Evaluations

The evaluations below are self-evaluations. While some of them have comments from clinical instructors, the purpose of my posting them is to highlight critical self-evaluation that I have completed the last three years.

FIRST YEAR                                                                         

NURS 1020: Clinical Practice in a Residential Setting
Summary of course objectives:

• Established therapeutic nurse-resident relationships in residential/long-term care settings
• Performed skills relevant to situating an individual within his/her personal, familial and community context
• Developed and demonstrated skills in basic assessment techniques relevant to the long-term care population
• Demonstrated skills in providing resident-centered support for activities of daily living
• Developed knowledge about the experience of residents living in a long-term care setting
• 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
• Examine 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

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 settings.	Week 1 (Jan 16)         -          I shook hands firmly, introduced myself and the purpose of our meeting, and kept appropriate eye contact -          Resident was comfortable such that she and I were able to converse without my prompting/probing -          Resident was warm and open and comfortable answering personal/health-related questions Week 4 (Feb 6) -          Ensured I was respectful of residents’ space when necessary, and followed lead of PSW during showering as I was not yet fully comfortable with that aspect -          Made sure to introduce myself during a new encounter with a resident -          Helped resident put on her brooch – seems insignificant but it is significant because it took a few tries to get in the right position, and when I did get it in the right position she told me I made her look beautiful. Since that interaction we always smile and say hello when I see her Week 5 (Feb 13) -          Similar to Week 4, made sure to introduce myself and explain my purpose during a new encounter with a resident and follow lead of PSW when unsure è POST-MIDTERM Week 7 (March 6) -          When providing residents with personal care, particularly bathing, I put in more effort than previous weeks to ask residents what they could do themselves and what they wanted me to do for them. Increases trust between resident and nurse and also allows nurse to familiarize self with level of independence of each resident -          Had several pleasant personal interactions during morning routines such as singing along to the radio with residents, making jokes, and talking about family. Asking questions about personal lives helps to form relationships and increase rapport Week 8 (March 13) -          During first shower with resident on new floor asked resident about her life both in the long-term care home and before she was in the home i.e. what she did for a living, where she grew up, etc. Important to have these kinds of conversations to show resident you care and are not just completing the rote task of showering them -          Noticed resident had an English accent so I asked her when she came to Canada, and she spun me a great story about how she came decades ago on a luxury ship called the Aquitania. Great example of how noticing small things (like an accent) can help relationship develop Week 9 (March 20) -          At the end of my shift I visited the resident with whom I had the fall and apologized if she was hurt at all, and she didn’t seem upset at all (she may not have remembered at all) -          During breakfast, a resident noticed my “first year nursing student” badge and seemed quite happy that I was a nursing student, so I talked to her as much as possible between bites with another resident and she kept holding my hand and patting it and smiling at me Week 10 (March 27) -          Had really lovely long conversation with resident about all sorts of stuff while I painted her nails – talked about her childhood, her life in Peterborough, found out we had a lot in common in terms of places we frequent(ed) in town. She seemed to feel more comfortable/at ease around me the longer we talked Week 11 (April 3) -          When using Hoyer lift to shower resident, resident kept saying she wasn’t ok because she was scared that she was going to fall out of the lift – kept reassuring the resident that it is indeed scary being up in the lift but that she is ok and isn’t going to fall -          Went around to residents that I had forged a connection with and told them it was my last day but it was really nice getting to know them; told one resident that I particularly clicked with that I would make sure to come back and visit (and I plan to!)
Performed skills relevant to situating an individual within his/her personal, familial and  community context	Week 4 -          Helped several residents with their daily routine including: getting them out of bed, assisting with dressing, giving them a cloth bath, giving them a shower, providing them with breakfast -          Assisted with feeding and cueing during breakfast Week 5 -          On my way to another task a resident was very slowly wheeling herself to her bedroom. I asked if she wanted me to push her there and she accepted -          I entered a residents room and she woke up and asked my where she was. I told her she was at home, but she was confused because she didn’t think it was her home. I then told her that this was a temporary home and that she will be going home soon – I discussed this with a PSW later and learned that this resident is always asking where she is and that the answer I gave is the answer most other people give è POST-MIDTERM Week 7 -          Included conversation about the weather outside during morning routine with residents to help them feel more in-tune with their environment -          Performed mini mental health assessment which included orienting patient to person, place and time: asked questions such as “Can you tell me your first and last name”, “Can you tell me what town we are in”, “Can you tell me the month/date/season” (learned that asking for specific date is not the best as date can be tricky at the best of times for those who are cognitively well!) Week 8 -          Provided encouragement to residents between bites when I was helping them at mealtimes; told them about the weather outside to make them feel more connected within the community Week 11 -          As with most other weeks, several residents with dementia were confused of their surroundings so I would repeatedly be telling residents what day it is and talking to them to tell them about the weather outside and where they were
Developed and demonstrated skills in basic assessment techniques relevant to the long-term care population	Week 1 -          Used SPICES tool to do basic assessment for older adults -          Was continuously assessing cognitive function as resident perhaps exhibited some features of dementia Week 4 -          Resident had pulled call bell and a PSW hadn’t responded so I went into resident’s room. I told her I would try to find a PSW but couldn’t find one after one loop around the home area; assessed the situation which didn’t seem to be critical so I decided to keep the patient company until a PSW arrived. Patient was partially non-verbal so it was difficult to determine what she needed but I kept talking to her and getting her water which she wanted until PSW arrived è POST-MIDTERM Week 7 -          Performed first head-to-toe assessment on patient including mental health, vitals, respiratory, abdominal, and integumentary. Learned it is important to look at resident’s surroundings as well and integrate all areas of assessment for holistic picture of resident’s health -          While I have taken vitals many times before this was my first time taking vitals on an older, frail individual which opened my eyes to the fragility of skin (esp. when taking blood pressure), the weaker heartbeat, and pitting edema in the ankles -          Learned that symmetry is very important to watch for during assessment as asymmetry may point to something wrong which is affecting one side Week 8 -          Performed second full head-to-toe assessment on a new resident. Felt like my partner knew what she was doing a little bit more than me so I made sure to think about areas I was uncomfortable in and practice them for the following week Week 9 -          Performed head-to-toe assessment alone on same resident as previous week and felt really comfortable – only forgot a couple things and flowed smoothly between interviewing, palpating and auscultating, and between body systems Week 10 -          Noticed today that assessment during basic care is coming more naturally – just because I am not doing a formal assessment doesn’t mean I am not assessing health. Found myself checking for wounds, assessing dryness/temperature/overall quality of skin during care without really thinking about it Week 11 -          Performed final assessment today that went really well – moved between each system really smoothly, was able to stay focused while still making resident feel comfortable, and felt very confident
Demonstrated skills in providing resident-centered support for activities of daily living	Week 4 -          Assisted several residents with limited mobility toilet, clean selves, groom selves, and get dressed -          Assisted resident with zero mobility shower using Hoyer lift and shower chair Week 5 -          Changed resident’s brief while in Hoyer lift, while making effort to keep her comfortable and preserve her dignity by talking in soothing manner -          As with previous week, assisted several residents in toileting, cleaning selves, grooming, dressing è POST-MIDTERM Week 7 -          As with previous weeks, assisted residents with cloth bathing and dressing but was able to do it this week more quickly and with more comfort in talking to residents while performing care Week 8 -          Showered 1 resident, changed several briefs/helped several residents with toileting, fed residents during breakfast, made beds. Feeding is more difficult than I thought it would be because you have to assess how quickly resident is able to finish each bite, how big the bites can be, how agreeable the residents are to taking food, how much of their meals they generally finish Week 9 -          Toileted several residents using sit-to-stand lift which I hadn’t used up to that point, so I’m glad I know now how to use it in practice -          Did more basic care such as feeding, clothing, changing briefs Week 11 -          One resident seemed to be in a lot of pain and had to hold a warm towel to her side to relieve the pain but this left her hands unavailable to use her walker. A PSW basically said she was faking it and she “plays the new employees like a fiddle” but I still wanted to provide resident-centred care so I held the warm blanket to her painful side so she could use both hands on her walker
Developed knowledge about the experience of residents living in a long-term care setting	Week 1 -          Learned about activities and social events resident engages in -          Discussed one resident’s joy in living at retirement home, while another resident expressed her desire to be closer to downtown -          Families don’t often visit retirement homes -          First experience in long-term care setting with ~80% of residents having dementia; saw how long-term care living is both very structured while allowing residents their freedom and dignity Week 5 -          Realized that the first three weeks of working in LTC, I saw barely any family members (I can only recall two instances). I now wonder what the social/familial experience of LTC residents is and this is something I want to know more about during Week 6. è POST-MIDTERM Week 7 -          Talked to a resident who says she feels trapped in long-term care. I asked her if her family lived close-by (Toronto) and if she had ever talked about her feelings with her family and she said she had but they made the decision to keep her in Millbrook -          Whenever I talk to a resident I ask them how they are/how they are feeling and I realized today that the answer I get is usually neutral to negative (“I’m ok” to “I’m not so great”). Wondering if this is symptomatic of aging in general or of living in long-term care?? From what I have seen, residents do not seem too happy/satisfied with life. Week 8 -          First day on new home area and several residents seem much happier here, while several residents are merely placed by the window in their wheelchairs between mealtimes which seems questionable in terms of QOL (but difficult to really know due to their level of dementia??) Week 9 -          Seeing that balancing dignity and care is tricky. Before resident had her fall, I had just pulled her pants down for her to go to the washroom, and after her fall, she was stuck on the ground with no pants (as I couldn’t lift her off the ground myself) when the nurse and 3 other PSWs were in the room with us. Of course having the other people there were necessary to handle the situation but at that point in life when you are so dependent on others there is an inevitable loss of dignity to some degree Week 11 -          During shower resident was very agitated and kept saying things like “It’s not okay. It’s okay for you but you don’t have to live here.” I would have really enjoyed sitting down and talking to her about her living experience but it was the end of my shift
Demonstrated safe and ethical clinical practice at the level appropriate for a year one nursing student	Week 1 -          Stated name, purpose, and future use of information gathered during interview to ensure informed consent Week 4 -          Ensured that all mechanical lifts were done with a PSW assisting -          Implemented proper handwashing techniques at critical times including bathing, oral hygiene, and meal times Week 5 -          During Week 4 I was reprimanded by a staff member for doing something incorrectly during breakfast as I did not know how to do it. Realized that staff don’t always know what we do and don’t know so it is my responsibility to ask questions – made sure to ask lots questions during the Week 5 breakfast as errors could be dangerous to residents who have special dietary needs è POST-MIDTERM Week 7 -          When performing first head-to-toe assessment made conscious effort to get permission from resident before physically touching her and to tell her everything that I was about to do. Still need to improve on this however. Week 8 -          PSW asked me to toilet a resident who used a special device for the toilet; I didn’t know how to use this device so I told the PSW this instead of trying to use it without proper knowledge Week 9 -          Made sure a PSW was always present each time a mechanical lift was required to toilet resident -          Experienced a fall with a resident. As soon as I noticed she was falling I knew there was nothing to do to stop it so I immediately put my hand behind her head to prevent head injury and helped the resident gently to the ground as she fell Week 11 -          By the end of these 12 weeks I now feel totally capable of providing safe and ethical care – while I would sometimes forget these things at the beginning of this rotation it is now second nature to ensure privacy, perform hand hygiene, tell the resident everything I am doing before I do it etc
Participated in professional development based on reflective practice and clinical inquiry	Week 1 -          Clinical day one: participated in over 3 hrs of discussion + reflection with peers in clinical group -          Reflected upon possible cognitive decline in resident with clinical instructor -          Submitted reflective journal during Week 4, focusing on initial experiences in long-term care and retirement living Week 4 -          Felt very overwhelmed as there wasn’t a whole lot of guidance – we were sort of placed right into action. Expressed these feelings during debriefing and was glad to hear that others felt the same way Week 5 -          Feeling like I am not practicing a lot of skills as much as other students are as the residents in my home are quite independent; explored other options during debriefing such as moving to another home area where I will be more challenged and will have more opportunities to get my hands dirty -          Also acknowledged that I can always assert myself even more and actively seek opportunities to practice skills -          On two separate occasions I gave a resident a drink which they dropped. After this I did some reflecting and decided it is very important to assess the ability of an individual to hold a cup of liquid independently, and assist if necessary – will implement this assessment in the future è POST-MIDTERM Week 7 -          Debriefed with Kristen after my first assessment on rationale for various assessment techniques and what to watch for when assessing – i.e. the technique of asking simple questions that residents can understand, watching for symmetry, feeling for skin breakdown, always inquiring about any pain -          Accompanied two other students in their head-to-toe and tried to guide them and prompt them through the assessment where I could. Was helpful in making me remember what to include in an assessment, and by watching what other students are doing right/wrong I can use that to reflect on what I did right/wrong. Week 9 -          While I realize falls are taken seriously, I didn’t realize there was so much follow-up required – nurse had to be called in to do an assessment on resident, follow-up assessments are required every few hours, and paperwork had to be filled out. While I am unhappy the resident had a fall I’m glad my first fall experience happened early in my training so I will know how to handle it better next time -          Today and last week were days where I was really starting to feel more comfortable with the tasks of long-term care and communicating with older individuals with dementia – feeling more like a nursing student at this point. Week 11 -          Reflected on experience with group after final clinical day. Amazed at the growth I have experienced – for the first few weeks was distraught at my feelings of inability to care for the elderly and my dislike of the rotation and doubt that I actually wanted to be a nurse, and now feeling confident that this is where I want to be (not long-term care, but definitely nursing in general)
Examined personal attitudes regarding the elderly and other residents of long-term care homes	Week 1 -          Residents have opposing views: first resident was “happy-sad” to be living in home, other resident has “died and come to heaven”. Delved into explanations behind these viewpoints during conversations with residents Week 3 (Jan 30) -          During tour of LTC witnessed a January birthday party with live music being played by residents. Thought about all the talents and hobbies residents had when they were younger and how they still seem to have opportunities to practice these talents in LTC. Residents seemed very happy and joyful Week 4 -          After first day caring for long-term care residents, I felt uneasy about the quality of life for long-term care residents and felt that they were just following directions of LTC staff (despite the previous week seeing how happy the residents looked). I did a bit of research after clinical on how to ensure fulfilment and comfort of residents in LTC so I could implement it in future weeks (I don’t want to elaborate here because I could probably take up a whole page – I might include this in my next reflection.) è POST-MIDTERM Week 7 -          Before I started this placement, I thought I loved older people because they were personable and easy to talk to. This was before I had talked to individuals who had at least some degree of dementia. While I still appreciate older people, at this point I am not comfortable communicating with those with dementia simply because I don’t know how to do so properly. This was poignant today when trying to communicate with resident who was wailing and it was very difficult to get her to calm down – holding her hand seemed to help a bit which highlighted the importance of not just verbal communication, but also physical communication Week 8 -          Learned that loneliness is common with residents in long-term care. Sat with resident and tried to talk to her about her loneliness – she said she is lonely and has family who don’t visit as often as they could Week 11 -          Had two opposite experiences with residents – one resident was very upset at her lack of autonomy and verbalized “It’s ok for you but you’re not the one who has to live here” and another resident kept saying how happy she was living there. I guess it is like any other situation in life: experiences are subjective and your attitude and past experiences really shape how you will enjoy the current experience. Long-term care isn’t inherently an unpleasant place to live but all residents have a different experience of it.
Developed a basic knowledge of the clinical manifestations and relevant nursing interventions of chronic diseases	Week 3 -          During first clinical day in long-term care learned about appropriate interaction to those with dementia: do not try to argue or correct the resident as this may agitate them and is more likely to cause harm than to help -          Experienced this first hand: older man came up to me and told me he was 35 and held his hand out for a dance. My reply was “Wow, you look great for 35!” and danced with him. Any other reply may have caused confusion or agitation for him. Week 4 -          When I first entered the room of an incontinent patient I was overwhelmed by the smell. However, I quickly became desensitized to it and realized that incontinence is a common manifestation of the aging process and my aversion to bodily fluids has decreased and will continue to decrease Week 5 -          Noticed that several residents carried stuffed animals/baby dolls with them. Learned that this is a common intervention for those with dementia as it provides a way for them to have social interaction and to care for another “living” creature è POST-MIDTERM Week 7 -          Discussed during debriefing the clinical significance of symmetrical presentation, importance of assessing skin during all parts of an assessment (especially relevant for frail and immobile residents at risk for pressure ulcers), various sounds heard during auscultation – bowel sounds present/absent (learned that nurse has to hear no bowel sounds for full 5 minutes per quadrant to state bowel sounds absent!) Week 8 -          Realized how much difficulty people with dementia have in following directions – when toileting one resident with my partner it took a lot of cueing to get resident safely from wheelchair to toilet despite the simple, clear instructions we were giving her Week 11 -          Saw the effects of aging and dementia on incontinence: as soon as we placed resident on shower commode the position she was sitting in prompted an uncontrollable urge to defecate which she immediately did

SECOND YEAR                                                                         

NURS 2021: Family-Focused Practice
Summary of course objectives:

• Recognize and begin to navigate the complexities of family nursing
• Integrate knowledge from previous courses to support diverse populations
• Critically appraise relational inquiry processes and begin to develop meaningful relationships with health care providers and family members
• Collaboratively formulate a plan of care based on knowledge of family nursing, related theories and scholarly literature
• Develop, implement and evaluate the effectiveness of health-promoting, evidence-based practice, reflecting principles of family nursing as relational practice
• Demonstrate accountability and professionalism that is consistent with a nurse entering a self-regulating professions
• Select appropriate community support services for families needing referral to enhance coping with diverse transitional experiences

					Progress
Course Objective					Evidence/Indicators MIDTERM	Evidence/Indicators FINAL
Recognize and begin to navigate the complexities of family nursing.					Student: In family nursing, the health of the family is just as important as the health of the individual patient. Family health is promoted when the whole family is involved in the care plan. I promoted the health of the family by explaining the steps of changing a diaper to the father and having him demonstrate it back to me; later on, when the diaper needed to be changed again, I helped the mother walk over to her baby’s cot and encouraged the father to assist her in changing the diaper. This way, the whole family was involved in the care of the baby. Clinical Instructor: Chloe has demonstrated continuing development in her nursing practice in working with families and the provision of safe throughout the semester. She seeks guidance from the appropriate sources and has developed her nursing knowledge and skills in relation to supporting families.	Student: Family nursing, especially maternal child, is complex because every patient has a different level of experience when it comes to caring for their baby. My patient’s newborn was her third child, so despite the fact she was having difficulty breastfeeding, I felt I couldn’t help her as she was already very experienced. I discussed this with Kelly, the Clinical Learning Facilitator, who suggested I ask the patient what methods have worked in the past. I implemented this in my care later that day which was helpful. Asking the patient about past methods also strengthens the therapeutic nurse-patient relationship as it shows I am interested in obtaining contextual information from other areas in her life to enhance her care. It is also a way of making the patient a partner in her care, and reduces her perception of the nurse as an authoritative figure. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP				Progress Final ¨  SP  ¨  ND ¨  UP
Integrate knowledge from previous courses to support diverse populations.					Student: In NURS 1020, we learned how to take vital signs and perform head-to-toe assessments. I have integrated this knowledge from NURS 1020 by taking vital signs and performing head-to-toe assessments. In NURS 1020 we only completed assessments on elderly individuals; I have integrated this knowledge in this current course by applying assessment skills to both young mothers and newborn babies. Additionally, we learned in NURS 1020 about the importance of establishing therapeutic relationships. I have integrated this knowledge in this course by ensuring I am always talking with my patients during assessments, asking questions, encouraging them to share their feelings, and asking what I can do to support them. Clinical Instructor: Chloe has applied an appropriate level of investigative nursing skills to effective complete her patient assessments. Her documentation skills have improved in relation to content that should be included.  She needs to ensure that the correct medical terminologies and normal values for assessment values are reviewed and any abnormalities are communicated and followed up in a timely manner.	Student: In NURS 1550 we learned about the 10 Rights of Medication Administration with an emphasis on patient safety and education. At the beginning of this course I had never administered medications and felt very nervous the first time I did so in this placement. By the last shift of this placement I had administered oral medications several times and feel comfortable with the 10 Rights and patient education. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP				Progress Final ¨  SP  ¨  ND ¨  UP
Critically appraise relational inquiry processes and begin to develop meaningful relationships with health care providers and family members.					Student: While getting report from the night shift nurse on my patient, she told me the father was anxious to the point where he could be rude at some points. I used this knowledge to watch out for signs of anxiety, such as him interrogating me, pacing, and being restless. To decrease his anxiety I answered his questions, reassured him, and remained very kind, friendly and professional towards him. His anxiety appeared to diminish and I reported this to my co-assigned nurse. Clinical Instructor: She has demonstrated the ability form effective and appropriate relationships with patients, her peers and members of the health team.	Student: I used relational inquiry by realizing that my patient, who was not a Canadian citizen nor a native speaker of English, may experience a language barrier when she is being taught to care for her baby. I therefore attended the discharge clinic with my patient so that if there were concepts taught that she didn’t understand due to the language barrier I could go over them again with her back in her room. This also supported the development of a meaningful, therapeutic relationship as it demonstrated that I was actively supporting her both educationally and psychosocially by attending the clinic. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP			Progress Final ¨  SP  ¨  ND ¨  UP
Collaboratively formulate a plan of care based on knowledge of family nursing, related theories and scholarly literature.					Student: Each day before I start my assessments I write out a detailed plan of my tasks for the day with the times for each assessment included. I communicate with my co-assigned nurse by asking her what other care is necessary that day for my patient and I write down everything she tells me. I also gather listen to the night nurse give report, and make sure I note anything she says about the state of the family’s emotional well-being so I can address this in my assessments and other care. Clinical Instructor: She has demonstrated the ability to access and utilize relevant resources to support nursing practice. She asks appropriate questions to enhance her nursing care and promote patient safety.	Student: I had a patient who was producing plenty of milk but was having difficulty getting her baby to latch. My co-assigned nurse and I determined that the main priority for that patient and her baby was to ensure the baby was getting adequate nutrition. I worked with my co-assigned nurse to keep track of and document all feedings, and I also educated the patient on manual expression of milk and tips to help baby latch. I also observed my co-assigned nurse teach the patient how to use a breast pump machine, so I now feel that in the future I will be comfortable independently teaching patients to use a breast pump machine. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP				Progress Final ¨  SP  ¨  ND ¨  UP
Develop, implement and evaluate the effectiveness of health-promoting, evidence-based practice, reflecting principles of family nursing as relational practice.					Student: After my patient had taken off the bandage covering her C-section wound, I asked her if she was aware of the signs of infection. After she told me what she knew, I continued to explain to her more signs of infection to watch out for based on what we have learned in our theory courses. I also answered questions she had about caring for/cleaning her wound. My co-assigned nurse and I followed up on her understanding of signs of infection during discharge. Clinical Instructor: She as attempted to apply the teaching and learning process develop to individualised support plan to parents. Her health teaching skills will develop as she gains more knowledge and exposure.	Student: My patient had failed to breastfeed her baby for over four hours because she stated “He looks so cozy sleeping in his blanket and I didn’t want to disturb him.” I emphasized to her the importance of feeding every 2-3 hours, even if he is sleeping, as infants need proper nutrition to thrive. After we had this conversation my patient increased breastfeeding frequency which indicates that my implementation of health promotion regarding feeding was effective. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP				Progress Final ¨  SP  ¨  ND ¨  UP
Demonstrate increasing competence and confidence in the application of psychomotor skills in practice settings.					Student: Each clinical shift I feel increasingly confident performing head-to-toe assessments and taking vital signs. In NURS 1020 and during my first two clinical shifts of NURS 2021 I only performed assessments with my instructor/another nurse present, but I am now able to do so independently and chart all my findings. Additionally, although I had previously learned how to remove a catheter in first year labs, I had never done so in practice. I removed a catheter during my third clinical shift of NURS 2021 under supervision of my supervisor. I now feel confident in my ability to do so independently in the future. Clinical Instructor: She has shown increased confidence performing the required assessment. She is also working on developing her medication preparation and administration skills. She is encouraged to review the skills that were previously learnt to enhance her preparedness to apply them in the clinical setting as the opportunity arises.	Student: During the first half of the semester I removed a catheter for the first time, a skill I learned in first year nursing. During the second half I assisted one of my co-students in removing a catheter. I felt comfortable during the process before assisting my colleague, but by teaching her how to remove a catheter my confidence and competence in this skill greatly improved. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP			Progress Final ¨  SP  ¨  ND ¨  UP
Demonstrate accountability and professionalism that is consistent with a nurse entering a self-regulating profession.					Student: At the beginning of NURS 2021 I did not feel confident in electronic documentation and made several errors and would document later than is professional. I now make sure to document all my findings accurately. I also make sure to document as soon as possible after performing an assessment. When I have finished documenting, I review my documentation and compare it to my handwritten notes to ensure I have made no errors or omissions. Clinical Instructor: Chloe has shown consistency in applying the practice standards outlined by the regulatory bodies as it related to her responsibilities as nursing student practicing in this setting.	Student: My student colleague and I removed a patient’s catheter by having her sit on the toilet; later, my co-assigned nurse explained to me that on the maternal child ward catheter removal is usually done in bed. I rationalized my actions by explaining that my clinical instructor had taught us to remove a catheter with the patient sitting on the toilet, and my co-assigned nurse told me that catheter removal is done in bed because the patient will usually not have the urge to void immediately after removal. This is an example of healthy, professional discourse between two nurses, showing that different nurses will often have different ways and reasons for their actions. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  SP  ¨  ND ¨  UP
Select appropriate community support services for families needing referral to enhance coping with diverse transitional experiences.					Student: I encouraged my patient and her husband to attend the optional discharge clinic on the day the mother and baby were to be discharged. I walked with them to the clinic and, after the clinic, followed-up by asking them how the clinic was and if it was helpful. Clinical Instructor: She is aware of the various in-hospital and community support resources that are available to families in the community. She needs to take the initiative and convey that information to parents.	Student: My patient was having difficulty getting her baby to latch onto her breast during feeding, and was worried she would have difficulty once discharged. I told her there were community supports for breastfeeding, and when she said she was worried about finances, I pulled out the Durham region community resources for breastfeeding leaflet and showed her the locations and phone numbers for various free resources to assist with breastfeeding. I also encouraged her to sign up for Healthy Babies Healthy children as this would be a vital resource not just for breastfeeding but for various types of new parent assistance. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP	Progress Final ¨  SP  ¨  ND ¨  UP
This section to be filled out by the student.					Student Areas of Strength 1.      Increasing confidence and competence of psychomotor skills, particularly in assessment skills. 2.      Integrating knowledge from previous courses by developing therapeutic relationships with all patients. 3.      Increasing professionalism and accountability through communication with nursing staff. Student Areas for Future Development 1.      Recommending appropriate community support services for families. 2.      Implementation and evaluation of patient teaching and health promotion. 3.      Collaborating a plan of care (specifically, I need to develop my organization skills regarding medication administration).	Student Areas of Strength 1.      Establishing and maintaining therapeutic nurse-patient relationships. 2.      Post-partum mother assessment and infant assessment. 3.      Time management and knowledge of which assessments must be performed and medications administered at the proper times. Student Areas for Future Development 1.      Increasing confidence in providing patient teaching and health promotion. 2.      Administration of injection medications – did not have the opportunity this semester to do so and is therefore a skill I look forward to practicing in future placements. 3.      Providing patient education in a way that demonstrates my own knowledge in that specific area while also enhancing the therapeutic nurse-patient relationship.

NURS 2020: Community Based Nursing Practice
Summary of course objectives:

• Demonstrated professional responsibility and accountability to collaboratively plan, implement and/or evaluate a health promotion project relevant to the community population served, using elements of the course website such as the learning system and regular, punctual communication with preceptor and faculty
• Applied their knowledge to support population assessment, collaborative and evidence informed health promotion project development, implementation and process and outcome evaluation
• Demonstrated ethical, respectful and professional practice when working with community organizations and the population with whom they work
• Demonstrated knowledge of relational practice in project development, respectful of group process, leadership/followership and collaborative practice to meet the needs and build capacity of the population in the given context

			Progress
Course Objective			Evidence/Indicators MIDTERM	Evidence/Indicators FINAL
1. Demonstrated professional responsibility and accountability to collaboratively plan, implement and/or evaluate a health promotion project relevant to the community population served, using elements of the course website such as the learning system and regular, punctual communication with preceptor and faculty.			Student: While Margaret and I were researching for our project we had several video chats and email chains with Barbara to keep communication open. I have always been used to comminucating face-to-face with professors when discussing projects; I learned that digital communication is a crucial form of communication in the field of glbal health as project members are often not in close physical proximity. Barbara also suggested talking to Brittany, the OT, as her area of work correlated with our project. I emailed Brittany to describe our project to her, and she told me about the Zones of Regulation which we added to our project, demonstrating interdisciplinary collaboration. Clinical Instructor: Chloe demonstrated professional responsibility and accountability to plan and implement her project managing challenging behaviours and communication along with her project partner. She used frequent communication using email and Zoom communication with her CI and with the Ocupational Therapist (OT) travelling with the group to gain insight into her project goals and seek feedback on her project ideas.	Student: I demonstrated collaboration by completing our poster with Margaret. We met at her house to design the template of the poster and then divided up each section that we would complete and ensured communication over email and social media to complete the poster. I did additional research into the effect of exercise on challenging behaviours to include in the recommendations, which is an important part of evaluation of a health promotion project. Lastly, we sent the poster to our clinical instructor for review in a timely manner, demonstrating professional responsibility and accountability, and we made the appropriate changes to the poster based on the feedback our clinical instructor provided. Clinical Instructor:
Progress Midterm ◻   SP  ◻   ND ◻   UP		Progress Final ◻   SP  ◻   UP
2 Applied their knowledge to support population assessment, collaborative and evidence informed health promotion project development, implementation and process and outcome evaluation.			Student: During research for our project at PREPACE El Hatillo, I learned about redirection methods to implrement when a child is displaying challenging behaviours. These methods included ignoring the behavior and redirecting to a preferred behavior (for example, ignoring when a child was throwing blocks and giving a soft toy instead). I implemented this at El Hatillo: a child was trying to grab at my face and I redirected by holding her hands firmly to which she responded very well and didn’t try to grab my face again. I also learned a lot from Brittany about OT methods such as deep pressure to decrease challenging behaviours and implemented them while working with the children. Clinical Instructor: Chloe applied her knowledge to develop an evidence informed project that met the needs of her target population. She met with the OT to gain more insight into the project goals and asked relevant questions of her CI. She used the first 2 days at PREPACE to make assessments of the children and develop strategies on how to best implement the communication boards and discussed these ideas with the caregivers during her presentation.	Student: After returning from Honduras, I worked with Margaret to complete Project Note 2. In this assignment we used the CDC’s Outcome Evaluation Method to ask questions about the outcome of our project and develop outcome indicators to evaluate the effectiveness of our project. Clinical Instructor:
Progress Midterm ◻   SP  ◻   ND ◻   UP		Progress Final ◻   SP  ◻   UP
3. Demonstrated ethical respectful and professional practice when working with community organizations and the population with whom they work.			Student: When working in a foreign country, I believe one of the most respectful things you can do is to communicate in the host country’s language. This shows you are respecting your role as a guest and not overstepping boundaries. Although there were times I had to rely on the translators, I worked hard to pick up phrases in Spanish and use the Spanish I already knew to communicate with tias, chidren, and students. I also extended this practice beyond the workplace, using Spanish to communicate to citizens and shop employees. This is because being a good global health worker involves immersing yourself in the community and being globally aware. Clinical Instructor: Chloe demonstrated respectful and professional practice while working with the community organizations. She demonstrated compassion while working with the children with disabilities. She worked hard to meet their needs while being cognizant and sensitive to the challenges facing the caregivers to manage the behaviours of the children.	Student: At the end of the semester I, along with my project partner, participated in a poster presentation event where we presented a summary of our work to our peers, instructors, and community members. Being asked questions from individuals who didn’t know what our work was about provided an opportunity to reflect on my work as I had to summarize it in my head before answering so I could answer questions in a way my audience would understand. I maintained professionalism throughout the presentation by making sure I was usually at my poster, ready to answer questions, and if I wasn’t at my poster I was asking my peers questions about projects they did during their clinical placement. Several times my partner and I were asked the question “What was your main takeaway from this experience?” I have thought many times about what I’ve learned from being in Honduras, but I never thought about my main takeaway – I learned today what that was. As nurses, it is our job to collaborate with our population rather than dictate what the population needs. This was obvious during our work in Honduras, as there is no way we know better than the citizens what they need, so it was a great example of collaboration and capacity building. This was my main takeaway from my clinical experience in Honduras. Clinical Instructor:
Progress Midterm ◻   SP  ◻   ND ◻   UP	Progress Final ◻   SP  ◻   UP
4. Demonstrated knowledge of relational practice in project development, respectful of group process, leadership/followership, and collaborative practice to meet the needs and build capacity of the population in the given context.			Student: Even though Margaret and I were “finished” our project before arriving in Honduras, we continued to develop it afretr observing the conditions within the PREPACE El Hatillo community. After seeing on the first day how understaffed and underfunded El Hatillo was and seeing how tirelessly the tias work, I was nervous our presentation would come off as too demanding and instructive (as opposed to helpful and constructive). I communicated this with Margaret, showing respect for the group process, and suggested we alter our presentation to make it more discussion based and to involve the tias more. We also invited Brittany to join our presentation as a member of the interdisciplinary team. Lastly, we started our presentation by commending the tias for their incredibly hard work. This is relational practice because it demonstrates our willingness to partner with the tias, as opposed to overruling the work they do. Clinical Instructor: Chloe worked collaboratively with the team to meet the needs of the population including her peers and the interdisciplinary team, specifically with the OT and PT. She worked as an active member of the team at PREPACE (her target population) and participated actively when visiting other community organizations.	Student: One of my post-brigade assignments was to create a document outlining the methods and tools that were helpful in addressing the children’s challenging behaviours at El Hatillo. I used collaborative practice in this scenario by asking my fellow students what methods they noticed as being helpful for addressing challenging behaviours; while I worked with most of the children I wrote about in the assignment, some of the children (for instance, the child who was very closed off and opened up when he was held very tightly) were given more attention by my colleagues who were able to tell me about the methods they used. This document I created is important for capacity building because it gives future brigades an idea of the behavioural methods that work well for some children, which they will then be able to use to further assess the behavior of the children and devise strategies for the Tias to implement. Clinical Instructor:
Progress Midterm ◻   SP  ◻   ND ◻   UP		Progress Final ◻   SP  ◻   UP
5. Demonstrated self-regulation by engaging in self-reflective practice and identifying learning needs through self-assessment that align with the SON’s program goals and the Community Health Nursing Standards of Practice in Canada.			Student: During this brigade trip, I engaged in self-reflective practice each day by thinking about how my day went, what I did well, and what I could have done better. I determined what I could have done better by reflecting on my observations of other people/students’ practice in the community, noting their strengths and thinking about how I could incorporate their methods into my practice. I also engaged in reflective practice by discussing extensively with other students after work (informally) and during debrief after dinner (formally). This aligns with SON standard #10, to perform community assessment. After our walking tour, I contributed to the discussion of strengths and weaknesses of the Yoro community and consolidating these into three health needs: safer traffic/infrastructure, non-communicable disease, and communicable disease/access to safe drinking water. Clinical Instructor: Chloe should continue to develop her self-regulation and reflectice practice. She struggled to asked contextually relevant questions when visiting health facilities and community organizations in Honduras. Such as when asking about non-meat eaters at the rural schools and about homelessness at the municipal office. She frequently asks questions that are not relevant to the situation and should take time to formulate consise questions to the relevant persons. She can improve her ability to reflect on the context and use self-regulation and relational practice to ask appropriate and consise questions through her remaining assignments for the course. Chloe performed a community assessment with her peers to understand the needs of the community and develop an understanding of how the SDOH affect the populations.	Student: As mentioned in Course Objective #5, one of my post-brigade assignments was to create a document outlining the methods and tools that were helping in addressing the children’s challenging behaviours at El Hatillo. I didn’t complete this assignment in as timely a manner as I should have, which I learned is akin to documenting very late as there is increased risk of missed/inaccurate information. I engaged in self-reflection by reviewing the CNO’s practice standard on documentation, particularly as it pertains to the communication and accountability sections. I followed this document while completing my assignment, ensuring that I was including only information that I know to be true, and indicating where there was information I was unsure of and would need to verify in order to ensure accurate documentation. Clinical Instructor:
Progress Midterm ◻   SP  ◻   ND ◻   UP		Progress Final ◻   SP  ◻   UP
This section to be filled out by the student			Student Areas of Strength 1.  Extensive contribution to debrief discussions and consolidation of ideas. 2. Ability to observe my surroundings and connect observations to the social determinants of health. 3. Ability to apply the aesthetic way of knowing by recognizing each individual’s strengths and applauding them (especially children at El Hatillo). Student Areas for Future Development 1. Asserting self to apply skills in areas I am uncomfortable/unfamiliar with. 2. Emotional regulation in high-stress situations. 3. Preparation and awareness of communications from others (this relates to emotional regulation – when I am feeling overwhelmed I often forget/fail to comprehend what has been communicated).	Student Areas of Strength 1. Presenting findings and experiences to peers and members of the community. 2. Ability to accept criticism and feedback to improve my practice and academic habits. 3. Collaboration during groupwork/partner work and the ability to divide work into manageable tasks for each of us. Student Areas for Future Development 1. Time management of assignments and documentation which pertain to individuals’ health information. 2. Critical evaluation of my experiences as it pertains to what I learned and how I can apply my learning. 3. Asserting self during group work (although Margaret and I worked well together, I perceive her as having more confidence which often resulted in me inadvertently letting her talk more during presentations even though I was just as capable as her to present our project).

THIRD YEAR                                                                         

NURS 3031: Clinical Practice Focused on Chronic Disease Management
Summary of course objectives:

• Demonstrate accountability and responsibility in the teaching-learning relationship
• Explain the experience of chronic illness in individuals receiving care in chronic care settings
• Interpret critical aspects of the person's experience of chronic illness in relation to the nursing process such as common signs and symptoms, responses to treatment, patterns of coping, and impact on individual and family relationships
• Identify symptoms and common medical treatments of selected chronic illness
• Demonstrate select nursing and collaborative interventions related to caring for the person with chronic illness such as specific assessments, medication administration, physical and chemical restraints, enteral feeding & residual volumes, NG tube insertions, wound care, patient-controlled medication administration pumps
• Identify potential consequences/complications of select chronic illness and related interventions
• Under the supervision of a Registered Nurse, demonstrate safe, competent, evidence-informed, holistic nursing practice with clients with chronic illness

			Progress
Course Objective			Evidence/Indicators MIDTERM	Evidence/Indicators FINAL
1.       Demonstrate accountability and responsibility in the teaching-learning relationship.			Student: Clinical Instructor:	Student: 1.      Similar to the first half of this semester, I always showed up for my clinical shift by 0640-0645 to ensure I could receive report and read up on my patient before starting care. 2.      I missed a clinical shift due to being ill, but I showed accountability by emailing my clinical instructor and course lead as soon as I decided I wouldn’t be going to clinical. I demonstrated further responsibility by writing a care plan and hypothetical schedule of care for the day that I missed and sent it to my instructor and course lead by the required date. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP	Progress Final ¨  S  ¨  U
2.       Explain the experience of chronic illness in individuals receiving care in chronic care settings			Student: Clinical Instructor:	Student: 1.      Each week for my care plan I research and write about the pathophysiology of the patient’s disease – while I know this is not synonymous to the chronic illness experience, it is important for nurses to know the pathophysiology so we can administer medications correctly and provide education for the patient. 2.      As I discussed in my midterm evaluation, patients with chronic illness have to re-evaluate their life goals and plans for the future. One of my patients was living with her daughter and they were planning on converting their basement to an apartment. She talked about how she was disappointed that they were going to have to re-evaluate this plan or push it ahead. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
3.       Interpret critical aspects of the person’s experience of chronic illness in relation to the nursing process such as common signs and symptoms, responses to treatment, patterns of coping, and impact on individual and family relationships.			Student: Clinical Instructor:	Student: 1.      While caring for a patient who was both asthmatic and a smoker, I was auscultating his lungs and heard wheezes. I asked him if he was experiencing shortness of breath or pain with breathing and he said no. He also said these sounds were normal for him. I used my nursing judgment to determine that this was not a concern and simply reported it to my co-assigned nurse. If I thought it was a concern I would report it to my co-assigned nurse and inquire about obtaining tests for respiratory infection, and if he was having continued SOB and decreasing O2 saturation after trying all other measures such as positioning him in Fowler’s and using relaxation exercises I would talk to my nurse about administering oxygen through nasal prongs. 2.      I was caring for a patient with a migraine who stated that his pain was 15 when I asked him what his pain was on a scale of 0-10. I administered 1000mg of acetaminophen PO and an hour later I assessed the therapeutic efficacy of the drug by asking him how his pain was (it was better). 3.      I was caring for another patient who was experiencing severe pain (8 on a scale from 0-10) and since he experiences pain frequently, I asked him what techniques he uses to control his pain. He told me that he just tries to ignore it and hold off taking medication for as long as possible because he doesn’t want to bug the nurses; I affirmed what he was saying by agreeing that it is good to have non-pharmacologic techniques for pain management, but I told him that it was very important to have well-controlled pain and that our job is to do that. I then offered to see if I could get an ice pack to help with the pain and he agreed. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
4.       Identify symptoms and common medical treatments of selected chronic illness.			Student: Clinical Instructor:	Student: 1.      During one of my clinical shifts I was scheduled to administer insulin subcutaneously. This was a skill I had never performed before and I was looking forward to my first time administering an injection. However, when it was time to administer the medication, I was unable to find my instructor. Rather than wait so that I could administer the medication, I recognized that missing a dose of insulin could result in a hyperglycemic emergency so I notified my co-assigned nurse so she could administer the medication. 2.      During my morning assessment on one of my patients, I asked him the current year and he told me that it was 2010 or 2011. I knew that the patient had alcohol-related dementia so I was not overly concerned that he was disoriented to time, as I recognized this to be a sign of dementia. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
5.       Demonstrate select nursing and collaborative interventions related to caring for the person with chronic illness such as specific assessments, medication administration, physical and chemical restraints, enteral feeding & residual volumes, NG tube insertions, wound care, patient-controlled medication administration pumps.			Student: Clinical Instructor:	Student: 1.      I consistently demonstrate knowledge of interventions and ability to perform these interventions. While caring for a patient with a G tube, I administered medications through this tube. I understood the importance of crushing and mixing the medications in water before administering them through the tube – a couple weeks prior a nurse on the floor had been administering medications through a G tube and had not diluted them enough, so the tube became blocked and the patient had to have a new tube inserted. This poses serious risk as this prevents the patient from getting enough medications, fluid, and nutrition and can cause their disease state to deteriorate. 2.      While caring for this same patient, she also had a tracheostomy and required deep suctioning to clear her airway. I understand that suctioning is important for adequate gas exchange; when I noticed my patient’s oxygen saturation decreasing, I knew I had to find a nurse to assist me while I suctioned the patient’s tracheostomy so she could have airway clearance. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
6.       Identify potential consequences/complications of select chronic illnesses and related interventions.			Student: Clinical Instructor:	Student: 1.      While caring for the patient with the G tube and tracheostomy, I understand risks associated with tube feeding and tracheostomies. I understood that while performing care for this patient I had to pause the feeding tube before placing her in a horizontal position or else the patient could aspirate; I always made sure to do this. I also recognized that clearing her airway, including deep suctioning and suctioning of secretions from her mouth, is important otherwise secretions could build up and cause asphyxia or aspiration. 2.      Each time I perform wound care on patients with wounds I ensure to use sterile technique, because I understand that a complication of wounds is infection. Cleaning wounds using sterile technique minimizes this risk. 3.      When I was caring for a patient with psoriasis who was bed bound and chair bound I noticed a small skin tear on her back which was bleeding. I recognized that several factors caused this patient to be at risk for pressure ulcers so I made sure to report the skin tear to my co-assigned nurse, who put a band-aid on it. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
7.       Under the supervision of a Registered Nurse, demonstrate safe, competent, evidence-informed, holistic nursing practice with clients with chronic illness a.       Use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship b.       Demonstrate accountable, responsible and ethical practice c.       Engage in respectful, collaborative, therapeutic and professional relationships                                                    i.      Demonstrate therapeutic use of self                                                  ii.      Create a culturally safe environment d.       Apply nursing models and theories e.       Demonstrate health promotion and illness prevention practices f.        Demonstrate patient advocacy g.       Predict outcomes of nursing care h.       Evaluate client response to nursing care i.         Critically appraise own practice in relation to nurse-client/family interactions and as a member of the health care team			Student: Clinical Instructor:	Student: 1.      On the day before one of my patients was to be discharged, he had an indwelling catheter that he would still have upon discharge. On the Thursday I walked him through step-by-step how to empty his catheter bag, and on the Friday (discharge day) I had him do it by himself with me watching so that he would be able to self-manage at home. 2.      While caring for a patient who was non-verbal, I created a culturally safe environment by using multiple communication techniques that the patient was familiar with. The patient often communicates by blinking for yes and shaking her head for no. When I couldn’t figure out what my patient needed, I tried to use the patient’s alphabet communication board. I had to leave the floor to go to post-conference but I maintained the therapeutic relationship and demonstrated respect by telling the patient I wasn’t giving up on asking what she needed, but that I would find another nurse to help her.  Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
8.       Critically appraise own practice in relation to nurse-client/family interactions and as a member of the health care team			Student: Clinical Instructor:	Student: 1.      After every clinical shift I talk with my roommate about what happened during each of our shifts (without using patient identifiers). She is in a different chronic placement and talking to her about our shifts helps me to reflect on what I did well and what I could do better; saying what I did out loud affirms that I am learning/doing more than sometimes I think I am. 2.      One shift my patient was discharged, and a little while later a new patient was admitted to the room my old patient was in. My co-assigned nurse asked me to take his vitals and report back to her. I met the patient and his wife and since I am used to my patients having been in C2 for a while, I interacted with them as if they knew what the routine was. The wife started asking me questions and I realized she was nervous and unsure about her husband’s situation. I now realize that whenever I meet a new patient and their family I shouldn’t assume their level of knowledge and I should work with them to determine where they are at in their experience of chronic illness. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
9.       Participate in professional development based on reflective practice and critical inquiry			Student: Clinical Instructor:	Student: 1.      Each week I participate in my peers’ post-conference presentations by bringing helping brainstorm nursing diagnoses and interventions for the patient they are presenting on. 2.      While writing this final evaluation, I looked up wheezes to better understand what causes them. While I was reading about wheezing I came across the terms ronchi and stridor which I had learned in first year but forgotten about. I realize that I need to spend more time learning about respiratory assessment and treatments. I plan to review the RNAO BPG about nursing management of dyspnea, and I hope to have the opportunity to assess and treat respiratory problems in my acute placement next semester. Clinical Instructor:
Progress Midterm ¨  SP  ¨  ND ¨  UP		Progress Final ¨  S ¨  U
This section to be filled out by the student.			Student Areas of Strength 1. 2. 3. Student Areas for Future Development 1. 2. 3.	Student Areas of Strength 1.     Developing the therapeutic relationship. This was an area of strength for my midterm evaluation but I believe it is one of my greatest strengths and I have improved even more in the second half of the semester. 2.     I can chart with minimal errors and I am able to identify information that is most important to include in a progress note. 3.     Preparing for my shift including reading the MAR to determine when I need to administer medications, when I need to perform skills (wounds, trach care, etc.) and once I have done so I gather all the materials I need far ahead of time. Student Areas for Future Development 1.     While I have definitely improved my confidence in administering medications, I still need to practice this skill as I sometimes forget critical aspects such as asking for patient identifiers prior to administering medications. 2.     Setting boundaries. Sometimes I will spend too long with a patient who loves talking and I have difficulty respectfully ending the conversation and leaving the room. 3.     While I have improved the quality of my charting, I still need to improve on completing my charting in a timely manner.