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Student Name: Dawn Neal

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: Dawn Neal
. 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 5/27 6/3
Attendance: P=Present, A=Absent, T=Tardy P P P A P P P P
Facility/Unit 3C PSU PSU PSU 3D IMCU LDRP
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 S NA

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

3. Prioritizes health problems. 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 S S S

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

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

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

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

C6/O2 Utilizes resources as needed S 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 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 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:
2. Performs safely in clinical.
S S S S S S S NA

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 S

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

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

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

C1/O3 7. Maintains patient confidentiality.
S S S S S S S

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

C2 9. Organizes and manages time effectively. S S S S S S S
C4 10. Attends and participates at post-
conference.
S S S S S S S

Instructor Initials DH DH DH DH DH DH DH
Student Initials DN DN DN DN DN DN DN





Clinical
Week
Instructor Comments (Include Signature)
Student
Initials
1

PASSGood first day, next week Ill try and find you some more SC injections. Looking forward to the weeks ahead.

Dustin Hawk, RN, BSN, PCCN

DN
2
PASSGood work. I know technology can be a pain. If you ever think your care plan did not get into the drop box
email it to me.

Dustin Hawk, RN, BSN, PCCN

DN
3

PASSGood work with this patient. You always do a good job introducing me and yourself as the student nurse.
Great heart and lung assessments. Keep up all the hard work.

Dustin Hawk, RN, BSN, PCCN


DN
4

Absent

DN
5
PASSGood work! You are working hard to perfect your nursing assessments. Start to organize your day while
thinking about having more patients to care for. Almost a second year and then you will have to manage two
patients.

Dustin Hawk, RN, BSN, PCCN




DN
6
PASSEvery week your nursing care improves. Its great to see you grow, keep up the hard work.


Dustin Hawk, RN, BSN, PCCN


DN
7

PASSgreat job this week with a difficult pt, your nursing note is a good example of good clinical documentation.
You have been a joy to have in clinical.

Dustin Hawk, RN, BSN, PCCN

DN
8

PASSgood job this term!!! You will make a great nurse and then NP. Keep working hard and soon you will achieve
all your goals.

Dustin Hawk, RN, BSN, PCCN

DN
9

NA


12/08/12: sw 5