UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073)
Student Name: Rajvir Saini Instructor: Madonna Martin
Total Clinical Hours Missed: 7 hours
Clinical Area: Brampton Civic Hospital
Dates: April 9, 2014
Nature of Experience: Acute Health Care (Neurology)
Acute Health Challenges clinical practicum in Neurology Unit, Brampton Civic Hospital.
Legend (S = Satisfactory, U = Unsatisfactory)
Ability Instructor
1. Knowledge and its Application S
Outcomes:
1.1 Draws from multiple forms and sources of knowledge when providing nursing care with clients’ and families experiencing acute health challenges.
Student: I used Kardex to gather information for my assigned patient regarding his/her health history, diagnosis, immediate problem, diet, and ADL status, code, and physician order and progress notes .
To gather information regarding pathophysiology of diseases and nursing care, I used Lewis et al (2009), Potter & Perry (2009),BCH policies, BCH library, and Taber’s medical dictionary(2010). I used patient MAR to know about his/her medications and I used Mosby’s nursing drug reference book(
2010) to search the mechanism and compatibility of all the medications patient receiving. I reviewed Jarvi’s health assessment book and Mosby’s nursing skill videos to refresh my assessment skills. I attended labs to practice my nursing skills. I also attended Simulation labs to sharpen my skills to handle acute challenges. I referred CNO (2009) practice guidelines and standards to promote optimal well being of my patients. I attended all the in services provided by BCH during my clinical days to gain knowledge regarding new medical research and hospital policies.
1.2 Uses an holistic approach that considers knowledge from nursing and the social sciences when planning and implementing nursing care with clients experiencing acute health challenges.
Student: While providing care to a particular person, I always considered his/her physical, psychological, social, cultural, spiritual and environmental context to plan my nursing care. I used CNO (2009) practice guidelines, RNAO best practice guidelines, CNA standards, Humber-UNB curriculum, BCH policies and protocols to guide my knowledge to plan and implement nursing care. I used different evidence based assessment tools to identify the issue, for example pain assessment tool, Mini mental status examination etc. I am impressed from Nightingale Theoretical Model and used the same in my practice
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073) to meet my patient’s needs. For example I assessed my patients’ beds for quality and comfort. I always make sure that my patient have clean, dry, wrinkle free bedding to prevent infection and to reduce shearing force. Most of my patients are hypertensive. I educate them to maintain well balanced diet and healthy life style to control their blood pressure. I also incorporated Roy’s theory in my practice to help my patient to adapt to his environment. I used Roy adaptation model to create my nursing care plan. For example one of my patients was unable to empty his bladder completely; I assessed the focal stimuli responsible for his retention and implemented nursing interventions accordingly to facilitate bladder emptiness.
Instructor comments for Knowledge and its Application Ability:
Rajvir, throughout this semester you have always critically examined and integrate evidence based knowledge from credible sources in nursing. You integrated this knowledge into your practice to provide comprehensive and holistic care to your clients.
You have a full understanding of the Canadian health care system, this was noted in the way you interact with the team and advocate for the clients in your care. You have also utilized the evidence based practices according to the regulating nursing bodies to ensure safe practice and care for your clients.
2. Communication
Outcomes:
2.1 Reports and documents information effectively in a concise and defendable manner according to policies of the practice setting.
Student: In the beginning of my shift, I always participated in “bed side report” to get information regarding the current status of my patient to ensure continuity and safety of patient care. I communicated effectively with the previous shift nurse and my mentor nurse to provide client centered care to promote his/ her well being. Throughout my day, I document my every assessment and observation in a timely manner to ensure its accuracy and legibility as per hospital policies. I also share my every observation to my mentor nurse to ensure continuity of care. I always use hospital approved appropriate abbreviations in my documentations to give comprehensive, accurate and clear picture of patient’s needs, interventions and response to care received. I avoid opinions and always document specifically and objectively what I observe, smell or hear. At the end of my clinical day, I communicated my all observations and nursing care given by me to my mentor nurse.
2.2 Provides appropriate teaching to clients and families in the acute care setting.
Student: I always assess my patients and families educational level and knowledge regarding their diagnosis and treatment plans. I act accordingly and incorporate my teachings in my nursing care at appropriate time. For example while administering medication I tell them about the medication action, side effects and the methods to prevent those side effects. I motivated my S
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073) patients to learn what is necessary for them to care for themselves. Most of my patients have hemiperesis, so I teach them how they can manipulate the things to perform their ADL’s.
2.3 Begins to incorporate developmentally appropriate communication techniques within a counseling framework to facilitate therapeutic and caring relationships in anticipated acute health care situations.
Student:
I use Motivational way to change my patient’s behavior if he/she is resistant to required regimen. I always respond empathetically to meet my clients’ needs. I always remains non judgmental and aware of my personal feelings and beliefs. I use CNO (2009) practice guidelines to establish a therapeutic professional relationship with my patients. For example one of diabetic patient who was obese stated that she changed her diet after diabetes diagnosis but she could not do exercise because of time constrain. I supported my patient’s self efficacy and motivated her to do exercise by developing discrepancy.
2.5 Uses appropriate technology to retrieve, manage and interpret relevant information related to client care.
Student: I use patient Kardex and hospital computers to retrieve and interpret patient information regarding their care plans, lab reports and diagnostic tests to get up to date information to ensure client centered care that meets their current specific needs. I always protect my patient information by secured password. I use only reliable medical sites to search my patient’s diagnose and nursing interventions.
Instructor comments for Communication Ability:
Rajvir, you were able to compose concise and credible information to convey effective communication with the team. You are able to also effectively communicate independently to facilitate and maintain therapeutic and caring relationship with clients in your care.
3. Critical Thinking/Skills of Analysis
Outcomes:
3.1 With direction, analyzes data and considers perspectives and ways of knowing to make connections, formulate clinical decisions and plans for care.
Student:
Before providing care or administering any medication, I always consider patient’s current situation in my mind. I review his/her chart to see history, old and new lab values, diagnostic tests and old & current vitals. I recall my knowledge from pathophysiology and pharmacology to analyze the existing data to recognize any inconsistency. With the guidance of my
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073) teacher or mentor nurse I synthesize existing information to formulate a plan of care. I always assess my patient’s physiological, psychological, developmental, sociocultural and spiritual levels to formulate a care plan.
3.4 Reflects on previous experiences determining the meaning and relevance to current nursing care.
Student: I use reflective tool to assess my strengths and weaknesses by using Gibbs model (1988). At the end of each day I always analyzed the work I performed that day. Each situation gave me a new idea to perform the same work in a more proficient way next time. For example on the very first day when I administered meds via peg tube, I held the feed but I forgot to clamp the tube before opening port and feed leaked out. After this incident I never forgot to clamp the tube. My instructor always provided me with a constructive feedback to enhance my practice. I am continuously working to gain more practice to enhance my research skills, social determinant assessment and communication to get more accurate results.
Through continuous learning, I have improved my research skills and I utilized my knowledge to make sustainable ties with patients, other health professional and community resources. I enhance patient awareness by providing them appropriate teachings to make informed choices regarding their treatment plans.
Instructor comments for Critical Thinking/Skills of Analysis Ability:
Raj, you have implemented nursing actions after engaging in holistic enquiry and critical reflection independently. You have on continuous bases critically reflected on, and evaluated previous nursing situations intentionally and carefully transferring theoretical knowledge to the care of clients with similar diagnosis.
4. Professional Identity/Ethics
Outcomes:
4.1 Integrates applicable legal, ethical and professional standards when providing nursing care with clients and families in complex situations.
Student: I follow CHNC standards of practice and CNO (2009) to deliver safe and effective ethical care to my patients. I maintain my professional relationships with clients by providing care during my clinical hours. I deliver quality care to clients by providing them all the information they need in their acute health condition. I promote equality by connecting my patients to the support groups and resources, thus reorienting the family to existing services. This aligns well with the nursing practice
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073) standard to facilitate access and equity to promote health of population (CNO, 2009), as well as the Ottawa Charter (WHO,
2002). Whenever I feel ethical dilemma, I always consider patient’s choice as starting point unless there are some limits on that choice.
4.2 Reflects on knowledge of nursing theories to deepen one’s philosophy of nursing care and guide practice.
Student: Nightingale theory is a foundation of my nursing practice. I believe that nursing is a combination of both science and art. I provide holistic patient care, by not only taking person’s concern into consideration but also how that concern is affecting that person as a whole. The concepts of nursing, person, environment and health are the fundamental constituents of the nursing paradigm. My personal philosophy of nursing is strongly related to these constituents. Each of these concepts has their own importance in my life. Exposure to Nightingale theory provided me a great knowledge and understanding of holistic care.While Nightingale addressed the technical skills associated with the care of the sick, she also discussed attending to their psychological, social, and emotional well-being as important in the overall plan of care.
4.3 Begins to develop leadership skills to advocate for clients and families with other health professionals.
Student: I assumed leadership roles at various occasions to provide client centered care. I volunteered myself for the role of an assistant whenever my colleague or my mentor nurse needs help. I voiced my patient’s preferences to appropriate person to ensure and promote patient’s respect and dignity. For example, one day my patient Mrs. A declined to sit in a chair and my mentor nurse said, “No, you have to sit in a chair for at least 2 hrs.” I advocated for my client’s wish and changed my mentor nurse’s mind to transfer her to chair by saying that it’s her wish and we can transfer her later when she feel comfortable. Then,
I asked Mrs. A that at what time she like to sit in a chair and she replied, “may be in an hour.” I asked her again after an hour and she agreed to go in a chair.
4.5 Identifies learning needs and formulates a plan to develop professional competence.
Student: My theoretical knowledge provides me a rationale for collecting valid and reliable data about the health status of my patient, which is essential to develop effective plan and interventions. It also provides me a framework to generate knowledge and new ideas. My theoretical knowledge assists me to predict my personal nursing experience and to establish criteria to assess the quality of my nursing care. The combination of my knowledge and daily experience helps me to deliver quality care.
I empower my patients and family members by involving them actively in the process to determine their health needs and to understand the determinants of health. I help my mentor nurse to educate patients about the local resources and facilitated their interaction with the resources by fixing an appointment (CHNC, 2008).
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073)
I use reflective tool to assess my strengths and weaknesses by using Gibbs model (1988). At the end of each day I always analyzed the work I performed that day. Each situation gave me a new idea to perform the same work in a more proficient way next time. My instructor always provided me with a constructive feedback to enhance my practice. I am continuously working to gain more practice to enhance my research skills, social determinant assessment and communication to get more accurate results.
Through continuous learning, I have improved my research skills and I utilized my knowledge to make sustainable ties with patients, other health professional and community resources. I enhance patient awareness by providing them appropriate teachings to make informed choices regarding their treatment plans.
4.7 Considers personal wellness in individual health practices.
Student: I always use proper body mechanic techniques to prevent back injury during transferring or repositioning the client. I always bend my knees and keep my back straight to maintain proper body posture. I never used mechanical lift alone to transfer my patient, always ask for assistance from my mentor nurse during transfer process. I always follow infection control protocol to protect myself. I wash my hands before, in between and after client contact. I always use PPE’s wherever applicable. My immunization status is up to date.
Instructor comments for Professional Identity/Ethics Ability:
You have independently used critical self reflection to assess and modify nursing practice to ensure the ongoing delivery of comprehensive nursing care. When you have identified gaps in your knowledge you incorporated strategies to improve those gaps to provide effective nursing care and to guide practice.
5. Social Justice/Effective Citizenship
Outcomes:
5.2 Applies the principles of primary health care and recognizes the impact of the determinates of health on the hospitalization of patients and families and engages in culturally safe nursing practice.
Student: I follow CHNC (2008) standards, Primary Health Care (PHC) principles, and the Ottawa Charter (WHO, 2013) strategies to ensure equity in health services. During patient assessment, I assessed the physical, social and economical environment of my patient or his community to identify health disparities. I also remain nonjudgmental to my client’s beliefs and values in order to deliver culturally sensitive care. For example I helped social worker to identify the home care needs of a
90 year old CVA patient. We interviewed the patient and his son and explored his environment to determine the risk factors.
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073)
We offered suggestions to make change in patient’s bed room location but at the same time we explored family’s values and beliefs to accept that change.
5.5 Critically examines personal bias, scientific evidence and cultural knowledge in decision making.
Student: I remain nonjudgmental to my client’s beliefs and values in order to deliver culturally sensitive care to diverse or multicultural population which aligns well with standards . I engage in self reflection by discussing and sharing my clinical experience with my professor and my peers. I also self reflect on my own cultural beliefs and practices when I interact with patients of varying cultural background, which aligns well with practice standards of CNO (2009). Wherever possible, I incorporate generic care to my professional care to promote patient well being. Combination of generic care to professional care is an essential component of cultural sensitive care (Alligood, 2014).
Instructor comments for Social Justice/Effective Citizenship Ability:
Rajvir, I always get such positive feedback from the staff every time you work with them. You have engaged in activities independently, that consciously develop you as a respectful responsible and committed citizen. Your approaches to care are culturally competent and safe.
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Final Summary Comments:
Student Comments: I used Nightingale’s holistic approach and Roy’s adaptation model to provide optimal care to my patients. I used only evidence based practice to ensure its reliability and validity. I used variety of sources such as patient Kardex, potter &
Perry (2009), Lewis et al (2010), World health Organization website (2013), CNO website (2009), journal articles, BCH policies, Ottawa Charter, Canada Health Act and internet websites to implement my nursing interventions. I worked independently and collaboratively with my team members to determine the needs of population by studying their social determinants. I communicated effectively to gather and share information with physicians and other health care professionals. I follow CNO standards of practice and federal &provincial professional standards to deliver safe and effective ethical care to my patients. I assessed the physical, social and economical environment of my patient to identify health disparities. I worked collaboratively with health care team to promote social justice by assisting and connecting the patients to appropriate supports services. I also remained nonjudgmental to my patient’s beliefs and values in order to deliver cultural based safe care. I performed leadership role at various occasions to advocate my patient’s concerns. I incorporated my theoretical knowledge into my practice to deliver quality care. I always completed my assignments within a defined timeframe and helped my fellow students if they need any assistance. I enjoyed every moment of my clinical placement. It provided me the opportunities to
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073) establish and foster my learning skills specially G tube and IV maintenance. This placement helped me to realize the impact that nurses can have on a patient in their vulnerable condition. This course also helped me to grow professionally to a point where I can advocate for my client and for myself anywhere regardless of my work setting.
Instructor’s Response:
Rajvir, you have met all the abilities for this semester in an excellent manner. It was such a pleasure working with you this semester. From day one, your independence and professionalism was noticed and applauded. You were effective in the care you provided to your clients while integrating your knowledge from previous learning. You have a great understanding of the
Canadian health care system and the nursing regulating bodies and you continually practice according to those standards. You were able to integrate and apply the knowledge from previous courses to provide competent care. Your ability to communicate in an accurate and purposeful manner was dually noted. As you continue on your professional journey continue to take with you, the skills of critical thinking and your understanding of client care. A job well done, Good luck in the rest of your studies.
___Credit ___No Credit
Student: _______________________ Instructor: ____________________________ Date: __________________
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UNB Faculty of Nursing
Final Collaborative Assessment of Student Abilities (CASA) for NRS.323 (NURS 3073)
References:
Alligood, M. R. (2014). Nursing theory: Utilization and application (5 th
ed.) Mariland Heights, MO: Elsevier Mosby
Community Health Nurses Association of Canada, ( CHNAC, 2008). Canadian community
health nursing standards of practice.
Ottawa, ON.
College of Nurses of Ontario, (2009).
CNO Nursing Standards of Practice.
Retrieved on
Feb.23, 2014 from www.
cno .org/Global/docs/prac/41006_ProfStds.pdf
Mosby (2013). Mosby’s dictionary of medicine, nursing and health professions ( 9 th
ed.) . Toronto.
World Health Organization, (2013).
Social determinants of health . Retrieved from
WHO website: http://www.who.int/social_determinants/en/
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