NR 574 Week 5 Midpoint Self-Appraisal Example

Midpoint Self-Appraisal, Week 5: Five Aims in Their Original Wording, Each With a Verdict and the Material It Rests On

Student Name

College of Nursing, Chamberlain University

NR 574: Acute Care Practicum I

Instructor Name

Month Day, Year

Midpoint Self-Appraisal, Week 5: Five Aims in Their Original Wording, Each With a Verdict and the Material It Rests On

How This Appraisal Is Laid Out

The five aims below follow my week 2 objective set in its original order; each is given here by its target, and the full week 2 wording is attached unchanged so a reader can check every verdict against it. Each has one of three verdicts: met in full, partly met or not reachable here. Under each verdict is the material it rests on: a count, a document or written feedback, with dates. My preceptor read this appraisal before I submitted it and initialed each verdict. Written feedback tied to stated aims is what makes a verdict checkable by a second reader (Ende, 1983).

Aim 1

Aim 1, as set in week 2: my own plan first on rounds, at least four times, by the end of week 6.

Verdict: partly met.

Material: seven presentation forms completed by my preceptor between weeks 2 and 5. "Plan offered independently" is marked on three of them, all from weeks 4 and 5. On the other four, my preceptor's comment on two of them reads, in substance, that I waited for the plan before giving mine.

What the rest of the term would need: one more presentation with the plan offered independently by the end of week 6. Given that three of the last four met the item, that looks achievable.

Aim 2

Aim 2, as set in week 2: three noninvasive ventilation decisions, starting or weaning, each in a cosigned note.

Verdict: partly met.

Material: one cosigned note, week 4, recording the decision to continue settings and begin daytime trials off the machine for a patient with COPD, with the gas and the reason. No initiation decisions: in five weeks, every patient on noninvasive ventilation started it in the emergency department before reaching the unit.

What the rest of the term would need: two more weaning decisions, which the unit can supply, and at least one initiation, which it may not. This is the subject of my week 6 memo.

Aim 3

Aim 3, as set in week 2: eight admission notes with problem-based plans, each reviewed.

Verdict: met in full.

Material: nine admission notes between weeks 2 and 5, each with my preceptor's review recorded; written comments on four. The comments in week 2 asked for shorter histories; those in week 5 did not.

Aim 4

Aim 4, as set in week 2: two ultrasound-guided peripheral lines with a supervisor present, after watching one.

Verdict: not reachable here.

Material: the vascular access team lead told my preceptor in week 3 that hospital policy limits placement by students to those enrolled in the hospital's own credentialing course, which is not open to visiting students. I observed two placements in week 3. The aim was written in good faith in week 2; the policy was not known to my preceptor or to me until we asked. The replacement was proposed by my preceptor, not by me, and recorded with the date.

Replacement, agreed with my preceptor on the date of this appraisal and recorded on the form: perform two arterial blood gas punctures under the direct observation of the respiratory therapist, after completing the hospital's online module, which is open to students. The replacement keeps the aim in the procedural domain and keeps its supervision level stated, as frameworks for entrusting clinical activities expect (ten Cate, 2013).

Aim 5

Aim 5, as set in week 2: lead one goals-of-care family meeting with the preceptor present, after watching one.

Verdict: partly met.

Material: one family meeting observed in week 4, led by my preceptor. No meeting led yet. My preceptor has identified a likely opportunity in week 7 for a patient whose family has asked to talk.

What the Term Has Shown About My Own Practice

Two things. First, the aims I met fastest were the ones that depend only on my writing, such as admission notes. The aims that depend on speaking in front of the team or on the unit's timing are behind. Second, my first draft of this appraisal marked aim 1 as met, because I remembered feeling more confident on rounds. The forms said otherwise. A systematic review comparing clinicians' self-assessments with external measures found that self-assessment often had little or no relationship to observed performance, and was worst among those who were least skilled and most confident (Davis et al., 2006). That finding was the reason I attached a document to every verdict. It also means the reflective passage above is my reading of the documents, not a feeling about how the term is going.

Agreed Next Steps

Before the end of week 6: one more independent plan on rounds; my week 6 memo about noninvasive ventilation starts; the arterial blood gas module completed. My preceptor and I will review the replacement aim at the end of the term alongside the others.

References

Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006). Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA, 296(9), 1094-1102. https://doi.org/10.1001/jama.296.9.1094

Ende, J. (1983). Feedback in clinical medical education. JAMA, 250(6), 777-781. https://doi.org/10.1001/jama.1983.03340060055026

ten Cate, O. (2013). Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education, 5(1), 157-158. https://doi.org/10.4300/JGME-D-12-00380.1