NR 537 Week 7 Assignment; Performance Evaluation - Summative Performance Evaluation...., Assignments of Nursing

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Summative Performance Evaluation of New Hire RN

Chamberlain University College of Nursing

NR-537: Assessment and Evaluation in Education

Date Submitted

Successful Learner’s Summative Evaluation Practice setting: New hire RN being evaluated for professional development within a hospice agency that provides care to end-of-life patients within the home setting. The learner in this scenario is a new graduate associate degree RN without experience beyond clinical rotations during their educational experience. The learner has completed 15 days of precepting and is being evaluated on their skill level for the patient admission process to hospice services within the home setting. The learner is being evaluated by the director of clinical education within the hospice agency. The learner has completed 15 days of precepting with an RN who has 15 years of hospice experience. The learner has assisted in three hospice patient admissions within the home setting with varied terminal diagnoses. Instructor observation: Learner A Prior to arriving at the potential patient’s home, the learner obtained the history and physical of the potential admission to hospice services from the admission coordinator and reviewed the documentation to ensure the patient will meet the local coverage determination (LCD) as determined by Medicare guidelines. Learner A determined that the patient should qualify for hospice services with the diagnosis of heart failure due to an ejection fraction of 20%, shortness of breath at rest, and the inability to carry out activities of daily living without maximum assistance. Learner A contacted the hospice physician and primary care physician for an order to admit to hospice services. Learner A called the patient’s home to arrange a time for admission and gathered the appropriate paperwork and supplies prior to leaving the office. Upon arrival at the patient’s home Learner A introduced herself and this observer in a professional manner. Learner A identified the patient based on name, date of birth, and Medicare identifier. Learner A began discussing how hospice services can benefit the patient and family at this point in their disease process with compassionate but professional wording. Learner A walked the patient and family through the consent process and began the assessment of the patient. This patient is an 88-year-old male who was diagnosed with heart failure in his 60’s. The patient’s condition is complicated by hypertension, hyperlipidemia, and diabetes mellitus type II. Learner A reviewed each body system including assessment of vital signs, heart and lung sounds, pulses (including peripheral pulses), bowel sounds, neurological assessment, height and weight, and blood sugar reading using the patient’s glucometer. Learner A did assess the patient’s skin but did not ask the patient to change position to assess the buttocks and coccyx for signs of skin breakdown. Learner A was reminded to assess all skin areas to provide a comprehensive plan of care for the patient. Learner A expressed the patient has difficulty moving and asked for assistance from the patient’s son in repositioning the patient to assess all areas of skin. Learner A then reviewed all medications with the patient and family and assessed any potential needs which included the following: oxygen, hospital bed, bedside commode, over bed table, and medications to manage shortness of breath symptoms and anxiety detected during the admission process. Learner A asked about drug allergies then asked to be excused from the room to contact the hospice physician and obtained orders for medical equipment needed and new orders for Morphine concentrate immediate release liquid 20mg/1ml 0.25ml PO/SL every 2 hours as needed for shortness of breath and Ativan 0.5mg 1 tab PO/SL every 4 hours as needed for anxiety or restlessness. Learner A reviewed the new orders with the patient and family and provided instructions for use, indications for use, side-effects, adverse reactions, and contraindications. Learner A also revied medical equipment safety with patient and family. Learner A asked which disciplines the patient and family wanted to utilize and explained the benefits of each service. The patient and family expressed they wanted a home health aide, chaplain,

symptoms of disease process. Demonstrated behaviors related to: a. Knowledge b. Skill c. Attitude Satisfactory K- Learner A determined additional assistance would be needed in the home beyond nursing services. Learner A determined medical equipment and medications would be needed to manage symptoms. S – Learner A contacted physician to obtain orders to medications and medical equipment to manage the patient’s symptoms. Learner A educated the patient and family on new medications and equipment. A – Learner A excused herself from the room to contact the physician to obtain orders. Learner A provided education to patient and family with professionalism and did not use medical terminology to simplify the explanation. Concluding statement by educator: Based on the findings detailed in the summative evaluation, Learner A achieved a satisfactory score overall. Learner A was able to determine hospice eligibility based on the LCD Medicare guideline based on review of history and physical and physical examination of the patient. Learner A performed an adequate physical assessment but failed to assess all areas of skin without a reminder. Learner A did not lose their professional composure after correction and completed the assessment with the assistance of the patient’s son. Learner A determined additional measures would be needed to manage the symptoms of the patient’s disease process and obtained appropriate orders for medication and medical equipment along with home health aide, chaplain, and social worker services. Learner A appears to have taken the knowledge and skill obtained during the 15 days of precepting and applied it to their practice setting. Learner A approached the admission process with professionalism, compassion, and courtesy to the patient, family, and interdisciplinary team. Unsuccessful Learner’s Summative Evaluation Practice setting: New hire RN being evaluated for professional development within a hospice agency that provides care to end-of-life patients within the home setting. The learner in this scenario is an associate degree RN with five years of experience in the long-term care setting and one year of experience in the home hospice setting. The learner has completed 10 days of precepting and is being evaluated on their ability to perform routine patient care within the home hospice care setting The learner is being evaluated by the director of clinical education within the hospice agency. The learner has completed 10 days of precepting with an RN who has 15 years of hospice experience. The learner has assisted in three at home hospice patient admissions and five routine skilled nurse visits within the home setting with varied terminal diagnoses. Instructor observation: Learner B Learner B arrived at the hospice agency prepared for work on time. Learner B received their patient assignment and checked in with this educator prior to receiving patient report. Learner B was assigned two routine skilled nurse visits with supervision of the licensed vocational nurse and home health aide. Patient A is a 90-year-old female with a primary hospice diagnosis of dementia and

Patient B is a 68-year-old male with a diagnosis of prostate cancer with metastasis to the bone. Patient B has two pressure ulcers on the left hip and requires wound care. Learner B printed demographic information on both patients along with a medication list and treatment plan for each patient. Upon arriving at Patient A’s home Learner B introduced herself and this educator to the patient’s daughter but failed to identify the patient. Learner B was reminded that all patients must be identified to ensure care is being provided to the correct patient. Learner B identified the patient based on information obtained from the patient’s daughter indicating name and date of birth. Learner B performed a comprehensive assessment of the patient and asked the daughter if any changes have occurred since the last skilled nurse visit. The daughter reported that Patient A had not been sleeping well and attempting to get out of bed at night. Learner B reviewed medications and counted medications available to ensure adequate supply. Learner B suggested the daughter administer Melatonin at bedtime to aid in sleep. This educator reminded Learner B that all medications even over the counter medications require an order from the physician. Learner B stated that at their previous employer this is a standing order and could be initiated as needed. This educator informed Learner B that no standing orders are available for this patient and the hospice physician must be contacted to initiate any medications. Learner B contacted the physician and obtained an order for Melatonin 3mg by mouth at night as needed for sleep. Learner B educated the daughter on the new order and medication including name, indication for use, side-effects, adverse reactions, contraindications, and precautions. Learner B asked the daughter if there were any other needs and began to excuse themselves from the home. This educator reminded Learner B that questions must be asked on the performance of the licensed vocational nurse and home health aide. Learner B asked the daughter the supervisory questions and instructed the daughter to contact the hospice agency for any additional needs. Upon arriving at Patient B’s home, Learner B introduced herself and this educator to the patient and their spouse and identified the patient based on name and date of birth provided by the patient. Learner B performed physical assessment of the patient and stated they were going to change the dressing to the pressure ulcers on the left hip. Learner B reminded to ask the patient if the dressing changes are painful and if medication is required prior to changing the dressing. Learner B asked the patient their level of pain, Patient B responded with 8/10. Learner B reviewed the medication list and administered Morphine Sulfate Immediate Release (MSIR) 15mg by mouth and began to prepare to change the dressings. Learner B reviewed the wound care orders, washed their hands, and began to gather the wound care supplies. The wound care supplies were being laid out on the patient’s bed without a barrier. This educator reminded Learner B that when performing wound care, a barrier such as wax paper or other waterproof barrier must be placed between the environment and the wound care supplies. Learner B did as instructed but mumbled under their breath “never had to do that before”. This educator quietly reminded Learner B to remain professional in the presence of the patient and family. Learner B asked the patient their level of pain with a response of 2/10 and they proceeded with the ordered wound care. Learner B completed the wound care and disposed of waste appropriately, washed their hands and began to complete the visit and leave. Learner B reminded that this patient receives care from a licensed vocational nurse (LVN) that requires supervision. Learner B then asked the patient and spouse questions regarding the care provided by the LVN. This educator reminded Learner B to review and count medications prior to leaving the home to ensure adequate supply and usage. Learner B complied with medication review and noted several medications needed to be refilled. Learner B informed Patient B and spouse that medications would be reordered and delivered to the home and asked if there were any other needs and exited the home. This educator apologized to Patient B and spouse for any unprofessional behaviors exhibited during the skilled nurse visit. Upon returning to the vehicle, Learner B started to call Patient B’s case

behaviors related to: a. Knowledge b. Skill c. Attitude professional manner. Concluding statement by educator: Based on the findings described in this summative evaluation, I recommend that Learner B not be allowed to perform any patient visit without supervision until another evaluation is performed. Learner B failed to ask patient identification information at the home of Patient A but did ask at Patient B’s home. Learner B failed to perform supervisory duties at both Patient A and Patient B and required reminders to perform the task which was performed in a minimal fashion without probing questions that could indicate problems. Learner B also failed to assess pain prior to performing wound care and did not place a waterproof infection control barrier under the wound care supplies. Learner B exhibited unprofessional behavior by stating “never had to do that before” in the presence of the patient and spouse after being corrected on the waterproof barrier. Learner B also made assumptions that some medications are included in standing orders and attempted to start a medication without contacting the physician. I recommend Learner B continue with 10 additional days of precepting with another summative evaluation performed at the completion of the 10 days. I additionally recommend the preceptor review the duties of a home hospice care RN and the regulations associated with this position.