ANRS 311, 2014

RNRS 311 Clinical Evaluation Tool Student: Emily Tarrell Instructor: Barb Gallogy Advisor: Katie Selle Semester: Fall Session II Course Description: Clinical course focused on nursing care of adult clients in an acute care setting. The course is designed to further develop the necessary skills for baccalaureate generalist nursing practice including an introduction to patient safety, quality improvement, and information management. Continued development and application of professional practice standards are addressed. Student Signature: ______________________________________________ I am willing to have subsequent clinical instructors review this evaluation for the purpose of promoting my learning in future clinical experiences.

Course assignments are designed to allow students to demonstrate the knowledge and behaviors essential to meet each clinical objective and succeed in the course. The interdependent nature of the objectives precludes having any one assignment sufficiently correlate with or measure student progress. Instructor ratings and comments on the various assignments, do however serve to document the student’s growth and areas for development. Ratings of – or + should be supported with comments. Each critical behavior is considered essential and must be satisfactorily demonstrated to pass the course. Passing the course includes satisfactory completion of all the assignments. Midterm Rating Key: Progressing (√) Needs Improvement (NI) Failing (-) Final Rating Key: Pass Fail

Evaluation Standards

Meets the standard Fails to meet the standard • Demonstrates expected behavior consistently. • Initiates expected behaviors constantly. • Requests assistance as needed and appropriate. • Rarely requires reminders to demonstrate expected behavior. • Demonstrates competence in expected behavior. • Performance improves with practice and experience. • Consistently solves routine problems. • Makes accurate clinical decisions in routine situations.

• Demonstrates expected behavior only occasionally or inconsistently. • Requires promoting or reminders from others to initiate executed

behaviors. • Requires assistance from others to demonstrate the behavior. • Seldom initiates expected behavior. • Performs expected behavior inaccurately or incompletely. • Makes errors in performance and/or judgment, or would make errors

without the intervention of others. • Does not recognize need for assistance and/or does not request assistance

when needed. • Performance is not significantly improved with practice and experience. • Often fails to solve simple problems or make routine clinical decisions.

ANRS 311, 2014

Essential I. Integrate the liberal

arts into the practice of nursing

Competency: Use skills of inquiry, analysis and information literacy to address practice issues.

Evaluated by: Date Rating Instructor and Student Comments Weekly writing assignments and journal entries demonstrate increasing analytical skills and increasing depth of inquiry.

Throughout √ Each week, my written assignments are becoming easier due to an increase knowledge of nursing care, as well as an improvement of critical thinking skills. I believe I always show my desire to learn and observe procedures.

My preps are becoming more in depth with less prompts and corrections. After more practice, I am able to sort of the differences between major medical diagnoses and symptoms with less guidance.

I am able to successfully complete my charting in Epic by a reasonable time throughout each work day. My SBAR notes are well-detailed and applicable to each patient as well as the interdisciplinary team.

My journal entries are thorough and well-thought out. I try to focus on several areas of the clinical experience instead of the skills alone. I am becoming more confident with my skills, therapeutic communication, and critical thinking abilities.

I have completed all of the written assignments prior to my alternate experiences, coming up with situational specific questions to inquire about that particular unit.

During post-conference, I follow up with concepts assigned in preconference that require further investigation.

I view each day as a learning experience, and I utilize the care team to answer my inquiries. For example, I made a trip to 9 Tower to request more information regarding urology concerns and CBI.

ANRS 311, 2014

Essential II. Apply skills in

leadership, quality improvement, and patient safety to provide high quality health care in a systems environment.

Competencies: 1) Apply quality improvement processes to effectively implement patient safety initiatives and monitor performance measures, including nurse sensitive indicators, in the microsystem of care. 2) Promote adherence to the evidence-based practice of providing restraint-free care (both physical & chemical restraints) 3) Implement & monitor strategies to prevent risk & promote quality & safety (falls, medication mismanagement, pressure ulcers) in the nursing care of older adults with physical & cognitive needs.

Evaluated by: Date Rating Instructor Comments Competency 1 As demonstrated by collaborative concept maps in clinical setting. Student will participate in organizational initiatives for quality improvement. Competency 2 Adheres to organizational safety and comfort assessments as evidenced by charting observations Competency 3 Utilize and demonstrate use of Braden Scale, fall prevention, restraint free protocols and other patient safety organizational protocols.

11-2 11-9 11-23 Throughout Throughout

√ √ √

I have been attempting to make each week’s concept map as detailed as possible. My first attempt flowed nicely, but could have had a bit more detail. My second attempt seemed more thorough, but lacked flow in the last page of nursing interventions. My third week was very detailed and my best work so far.

I am improving each week with my charting, getting my assessments done systematically methodically in order to complete my first charting as early as possible in the shift.

I am comfortable with the organizational machines to assess VS, and I accurately document these findings in Epic.

I try to complete most charting in the patient’s room immediately after assessments in order to assure accurate timing of care is noted.

I successfully log out of Epic to safeguard the privacy of my patients, as well as other people within the database.

I try to carefully assess each patient, utilizing the Braden Scale, FPP, and using a lack of restraints to ensure safety.

I use the Braden scale for each patient, and take extra precaution with our older adult patients, who may be at a higher risk for skin breakdown.

I implement the use of the red FPP socks, gait belts, and assistance whenever ambulating my patients to provide safety.

Fortunately, my patients have not needed to be placed in restraints. During my alternate experience in the ICU, I was able to observe two sets of restraints, and I was mindful of observing these sites for the possibility of pressure sores.

ANRS 311, 2014

Essential III: Translate current

evidence into the practice of nursing.

Competency: Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing

and evaluating outcomes of care. *

Evaluated by: Date Rating Instructor Comments Address in weekly journal entries, hand- off report, weekly clinical preps. Shared information in pre and post conference discussions. Students demonstrate this through the teaching and learning project, researching evidence-based nursing interventions from the current literature with a focus on management of the acute care of the patient. Incorporate evidence- based practice for underlying pathology on individual plan of care

11-9 10-26 Throughout 12-4 10-25 11-23

√ √ Rate NI √

I have begun to be able to communicate easier with medical jargon when needed between staff/Epic/preps. However, I am also making progress using lay terms with patients. Critical thinking is becoming easier with each week.

Each day, I have been present at the bedside report between the night shift nurse and the RN that I will be following. I have been able to share additional information due to my preps and early morning Epic checks.

During our first patient care day, I was able to share information related to my case. I came prepared to discuss my POC with my classmates, as well as other pertinent information.

I have continued to come prepared to each conference, and I have check back when I needed to gather more information throughout the day.

Teaching Learning project submitted after methodical research regarding discharge education. I believe the essay was thoroughly written and well-detailed.

My first prep went well for an initial attempt, but I know I have a lot to improve on as the session progresses. I hope to become efficient at writing NCPs.

I am becoming more and more confident with my prep assignments. I was able to show our graduate student helper my work and the constructive criticism on my sheets.

ANRS 311, 2014

Essential IV: Demonstrate

knowledge and skills in information management and patient care technology

Competencies: 1) Demonstrate skills in using patient care technologies, information systems & communication devices that support safe nursing practice.* 2) Apply safeguards & decision making support tools embedded in patient care technologies & information systems to support a safe practice environment for both patients & healthcare workers.* 3) Understand the use of CIS systems to document interventions related to achieving nurse sensitive outcomes. 4) Recognize the role of information technology in improving patient care outcomes and creating a safe care environment. 5) Implement & monitor strategies to prevent risk & promote quality & safety in the nursing care of older adults with physical & cognitive needs.*

Evaluated by: Date Rating Instructor Comments Competency 1 Complete clinical organization Electronic Medical Record training class. Uphold HIPPA policies regarding use of a patient’s electronic medical record. Competent use and appropriate application of all bedside technology systems (blood glucose meter, pulse oximetry, bladder scan, volumetric IV pumps, secured drug dispensation system). Competency 2 Use of patient’s medical record to retrieve relevant information for planning, implementation, and evaluation of clinical data to develop a safe and specific action plan of care. Competency 3 Engages in appropriate professional care during simulated scenarios. Competency 4 Comprehension of the unique health care needs of an older adult and national safety concerns regarding appropriate care of the older adult within a technological health care setting.

10-24 11-9 11-23 Throughout 12-6 10-25 11-23 11-9 11-2

√ √ √ √ √ NI √ √ √

I had all of my training and paperwork successfully accomplished before the beginning of clinicals.

We reviewed HIPPA and performed blood glucose monitoring with partners during our orientation training day.

This marked the end of our third week of clinicals. So far, I have completed BGM, pulse oximetry, and the secured drug dispensation system.

I have validated the intravenous Alaris pump system.

I competently obtain pulse oximetry levels daily.

My patient required the bladder scanner, and I completed the scan and straight catheterization.

I am able to log into Epic, gather a patient’s information, and apply that to my prep. I will improve my critical thinking skills as I practice writing more NCPs.

I am proud of the two preps from this weekend. I think they have been the most thorough and clearest to date.

At the CNE, I maintain a professional attitude as I would in the hospital setting. For that time, the mannequin is just as a real patient would be for me.

I worked with two older adult patients this weekend, and it was necessary to pay special attention to the FPP required for each one, adequate nutrition, encourage hydration, and assess neuro changes.

ANRS 311, 2014

Attended the Geriatric seminar in the Meriter conference room, where we discussed needs specific to the older adult. These include adequate nutrition, hydration, mobility/repositioning/rehabilitation.

Essential VI. Perform

communication and collaboration skills consistent with professional standards when working in interprofessional settings to improve health services

Competencies: 1) Use inter-and intraprofessional communication skills to deliver evidence-based, patient-centered care.* 2) Incorporate effective communication techniques, including negotiation and conflict resolution to produce positive professional working relationships.*

Evaluated by: Date Rating Instructor Comments Competency 1 Initiates relationship building with client, unit staff and other health care professionals Appropriately documents in computerized information system. Demonstrates individual accountability through weekly journals. Participates in interprofessional collaboration through shift-shift report. Competency 2 Accurately interprets communication techniques based on communication discussion in post-conference. Arrives at resolutions to conflict through brainstorming, questioning, active listening or negotiation. Communicates effectively using verbal and nonverbal techniques. Involves the client in decision-making.

10-25 10-26 11-9 11-9 11-16 11-2 10-26 11-22

√ √ √ √ √ √ √ √

During the shadowing experience, I immediately started to build a professional relationship with the 8 Tower staff.

During our first patient day, I worked hard throughout the day in order to document appropriately.

I am striving to make each day with patients individualized to their needs and connect with them in their own necessary way.

I have attended bedside report and always check out with my RN and NA, as well as relaying important information throught the day.

Improved on therapeutic communication techniques from the first portion of the project through the second. I was able to utilize more communication techniques with my patient DH.

At the end of the shift, I was struggling because my Pt’s IV line was not flushed at any point over the course of the day. I questioned the MAR, and my RN was impressed by my observation and contacted the MD.

During our first patient day, I established rapport and communicated effectively with my patient.

I was able to discharge my patient SF. During this process, I was able to complete discharge teaching, which included instruction about two new medical prescriptions, care at home, and methods to prevent/observe signs concerning this condition in the future.

ANRS 311, 2014

Essential VIII: 1) Integrate

professional standards of moral, ethical and legal conduct in nursing practice. 2) Formulate a personal professional practice model that addresses accountability, continuous professional engagement & lifelong learning.

Competencies: 1) Promote the image of nursing by modeling the values & articulating the knowledge, skills & attitudes of the nursing profession.* 2) Protect patient privacy & confidentiality of patient records & other privileged communications.* 3) Act to prevent unsafe, illegal, or unethical care practices.

Evaluated by: Date Rating Instructor Comments Competency 1 Review the ANA Nursing Code of Ethics. Discuss how each statement applies to current practice at the 311 level. Review and discuss the Edgewood College SON Code of Professional Conduct, as it applies to the clinical unit, during clinical orientation. Provide examples of violation and consequences through discussion and reflection. Competency 2 Review institution’s Patient Confidentiality policies and procedures. Attend Lab; “Reporting and Documentation” Student signs confidentiality contract. Review policies and procedures for computer access to client records. Monitor student performance during clinical practice and provide feedback. Competency 3 Use of simulated vignettes that address ethical, legal and moral patient care situations. Or attendance at an interdisciplinary ethics committee meeting.

10-24 10-24 10-24 10-25 10-24 10-24 Throughout 11-9 N/A

√ √ √ √ √ √ √ √ N/A

In our orientation and training day, we reviewed these ethical standards and applied them to our situation as nursing students.

I am aware of the Edgewood Code and I strive to act as a model for the Edgewood community. I dress appropriately and use appropriate language throughout my clinical environment.

I am mindful of the Edgewood values and strive to incorporate them into my experience at Meriter.

I come to the clinical setting is freshly washed and pressed scrubs according to the dress code, and I do not wear additionally clothing that is not a part of this policy.

These were completed by the clinical rotation began through the Meriter training modules.

The rest of these were completed prior to orientation, and we reviewed them as a class in the Meriter conference room.

I hope to give my classmates constructive criticism. I provide a lot of moral support and encouragement for my peers, and I am always willing to help others.

I played the role of handoff nurse to set up the CNE Simulation for three following scenarios.

The ethics committee meets on Thursdays during other course time, so I am unable to attend.

ANRS 311, 2014

Essential IX. Demonstrate

knowledge & skills in the care of patients, including individuals, families, groups, communities, and populations across the lifespan and across the continuum of healthcare environments.

Competencies: 1) Deliver compassionate, patient-centered, evidence-based care that respects patient & family preferences. * 2) Implement evidence-based nursing interventions as appropriate for managing the acute & chronic care of patients & promoting health across the life-span.* 3) Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. 4) Facilitate patient-centered transitions of care, including discharge planning & ensuring the caregiver’s knowledge of care requirements to promote safe care. 5) Provide nursing care based on evidence that contributes to safe & high quality patient outcomes within healthcare microsystems.* 6) Revise the plan of care based on an ongoing evaluation of patient outcomes.*

Evaluated by: Date Rating Instructor Comments Competency 1 The student demonstrates compassion through listening, empathy and reflection of patient’s preferences as shown through their self-evaluation and conversations shared in clinical conference. Weekly clinical encounters observed by the instructor and weekly nursing diagnosis. Competency 2 Students demonstrate their evaluation of the effectiveness of psychobiological interventions through enacting the nursing process in the clinical setting, through direct observation by the clinical instructor, and nursing diagnosis of their assigned patients, and sharing their evaluation of the outcomes that spans both psychobiological interventions in post-conference discussions. Competency 3 Anticipate discharge needs of patient, family and caregivers. Include discussion of discharge needs with interdisciplinary team members to promote safe care.

11-2 11-16 11-9 11-10 11-8 11-22

NI √ √ NI √ √

My Therapeutic Communication Part I was not as clear as I had hoped. I wish to improve for Parts II and III.

Part II was greatly improved. My patient was so thankful for my care, and I knew that I had connected with her.

Nursing diagnosis are becoming easier, as I write concept maps, as opposed to writing medical diagnosis.

I am working on improving the flow of my concept maps in order to show the activities that may benefit the patient’s condition and why. These concept maps allow me to think through the nursing process and actively participate in these activities to improve the patient’s health. DH was diagnosed with pneumonia. Throughout my concept map, I showed how CDB, ambulation, and increased fluid intake could improve her condition by eliminating excess secretions and improving lung expansion.

I was able to prep a patient and his daughter for an upcoming discharge, by teaching them about things to expect that afternoon before discharge and upon return to their home.

I helped SF and her husband prepare for discharge, planning the discharge teaching, and answering their questions. I accompanied SF to the lobby via wheelchair, and the NA helped me to position her safely in her car.

ANRS 311, 2014

Competency 4 Incorporate knowledge of pharmacology and diagnostic tests when planning and providing patient care. Student’s ability to provide a plan of care that includes safety and quality care outcomes for weekly assigned patient. Competency 5 Demonstrates ability to consider alternate interventions for identified nursing diagnosis. Shares in clinical discussions reevaluation of patient outcomes based on assessment data. Ability to be make adjustments in plan of care based on changes in patient status.

Throughout 10-26 11-16 11-23 11-16 11-8

NI NI √ NI √

Pharmacology is not second nature to me, so I need to continue applying the course work from lecture to clinical.

I am beginning to form NCPs, but I would like to improve as I complete more preps.

I think that my preps are becoming more in depth, and I am beginning to be able to form a better CP for each day to include beneficial activities.

I am proud of the flow I had this weekend. Besides a flub in communication with my RN, I successfully accomplished all of my hourly rounds, assessments, and charting.

I am trying to consider alternate interventions and recommendations for the interdisciplinary team. I wanted to encourage more PT sessions for DH to improve the strength and mobility in her left side.

I am flexible to new appointments and cares that are scheduled last-minute for my patients. I was able to switch around my POC to accompany my patient to his stress test and reevaluate our schedule for the afternoon.

n*Competency begins in NRS 311 and continues throughout entire program

ANRS 311, 2014

Midterm Evaluation Student Comments: Date: 11-17

1. Strengths with supporting examples: o I always volunteer to help Professor, the other students, and the hospital staff. After I complete my cares, I always try to check in with each

student to see if they are in need of any assistance. o I am capable of showing an emotional connection to patients in an appropriate manner. I try to check in on past patients (my admission JS is

an example) to show emotional support. 2. Areas of knowledge or skill that require further development:

o I need to improve my dexterity with certain medications. I have trouble ripping IV bags and turning off injection caps, which tends to make me nervous.

o I want to improve my knowledge from our Pharmacology course and apply it to my patients. I enjoy looking up each medication for prep each week. However, I cannot always remember what the medications are for without my notes. I hope to improve my knowledge, and be able to communicate each medication and its effects efficiently to my patients.

3. Realistic and measurable learning goals for the remainder of the semester. o I enjoyed working with a fairly complex patient this weekend. I would like to continue this in order to improve my time management skills,

complete in depth preparatory forms, and provide as much care as possible. If possible, I would like to challenge myself to prep for two patients if I was demonstrating quality care and expertise as the session continues.

o I would like to incorporate more communication with the interdisciplinary team. I learned so much from my cardiac short stay experience, as well as my trip to the stress test. I want to continue meeting as many care team members as possible. I always try to have a few solid questions to address in order to learn as much as possible.

Midterm Rating and Instructor Comments Date:

Essential I: Integrate the liberal arts into the practice of nursing. (Needs Improvement) Preps have consistently shown good data collection and

plans of care. Emily does struggle with determining the major medical diagnosis vs. symptoms, which must be researched for a good

understaning of the patient care situation. For example, on 11/15-16 she researched hypoxia, obtundation, and loss of consciousness rather than

the medical diagnosis of opiate overdose, pneumonia, and rhabdomyolosis. I discussed this with Emily during clinical as well as on the phone

after the clinical was completed. A goal for Emily is to be able to better disaggregate a vast amount of medical information and focus on the acute

problems the patient is experiencing and being treated for. Being able to identify the key diagnosis will enable her to better understand the

interventions being provided (e.g. medications), the diagnostics (abnormal lab values), and the overall plan of care. It is

important that Emily is able to put all of these pieces together before moving on to the next level. I suggest she call me while prepping, so that I

can understand her thinking and provide guidance as necessary.

ANRS 311, 2014

She is demonstrating consistent improvement in accurately identifying the reasons why patients were prescribed the medications she was passing

with and without the use of the prep sheet. She asks questions and problem solves as necessary. Her work is methodical and thorough and

demonstrates good manual dexterity while performing skills.

She is beginning to show confidence while conferring with other members of the health care team r/t plans of care. She has had the opportunity to

work with OT, PT, RNs, CNAs, and members of Care Coordination. She is not afraid to ask questions and act as patient advocate.

Journal entries provided adequate reflection on the clinical day – she discusses challenges and successes of the clinical day. She consistently

shows good insight into her strengths and areas needing improvement.

Essential II. Apply skills in leadership, quality improvement, and patient safety to provide high quality health care in a systems environment.

Emily has completed three concept maps. She needs to work on writing a complete Nursing Diagnosis statement and focus on one specific

subsystem. Feedback has been provided and I suggest that Emily bring the latest submission to her midterm conference on 11/20/14, for

continued instruction on Concept Mapping.

Emily ensures a safe environment by adhering to the 8 Tower standards of care such as implementing the Fall Prevention protocol and assessing

patients using the Braden scale. She has been very conscientious in ensuring a safe environment for her clients.

She accurately documents assessments, interventions and evaluations on the Epic documentation system. As the weeks progressed, she required

less prompting to complete all fields of the EMR.

Essential III: Translate current evidence into the practice of nursing.

Emily’s plans of care (written on prep and discussed during pre-conference) for her assigned patients are well organized and thorough. She

requires less prompting from the clinical instructor to include all essential data in her reports. She has been very flexible in reorganizing care as

priorities shifted.

Essential IV: Demonstrate knowledge and skills in information management and patient care technology.

Emily is comfortable navigating the Epic documentation system and utilizes the electronic resources to access information to facilitate

comprehensive patient care (e.g.teaching materials, discharge).

She appears comfortable with other 8 Tower technology resources such as the glucometer, bladder scanner, and Alaris IV pumps (improving with

practice and experience). She has cared for four older adult patients – her preps have addressed assessments and interventions specific to this

patient population. She is very sensitive to the care needs of the older adult and works extremely well with this patient population.

ANRS 311, 2014

Essential VI. Perform communication and collaboration skills consistent with professional standards when working in interprofessional settings

to improve health services.

Emily is showing growth in this area. She has become more confident in communications with members of the IDT as well as with patient and

family interactions.

She has completed the Therapeutic Communication assignment, Parts I and II. Part I (written portion) did not demonstrate a good understanding

of therapeutic communication (as written). Communication techniques were discussed but there were missed opportunities for more in-depth

communication to occur. Feedback was given. Emily demonstrated improvement in Part II (post clinical discussion). With this experience she

gained insights into her abilities as a therapeutic communicator. She now has a better understanding of the purpose of therapeutic communication

and the nurses role as facilitator.

Emily provides client-centered care, accommodating their needs and wishes over a nurse driven schedule. Patients and families respond positively

to Emily’s attentiveness and caring presence.

Essential VIII: 1) Integrate professional standards of moral, ethical and legal conduct in nursing practice.

2) Formulate a personal professional practice model that addresses accountability, continuous professional engagement & lifelong learning.

Emily has provided excellent examples of how she has met this Essential and the competencies. I concur with her self-assessment.

The ANA Nursing Code of Ethics was discussed during clinical orientation. The discussion focused on the students’ interpretation of each

provision and how they can apply them to their current practice.

Essential IX. Demonstrate knowledge & skills in the care of patients, including individuals, families, groups, communities, and populations

across the lifespan and across the continuum of healthcare environments.

Emily has demonstrated progress in this area. She has consistently provided client and family centered care. She developed plans of care that

took into account patient and family preferences. I concur with her self-assessment.

Emily will complete the required Teaching/Learning project in the next few weeks. She does provide patient teaching on a daily basis, which

includes addressing understanding of medications, safety precautions, and general plans of care. This activity is documented on the patient’s

EMR.

Emily has become increasingly efficient with care planning and delivery. Initially, she was unable to complete the baseline assessments before 9

am, but as the session has progressed she has been able to meet this goal. She anticipates care needs and follows through with assessments and

ANRS 311, 2014

evalations. She strives to be “on top of things” as observed by the clinical instructor. She is able to prioritize her work and and asks questions if

unsure of how to proceed. On 11/15-16 she cared for a complex patient with many medical issues, medications of varying routes,

blood glucose monitoring, IV fluid infusion, voiding trials after removal of a Foley catheter, changing trach ties, etc. She was able to provide

systematic care with good attention to detail as she accomplished the tasks of the day.

Emily has been present, on time, and prepared for the clinical day. She has been Care Team Leader on one day and demonstrated excellent

organizational, leadership, communication, and delegation skills. This experience provided a brief glimpse into the work flow and complexity of

care needs on 8 Tower and those of her peers. She will have another opportunity to act in this role on 12/8.

Emily is gaining confidence, but needs to share her fears more readily with the instructor when she is feeling unsure of herself. She fears she is not

keeping up with her peers (some have lots of CNA experiences in acute care), which I think she finds intimidating. In a phone conversation with

Emily (11/17/14) I stressed that everyone has different learning needs and is on their own path. I told her that it is my job to ascertain each

students learning needs and provide education accordingly, however it is important that she be more confident and communicative in sharing her

learning needs with me. I assured her that at this point in the session she is meeting objectives – with some areas needing improvement – but with

continued diligence on her part and support by me, she should be able to meet the objectives of the course.

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Final Evaluation Student Comments: Date: 12-12

Identify your growth over the semester in relationship to each of the six course objectives. Provide clear examples to support your assertions. I. Apply the nursing process to meet health needs of adults with a focus on secondary prevention.

a. Each week my written work expanded in medical knowledge and awareness. It became easier for me to find specific diagnoses by utilizing physician’s notes. My preps were submitted with concrete information, as well as appropriate citations. I composed my journals after ample consideration time, in order to ensure thorough reflection on my weekly work.

II. Incorporate individual differences of clients into nursing care within an acute care setting. a. As I wrote in my final journal, in the beginning I was focusing so much on each condition as a separate entity. After this clinical, I have been

able to develop a broader sense of care for each patient as an individual, realizing that the patients with the same comorbidities will have different symptoms, methods of treatment, and reactions to medication. I have established a new way to critically think through each prep in order to provide the best care for each of the individual differences of clients.

III. Communicate therapeutically with clients to promote their personal integrity. a. I developed many communication skills that needed improvement over the course of the semester. I began to employ new techniques, and

those that were uncomfortable in the beginning of the semester progressed throughout each weekend. I had a few patients that needed me to explain each process, medication, reason for care. Others needed silence in order to voice their own concerns. My last patient required therapeutic touch throughout the entire hospitalization.

IV. Analyze the acute care environment to promote and protect the health of clients. a. Each week I employed patient safety more accurately than the week prior. I made sure that my patients always had the correct number of

aides/SNs to ambulate. I adamantly attempt to clean patients’ rooms in order to free the walkways from any obstacles. I administered the correct medications while knowing the reason and action; I held medications when the patient was not in the correct state to receive them (low blood glucose, low blood pressure), and I quickly put the remaining medications back in the safety lock box.

V. Apply knowledge from nursing, the humanities, and the natural and behavioral sciences to nursing practice with adults. a. The nursing process genuinely utilizes so many areas of expertise. I attempted to bring in all of the knowledge from our courses thus far, as

well as personal experience while caring for each client. As our pharmacology course progressed, I was able to apply that education to my medication preparations. I used anatomy and physiology when researching comorbidities. However, I always maintained an ethical standpoint throughout the entire process. As an Edgewood alum, and returning student, I placed the Edgewood values at the forefront of my care.

VI. Demonstrate professional accountability when providing care with adult clients. a. The older adult population may require more thorough assessments during their hospitalization due to a greater chance of functional decline. I

listened intently during our presentation on functional decline in the hospitalized older adult, and I truly began to bring those considerations into my nursing process. I accurately used the Braden scale for this population, attempting to prevent any risk of shearing or possible pressure ulcer formation. I tried to promote suitable nutrition and hydration for each individual. I incorporated their families as much as to promote a supportive atmosphere for healthy living after discharge.

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Final Rating and Instructor Comments Date: 12/11/14

Essential I: Integrate liberal arts into the practice of nursing.

Preps showed steady improvement through out the term. Emily has incorporated Instructor feedback and since midterm has shown drastic improvement in

the prep work. Emily continues to develop her critical thinking and clinical reasoning skills. She is beginning to sort out large amounts of patient data so that

priorities can be developed. This is a huge improvement from the beginning of the term when it was difficult for her to disaggregate large amounts of patient

data. She has become more fluid with medication knowledge and passes. It is evident that she is utilizing new knowledge gained in the concurrent

Pharmacology course into everyday practice. She is also demonstrating increased confidence in her knowledge both in her written work and clinical

performance.

Emily continues to share candid insights in her journal entries. She knows her strengths and areas needing growth. Since midterm, she readily confers with

the instructor when she needs feedback on performance. A goal for Emily in her future clinical courses, will be to be more confident in her knowledge.

Essential II: Apply skills in leadership, quality improvement and patient safety to provide high quality health care in a systems environment.

With practice and feedback, the concept maps have become more fluid with good logic and flow. Emily is able to identify priority nursing diagnosis, write a

cohesive ND statement, and identify appropriate goals and interventions for each patient she has cared for. She follows the nursing process by evaluating the

interventions provided.

Emily continues to show great attention to safety with her patients on fall precautions, remaining present for patient and consistently reinforcing teaching. She

is attentive to ensuring safety by supporting and facilitating organizational initiatives for quality improvement. She utilizes the 5 R’s consistently with med

passes.

She has been Care Team Leader on one occasion and was excellent in this role. She demonstrated effective leadership skills, work flow management, and

support for her peers.

Essential III: Translate current evidence into the practice of nursing

Emily has been consistent in using evidence-based research in her written work. She is able to apply this theorectical work into practice by discussing how this

information applies to her patient’s health condition. Plans of Care (POC) are discussed during pre-clinical conference and over time she has required less

instructor support in establishing priorities for care. Reports have been thorough with few instructor cues required. Even though established POCs require

alterations as the day progresses, Emily has demonstrated flexibility in doing so. She has cared for several complex patients where shifting priorities occurred.

She required support for reorganizing the POC, but was receptive to the assistance and learned from these experiences.

She has shown improvement in “thinking like a nurse”, that is following the nursing process in it’s entirety (e.g. has become more efficient at re-evaluating

pain status after prn administration).

She is engaged in her learning during pre and post clinical conferences. She shares her knowledge regarding her patient care experience as well as contributes

knowledge related to her peers’ patient care issues. She asks appropriate questions and seems to have a great thirst for knowledge.

A score of 43/50 was received on the Teaching and Learning project. Most points were deducted for APA and Scholarly format. I will discuss the paper with

Emily at her final conference (12-11-14).

ANRS 311, 2014

Essential IV: Demonstrate knowledge and skills in information management and patient care technology.

Emily has become much more confident and fluid with navigating the EMR. She is able to retrieve relevant data to safely care for her client.

To the best of my knowledge, she upholds confidentiality polices. She has become more adept at using 8 Tower technology such as the glucometer, Alaris IV

pump, bladder scanner, etc.

Emily participated in a Simulation experience (older adult s/p hip arthroplasty requiring a blood transfusion). She was very prepared for the experience

(completed all written work and contributed to the pre-Simulation discussion). She acted out her role in a professional manner. She provided constructive

criticism to her peers in an atmosphere of mutual trust.

Emily has cared for four older adult patients. She provides information about assessments and interventions required for each patient on her clinical prep. She

has a solid knowledge base in this area. She has continued to be very cognizant and sensitive to the care needs of this growing patient population. She

attended an inservice on “The Hospitalized Older Adult” on 11/21 which further facilitated her knowledge development in this area.

Essential VI. Perform communication and collaboration skills consistent with professional standards when working in interprofessional settings to

improve health services.

This is one of Emily’s greatest areas of growth. She has become more confident in her use of effective therapeutic communication strategies, based on

individual needs.

She has become more confident while conferring with members of the interprofessional team. She recently conferred with an off-unit nurse (9T) regarding the

documentation for CBI, which isn’t typically performed on 8 Tower. With this experience, Emily learned that we need our team members (can’t know

everything) in order to facilitate quality care delivery for our patients.

She has participated in am and pm shift to shift report.

The Therapeutic Communication assignments were completed. The Part III was discussed on 12/7/14. Emily discussed how her skills have improved over

time. She utilized effective strategies (touch, silence, presence) which facilitated accomplishment of the goal (providing comfort). All criteria was met for this

assignment. Emily stated that her growth has centered on understanding the importance of individualizing communication with each patient care situation –

using silence is a technique she is becoming more comfortable with.

Throughout the term, patient centered care was provided. She was very willing and accommodating to their needs and requests.

Essential VIII: 1) Integrate professional standards of moral, ethical and legal conduct in nursing practice.

2) Formulate a personal professional practice model that addresses accountability, continuous professional engagement & lifelong learning.

Continues to have excellent self reflection and assessment of personal strengths and needs. She continues to demonstrates learning from all patient care

experiences. She continues to be very open and honest about her strengths and areas needing growth.

To the best of my knowledge, Emily upholds the moral, ethical, and legal standards of nursing practice.

ANRS 311, 2014

Essential IX. Demonstrate knowledge & skills in the care of patients, including individuals, families, groups, communities, and populations across the

lifespan and across the continuum of healthcare environments.

Emily became much more efficient with care planning and delivery toward the end of the term. She required less support from the clinical instructor over

time. She developed excellent rapport with her patients and families through her ability to develop trusting relationships. Patients greatly appreciated her

care and concern. Emily took the initiative to call her pateint’s daughter (12/7/14) to update her on his status – the daughter was very upset the day prior about

her father’s condition.

Emily has been aware of discharge/transitional care. She reads the Care Coordination notes as well as documents daily on the discharge plans (standard of

care). She has actively participated in the discharge process. She was able to witness the complexity of this process. She saw first hand the importance of

communication – both written and verbal- for smooth transitions to occur.

She has been present, on time, and prepared for all clinical days.

It has been a pleasure having Emily in the clinical group. She is persistant in her quest for learning and understanding. She takes responsibility for her

learning. She brings a positive energy to the work group, and does not let challenges impact her level of professionalism. She has handled the stress of caring

for high acuity patients, long, back to back work days, and lots of homework well. These attributes are very important to the academic challenges ahead of her.

She is very sensitive/emotional, but has maintained a professional demeanor while caring for patients.

Keep up the hard work and things will come together for you. Your caring presence will make you a great nurse!

Instructor Signature:__________________________________________Date:_______

Student Signature: ___________________________________________Date:_______