and orally.
L.P.L. : With each pt, it is important to collaborate with the clients across the lifespan and with members of the interprofessional health care team to
create a client centered plan of care that is articulated with competence both in writing and orally. When we collaborate with the interprofessional
team especially in bullet rounds, sometimes orders for the team need to be ordered by the MRP and that is when we obtain it through the phone and
then it is articulated in writing afterwards either by my preceptor (verbal/phone order) or the doctor orders it themselves.

R.M. : Present st all bullet rounds. Watches time and making sure we go on time.

5. 7 Use awareness of own knowledge and skills, the three factors of nurse, client and environment

Satisfactory

Satisfactory

and the practice decision-making framework to guide practice.

L.P.L. : As an RPN I can work autonomously, however when there is a change of my pts status and they suddenly become very unstable, it is vital
that I communicate that with my preceptor the interventions that I am providing and knowing when my knowledge and experience are limited and
need help and/or collaboration with the charge nurse or even transfer the assignment to the charge nurse or who she will assign it to.

We had a pt who had a tracheostomy, and using the three factor framework it was decided that this pt stable or not was not supposed to be under an
RPN's care, as per protocol of the hospital as well. We followed that decision making tool and the assignment (the three factor framework) and was
transferred to an RN.

R.M. : Lara works well in a team or independently

5. 8 Manage workload, time, and physical resources to provide effective, efficient and ethical care.

Satisfactory

Satisfactory

L.P.L. : To manage workload, time and physical resources it is important to prioritize nursing care and interventions or simply planning when to do
the care is important. I had an ISOLATION case where I prioritized and think of a plan so that once I was in the room, I did not need to leave the room
and regown again. This way it was not time consuming and it did not tire me out going in and out of the room (putting PPE on and off). E.g. gathering
all the equipment for am care, and meds so going in and out of the room would not be cumbersome. Gave perineal care before changing the wound
dressing and provided morning care etc.)

R.M. : Lara keeps herself safe by checking patient

Teacher comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :
Doing well

Advisor comments for Integrate the nursing process into all aspects of nursing care and across diverse practice settings. :

Lara is encouraged to work to improve her ability to assess clients, prioritize needs, outcomes, and provide appropriate nursing interventions.
Take time to review the patient care plans, suggest possible changes and learn from the process.
On a day to day level review all nursing interventions, assess patient progress, implement changes if necessary and evaluate progress or actions.
Seek out any opportunities to inform/educate support staff, client or family as an aspect of this process.

6. Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and holistic health care in a
complex and changing environment.

6. 1 Collaborate with clients to determine needs, mutually agreed health outcomes, approaches to

Satisfactory

Satisfactory

care, and to evaluate care.

L.P.L. : I collaborate with my preceptor in modifying my plan of care for my client to achieve a holistic plan of care for my pt. I discuss my plan of
care with the nurse and then implementing. When my client was complaining of nausea and she was throwing up but she would refuse Gravol and
pain medication. I explained to her that the Gravol can help with her feeling nauseated maybe from the anesthesia that she received from surgery and
pain medication can help her feel better from the surgery she received. She still refused the medication and I supported her needs and mutually
agreed that when she felt worse she can ask for the medication or any other help. Later in the day once her nausea was gone, however she felt pain
so she asked for pain medication that I gave to her immediately. Both of us were happy with the health outcome.

R.M. : Communicates with staff. Listens well to feedback.

6. 2 Contribute as a member of the interprofessional and health care teams to respond to changing

Satisfactory

Satisfactory

client needs and outcomes.

L.P.L. : I contributed as a member of the inter-professional health care team and responded to the changing needs and expected outcomes of the
clients when my client was experiencing a lot of pain, I checked her pain medication and when it could be given, I carried out the order and monitored
my patient for the therapeutic effect of the pain meds, I also gave the medication time to be absorbed before providing dressing change so that she
wouldnt be in a lot of pain while doing the procedure or while moving her leg.

R.M. : Communicates well with other members if the team.

6. 3 Consult with and seek out assistance from members of the interprofessional health care team.

Satisfactory

Satisfactory

L.P.L. : When doing transfers with the ceiling lifts I would seek out assistance with the unit staff. Or if I needed some assistance with something I ask
for help and consultation with my preceptor. The unit nurses are generous with their knowledge and most are more than happy to help especially with
clients who have preferences. Knowing patient preferences help with providing safe and compliant care, and helps in a therapeutic client nurse
relationship.

R.M. : Lara asks fur help when needed.

6. 4 Use teamwork, consensus building, and conflict resolution and leadership skills to meet

Satisfactory

Satisfactory

expected client outcomes.

L.P.L. : I help the nurses with what they needed, this enables for teamwork and concensus building and to avoid conflict (e.g. when I need help they
would be willing to help me out as well because I helped them when they needed someone). When giving a bed bath with a heavy resident, I would
ask if they needed an extra set of hands and hope that vice versa they would do the same. (Common courtesy)

R.M. : Speak to staff, mangers in appropriate manner.

6. 5 Integrate effective, collaborative, and consultative strategies to meet clients needs within a

Satisfactory

Satisfactory

changing environment.
L.P.L. : One pt, she had a psych consult in her file, it was for query of bipolar or schizophrenia, on the evening before her surgery to be held in the
morning, it was observed that she was getting a little worried and more not herself, even her family who visited everyday noticed the change in her
usual self. She would forget things and everyday events such as shift report that did not bother her before she was getting agitated about. I
integrated effective strategies to meet the client needs and the changing environment (her upcoming surgery) to calm her down by explaining all her
queries, and this would settle her until she had another concern that I would address right away. (The time of the surgery, the talking of the nurses
during shift change, the time that she was to be NPO for the next day etc) I would remind her gently everytime she would forget and understood that
the change in situation (surgery) was a factor and all she needed was reassurance and explanations.

R.M. : Seeks clarification if unsure about task to be done.

6. 6 Respect the unique role and competencies of all members of the interprofessional health care

Satisfactory

Satisfactory

team.
L.P.L. : I respect the unique role and competencies of all members of the interprofessional team (rpn or rn, administrator, pain team, vac team, IV
specialist, phlebotomists, pharmacists etc.). Also interact with the PT whenever they are to see my pt. The tray deliverers, the maintenance all help
to provide a holistic health care approach to the residents. Everybody is there for the holistic care of the patients.

R.M. : Cares for patients well.

6. 7 Collaborate as a member of the interprofessional health care team to respond to changes in

Satisfactory

Satisfactory

nursing knowledge and practice and in the health care environment.

L.P.L. : I respect the unique role and competencies of all members of the interprofessional team (rpn or rn, administrator, pain team, vac team, IV
specialist, phlebotomists, pharmacists etc.). Also interact with the PT whenever they are to see my pt. The tray deliverers, the maintenance all help
to provide a holistic health care approach to the residents. Everybody is there for the holistic care of the patients.

R.M. : Lara likks at the whole patient and family when giving care.

Teacher comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
In tiny to do a good job.

Advisor comments for Collaborate and consult with clients and the interprofessional health care team to provide comprehensive and
holistic health care in a complex and changing environment. :
Satisfactory progress - Lara is learning to develop professional responses though effective collaboration with the team. She is learning to develop
professional responses though effective collaboration with the team, clients and families. With more clinical time Lara can implement the nursing
process into all aspects of client care, education and discharge planning.

7. Engage in Quality Assurance consistent with the regulatory framework.

7. 1 Act in the best interests of clients and protect clients from harm through collaboration and
consultation with other members of the interprofessional and health care teams and by through
competent and safe practice.

Satisfactory

Satisfactory

L.P.L. : Same as point 6.2, I acted in the best interest of my client, waiting for the medication to work before providing the painful dressing change
that had to be done daily, which shows competent, safe and holistic nursing care.

R.M. : Assess patient and Give appropriate care.

7. 2 Commit to Quality Assurance practice to identify strengths and areas for professional growth and

Satisfactory

Satisfactory

in accordance with the regulatory framework (CNO).

L.P.L. : I engage in ongoing reflective practice to identify strengths, areas for improvement and integrate feedback into practice using the Quality
Assurance program from the CNO website, and received feedback from my peer and integrate it into my QA to be handed in at the end of the rotation

R.M. : Hand in workbook time. Keep up to date on all task and school work to be done

7. 3 Create, implement, and evaluate a learning plan consistent with the Quality Assurance program

Satisfactory

Satisfactory

Satisfactory

Satisfactory

(CNO).
L.P.L. : Learning plan consistent with QA program is also due by the end of the rotation

R.M. : Does he rework in timely manner.

7. 4 Assume responsibility to seek out feedback for colleagues and peers and learning opportunities
that foster professional development.

L.P.L. : By being vigilant and observant I was able to seek out learning opportunities and feedback that foster professional development and integrate
it into practice. Seeking out opportunities if IV lines need to be primed or 2ndary lines to be changed and also primed, wound changes, vac dressing
changes, catheters, NG tubes, colostomy etc.)

R.M. : Learns quickly and alwaysvwillingnto help.

7. 5 Consistently review nursing research and information about health care to improve competence

Satisfactory

Satisfactory

and to support clients.

L.P.L. : I was able to utilize nursing, theory and literature to improve my nursing practice when I did my scholarly paper in THEORY semester. (E.g.
nursing research such as our ebooks to research for our concept maps on a specific medical diagnosis of a patient and prioritizing nursing
interventions, scholarly paper reviewed papers etc.)

R.M. : Keep up with school work.

7. 6 Develop professional responses to health care system changes resulting from advances in

Satisfactory

Satisfactory

research, technology, and changes in societal and political forces.

L.P.L. : Always educating myself and reminding myself that there are changes to the health care system, technology and society as it affect nursing
practice. (Meditech software, being used in the unit for documentation etc.)

R.M. : Documents clearly. Asking for help when needed.

Teacher comments for Engage in Quality Assurance consistent with the regulatory framework. :
Ok

Advisor comments for Engage in Quality Assurance consistent with the regulatory framework. :

Lara is developing professional standards for her practice and she is aware of the professional requirements of the CNO. She is participating in self
evaluation which is an aspect of quality assurance. Through leadership studies and discussion she is learning about the changes possible as a result
of advances in research, technology, and changes in societal and political forces. She is currently taking a leadership course to support this process.

8. Use critical thinking, problem solving and decision making skills to meet the health care needs and expected outcomes of clients.

8. 1 Use critical thinking to inform decision making in all aspects of nursing care.

Satisfactory

Satisfactory

L.P.L. : Using a care plan as a tool, helps me complete my care responsibilities and nursing interventions in an organized manner. It helped me
utilize my problem-solving skills to inform decision making in all aspects of nursing care by helping me to point out the ineffective or maladaptive
aspect of the client's progress.

E.g. Knowing to administer pain meds before performing a painful wound dressing, and evaluating that the increased pain medication dose has a
therapeutic effect.

R.M. : Takes iiniatiat me and does not shy away when asked to get involved in patient care. Example taking out any rives and doing dressing
changes.

8. 2 Use clinical judgment to assess and refine assessments in collaboration with the

Satisfactory

Satisfactory

interprofessional health care team, formulate nursing diagnoses, plan nursing interventions, and
outline evaluative criteria.
L.P.L. : Using a care plan as a tool, helps me complete my care responsibilities and nursing interventions in an organized manner. It helped me
utilize my problem-solving skills to inform decision making in all aspects of nursing care by helping me to point out the ineffective or maladaptive
aspect of the client's progress.

E.g. Knowing to administer pain meds before performing a painful wound dressing, and evaluating that the increased pain medication dose has a
therapeutic effect.

R.M. : Assess patient and offer care appropriately.

8. 3 Evaluate and refine critical thinking, problem solving, and decision-making skills.

Satisfactory

Satisfactory

L.P.L. : I engage in ongoing reflective practice to identify strengths, areas for improvement and integrate feedback into practice using the Quality
Assurance program from the CNO website, and received feedback from my peer and integrate it into my QA to be handed in at the end of the rotation.

R.M. : Searches Internet to get more information when needed.

8. 4 Integrate knowledge from variety of nursing, health, and other theory into nursing practice to

Satisfactory

Satisfactory

provide safe and competent care.

L.P.L. : I was able to utilize nursing, theory and literature to improve my nursing practice when I did my scholarly paper in THEORY semester. (E.g.
nursing research such as our ebooks to research for our concept maps on a specific medical diagnosis of a patient and prioritizing nursing
interventions, scholarly paper reviewed papers etc.)

R.M. : Seeks own learning by searching online.

8. 5 Prioritize effectively.

Satisfactory

Satisfactory

L.P.L. : Using my care plan and being able to change and modify it throughout the day to accommodate the client and their needs. I am able to
prioritize effectively incorporating the time that I need to go on my morning break, and the time I need to give medication and morning care along and
using my critical thinking skills in helping me decide what can be done after my break and what needs to be done right away in the beginning of the
shift.

R.M. : Organizes herself each morning. Seeks help when needed.

8. 6 Demonstrate professionalism, responsibility, and accountability.

Satisfactory

Satisfactory

L.P.L. : I act in a responsible, ethical and accountable manner by arriving early and being on the unit at least 30 minutes before the start of the shift
so that I can check the daily patient assignment, get a Med Cow ready with the patient room numbers, and have time to do some research on the
patient information.

When taking down client information, I only take information I need for the care for that day, do not talk about my patients to personnel who are not
authorized or outside of the unit and not take other information that can identify them to other people. I do not discuss the client information with
others, and all information stays at the unit. I keep passwords for the med cow, meditech safe and always log out when I leave the computer. At the
end of the day, all paper are put into the shredder.

R.M. : Protects patient unformation by logging out from computer when leaving to answer a call bell.

8. 7 Use critical thinking, the practice decision-making framework and the nurse-client-environment

Satisfactory

Satisfactory

framework to inform clinical judgments and practice.

L.P.L. : As an RPN I can work autonomously, however when there is a change of my pts status and they suddenly become very unstable, it is vital
that I communicate that with my preceptor the interventions that I am providing and knowing when my knowledge and experience are limited and
need help and/or collaboration with the charge nurse or even transfer the assignment to the charge nurse or who she will assign it to.

We had a pt who had a tracheostomy, and using the three factor framework it was decided that this pt stable or not was not supposed to be under an
RPN's care, as per protocol of the hospital as well. We followed that decision making tool and the assignment (the three factor framework) and was
transferred to an RN.

By using the critical thinking, with someone who was in unstable condition, something like an accident was avoided because that critical patient was
transferred to an RN who had more experience with tracheostomy care which was important to keep the airway. We avoided problems and kept the
pt safe and stable.

R.M. : Learns quickly and takes initiative to enhance learning.

Teacher comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
Lara is doing well. Seeking and giving information when needed.

Advisor comments for Use critical thinking, problem solving and decision making skills to meet the health care needs and expected
outcomes of clients. :
Satisfactory progress - with more clinical time Lara will have the opportunity to develop increased clinical judgment to refine assessments. In
collaboration with the interprofessional health care team and her preceptor she is encouraged to formulate nursing diagnoses, plan nursing
interventions, and follow up with an evaluation process. Keep up the steady efforts.

Student Midway Summary with Strategies for Continued Growth

I will continue to develop assessment skills and providing quality holistic care to patients and members of their family by enhancing critical thinking
skills through the use of concept maps.
I will continue to do self reflection for continued growth using the CNO QA program to reflect and celebrate my strengths and improve on my areas of
development, at least once every 6 months and keep a record on my nursing portfolio.
I will continue to seek out opportunities for in-services, nursing grand rounds, seminars that are available to enhance and add on to my learning and
widen my knowledge as a nurse/person.
I will strive and do my best to review all my courses to get ready for the March 28 exam so that I am more than ready for the licensure exam in May
2016.

Teacher Midway Summary with Strategies for Continued Growth

Lara needs to continue to do what she is doing. She needs to get more comfortable in speaking doctors.

Advisor Midway Summary with Strategies for Continued Growth

Lara has made steady and satisfactory progress and I encourage her to continue to take the opportunity to practice and learn the nursing skill
available on this unit. Her preceptor has been instrumental in her progress and has supervised her practice in this new area. They work well together
and this provides Lara with an effective learning experience. As Lara moves forward I encourage her to participate in clinical rounds or team
discussions, communicate with all of the interdisciplinary health care team and develop professional communication and confidence.
At this time is also taking two courses: Complex Issues and Leadership. Both of theses courses are demanding and have written assignments with
due dates. She is managing her and on my visit she was confident and engaged.
As you progress I encourage you to work independently and with less direct supervision. Safe practice and positive patient outcomes are of utmost
importance and both you and your preceptor have this as your focus.
Keep up the good work.

Student's References
CNO, Culturally Sensitive Care, 2009 (https://www.cno.org/Global/docs/prac/41040_CulturallySens.pdf)
CNO, Therapeutic Nurse-Client Relationship, Revised 2006 (http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf)
CNO, Quality Assurance Learning Plan Form, 2015 (http://www.cno.org/Global/docs/qa/qa2014/QA%20Learning%20Plan%20form.pdf)

Refer to Clinical Excellence Committee (CEC)

Grade

Satisfactory

Grade

Needs Development

Satisfactory

Program Coordinator Feedback

The Program Coordinator has reviewed the evaluation

Yes

No

Student Sign Off

I met with my Clinical Teacher/Preceptor and discussed my evaluation

Yes

No

In general this evaluation accurately reflects my performance

Yes

No

Submitted Date: 05-Mar-2016 19:02

Unsatisfactory