Student Name:

Adam N

Southwestern Oregon Community College Nursing Program

Nursing 111
Foundations of Nursing in Chronic Illness 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 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 grade of U, the faculty will review the students performance and
determine whether or not the student will be dismissed from the program.

Nursing 111 Clinical Evaluation Tool

Student Name:

.
Compete
ncy (C)
Course
Outcome
(CO)

C9
CO 1, 2

C1,
CO4
C5,
CO5
C8,
CO6
C4,
CO7
C6, 7, 8
CO2
C10

Clinical Week
Dates
Attendance: P=Present, A=Absent, T=Tardy
Facility/Unit
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 a chronic illness
2. Analyzes and interprets the data/assessment
findings.
3. Prioritizes health problems.
4. Develops a plan of care that considers the
individual, family, age of client,
developmental stage, psycho-socio-cultural
issues, and/or learning needs.
5. Evaluates and reflects on plan of care.
Applies ANA Code of Ethics in care of chronically
ill
Identifies roles and functions of members of the
health care team involved in providing care for
the chronically ill.
Uses therapeutic communication with patients
and agency staf
Recognizes potential legal and ethical issues
related to client autonomy across the lifespan in
at risk populations.
Recognizes cultural issues and interact with
clients in culturally sensitive ways
Uses research and evidence to support clinical
decision making

1/13
P
BAH

1/20
P
BAH

1/27
p
BAH

2/4
p
BAH

2/10
p
BAH

2/19
P
CC

2/24
P
BAH

3/3
A
NA

3/10
P
BAH

na

na

na

na

na

na

na

na

na

na

na

na

na

na

ni

na

n/o

ni

na

na

ni

na

na

na

Makeup

C6

Utilizes resources as needed

na

na

s
3

Competen
cy (C)
Course
Outcome
(CO)

C9, CO2

C3

C4
C3
C4
C1
C1
C3
C2
C4

Demonstrates responsibility and accountability

for professional behavior:
1. Performs safely in clinical.
2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope, skills
list, evaluation tool, assessment tools).
3. Takes initiative in making decisions and
assuming responsibility for decisions.
4. Looks for opportunities for continued learning
and self-development.
5. Identifies behaviors and attitudes influencing
professional behavior.
6. Demonstrates growth in coping with stressful
situations in a calm and dependable manner.
7. Maintains patient confidentiality.
8. Completes and submits assignments on time.
9. Organizes and manages time efectively.
10.Attends and participates at post-conference.
Instructor Initials
Student Initials

na

na

ni

na

ni

na

na

na

na

s
s
s
s

s
s
s
s

s
s
s
s

s
s
s
s

s
s
s
s

s
na
na
na

s
s
s
s

na
na
na
na

s
s
s
s

MJS

mjs

mjs

mjs

mjs

mjs

mjs

mjs

mjs

Makeup

Week

5
6

Instructor include comments that are positive, areas that need improvement or are
unsatisfactory. Reference the course outcomes listed in the syllabus and/or the OCNE
Competencies from the Nursing Student Handbook (Date/Sign all entries)

Student
Initials

First clinical experience in acute care. Beginning understanding of care planning. Uses time
to orient to unit, computers and time management. Nice patient focus and works well with
unit staf------------MSperry RNc BSN

AN

Cares for patient with active C-dif. Recognizes safety issues and assures that PPE fit well and
will provide needed safety measures. Identifies fluid volume imbalances and infectious agent
needs. Review notes on care plan.
-------------------------------------------------------------------------------------------------------------------------MSperry RNc BSN
Does medication administration with MAK and pyxis. Identifies 5 rights and follows with 3
checks. Does Subq injections and has very nice sterile technique. Nice therapeutic
communication with patients. MSperry RNc BSN

AN

Cares for patient on the med-surg unit. Identifies nursing dx and improving on goals and
interventions. Beginning to appropriately prioritize dx. Reflect completely on your diagnosis
as you see how your interventions
work.-------------------------------------------------------------------------------------------------------------------------------------------MSperry RNc BSN
Better physical assessment documentation and care planning. Excellent patient approach
and communication. Works well with unit staf and
classmats------------------------------------------------------------------------MSperry RNc BSN

AN

Community Caf clinic experience. Does IM injections and assists with dental screenings.
Minimal interaction with caf clients in conversation. Minimal active listening and therapeutic
interactions. This clinical was to help with communication and interaction with those that are

AN

AN

AN

not fortunate enough to be seen in traditional clinic settings. Helping them feel accepted is a
critical piece of this clinical. Be sure to interact with you clients and patients in every clinical
setting.---------------------------------------------------------------------------------------------------MSperry RNc
BSN

Cares for post surgical knee. Improving on assessment documentation and care planning.
Beginning to prioritize care planning. Work on being more specific and
measurable.----------------------------------------------MSperry RNc BSN

AN

Absent
8

Organized plan of care, patient care and charting this evening. Good priority setting and
patient focused care. Able to hang IV fluids properly and with aseptic technique. Pre-clinical
care plan was patient centered and prioritized.
------------------------------------------------------------------------------------------------------------------------------MSperry RN

9/1/09sw: revised 12/06/14sw

AN