Student Name: Jason Villavicencio

Southwestern Oregon Community College Nursing Program

Nursing 110
Foundations of Nursing: Health Promotion








Clinical Evaluation Tool



The purpose of the weekly clinical performance evaluation tool is to provide feedback about achievement of the course outcomes and
competencies and to assist the student to meet the standards of care for nurses in Oregon as outlined in the Nurse Practice Act.

Explanation of Rating Scale:
(S) Satisfactory = Clinical performance is safe and student adequately demonstrates application of the nursing process/clinical judgment, required
skills, and expected synthesis of learning appropriate to level in the program. Verified by direct instructor observation.
(NI) Needs Improvement = Indicates that additional learning and attention to detail is required for a particular item or that the overall
performance for the week is at a minimum level. The instructor will write an explanation of the rating on the comments page.
(U) Unsatisfactory = Clinical performance is unsafe and inadequately demonstrates application of the nursing process/clinical judgment model,
required skills, and expected synthesis of learning appropriate to level in the program. The instructor will write an explanation of the rating on the
comments page.
(NA) Not applicable = Particular item does not apply to the clinical performance.
(NO) Not observed = Instructor did not observe or has no knowledge of the students performance of the activity.
Students with a weekly grade of NI or U will be required to meet with their advisor and clinical instructor and discuss a plan for change in their
behavior before their next clinical experience.
Safety and legal/ethical concepts are considered critical to the profession and will be graded as NI or U if any violation occurs.
If a student is assigned a U or NI for two weeks, the faculty will review the students clinical performance and consider the options of either placing
the student on probation or dismissing from the program.
In cases of potential failure, notification of the student by the instructor that she/he has been assigned a grade of U or NI for one week constitutes
proper warning of the grade status.
If a student is placed on probation and then receives a weekly grade of U, the faculty will review the students performance and determine
whether or not the student will be dismissed from the program.





2
Nursing 110 Clinical Evaluation Tool Student Name: Jason Villavicencio
. Clinical Week
Competency
(C)
Course
Outcomes
(CO)
1 2 3 4 5 6 7
8
Make-up
9

Dates 2013/2014 10/8 10/15 10/22 10/29 11/05 11/12 11/19 11/26 12/03
Attendance: P=Present, A=Absent, T=Tardy P P P P P P P NA P
Facility/Unit BCV BCV BCV BCV BCV BCV BCV NA BCV
C9
CO 1, 2
Applies concepts and theory to clinical practice in client care and
written assignments:
1. Collects data and conducts a health assessment on a client.
S S S S NI S S Holiday S

2. Analyzes and interprets the data/assessment findings. S S S S NI S S - S
3. Prioritizes health problems. S S S S S S S - S
4. Develops a plan of care that considers the individual, family, age
of client, developmental stage, psycho-socio-cultural issues,
and/or learning needs.
S S S S NI S S - S

5. Evaluates and reflects on plan of care. S S S S S S S - S
C 8, CO 5 Uses therapeutic communication with patients and agency staff S S S S S S S - S
C 6,7,8
CO 1,4
Recognizes cultural issues and interact with clients in culturally
sensitive ways
NA NA NA NA S S S - S

C10, CO2 Uses research and evidence to support clinical decision making NA NA NA NA S S S - S
C6, CO2 Utilizes resources as needed S S S S S S S - S
C9, CO2 Demonstrate responsibility and accountability for professional
behavior:
1. Performs safely in clinical.
S S S S S S S - S

C3 2. Prepared for clinical (Appropriate attire, appropriate tools such as
stethoscope, skills list, evaluation tool, assessment tools).
S S S S S S S - S

C4 3. Takes initiative in making decisions and assuming responsibility for
decisions.
NO NO NO S S S S - S

C3 4. Looks for opportunities for continued learning and self-
development.
S S S S S S S - S

C4 5. Identifies behaviors and attitudes influencing professional
behavior.
NO NO NO S S S S - S

C1,2 6. Demonstrates growth in coping with stressful situations in a calm
and dependable manner.
NA NA NA S S S S - S

C1, CO3 7. Maintains patient confidentiality. S S S S S S S - S
C3, CO8 8. Completes and submits assignments on time. S S s S S S S - S
C2 9. Organizes and manages time effectively. S S S S S S S - S
C4, CO8 10. Attends and participates at post-conference. S S S S S S S - S
Instructor Initials OM OM OM OM OM OM OM OM OM
Student Initials JV JV jv JV JV JV JV JV JV
Key: C=Competency, CO=Course Outcome 3
Week Instructor Comments (Include Date/Signature)
Student Initials
1
10/08/13Jason, very nice first clinical. You show positive attitude in learning, ask pertinent questions, and sought
feedback from instructor and other students. I look forward to watching your growth in nursing this term.
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC

JV
2
10/15/13Jason, you had a good clinical this week and you completed many of your check-offs for the week. Way to
go. We need to work on you not talking to me while doing check-offs, but rather speaking out loud about what you
are doing to the patient. I will explain better next week if you dont understand what I am saying. You continue to
look for learning opportunities and show good teamwork. Nice job
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC

JV
3
10/22/13Jason, You take excellent care of your patient, however you are still in the CNA role of care. You need to
do more than tasks. Please see my comments on your paper. We will talk next week at clinical about this as well.
Seeks guidance from faculty &/or clinical staff
Maintains professional demeanor when communicating to pt, family, team members
Uses therapeutic communication when providing pt care
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC

jv
4
10/29/13Jason, nice clinical today, your care plan and patho paper are getting much better.
You accessed the facilities EMR with ease
Continues to seek external feedback and assistance in reflective process.
Can set realistic goals with consultation.
Developing self-monitoring strategies; developing insight on possible implications for practice or self
Increasingly open to new learning opportunities
Recognizes own learning needs with assistance.
Completes assigned learning activities and occasionally initiates additional learning activities.
Uses standard technology resources in practice with minimal assistance
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC,


JV
5
11/05/13Jason, you did not have your care plan completed today and we talked about this during our time
together at clinical. I expect much better from you next week. You do build a good rapport with all of your patients
and always have a positive attitude.
Continues to seek external feedback and assistance in reflective process.
Can set realistic goals with consultation.
Identifies own established patterns of behavior and thought.
Recognizes own learning needs with assistance.
Increasingly open to new learning opportunities; decreasing reactivity to change and multiple, valid points of view.
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC,

JV
6
11/12/13Jason, Excellent care plan and patho paper this week. Your nursing diagnosis and interventions were
great. I also appreciated the flexibility and positive attitude when we had to change rooms 3 times today.
Developing collaboration with other health care team members.
Developing role within a team and offers help or engage in problem solving and decision making
Developing skills in giving feedback to teams members
Reflects on constructive feedback, and usually incorporates its relevance into future behaviors/ nursing practice
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC,

JV
7
11/19/13Jason, good clinical this week. You consistently stay busy and utilize your time well. Your care plans are
improving greatly. Keep up the good work.
Views all situations as learning to be embraced
Seeks new learning experiences beyond the limits of assignments.
Recognizes that information continually evolves.
Readily identifies and takes responsibility for own learning needs.
Eager to share new learning with peers.
Uses standard technology resources efficiently and effectively in practice.
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC,

JV
8
Clinical
Make-
up
11/26/13make-up clinical only this week. Holiday




9
12/03/13Jason, nice clinical this week. You impressed the staff at BCV by being so helpful and completing all the
skin assessments you did. It also helped you in your assessments. You are going to be a great nurse; keep up the
good work. Have a great holiday break.
Works well with team members who have varying points of view; enters into team relationships and readily accepts and fulfills
assignments and commitments.
Actively contributes to team work ; offers help and assists team with problem solving and decision making; and shares
information necessary to make informed decision.
Utilizes verbal and nonverbal approaches for effective therapeutic communication
Readily elicits clients and familys communication. Caring apparent through tone and nonverbal
In most situations, interprets the clients data patterns and compares with known patterns to develop an intervention plan and
accompanying rationale
Opal Murphy RNBS, MSN
Nurse Educator, SWOCC,
JV
9/1/09: rev 05062011: reviewed 9/2012 sw 4