Learning and Goals

NURS 1020: Clinical Practice in a Residential Setting
Self-Identified Learning Objective
January - April 2018

       Goal setting in the professional life is important as it helps one clarify what path they will take as they develop their career. 

       The first goal I have set to achieve by the end of my NURS 1020 clinical placement is to adopt a healthier lifestyle by eating more fruits, vegetables and home-cooked meals and getting more regular, high-intensity exercise. I will know I have achieved this goal when I am in a routine that involves daily exercise and healthful, home-cooked meals at least five days a week. I know this goal is attainable as I used to go to the gym every day and cooked my own meals when I lived alone in Hamilton – if I did it once, I can do it again. This goal’s relevance to nursing may seem vague, but I actually believe it will have a strong impact on my efficacy as a nurse for two reasons. One reason is the effect a healthy lifestyle will have on my cognition and energy levels; if I am eating a balanced diet and exercising, I will have more energy and better concentration, and will therefore be physically equipped to care for the elderly. Another reason for adopting a healthy lifestyle is it will lead to increased credibility as a healthcare provider. Several studies have shown that nurses who have unhealthy habits, particularly nurses who are overweight, inactive, and who smoke, will be less likely to advocate for a healthy body weight, increasing levels of physical activity, and smoking cessation (Mujika, Arantzamendi, Lopez-Dicastillo & Forbes, 2017). In the past, I have made the mistake of increasing my exercise too quickly and injured myself. This time, I will start with half an hour of exercise three days a week. Each week I will add ten minutes per day, and every two weeks I will add an extra day per week until I am at five days a week of exercise. In terms of diet, I will start by adding an extra daily serving per week of vegetables and fruit, and gradually reduce my junk food intake until I am consuming junk food only one day a week maximum. For this, I will require the help of my mom by asking her to purchase more vegetables that can be easily incorporated into a meal.

       Another one of my goals I hope to achieve by the end of my NURS 1020 clinical placement is feeling at ease physically touching patients. Touching may include lifting, transferring, bathing, massages, assistance with eating, and other forms of therapeutic touch. Currently, I am slightly uncomfortable with physical contact, especially with those I do not know well. I will know I have achieved this goal when I view physical contact as not something to be uncomfortable about, but just an everyday task required of nurses; it should become an automatic process that I do without a second thought. I know this goal is attainable because I have practiced lifts, transfers, and bathing in simulation seminars. Therefore, I know I have the capability to touch others without feeling overly uncomfortable. This goal is particularly relevant to nursing as these forms of physical contact are basic; if I can’t be comfortable with basic touch, it will be difficult to provide adequate care when the practice of nursing becomes more complex. Ideally, this goal would be reached by the end of my 1020 clinical placement. However, I expect it will take at least a few more clinical placements before I am completely comfortable with physical contact. Despite this, I will have gained confidence in touching patients by the end of my placement. To gain these skills as quickly as possible, I will jump at every opportunity for physical contact with patients.

       While I am fortunate enough to have a wide network of friends in both Peterborough and Hamilton, I have yet to forge any strong friendships within the nursing program. I believe having friends in my program is beneficial to my success as a nursing student as we would be able to share in our struggles and successes, and depend on each other for support. Therefore, by the end of my clinical placement, I have made a goal to develop friendships with the other students in my clinical placement group. Specifically, I will make an effort to talk and share stories and interests, trying to move past discussion about school or small talk and create a relationship based on common interests. I will know I have achieved this goal when I feel comfortable in the presence of my groupmates and when I look forward to sharing my day with them, as opposed to feeing anxious or nervous as I often do around other people. This goal is relevant to nursing practice as support is difficult to get from non-nursing friends and family as they do not understand exactly what we are going through. Having strong connections with others may also help me academically/clinically when I need assistance in assignments and clinical skills. This goal should be achieved by the end of the 1020 clinical placement, but I have incorporated a few smaller timelines: before the first week of my placement, I will make a carpool schedule with others in my clinical placement, establishing the foundation for our relationship. From there, I will strive to talk to everyone each day about something not related to nursing. Through doing these steps, I hope to have made some solid friendships by the end of my first clinical placement. 

       Where do I go from here? After my first clinical placement, I have several more placements during my undergraduate degree. Once I graduate, I plan to work in a hospital setting for a few years to gain some experience, and then apply to graduate programs to be a Nurse Practitioner or Clinical Nurse Specialist. The future is wide open, and this year is only the beginning.

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     NURS 1020 is finished, and how have these goals turned out? Relatively well, I'd say. My lifestyle still isn't as healthy as I'd like it to be, but I've actively been trying to go to sleep at a normal time, eat food from home as opposed to buying food on campus, and incorporate activity into my lifestyle. I still have a lot of work to do and I plan on making big changes this summer. In terms of making friends, I wouldn't say I have made any close friends, but I've become comfortable with the people in my nursing group and had many laughs and shared stories of our residents with each other (in a confidential environment). I did offer to carpool with others, but everyone already had their own transportation plans. The goal I had the most achievement in was the goal to be comfortable with physical touch. I am very comfortable touching people in a clinical setting now, even in more intimate procedures such as bathing and toileting. The lack of goal achievement I had in my other two goals was definitely made up for by the amount of achievement I had in this goal.

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NURS 2021: Family-Focused Practice
Self-Identified Learning Objectives: First Half of Semester
September - October 2018

In second year the format of my learning goals changed slightly. They were focused more on clinical practice, as opposed to my personal life, and I used the CNO's Quality Assurance Learning Plan Format. These are both evidence of increasing professionalism. To create my learning goals, I first determined what my learning needs were.

My learning needs are improved assessment skills, patient education and health promotion, and improved time management skills. 

Goal #1: I want to demonstrate effective time management skills as they pertain to documentation. I plan to complete my full physical assessment and vital signs of both mother and newborn and have them documented before the first break. To do so, I will write out a detailed schedule of all assessments I am to perform that day so I know when to perform each one. If I am unsure of what I am supposed to document after reviewing hospital protocols, I will ask my co-assigned nurse or clinical instructor for assistance. This goal is relevant as proper documentation is extremely important in terms of monitoring patient safety and nurse accountability. The time frame for this goal is by my next clinical shift, October 18.

Goal #2: I want to become more proficient in delivering patient education on breastfeeding. I plan to provide education about breastfeeding using information covered in the Breastfeeding Matters booklet that is in the patient learning package issued to all patients by Lakeridge Health (La Salle, 2017). To do this, I will first observe my co-assigned nurse or clinical instructor provide education to gain insight to how teaching is most effectively done. Secondly, I will read and make sure I understand all the information in the Breastfeeding Matters booklet so I can relay that knowledge to my patients in a way they can understand. Thirdly, I will deliver education to my patients based on what I have read in the patient learning package. I will know I have reached my goal when I feel confident in my ability to teach, and when my patient is able to verbalize understanding of what they have learned. This is a relevant goal as health promotion is one of the course objectives for NURS 2021. I plan to have this goal completed by November 2.

Goal #3: I want to be able perform a thorough physical assessment of mother and newborn baby and document them in a professional and timely manner. To attain my goal I will read three sections in my Maternal Child Nursing Care in Canada which address physiological changes in the infant and assessment guidelines for the mother and infant (Keenan-Lindsday, 2017; O’Flaherty, 2017; Gladding, 2017). I will know I have reached my goal when I feel comfortable completing a full assessment with no omissions and minimal. This goal is relevant because as a second year student nurse it is important for me to understand what a healthy, normal newborn baby and mother look like and what all the normal findings should be. I plan to achieve this goal by November 2.

How do my learning goals support my commitment to continuing competency?
Goal #1: This goal relates to my competency as it reflects course objective #4 in developing a plan of care. By developing a plan of care, I will be able to complete documentation in an efficient and timely manner. 
Goal #2: This coal relates to my competency as it allows me to improve my skills in developing therapeutic nurse-client relationships. It also allows me to enhance my ability in providing patient education. 
Goal #3: This goal relates to my competency as it allows me to improve my assessment skills in diverse populations. It also allows me to improve my skills in professional and timely documentation.

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NURS 2021: Family-Focused Practice
Self-Identified Learning Objectives: Second Half of Semester
October - November 2018

My learning needs are medication administration skills, improved ability to provide patient teaching, and timely and professional documentation.

Goal #1: I want to be able to administer oral medications safely while providing the correct patient teaching. To achieve this goal, I will look in my patient's medication administration record at the beginning of my shift and write down the times for all the medications I am to administer that day. Next, I will read about each medication in my drug reference book and identify why the drug is necessary as well as the relevant patient teaching (Skidmore-Roth, 2019). Lastly, I will go through the process of administering the medication with my clinical instructor and provide the relevant patient teaching. I will know I have achieved this goal when my patient verbalizes understanding of my teaching and agrees to take the medication, and when I feel confident administering the medication with minimal support of my clinical instructor. This goal is relevant as safe and effective medication administration is one of the main duties of an autonomous and self-regulating nurse. I plan to complete this goal by the end of my next shift in which I have a patient who requires medications.

Goal #2: I want to provide patient education on community resources on breastfeeding they may access once they have been discharged from the hospital. One of the goals in my last learning plan was to provide education on breastfeeding, so for this goal I want to expand to include education on community resources. To attain this goal, I will first, if permitted, attend a discharge class held in the BABIES Clinic room at Lakeridge Health. Secondly, I will inform myself of all the community resources listed in the Breastfeeding Resources handout that is included in the yellow package provided to all new mothers (Durham Region Breastfeeding Coalition, 2018). Lastly, I will identify a need in my patients over the next three clinical shifts and provide education to the patient on the community resource that most fits their need from the Breastfeeding Resources handout. I will know I have reached this goal if my patient verbalizes understanding of what I have communicated to her and when I am able to document that I have provided this education. This goal is relevant as patient education is a main aspect of health promotion, which is related to course objective #5 for NURS 2021. I plan to have this goal completed by the end of my clinical placement, November 16.

Goal #3: I want to learn how to discharge a mother and baby from the hospital, including filling out the correct paperwork, correct patient teaching, and correct documentation. I plan to achieve my goal by first observing a staff nurse as she discharges a patient and her baby, observing the paperwork she fills out with the patient and the teaching she provides to the patient. Secondly, I will observe the nurse complete all the proper documentation on the computer. Lastly, if permitted, I will discharge a patient myself and complete all the documentation with a staff nurse present to ensure I am completing the process correctly. I will know I have achieved this goal once I am able to discharge a patient and complete the documentation in a professional and timely manner with minimal guidance from a staff nurse and when the patient leaves the hospital having verbalized understanding of everything I have taught her. This goal is relevant as it is an opportunity to improve my skills in patient teaching and documentation, both skills that are necessary for a registered nurse to have. I plan to complete this goal by the end of my clinical placement, November 16.

How do my learning goals support my commitment to continuing competency?
Goal #1: This goal relates to my competency as I will improve my skills in patient safety and critical thinking as it relates to drug administration. It also allows me to improve my skills in patient education. 
Goal #2: This goal relates to my competency as I will improve my skills in health promotion. It is also an opportunity for me to improve on my ability to develop a therapeutic nurse-client relationship.
Goal #3: This goal relates to my competency as it is an opportunity for me to apply and combine several course objectives (health promotion, accountability, therapeutic nurse-client relationship) in one activity.

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My clinical placement for the Winter semester of my second year was completed in Honduras and a self-identified learning objectives document was not required for this placement.

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NURS 3021: Clinical Practice Focused on Chronic Disease Management
Self-Identified Learning Objectives: First Half of Semester

September - October 2019

The format of my SILOs changed once again in third year. I still used the CNO's Quality Assurance template but I adapted it to my style. This year I decided to integrate the CNO Entry-to-Practice Competencies into my goals.

This Self-Identified Learning Objectives (SILO) was written using the Quality Assurance Program Learning Plan Form provided by the College of Nurses of Ontario (CNO) (CNO, 2019). To complete this SILO, I identified four learning needs based on previous clinical practice and related my learning needs to the Entry-to-Practice Competencies outlined by the CNO (CNO, 2014). The learning needs I will focus on in this SILO are medication administration, assessment skills, and adequate preparation before clinical shifts to ensure safety for myself, my patients, and my coworkers.

The first goal I aim to achieve is to administer a medication by parenteral route, specifically intramuscular or subcutaneous. Despite entering my third year of nursing studies, I have not yet had the opportunity to give an injection to a patient. This goal is relevant because Competency #62 in the CNO Entry-to-Practice Competencies for Registered Nurses document states that the Registered Nurse (RN) “Implements safe and evidence-informed medication practices” (CNO, 2014). Being on a Complex Continuing Care ward (C2), there are patients with complex diagnoses who will require several injections, so there will be many opportunities for me achieve this goal. I will ensure my medication practices are evidence-informed by reading the section on administering injections in Chapter 33 of my Canadian Fundamentals of Nursing textbook and a video on how to administer injections in the accompanying online skills modules prior to starting my first clinical shift (Kaasalainen, 2014 and Mosby, 2014). I will ensure my practice is safe by reading my patient’s Medication Administration Record each shift and informing my clinical instructor what times I need to administer an injection to make sure my instructor will be available to supervise at that time. To further ensure my medication practices are safe, I will review and memorize the 10 Rights of Medication Administration from Chapter 33 by Kaasalainene (2014) and be able to apply them when I am preparing and administering injections. Applying the 10 Rights includes completing three checks of the medication label against the Medication Administration Record which I will practice doing with my clinical instructor. I plan to have administered at least two injections, utilizing the 10 Rights and completing 3 checks for safety, before midterm evaluations (mid-October).

The second goal I aim to achieve is to complete a full head-to-toe assessment in an organized, efficient manner (within 10 minutes) with no major omissions. During the first week of this semester we were required to film ourselves completing a head-to-toe assessment on a peer and observe for areas of improvement; I forgot to complete a pain assessment, a full musculoskeletal assessment (omitted range-of-motion and gait), and I took large pauses in-between assessments. This goal is relevant because the CNO (2014) states in Competency #39 that the RN “Collects information on client status using assessment skills such as observation, interview, history taking, interpretation of data and physical assessment, including inspection, palpation, auscultation and percussion.” I plan to achieve this goal by performing a head-to-toe assessment on my first day of clinical practice under the supervision of my clinical instructor. Based on the feedback my instructor provides, I will review the appropriate areas in my Physical Examination & Health Assessment textbook and practice these areas at home and on other patients (Jarvis, 2014). Each clinical shift I hope to improve my head-to-toe assessment skills, and I hope to complete a full head-to-toe assessment within 10 minutes by the last clinical shift before midterm evaluations.

The third goal I aim to achieve is to improve my ability to identify and analyze respiratory and cardiovascular abnormalities. Up until now, I have only performed respiratory and cardiovascular assessments on mostly healthy individuals and all my findings during these assessments were normal. This skill is relevant because the CNO (2014) states in Competency #40 that the RN “Analyzes and interprets data obtained in client assessments to draw conclusions about client health status.” As an RN, it is important to be able to identify abnormal findings and analyze them to determine the appropriate course of treatment. I will have many opportunities to identify and analyze respiratory and cardiovascular abnormalities since common diagnoses on C2 include atrial fibrillation, chronic obstructive pulmonary disease, hypertension, and coronary artery disease (K. Cecchetto, personal communication, September 6 2019). To obtain this goal, I will watch videos that demonstrate what abnormal respiratory and cardiovascular findings sound like through a stethoscope and I will implement this knowledge by performing focussed respiratory and cardiovascular assessments on my patients during my clinical shifts. If I identify abnormal findings, I will confirm them with my co-assign nurse and/or clinical instructor and I will chart them appropriately. I will also review the chapters on Thorax and Lungs and Heart and Neck Vessels in my Physical Examination & Health Assessment textbook (Jarvis & MacDonald, 2014a and Jarvis & MacDonald, 2014b). I plan to be able to identify and analyze abnormal respiratory and cardiovascular findings largely independently by the last clinical shift before midterm evaluations.   

The fourth goal I aim to achieve during this clinical placement is to ensure I am adequately prepared each clinical shift. By adequately prepared, I mean that I will be able to explain the diagnoses and medication requirements of my patient, ensure I have gotten eight hours of sleep the previous night, and ensure that I have proper hydration and nutrition throughout the day. This goal is relevant because the CNO (2014) states that the RN “Promotes a safe environment for clients, self, health care providers and the public that address the unique needs of the clients within the context of care.” Adequate preparation is important for both my patients’ health and my own health. If I am not adequately prepared, I will not perform to the best of my ability which can cause harm to my patient, and cause me to be more stressed and overwhelmed than I should be. I plan to achieve this goal by completing drug cards and patient care plans the day before clinical, using my Nursing Drug Reference book and Medical-Surgical Nursing in Canada textbook as references, packing a healthy lunch with water, and getting to bed by 9:30 at the latest the night before clinical (Lewis et al., 2019 and Skidmore-Roth, 2019). I plan to achieve this goal by my first clinical shift on September 12, and maintain/improve this goal throughout the semester.

My fifth and last goal I aim to achieve is to be able to complete drug calculations quickly and efficiently. I have difficulty completing calculations under pressure, and this is an important skill to work on as an RN must be able to calculate medication dosages for several patients in a limited timeframe. To achieve this goal, I will complete practice calculations from my textbook Calculate with Confidence, focusing on areas of particular difficulty such as calculating flow rates (Morris & Brown, 2014). I will also work to incorporate mindfulness-based strategies to help me overcome feelings of anxiety, which are a main reason I have difficulty completing calculations. I will create a toolbox of mindfulness-based strategies by working with my counselor at the Trent Wellness Centre so I am able to work through feelings of self-doubt and anxiety and focus on calculations instead. My clinical instructor will create a mini-test for me to complete at midterm, and I will know I have achieved this goal when I am able to write this test and complete calculations easily and arrive at the correct answer even if I am having feelings of self-doubt. 

NURS 3021: Clinical Practice Focused on Chronic Disease Management
Self-Identified Learning Objectives: Second Half of Semester
October - November 2019

This is my second Self-Identified Learning Objective (SILO) document for the Fall 2019 semester. This Self-Identified Learning Objectives (SILO) was written using the Quality Assurance Program Learning Plan Form provided by the College of Nurses of Ontario (CNO) (CNO, 2019). The objective of this SILO is to identify four goals that I plan to achieve in the second half of my chronic care placement based on my identified learning needs. I will state my goals, outline how I plan to achieve them, and relate them to the College of Nurses Entry-to-Practice Competencies for Registered Nurses (RN) (CNO, 2014). 

The first goal I plan to complete for the second half of this semester is to improve my time management skills. Since I will be increasing my patient caseload from one to two patients for the second semester, it is critical that I develop good time management skills so that each of these patients receives high quality care. This goal is relevant because the CNO (2014) Competency #20 states that the RN “Organizes own workload and develops time-management skills for meeting responsibilities.” Additionally, as an RN, I will be responsible for care of at least four patients. If I can effectively manage my time with two patients I will be able to gradually work my way up to four. Specifically, I plan to be able to manage my time well enough that I will complete all my tasks and charting by 1315 so my clinical instructor can check it by 1330. I will know I have achieved this goal when I am able to complete my vital signs and head-to-toe assessment by 0800, manage to take a full half-hour break at my assigned break time, and have my charting complete by 1315. An additional indicator that I have achieved this goal is that I will not feel rushed to obtain information from my patient’s chart for my care plan and that I will have allowed myself enough time to be with my patient outside the role of actively providing care, developing a therapeutic relationship. I plan to achieve this goal through three activities. The first activity is to develop a plan of care on Wednesday and Thursday evenings for my shifts on Thursday and Friday. When I missed a clinical shift, I was required to complete a plan of care that demonstrated critical thinking. After completing this plan, I realized that it would be a very good tool to use for planning my shift and having good time management. I will develop a plan of care that isn’t as detailed as the one I completed for my missed clinical shift, but will still outline the times that I am to do certain activities such as giving medications, performing assessments, charting, and having conversations with my patient. The second activity is to complete my head-to-toe assessment at the same time as my patient’s vitals. During the first half of the semester I would complete my head-to-toe assessment just before I started morning care, as I thought it would be efficient to combine these two. However, I found that doing my head-to-toe assessment prevented me from going on my break at the time I was assigned. From now on, I plan to have both my vitals and head-to-toe assessment complete before 0800. Lastly, I plan to set aside 20 minutes solely dedicated to obtaining information from my patient’s chart for my care plan. I find that I am answering call bells all the time, and even though it is important to attend to patient needs, I also need to be able to obtain the required information to complete my assignments. As such, by setting aside 20 minutes where I only focus on obtaining information from my patient’s chart, I will feel confident that I have enough information to complete my care plan. I plan to demonstrate excellent time-management skills by my last clinical shift on November 22, 2019.

The second goal I plan to achieve is to increase my confidence when providing care and performing specific skills such as medication administration or wound care. This goal is relevant because Competency #6 states that the RN “Displays initiative, confidence and self-awareness, and encourages collaborative interactions within the nursing and health care team, with the client as the centre of the health care team” (CNO, 2014). I will know I have achieved this goal when I am able to provide care with similar efficiency to an RN, and when I am able to perform specific skills with minimal guidance from my clinical instructor. There are three activities I plan to use to increase my confidence. My previous SILO stated that I would work with a counselor at the Trent Wellness Centre; I tried this, but the counselor had extremely limited availability (about one appointment every month) and as such I have not been able to foster a strong therapeutic relationship with her. Another way I have been managing, and will continue to manage, is by going to 2-hour guided meditation sessions on Wednesday evenings. McClennon-Leong (2014)  states that meditation is a good alternative therapy for several conditions, including “mild depression”; meditation is further supported in an article by Boellinghaus, Jones, and Hutton (2014), stating that interventions such as meditation can help healthcare professionals such as nurses foster self-compassion and prevent burnout over the course of their career. Participating in meditation also helps to foster self-awareness, as stated in Competency #6 (CNO, 2014). Another activity I will use to achieve this goal is by seeking opportunities to provide care by answering call bells. Even though I stated above that I will set aside time to read my patient’s chart, I still plan to answer as many call bells as I can which will allow me to practice providing care and become more efficient, and will subsequently increase my confidence. Lastly, I plan to start journaling my clinical experiences, focusing on parts of my shift that went well. A study by Lundberg (2008) stated that when a nursing student documents their successful experience, this provides a tool for them to reflect on their accomplishments. Journaling is also a good tool to analyze emotions, as it requires one to slow down their thought processes and think objectively about an experience, what was done well, and what can be improved. I plan to demonstrate increased confidence in my clinical skills by my last clinical shift on November 22, 2019.

 The third goal I aim to achieve is to administer a medication by parenteral route, specifically intramuscular or subcutaneous. During the first half of this clinical rotation, I have administered several medications by oral, rectal, and ophthalmic route as well as inhalation, but have not yet had the opportunity to give an injection to a patient. This goal is relevant because Competency #62 in the CNO Entry-to-Practice Competencies for Registered Nurses document states that the RN “Implements safe and evidence-informed medication practices” (CNO, 2014). I will ensure my medication practices are evidence-informed by reading the section on administering injections in Chapter 33 of my Canadian Fundamentals of Nursing textbook and a video on how to administer injections in the accompanying online skills modules prior to starting my first clinical shift (Kaasalainen, 2014 and Mosby, 2014). I will ensure my practice is safe by reading my patient’s Medication Administration Record each shift that I am assigned to administer medications and informing my clinical instructor what times I need to administer an injection to make sure my instructor will be available to supervise at that time. To further ensure my medication practices are safe, I will review and memorize the 10 Rights of Medication Administration from Chapter 33 by Kaasalainene (2014) and be able to apply them when I am preparing and administering injections. Applying the 10 Rights includes completing three checks of the medication label against the Medication Administration Record which I will practice doing with my clinical instructor. I plan to have administered at least one injection, utilizing the 10 Rights and completing 3 checks for safety, before my last clinical shift on November 22, 2019.

The fourth and last goal I aim to achieve is to gain experience with wound care. Specifically, I wish to experience performing wound care on a deep wound that requires packing. This goal is relevant because Competency #61 states that the RN “Performs therapeutic interventions safely (e.g., positioning, skin and wound care …)” (CNO, 2014). So far in my clinical experiences, I have cleaned and dressed one wound but have not had experience with packing wounds. I practiced this skill in lab on a mannequin but had difficulty properly placing the dressing into the tunneling areas of the wound so I would like to practice this skill. I will know I have achieved this goal when I have completed wound care with packing on a patient I have been assigned. I will work towards this goal with three activities. I will read Chapter 46 in my Canadian Fundamentals of Nursing textbook to build my theoretical knowledge of wound care (Kohr, 2014). Secondly, I will watch videos on wound care found in the online videos set that accompanies my Canadian Fundamentals of Nursing textbook to expand my visual understanding of this skill (Mosby, 2015). Lastly, I will check my patient’s Medication Administration Record to determine what supplies are needed for wound care and gather them from the clean utility room well in advance of when I will be doing wound care. By doing this, I will be fully prepared to provide wound care, and will be able to do so efficiently. I plan to have performed care on at least one packing wound by my last clinical shift on November 22, 2019.