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DEPARTMENT OF NURSING
BSN PROGRAM
Clinical Performance Evaluation Tool
Junior/Senior level
Self Evaluation
Faculty Evaluation
Student Name
Course: NH2U-
Faculty,
Semester/Year
T~4-ll
Core Competencies
Midterm
S D Nl U
Final
Nl U
t
Patient-Centered Care: Program Goal 2; Essential II, VII
Demonstrates respect and sensitivity for patient and family preferences, values
and needs in the provision of holistic care.
Demonstrates caring behaviors
Implements comprehensive, holistic care including patient values, preferences
and needs
Provides patient-centered, culturally sensitive care to individuals and or families
with chronic or acute illnesses within complex health care systems
Assesses the presence and extent of pain and suffering
Demonstrates beginning competency in skills
Recognizes the boundaries of therapeutic relationships
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Core Competencies
Midterm
S D Nl U
patient/family care
References clinical related activities with evidence-based literature
Understands the concept of evidence-based practice in determining best clinical
practice
Integrates legal-ethical and policy issues in the delivery of optimal health care
Final
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NRSG
^Content based upon QSEN Competencies and KSA's.
S = Satisfactory
D= Developing
Nl = Needs Improvement
U = Unsatisfactory
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NRSG
Student
Student Signature
Date
Faculty Signature
Date
J2'/79
Student
Student Signature
Date
Faculty Signature
Date
Student
Student Signature
Date
Faculty Signature
Date