NURS 3021H Clinical Course Evaluation
Final Evaluation
Student: Rebecca Hill
Clinical Instructor: John Corso
Missed Clinical Hours: Zero
Missed Lab Hours: Zero
NURS 3020H Clinical Course Final Evaluation
Course Objective
Explain the experience
of acute illness in
individuals receiving
care in acute settings
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Interpret critical
aspects of the person’s
experience of acute
illness in relation to:
 common signs
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Progress
Evidence/Indicators
This was highly variable between patients
Many patients were in pain and lacked sleep due to around the clock nursing care
Many did not want to be there, and wanted to go ‘home’
Some felt that they were a ‘bother’ or ‘nuisance’ because they required care
Some patients appeared to be more comfortable with a hospital setting due to frequent
hospitalization because of various co-morbidities.
Many patients appeared to be motivated to regain functional ability
The amount of pain the patients experienced was also highly variable
Many felt vulnerable and embarrassed to require intimate nursing care
Many were overwhelmed by the equipment used (IV pumps), medications given, assessments
and nursing care
One patient stated that being in hospital was intimidating because there was a power
differential because the patient felt like they had no control. The patient did not want to be in
hospital and was on bed-rest, was bored with nothing to do. I discovered this through the use
of the therapeutic relationship. I attempted to rectify her feeling of intimidation by giving the
patient options with her care, so that she was able to make decisions.
Another patient confided to me that they did not like the care they received by the previous
nurse as they felt like the nurse thought the patient was complaining of pain simply to get
pain medication. This bothered the patient as they felt like the nurse disregarded his pain,
and didn’t think it was as bad as he was experiencing. As this patient was on a lot of pain
medications, this knowledge was insightful to know how the patient was feeling and
interpreting the nursing actions and behaviors. This made me conscious on my actions and
behaviors to ensure they patient did not make the same assumptions about myself.
With each assessment I tried to interpret objective assessments in conjunction with
subjective data
o For example with high blood pressure, I would look for subjective signs of pain, or
conversely with a low blood pressure ask them if they were feeling light headed and
look into medications they received recently
Satisfactory
Unsatisfactory
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and symptoms
responses to
treatment
patterns of
coping
impact on
individual and
family
relationships.
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With the use of therapeutic communication, I was better able to understand the patient’s
experience with hospitalization, surgery, recovery discharge and supports that are in place.
I asked the patient questions to better understand their values and perspectives as it may
impact on nursing care. For example if the patient states that they don’t want to be a bother,
ask what that means and if they need something they are not receiving. Also asking if the
patient is in pain if they are showing signs through body language. Asking the patient if they
are light headed when they have a low blood pressure, or are in pain when their pulse is high.
After a treatment I would follow up- to evaluate their response to the treatment. For example
I had a patient with low O2 sats, so I raised the head of the bed and encouraged deep
breathing. I then took the oxygen saturation again, and they were still low. I then applied
3L/min oxygen via nasal prongs and took the oxygen saturation again 5 minutes later. If the
patient stated they were in pain, I would look to see when they were due for scheduled pain
medications, and see if they could have any of the prescribed prn medications. I would notify
the nurse of this change in VAS, and offer them alternative measures such as ice. After pain
medication was administered I would return and ask the patient about their pain again, to
evaluate the effectiveness of the medication at treating their pain.
Through my therapeutic communication skills, I was engaged with the client and came to
understand what their patterns on coping were. Some didn’t want to bother the nurses and
suffered in silence, where others voiced that they were lonely or bored and tended to ring the
call bell often. Some patients had many visitors, while others had very few. Each person spent
their day a little differently by talking to other patients, nurses, visiting with family and
friends, watching tv, reading or staying in bed quietly.
Overall my critical interpretation of the patient experience encompassed my objective
assessments, subjective interpretations and using my nursing knowledge and critical thinking
skills to explore responses and meaning. A lot of important information that impacted my
nursing care came from conversations with the patient and asking them questions.
Looked up common lab values for patients
Linked co-morbidies with admission diagnosis and/surgery
Researched common signs and symptoms of DVT and sepsis
I came to realize that the impact of the hospitalization and surgery of the patient on the
family varied greatly as well, along with who the patient considered to be family. Some had
many visitors of family, friends or both, where others had phone calls and gifts given, where
others had no visitors at all. I found that some families requested extensive information on
my assessment, rationale and findings, where others did not seem interested in such
information.
Identify common
medical treatments of
selected acute illnesses
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Demonstrate selected
nursing and
collaborative
interventions related to
clinical pathways, perioperative 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.
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Common Orthopedic surgeries (due to OA, fractures etc)
o Uni knee surgery
o Total knee replacement
o Total hip replacement
o Knee stabilization
o Also looked after patients with frost bite, infection due to a femoral bypass graft, and
spinal stenosis
Following surgery the following were common medical treatments
o PCA pain pumps/ pain control
o O2 therapy
o Catheterization/ in and outs/ bladder scanning
o Anticoagulation therapy
o Incision care
Assessed vital signs and conducted head to toe assessment every 4 hours as per protocol. This
included:
o Neurological
o Cardiac
o Respiratory
o GI/GU
o CMS
o Integumentary
o Pain
Repositioned every 2 hours as per protocol
Documented urinary output & bowl movements
Documented fluid in and outs
Assessed pain frequently
Assessed neurological status with each patient encounter
Changed dressings on day 2 post op and provided patient with education concerning incision
care at home
Removed hemovacs on post op day 1
Used pillows to support affected limb on days 1 & 2 post op, and removed pillows for post op
days 3 & 4.
Notified preceptor and nurse of a patients changing condition
Collaboratively discussed discharge planning
Dispensed, administered and documented various oral, injection (SQ) and IV medications in a
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Identify potential
consequences/complic
ations of acute illness
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Under the supervision
of a Registered Nurse,
demonstrate safe,
timely manner
Changed soiled bedding
Assisted with am and hs care of clients
Troubleshooted IV pump errors such as distal occlusions
Hung IV bags, and primed and initiated the infusion
Inserted and removed Foley ctaheters and “In and Out” catheters
Instructed use of incentive spirometer
Educated patients and family (if applicable) on incision care and dressing changes, pain
management, signs and symptoms of DVT, PE, infection, importance of exercises, deep
breathing and coughing, repositioning and varying aspects of their recovery.
Researched various dressings applied after surgeries
Bladder scanned patients that had low urine output after surgery
Documented according to PRCH protocol: morse scale, braden scale, pathway and nonpathway charting.
Repositioned every 2 hours to reduce the likelihood of skin breakdown and pressure ulcers
and filled out the Braden scale every Thursday
Encouraged deep breathing and coughing to avoid pooling of fluids in the lungs that could
lead to infection.
Encouraged calf pumping to promote venous return
Educated patients on the signs and symptoms of DVT, PE and infection
Educated patients on incision care and dressing changes
Assessed for edema, bruising, lesions, distention, discoloration etc.
Notified preceptor when I noticed a hematoma on a patient that was having trouble with
peripheral circulation
Measured in and outs to determine fluid balance
Conducted bladder scans on patients that potentially needed a catheter
Changed attends frequently, even when not soiled
Researched signs and symptoms of a DVT, sepsis and infection
Evaluated lab values pertinent to the patient (CBC, WBC’s, biochem labs, lytes etc) and
hypothesized reasons for abnormals. Ex. Low hemoglobin after surgery due to blood loss.
a. Considered behavior change theories when educating patients on discharge planning, with
respect to their recovery. Reflected on Orem’s Self Care theory when providing and assisting
with am and hs care.
competent, evidencebased, holistic nursing
practice with clients
with acute illness
a. Apply
nursing
models
and
theories
b. Demonst
rate
therapeu
tic use of
self
c. Engage
with
patients
in an
ethical
and
culturall
y
sensitive
manner
d. Demonst
rate
health
promoti
on and
illness
preventi
on
practices
e. Demonst
rate
patient
b. Created an open and collaborate therapeutic relationship with patients by asking about
themselves with respect to their surgery and the significance of it. Was open to discussion
and answering questions to relieve anxiety.
c. Look for cues relating to cultural beliefs that may impact aspects of patient care through
observation and exploration with the therapeutic relationship. Ask about any preferences for
care and be open and flexible. Treat patients the way in which I would want to be treated,
upholding ethical principals and providing high quality care. I would also be attentive to body
language and non verbal cues from patient and family. I learned a lot from the patients. This
was demonstrated above when a patient confided that they felt intimidated with the nurses
as they felt that there was a power differential, or the patient that felt like the nurse was
disregarding their pain and intentionally seeking pain medications. In bot these situations, I
found this information through the use of therapeutic communication and with this
knowledge consciously evaluated by actions so the patient did not get the same impression
from my care and sought to give them back control of their care.
d. Health promotion & illness prevention practices revolved around patient education regarding
signs of a DVT, pain management, importance of exercises, deep breathing and coughing as
well as discharge planning. Illness prevention practices included encouraging the patient to
breathe deeply and cough during each assessment and repositioning every 2 hours. Illness
prevention practices including assisting with am and hs care, and patient education
concerning discharge and recovery. Researched medications that my patient was taking
looking at its indications, use, dose, adverse effects and contraindications.
e. I demonstrated patient advocacy on many occasions. For example, a patient told me that they
had irritable bowl syndrome and did not want to eat because they were scared of “messing
up the bed”. I asked if she would feel more comfortable wearing an attends and reassured
her that it was no problem at all if she messed up the bed. This diagnosis was not in her chart,
nor was the medication she took at home for this issue. I told the nurse about the issue and
asked the daughter to bring the medication from home so that it could be ordered by the
hospital. I also advocate for patients when they are in pain, for pain medication or
alternatives like ice packs. Another example would be when a patient discussed her fears with
me, and I discussed this with the patients nurse to allow for the appropriate emotional
support. I would also tell the nurse of changing patient status for example when a patient
(not my own) was complaining of new pain with high intensity. I went right to the nurse,
explained the issues and turned out the patient was having serious circulation issues that
needed to be addressed immediately.
f. I was able to predict many outcomes to nursing care by getting to know the patient through
the therapeutic relationship, intuition and knowledge. For example I had a patient that had
advocac
y
f. Predict
outcome
s of
nursing
care
g. Evaluate
client
response
to
nursing
care
h. Demonst
rate
accounta
bility
and
reliabilit
y
Critically appraise own
practice in relation to
nurse-client/family
interactions and as a
member of the health
care team
low 02 sats. I was able to predict that the oxygen levels would increase with elevating the
head of the bed because this positioning allows for greater lung expansion, as well as deep
breathing. I was able to predict greater oxygenation when I applied 4L/min of oxygen via
nasal prongs. I was also able to predict the change in VAS scores after pain medication was
administered.
g. Evaluating the patient’s response to nursing care included asking the patient questions,
actively listening, observing measurable indicators like O2 sat, pulse, blood pressure as well as
looking for patient cues such as body language, voice, posture etc. This was demonstrated by
asking the patient if they were comfortable after repositioning, the level of pain they were
experiencing after being toileted, asking if they have any questions or need clarification after
patient education. Another example would include a pain assessment of the patient
experiencing pain. This was then followed by the administration of pain medications. I would
go back after the pain medication was administered and re-assess for pain to evaluate the
effectiveness of the medication.
h. Each clinical shift I demonstrated accountability and reliability by attending clinical placement
each week, arriving early to view to kardex and chart if needed, receiving report from the
nurse and asking any questions and seeking clarification before assessing the patient. I would
frequently answer call bells and document voiding in their chart and inform the patient’s
nurse of any care provided or concerns whether the patients or my own. For my own patient I
documented all care provided and sought advice if I was unsure of anything.
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Informed patient, and family (if applicable) of the routine for the day which included
assessments, positioning and exercises
Provided with patient as well as family (if applicable) with patient education regarding pain
management, exercises, wound care and general discharge planning that involved the do’s
and don’ts when at home (don’t cross legs, lift heavy loads, bend more than 90 degrees for six
weeks etc)
During assessments I explained what I was doing and the rationale behind it in lay terms
Delayed assessments for short periods while patient had visitor understanding the
importance of emotional and social supports, but informed the patient and visitors of the
need for the assessment, how long it would take and that they were more than welcome to
wait in the hall while I conducted it. I answered any questions they posed to me, and sought
the answers when I was unsure.
I considered my practice in collaboration with the nurses on the floor, and asked if they
needed assistance throughout the day. I was enthusiastic about any learning opportunity they
presented.
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Participate in
professional
development based on
reflective practice and
critical inquiry
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I tried to help other nurses when they wanted it, and stayed out of the way when they didn’t.
I conducted myself in a positive and outgoing manner to increase the collaboration between
myself, the patient, the family and the health care team.
I was able to effectively take on the care of 2 patients concurrently and administering
medications to both, when the expectation was to only care for one patient. This
demonstrated my time management and organizational skills.
Self reflected on my performance after each shift
Participation in Pre & Post clinical discussions
Asking questions to preceptor, nurses, team leader and peers when unsure of a practice or
procedure or to get a different perspective
Watch other students carry out nursing skills such as dressing changes, catheter removal and
hemovac removal to solidify these skills and the steps involved for myself
Assisted other students with positioning, and toileting of patients because repetition of these
actions increased my comfort and knowledge
Answered call bells of other patients to better understand the patient population and
variance of health issues, and responses
Was enthusiastic about any learning opportunity that a nurse offered
Into future clinical shifts and placements (the remainder of the acute placement and into
chronic care), I hope to get more experience with 2 patients to further hone my
organizational and time management skills. I would also like more experience with
administering medications to gain further knowledge, comfort and confidence.
Clinical Instructor Comments (All areas marked as unsatisfactory must have a comment
Final Comments
Rebecca – I struggled to do your evaluation. Not because it was poor, but rather because you gave yourself such a thorough and complete
evaluation. In fact in my years of teaching I have seldom come across such a strong, confident student who not only functions well in clinical, but is
a well rounded individual. You have quiet leadership skills, strong basis of knowledge and skills and good critical thinking. You have an excellent
work ethic and are one of the core students in the group. I will submit this evaluation to Trent as is. I am unsure what more to do for an evaluation
other than give you the proper praise for being so diligent. I also believe that your evaluations should be submitted to Trent as an aid for other
clinical students. Your reflections were thoughtful and thorough. Your presentation on dressings was exceptional. I unfortunately can only offer a
passing grade as there is no other, but I would add that I will be glad to give you a reference at any time for such exceptional work. Your leadership
style is quiet and confident. I would also comment on your portfolio which was also exceptional. I almost did not write your evaluation in this way
because I do not want you to be over confident, but I thought about it and believe that will not happen. You were truly inspiring to work with and I
hope personally that you apply to work on B5 for consolidation and that I am able to work with you further then! I believe that you are headed for
wonderful things and I hope to keep in touch after clinical so that I can follow your career. I hope you inspire more students and clinical instructors
alike. I am glad you were in my group and I wish you success in all your future endeavors!
John
Total number of clinical hours completed_____________
Clinical Component
Satisfactory
Unsatisfactory
Please circle the appropriate outcome
Signature of Instructor___________________________________________________
Date _____________________________
Signature of Student_____________________________________________________
Date ______________________________