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Student Name:

Dawn Kaneen

Southwestern Oregon Community College Nursing Program


Nursing 221
Foundations of Nursing: Chronic Care II

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 221 Clinical Evaluation Tool

Student Name:

.
Compete
ncy
(C)
Course
Outcome
s
(CO)

C9
CO 1, 2,
3

CO5, 6

C8
C6, 7, 8

Clinical Week
1

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

1/15
P

1/22
P

1/29
P

2/5
P

2/13
P

2/19
P

2/26
P

3/5
P

3/12
P

Facility/Unit

LDRP

MCU

ED

REU

TRAU

PSU

APU

ICU

ICU

NA

NA

NA

NA

NA

Applies concepts and theory to clinical practice in


client care and written assignments:
1. Conducts evidence-based health assessment
2. Collects and monitors a variety of data
3. Analyzes and interprets the data/assessment
findings in increasing complex chronic
conditions.
4. Recognizes pathophysiological changes and
symptoms
5. Regularly monitors clients level of comfort and
ability to manage symptoms and symptom
distress
6. Prioritizes health problems.
7. Develops and uses evidence-based
individualized interventions
8. Develops a plan of care that considers the
individual, family, age of client, functional
issues associated with co-morbidities,
developmental stage, psycho-socio-cultural
issues, capacity for and engagement in selfhealth care, and/or learning needs.
9. Evaluates and reflects on plan of care for
clients with chronic conditions.
Develops discharge plans in collaboration with
client, family, and other members of the health
care community.
Uses therapeutic communication with patients and
agency staff.
Recognize cultural issues and interact with clients

Makeup

C5
CO5
C10
CO2
C6,
CO4
C4

in culturally sensitive ways.


Collaborates with other members of the health
care team to provide comfort and symptom
management.
Uses research and evidence to support clinical
decision making.

Utilizes resources as needed.

Able to identify/define leadership skills for nurse's


role

NO

S
3

Compete
ncy
(C)
Course
Outcome
s
(CO)

C9, CO
1

C9,
CO1
C3
C4
C3
C4
C1,2
C1
C8
C3
C2
C4

Makeup

Exhibits critical thinking skills when prioritizing


and delegating patient care.
Demonstrate 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. Documentation of client care is accurate and
relevant and consistent with agency policy
9. Completes and submits assignments on time.
10. Organizes and manages time effectively.
11. Attends and participates at post-conference.

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

Instructor Initials
Student Initials

JT
DK

JT
DK

JT
DK

JT
DK

SW
DK

JT
DK

JT
DK

JT
DK

JT
DK

Week

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)

Dawn, I am glad that you enjoyed your rotation through the family birth center. It sounds like
you took the initiative to seek out new learning opportunities (competency 3). This was a good
clinical rotation for you, your care plan was pertinent and complete. However, I feel that you
could work a little on your confidence level, and try to allow yourself to develop leadership skills.
Jenny Tausch RN MSN PCCN 1/22/15
Dawn, I made some comments on your care plan. I feel that you are trying to gather as much
information as possible, and you could narrow your focus some. This week was tough for you as
you had your patient assignment rearranged more than once, this can be difficult. You adapted
easily and did so with a positive attitude. You knew your limitations and were conscious of your
own self-care (competency 2). You mentioned that you had some time management barriers this
rotation; this is something you know you need to work on and can master.
Jenny Tausch RN MSN PCCN 1/24/15
The Emergency Department is extremely different from the floors, as you may have noticed. I
am glad that you enjoyed your time there. I feel that it is important to see how other areas of
the hospital flow, so that you are able to get the whole picture. Your reflection describes your
patient in good detail, and I did not have any comments on it demonstrating competency 8,
effective communication. You mentioned in post clinical and in your reflection the amount of
bleeding that occurred after removing the IV, this is a lesson learned for you, and I know this is
something that you will be prepared for next time.
Jenny Tausch RN MSN PCCN 2/1/2015

Student
Initials

DK

DK

DK

Dawn, this week REU was very busy, and I believe had less than optimal staffing. I liked that you
pitched in and helped out the unit (competency 5). The nurses said that you were helpful and
had a good attitude. Your care plan is complete and pertinent to your patient. You are adding
subjective data and I noticed that your nursing implications are pertaining to the adverse
reactions. As far as something to work on, I can tell that you are improving on your confidence
levels and that you are becoming more comfortable in the clinical setting. Keep up the good
work, and continue looking for ways to increase your knowledge base.
Jenny Tausch RN MSN PCCN 2/15/2015
2-13-15 Participated in Trauma Day. Assumed role of coordinator, acknowledge importance of
role and contributing to effective team functioning. Demonstrated the value of team work.
Functioned well within the nursing and inter-professional
team
.S. Walker, RN, MSN
Dawn, unfortunately I was not able to spend much time with you this week. It appeared that
every time I went to the unit, you were very involved in patient care and working with the staff
(competency 5). I did notice that you were working well with the staff and it appeared that you
had developed a good rapport with your patients. I do feel that you might need to work on your
time management some, this is something that will improve over time.
Jenny Tausch RN MSN PCCN 2/21/2015
Dawn, I am glad that you were able to rotate through the APU and that it was an area of interest
to you. We knew that there were some potential dangerous patients there, and you kept
yourself safe and aware of your surroundings (competency 2). Your reflection was appropriate
and described the patients on the unit. I feel this was a good week for you and that you really
went there wanting to learn. I did not see anything that you needed to work on this week, and I
feel this was a successful rotation for you.
Jenny Tausch RN MSN PCCN 3/3/2015
Dawn, I noticed that you were actively looking for skills to practice and new things to learn
during this clinical rotation (competency 3). You were proactive in seeking out opportunities and
actively listening to the ICU nurses. I realize that you had to changes to adapt to with patient
assignments, and you did that well. I did suggest on your careplan that you add a bit more
subjective data to help complete the picture of the patient. Overall, you had a good day and I
hope you enjoyed the ICU.
Jenny Tausch RN MSN PCCN 3/8/2015

DK

DK

DK

DK

DK

DK

Good job Dawn, good luck in your practicum.


Jenny Tausch RN MSN PCCN 3/14/2015
12/12/12: sw, revised 12/6/14sw