4th Year Theme: Integration of Professional Self into the Health Care System

Connecting Theory and Practice across NSE417, NSE418, NSE407, NUR 820/823/824/825/826
NSE 417 Student Self-Evaluation: Fall 2016
With Faculty Evaluative Comments
Mid-Term X
Student Name:

Rosette Lenon

Preceptor Name:

Marina Lam

Final _____

Faculty Advisor Name: Patricia Hynes

Clinical Practice Setting: Pediatrics (Michael Garron Hospital)

For Office Use Only:

Faculty:
End of term Review ___________
Midterm Review ____________

Student:

Self Review with Preceptors signature __

Preceptor:

Midterm Feedback ________

End of Term Feedback ________

Record of All Required Hours: _______

Accountability
Students are accountable to the
public and responsible for
ensuring that their practice
and conduct meets
legislative requirements.

For a hypoglycemic patient, they required point-of-care testing with a blood

glucose meter. From orientation, I was aware that as a pre-graduate student,
this out of my scope of responsibilities and I informed my preceptor about
this restriction. Rather than performing the procedure, I was able to watch her
perform and interpret the results, and intervention with my preceptor. I
demonstrated accountability by refraining from performing activities that I
know that I am not competent in. While I am not allowed to perform a
glucose-check, I interpreted the results with preceptor because that is a
required competency in nursing practice. I also watched her perform it
because I am aware that in the future of my nursing career, it is a skill that I
will learn through the agencys training.
During my second shift, I was unable to effectively hear a clear apical pulse
in a pediatric patient due to the lack of experience and skill. I demonstrated
accountability by seeking for my preceptors assistance immediately and
asked her for tips in the proper auscultation method in taking an apical pulse
in pediatric patients. From this, I also learnt that apical pulses are taken for all
pediatric patients. From seeking assistance, it filled the gap in knowledge and
ensured that my practice meets the appropriate guidelines in providing
accurate and safe care.

Faculty Evaluative Comments

Pass
Rosette demonstrates accountability to herself, to the clients/ families in her clinical placement and to her
preceptor. Assigned course work (LP1 and self-assessment) was thoughtfully prepared. Rosette is attentive to
timelines and negotiates her scheduled as per course syllabus guidelines.
Continued Competence
Students must assume
responsibility for their ongoing
professional development in the
practice setting (progressive
improvement in knowledge, skills
and judgment).

A nurse demonstrates continuing practice by investing time, effort and other

resources to improve knowledge, skills and judgement. A situation where I
invested time and sought resources is when I noticed a large number of
newborns being admitted for jaundice in the pediatric unit for phototherapy. I
had the basic idea on how bilirubin is a by-product of the breakdown of red
blood cells, but I did not know how it affected newborns. My preceptor filled
in this gap by addressing common reasons such as lack of nutritional intake
(due to supply of breastmilk) leading to poor output of bilirubin, or blood
incompatibility between mother and child. She also mentioned that
phototherapy aids in speeding up metabolism to secrete the excess bilirubin.
To further develop my knowledge, I researched jaundice in newborns after
my placement. I researched on its etiology, risk factors, signs and symptoms,
as well as common nursing interventions. The unit also had charts that I
reviewed regarding levels of bilirubin to determine their risk, expected
intervention, and when to notify MD. By investing time to gain knowledge of
the disease, I feel more equipped to care for the newborns diagnosed with
jaundice and perform the full scope of a nurse, and ultimately promote interprofessional collaboration.
I am demonstrating continuing competence by developing a learning plan on
asthma management that focuses on pharmacological and nonpharmacological interventions, as well as discharge teaching. I will be
creating charts, and reference notes for myself to apply into practice. I plan to
spend my time developing and applying my knowledge to my practice in
order to become competent in caring for pediatric patients with asthma.

Faculty Evaluative Comments

Pass
Rosette invests time and effort to improve her knowledge, skills, and judgment while in placement. She uses a
variety of resources to support the patients care needs and researches diagnoses and treatments that she is
unfamiliar with. Rosette participated in the HESI Exam and is working on a study plan to address content she is
still mastering.
Ethics
Students must understand, uphold
and promote the values and
beliefs described in the ethical
framework (1999). For example,
identification of ethical issues in
the practice setting and
identifying strategies, in
consultation with the health care
team, to resolve ethical issues.

The unit had a situation where the newborn has an infiltration and required an
IV to be re-inserted, and the RN explained the issue and plan to the
mother. The father became upset at an RN because we did not ask for his
permission, as he was out of the hospital, regarding the emergent nursing
intervention. One of the issues that I often encounter that clash with my
personal values are when the father often hold the power and authority to
make decisions regarding the childs care, meaning that the mother of the
child would sometimes not be form their own opinion due to their culture
where men hold power. My personal values would not tolerate this
behaviour, as I believe that gender should not equate who makes
decisions. I believe that it should be a collaborative decision between the
parents regarding a childs care. Despite my personal values, I reflected
on my thoughts and recognized this ethical issue to ensure that it does
not interfere with my professional practice, and will not show a negative
behaviour towards the family. I simply just recognized the issue, and
continued to promote a respectful therapeutic relationship towards the
family.

Faculty Evaluative Comments

Pass
Rosette understands the importance of maintaining privacy and confidentiality at all times. She acts with integrity
and honesty. She utilizes relational skill and ensures that her personal values do not conflict with professional
practice.
Knowledge
Students possess through basic
education and continuing
learning knowledge relevant to
their professional practice. For
example, being informed about
nursing and its relationship to the
health care system. Students
demonstrate the ability to provide
theoretical and evidence based
rationale for all decisions in the
practice setting.

When administering salbutamol on a pediatric patient, it is not simply

knowing how to administer the medication; I needed to possess the
knowledge to know the reason for the medication, pre and post
assessments, method of delivery to the pediatric patient and also know
the adverse effects. In order to provide the medication, I knew that
asthma causes the constriction of the bronchioles, and salbutamol is a
bronchodilator which promotes airway entry into the lungs. I also
performed a pre-assessment to hear a decreased air entry in the lower
bases, and wheezing in the left and right upper lobes. For my postassessment, I use the knowledge of the purpose of the medication and
determine that the expected outcome would be decreased wheezing and
better air entry into the lungs. The method of administering the
medication is through a spacer, and I had the knowledge to know that
this promotes better inhalation of the medication since it can be difficult
to synchronize pushing the puffer and inhaling for a two year old child. I
was able to effectively aid in administering the medication by knowing
the rationales for the intervention.

Faculty Evaluative Comments

Pass
Rosette is working hard to provide a rationale, or evidence, to support the patient care she provides on the unit.
She demonstrates the ability to access relevant resources as needed for the complexities she assesses in her patient
population. She proactively seeks new information and knowledge of best practices and was acknowledged by her

preceptor for taking this initiative.

Knowledge Application
Students continually improve
their application of professional
knowledge. Ensures practice is
based in theory, evidence and
meets all standards and
guidelines

Prior to starting placement, I did research on how taking vital signs are
different within the pediatric population. From the guidelines of Sick Kids, I
was able to know that apical pulse is taken for a full minute, respirations
taken for a full minute, and that temperature and blood pressure are often
done last because children perceive it as an invasive procedure. Many
guidelines also state that allowing the child to play with the tool before taking
it will ease the child from the procedure. There was patient that had Downs
Syndrome who was admitted. He was very afraid with the thermometer and
pulse oximetry. By reading the guidelines and tips in taking vital signs of a
pediatric patient, I took respirations and the pulse first. I let him play with the
thermometer and helped him put it on the axilla, and also demonstrated that
the pulse oximetry was not painful by putting it on my finger first, then
putting it on his finger. By doing so, the patient become comfortable and less
anxious about the situation. I was also able to effectively take vital signs in a
pediatric patient.
When administering a subcutaneous injection, I refrained from performing
it first because I recognized my lack of knowledge in performing it on a
pediatric patient, as well as lack of prior experience. My preceptor tested my
knowledge on performing the injection on a newborn. I learned that
subcutaneous injections are often injected into the thigh, with the skin
pinched at a 90 degree angle because the prepared enoxaparin had a small
needle. After placement, I researched on this. I had the opportunity of having
the same patient with a different preceptor. I informed her that I was
comfortable enough in administering a subcutaneous injection. With the same
method that I learned, I was able to successfully administer enoxaparin to the
child and applied my knowledge accordingly.
Faculty Evaluative Comments
Pass
Rosette ensures her practice is grounded in theory, supported by evidence, and in adherence to agency policies.
She uses appropriate assessment tools and techniques in consultation with clients and families and her preceptor to
assess, plan, implement, and evaluate client care. She is developing in her ability to organize her work, establish
priorities and she recognized the limits of her practice.
Leadership
Personally, I feel that this is an area of improvement as I feel that I need to
Students demonstrate leadership
demonstrate leadership. In a situation where I felt that I advocated for a
by providing, facilitating and
patient was when their child had dry skin, and they were ready for
promoting the best possible care
discharge. The mother was looking for a nurse, and I asked her what she
service to the public.
needed. She was looking for the doctor regarding the dry skin and
whether it needs a prescribed cream. To advocate for her inquiry, I
looked at her charts for any orders on the cream and could not find
anything. I was aware that the MD was in the unit, so I searched for her
and inquired her about any prescribed order for dry skin on the newborn.
She stated that it did not need any special intervention. By advocating for
the clients questions, she was able to go home with all needs met.
I also demonstrate my own professional values regarding integrity. I had the
opportunity to prepare enoxaparin. While the substitute preceptor for the day
stepped out of the room, I remained true to performing the three checks of
medication administration. By doing this, I noticed a medication error as the
prepared enoxaparin was only 0.3 mL with multiple air bubbles, and I was
intended to administer 0.5 mL as per order. I informed the RN, and she was
able to call pharmacy to correct the error. By maintaining integrity in the
safety aspect of medication administration, I was able to catch errors and
promote patient safety.

Faculty Evaluative Comments

Pass
Rosette works within the scope of practice of a nursing student-4 th year while collaborating with patients / families
and the health care team to implement professional practices. She demonstrates awareness of a safe and ethical
environment and follows established processes in her clinical encounters.
Relationships
Students establish and maintain
respectful, collaborative,
therapeutic and professional
relationships.

In promoting a nurse-client relationship, I am able to focus on familycentered care. I developed a therapeutic relationship towards the mother who
has a child that has been through multiple complication post-cardiac surgery,
and is recovering from a post-op infection. They have been in and out of the
hospital since the beginning of September. I showed respect and empathy by
recognizing the strength of not only the child, but also the mother and father
for being able to handle the stress. Whenever there is a PO medication, I
would give the medication to the mother to give to the child to promote
collaboration into the care. I felt that we had a good nurse-client relationship
as she felt comfortable with me, and trusted my skills to care for her child.
In terms of professional relationships, I role-model positive collegial
relationship between me and my preceptor as I treat her with respect and trust
her teaching methods. I acknowledge her skills and expertise, and I have been
learning about pediatric nursing by sharing knowledge with each other. This
has allowed me fill my gaps and gain a lot of knowledge regarding caring for
children.

Faculty Evaluative Comments

Pass
Rosette practices according to the Therapeutic Nurse-Client Relationship practice standard. She demonstrates
respect, empathy and interest in her patients and develops collaborative partnerships with parents, respecting their
needs, wishes, values and beliefs. Vanessa is also becoming a contributing member of the interprofessional health
care team. She is gaining knowledge of the various roles and unique health care contributions.
Areas for Growth and Development
Accountability
An area for growth and development is to demonstrate sharing nursing knowledge and expertise to meet the
clients needs. I plan to demonstrate sharing knowledge by being accountable for my patients status and report to
the following nurse. This is often done through verbal reports of significant findings, and also a paper-chart
documentation on the Kardex binder. In the future, I plan to become accountable with my patients by providing
report.
Continuing Competence:
To improve my skills of continuing competence, I plan to implement an aspect of my learning plan in asthma
management and be able to effectively administer medication with the knowledge of its purpose, adverse effects,
expected outcomes and how to incorporate the child and family into the care using my pharmacological chart.
Ethics
To develop my ability to demonstrate ethics, I want to become more conscious of the separation of my personal
and professional values. Before my shift, I want to encompass my professional values of nursing such as
maintaining integrity and promoting dignity to patient care at all times despite my personal beliefs. Preserving
dignity could include promoting privacy when needed, and accounting for their values, customs and spiritual
beliefs. When encountering a new patient, I plan to check their charts for cultural/spiritual preferences more
thoroughly and implement it into my care.
Knowledge
I believe that I still have a gap in knowledge of caring for newborns, as I feel that I have had no experience in

caring for this population. To understand the knowledge required to meet the needs of this population, I plan to
continue reviewing newborn assessments, and the common diagnosis and nursing interventions. Another aspect in
pediatrics is the shift of professional practice to a family-centered care approach. In my learning plan, I indicated
the need to recognize how to develop a family-centered care approach in order to apply it into the practice setting.
Knowledge Application
An area of growth and development is caring for PICC lines. While I learnt this skill in second year, I want to
address this gap by reviewing best-practice guidelines in caring for PICC lines (when to change dressings, how to
administer medication, locking and flushing). I plan on reading RNAOs best practice guidelines Care &
maintenance to reduce vascular access complications regarding PICC line care. I will also search for policies
regarding the nursing students role in PICC line care, and other specific hospital guidelines in order to apply them
in my practice.
Leadership
As mentioned, I feel that this is a gap in my care. I want to be able to demonstrate leadership by collaborating with
clients and the health care team to provide professional practice that respects the rights of the client. I want to be
able to promote inter-professional collaboration by independently report significant changes or inquiry about an
order to a physician and collaborate the plan of care. When reporting to a physician, I will utilize an SBAR
(Situation, Background, Assessment, Recommendation) approach when providing report to ensure communication
is clear. With this approach, I will be able to promote leadership in the clinical care setting by advocating for a
clients care.
Relationships
In order to develop my ability to promote a therapeutic relationship, I hope to be able to become more independent
with my patient assignments, and then be able to ensure that the family and childs need are met. To do this, I want
to encompass a relationship that is trustworthy, respectful, and use my power as a nursing student accordingly to
meet their needs. I plan to spend more time communicating with my patients, and asking them throughout the shift
if they have any questions or needs that I can fulfill.
In professional relationships, I hope to become more comfortable with the unit and promote inter-professional
collaboration, especially within the pediatrician. As I become more competent and knowledgeable about the daily
tasks, I hope to promote interprofessional collaboration by sharing my knowledge with other health care
professionals to determine the best quality of care to the patient. I also would like to maintain collegial
relationships with other RNs in the unit by continuing to seek guidance with respect to their expertise in pediatrics
and nursing in general.
Clinical Hours to date: 64 hours (+ 8 hours orientation, +8 LAB +3 HESI) = 83 hours
Midterm Written Work: LP1 A-

Midterm Practice: PASS

Student Signature: ________________________ Date: ______________________________

Rosette Lenon
Faculty Advisor Signature: ________________ Date: ______________________________
Patricia Hynes