NURS1020 Clinical Course Evaluation

Final Evaluation

Student: Leah Will

Clinical Instructor: Anne V.

Missed Clinical Hours: ______ Missed Lab Hours: ______

Satisfactory Unsatisfactory
Please circle the appropriate box

NURS 1020 Course Learning

objectives
Objective Evidence/Indicators of Progress: (The student has ...) Progress
Satisfactory Unsatisfac-
tory
Established therapeutic nurse-resident
relationships in residential /long-term care Mrs. L is a resident who has dementia and often forgets the conversations
settings. we have together. She is always excited to see me and will take my hand
and show me her room and her belongings. She often asks me the same
questions each week and I answer them the same every time. Although
this is repetitive for me, I recognize that she doesn’t not realize she has
asked me the same questions before, so I just answer like I would the
first time.

I felt empathy for a resident who normally does not feed herself. Due to
the short staff, a PSW comes over to the table I was feeding her at and
takes the spoon away from her. I explain to the PSW that the resident is
unable to feed herself and often gets upset when she is unable to do it.
The PSW didn’t care, and explained that because they don’t have enough
staff they are trying to get residents to feed themselves. I didn’t agree
with this and told the resident that I will continue to work with her and
encourage independence, but if the only way she will eat is to be fed,
then this is how I will practice as a nurse.

Throughout the term I have established therapeutic nurse-resident

relationships through all activities of daily living. It demonstrates
personal intimacy when I am getting residents up out of bed, bathed and
dressed for the day. It is nice to know that the residents trust me while
doing this.

Performed skills relevant to situating an

individual within his/her personal, familial As a group, we were able to witness a body of a resident who recently
and community context passed earlier in the day. We were able to pay our respects to the resident

Developed and demonstrated skills in
basic assessment techniques relevant to
the long-term care population
who has taught us over the past semester. We demonstrated respect for
the resident as well as the family and his belongings as we continued to
learn from him even after his passing. This was a great learning
opportunity.
While interacting with the residents, I always make an effort to try and
learn about their life and their personal lives as well. While talking with
one resident one day while I was practicing an abdominal assessment, I
got talking about where I live and coincidentally, her granddaughter lived
in the same town and went to school with me. It was such a small world
and it made her excited to know that I knew her granddaughter many
years ago.
The second half of the semester was better for me in terms of being able
to do assessments on residents and I was given the opportunity more
often. While bathing patients, I would do a skin assessment. I would also
do a partial musculoskeletal assessment while dressing the residents to
see how much they could move themselves. I would conduct a
respiratory assessment whenever possible and would take a resident’s
vitals at least once a shift for practice. This enhanced my learning and
make me more confident in what I was doing.
I was able to practice a full respiratory and abdominal assessment on a
woman who was willing to let me practice on her. It was nice to do this
on a resident, opposed to a peer in lab who is likely healthy.
My partner and I walked in on a resident who was in respiratory distress.
Luckily, our clinical instructor was walking by shortly after and we all
ended up conducting a full cardiovascular and respiratory assessment on
the resident. Her O2 sats were low, as well as her BP and HR. This was
concerning to all of us because we do not know this resident well, nor do
we know her baseline. Luckily, she ended up being okay. It was a great
 learning opportunity to be put in a situation where we need to think fast
and practice our assessment skills.

Demonstrated skills in providing resident-

centered support for activities of daily Every week I continue to assist during feeding for meals. I have
living continued to demonstrate patience while feeding for some residents who
are slower to feed than others.

There have been multiple situations where a PSW or RPN will try to
pressure the resident into eating faster, or aggressively shove the spoon
into their mouth. I have advocated for the resident in explaining why it is
taking so long, or that I am trying to assist them in feeding themselves,
which takes longer than if I was feeding them myself.

I gave a resident a tub bath for the first time a few weeks ago, only have
ever given them a shower or bed bath before. I am now comfortable
giving all types of baths to residents.

Developed knowledge about the

experience of residents living in a long- Throughout the small conversations I have with residents, I am able to
term care setting gather insight about what their life is like within the long term care
facility.

Mrs. L is a lovely lady with dementia and we often have the exact same
conversation every single time we meet. I often ask her about her home
and she is always excited to show me her room and her belongings. From
her excitement, I can assume that she realizes that this is her home and
she is enjoying her experience here.

Another resident, Mrs. P is younger than most of the other people living
in the home and she does not see the long term care facility as her home.
Her room is quite empty and based on the conversations that we have, I
can assume that she has not quite accepted that this is her home and

Demonstrated safe and ethical clinical
practice at the level appropriate for a year
one nursing student
Participated in professional development
based on reflective practice and clinical
inquiry
where she lives permanently.
Even though I’ve become quite comfortable at the long term care facility
and have got to know some of the residents quite well, I still always
check for any special instructions before entering the room in case they
have changed since the last week I was there. This can include feeding
instructions regarding diet or level of assistance.
There was a situation where the floor where I was working on was
slightly short staffed for the morning shift. The PSW that I was helping
told me to get a resident up who was a mechanical and 2-person assist. I
came back out to the PSW to tell her that I needed another person to be
with me to get the resident out of bed. She seemed angry and frustrated
that I asked her for help, because the floor was busy but I still refused to
use the lift myself even though she wanted me to. I waited until another
staff member became available to assist.
Professional development includes the training course we all had to
complete prior to the start of the clinical rotation in the long term care
facility. This consisted of several modules related to situations we will
come across in the long term care setting.
Reflective practice will include the first and second reflective journal I
wrote during the 12 weeks of placement at the long term care facility. I
focused my second response on a resident that I have been feeding
consistently during our time here. She is quite difficult to feed, but I have
been learning tactics to use that work, and have come to realize what
things don’t work with her as well.
Finally, I have been looking at the charts of the residents I care for quite

Examined personal attitudes regarding the
elderly and other residents of long-term
care homes
Developed a basic knowledge of the
clinical manifestations and relevant
nursing interventions of chronic diseases
often, and it is a good feeling to understand more terms and understand
what different things mean in relation to the patient.
During feeding many times, a family member will often be present at the
table that I am feeding at. It is insightful to have a conversation with
them and understand how they feel about their loved one living in the
home. I got talking to one daughter of a resident and she was expressing
that she loves the staff that works with her mother, as it is usually
consistent staff members that care for her. It was nice to hear positive
comments from the daughter.
Not all of the experiences at the long term care home were positive. My
student partner and I were changing a resident in a room that was
attached to another room. The resident in the other room is on a strict
toileting routine and was to be changed q2h. The PSW’s who left the
room refused to change her because it was before 2 hours, however she
was claiming to be sitting in her own stool and needed to be changed.
She got quite upset and was in tears and was saying things like “I’m such
a fool to live here” and cursing. It was upsetting to see how she was
treated in that situation.
It was also nice to see that the long term care facility offered various
programs and activities for the residents to do during the day. This plays
a huge role in the experience and the personal attitudes of the residences.
I was talking to one resident who was very excited to go to Walmart for a
shopping trip. She said that it is nice to be able to get back out in the
community opposed to being “stuck” inside the facility. I have noticed
other activities such as exercise, arts and crafts, knitting and various
games to keep the residents in good spirits.
I learned a lot about dysphasia, as a lot of the residents on the unit I was
working on were needing to be fed. They were fed purred or minced
diets as a nursing intervention to avoid choking.

As the semester went on, I became more comfortable performing head to

toe assessments on residents. I would often ask residents if I was able to
practice my skills on them. This helped me gain confidence and
experience working with various people with various chronic diseases.

I learned about the practical nursing interventions for various chronic

diseases I saw in the long term care facility. Many of the residents have
dementia. Typical signs of this illness is having an impaired recall of
events and things going on in their lives, repetitive statements, difficulty
forming sentences and finding the words they want to say, becoming
agitated and becoming lost or disoriented. Nursing interventions for a
resident with dementia would be to use reminders and talk to the resident
about recent events to orient them. If they cannot find the words to say, I
could try to figure out what they are trying to say based on the previous
context of the conversation. If the resident became lost or confused as to
where they are, I would walk with them and make sure they know how to
get back to their room or wherever they were going safely. Finally, I saw
many residents get agitated, and to calm them down I would remove
what is causing the agitation, or use something to distract them to get
their mind off the topic.

While looking at charts regarding feeding, I noticed a lot of residents

have diabetes. This becomes important as an RN during meal times to
make sure they are getting a diet that is suitable for their illness. Relating
to what I learned in labs this semester, a nursing intervention is also to
look for signs of hyperglycemia, which includes an increase in thirst,
hunger and urination, as well as elevated blood glucose levels. A nursing
intervention can also be to track the resident’s physical activity and
encourage it, as physical activity can lower blood glucose levels
associated with diabetes.
 Finally, a lot of the residents I encountered have Chronic Pulmonary
Obstructive Disorder (COPD), making it increasingly difficult for them
to breathe and take in adequate oxygen. I learned how to auscultate chest
and breath sounds in lab, and got to practice a few times on a resident.
Things I could hear were inspiratory or expiratory wheezes, cracking or
other chest sounds. Nursing interventions for a resident with COPD is to
raise the head of the bed to make breathing easier. This also prevents
mucous from getting trapped and causing even more trouble breathing.
Increasing the amount of oxygen the resident is receiving is also an
important intervention to ensure maximum breathing efficacy. Also
making sure that the resident is consuming enough water and fluids to
keep the mucous from becoming thickened, which would make breathing
and coughing more difficult.

Attendance

Week 1 Week 2 Week 3

Week 4 Week 5 Week 6
Week 7 Week 8 Week 9
Week 10 Week 11 Week 12

Total number of clinical hours completed_____________

Peer Evaluation Completed ____________ _____________________

Clinical Instructor Comments Please include strengths as well as needs for improvement. There must be comments to
elaborate on any objective marked “unsatisfactory”.
 Student Comments:
Identify 3 personal strengths developed in this placement.

1. Increased confidence with basic assessments and ADL’s

2. Skilled in feeding residents with dysphasia
3. Ability to work as an interpersonal team with the LTC staff, as well as my peers.

Identify 3 areas requiring further development.

1. Understanding normal values for vitals and tests to quickly determine abnormalities
2. Medicine administration/dosages
3. Family conferences and interactions/admission processes/specific considerations & requests.

Signature of Instructor___________________________________________________ Date____________________

Signature of Student____________________________________