Student Name: Micah Finney

Southwestern Oregon Community College Nursing Program

Nursing 112
Foundations of Nursing in Acute Care I








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 112 Clinical Evaluation Tool Student Name: Micah Finney

. Clinical Week
Competency
(C)
Course
Outcomes
(O)
1 2 3 4 5 6 7 8 9
Make-
up
Dates
4/8 4/22 4/29 5/6 5/13 5/20


Attendance: P=Present, A=Absent, T=Tardy
P P P P P P


Facility/Unit
PSU IMCU PSU IMCU PSU PSU


C9/O1, O2
Applies concepts and theory to clinical practice in client care
and written assignments:
1. Collects data and conducts a health assessment on a
client with an acute condition.
S S S S S S


2. Analyzes and interprets the data/assessment findings.
S S S S S S


3. Prioritizes health problems.
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 S S


5. Evaluates and reflects on plan of care.
S S S S S S




C1/O3 Apply ANA Code of Ethics to care of patients with acute
conditions/processes.
S S S S S S


C5/O3 Identifies roles and functions of members of the health care
team involved in providing care for acute
conditions/processes.
S S S S S S


C8/O5 Uses therapeutic communication with patients and agency
staff
S S S S S S


C4/O4 Recognizes potential legal and ethical issues related to client
autonomy across the lifespan in at risk populations.
S S S S S S


C6, C7, C8/
O1
Recognizes cultural issues and interact with clients in
culturally sensitive ways
S S S S S S


C10/O2 Uses research and evidence to support clinical decision
making
S S S S S S


C6/O2
Utilizes resources as needed
S S S S S S


C9/O2 Demonstrate responsibility and accountability for
professional behavior:
1. Performs safely in clinical.
S S S S S S


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










Competency
(C)
Course
Outcomes
(O)
1 2 3 4 5 6 7 8 9
Make-
up
C9/O2
Demonstrate responsibility and accountability
for professional behavior:
1. Performs safely in clinical.
S S S S S S


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


C4 3. Takes initiative in making decisions and
assuming responsibility for decisions.
S S S S S S


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


C4 5.Identifies behaviors and attitudes influencing
professional behavior.
S S S S S S


C1,
C2
6. Demonstrates growth in coping with stressful
situations in a calm and dependable manner.
S S S S S S


C1/O
3
7. Maintains patient confidentiality.
S S S S S S


C3 8. Completes and submits assignments on time.
S S S S S S


C2 9. Organizes and manages time effectively.
S S S S S S


C4
10. Attends and participates at post-conference.
S S S S S S



Instructor Initials
DH DH DH DH DH DH



Student Initials
MF MF MF MF MF MF





















Clinical
Week
Instructor Comments (Include Signature)
Student
Initials
1
PASS--Great first week. You kept positive and seemed to find things to keep you busy. I look forward to the weeks
ahead.

Dustin Hawk, RN, BSN, PCCN
MF
2
PASSSee notes MF
3
PASSSee Notes MF
4
PASSYou are doing a good job, but need to work on your nursing notes. This can take some time. I would like to work with you
on this during the clinical day, but call and let me know when you would like to go over this. Also rem you can always to a draft and
show it to me or the nurse you are working with.

Dustin Hawk, RN, BSN, PCCN
MF
5
PASSYour nrs notes improved this week, see care plan for feedback. This pt was a good example of why its so
important to learn while a student all that you can, so you are able to jump into action when your pt develops an
arrhythmia.
MF



Dustin Hawk, RN, BSN, PCCN
6
PASSIf I ask you always try to improve in that area. Very thankful for great students like you. As a reminder think
about the nursing process when coming up with your plan of care ADPIE, it is the foundation for the care you provide.
Dont be afraid to change your nursing dx after the day of clinical. Pts are always changing and nurses cont to reassess.

Dustin Hawk, RN, BSN, PCCN
MF
7

8

9






12/08/12: sw 5