Student Name:

Brooke Perry

Southwestern Oregon Community College Nursing Program

Nursing 110
Foundations of Nursing: Health Promotion

Clinical Evaluation Tool

Nursing 110 Clinical Evaluation Tool

Student Name:

Clinical Week
1

Compete
ncy (C)
Course
Outcome
s
(CO)

C9
CO 1, 2

C4
C3
C4
C1,2
C1,
CO3

4
10/2
7

7
11/1
7

8
11/2
4

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

Facility/Unit

AVA

AVA

AVA

AVA

CFD

AVA

AVA

CC

AVA

N/A

N/A

S
S

S
S

S
S

S
S

N/A
N/A

S
S

S
S

N/A
N/A

S
S

N/A

N/A

N/A

N/A

Uses therapeutic communication with patients and agency

staf

Recognizes cultural issues and interact with clients in

culturally sensitive ways

Uses research and evidence to support clinical decision

making

N/A

Utilizes resources as needed

Applies concepts and theory to clinical practice in client

care and written assignments:
1. Collects data and conducts a health assessment on a
client.
2. Analyzes and interprets the data/assessment findings.
Prioritizes health problems.
Develops a plan of care that considers the individual,
family, age of client, developmental stage, psychosocio-cultural issues, and/or learning needs.
Evaluates and reflects on plan of 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 selfdevelopment.
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.

11/3

6
11/1
0

10/6

5.

C3

3
10/2
0

Dates

3.
4.

C 8, CO
5
C 6,7,8
CO 1,4
C10,
CO2
C6,
CO2
C9,
CO2

2
10/1
3

12/1

Makeup

C3,
CO8
C2
C4,
CO8

8.

Completes and submits assignments on time.

9.

Organizes and manages time efectively.

10. Attends and participates at post-conference.

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

Instructor Initials
Student Initials
Key: C=Competency, CO=Course Outcome
2

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.

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)

Avamere; Day one; familiarizing yourself with facility and patients. Some basic care and blood
sugars done.
Pamela Wick RNCMSN
Avamere; Beginning to get patient information to perform care. Did complete basic care, bed
making, bathing, blood sugars, some observations with physical therapy.

Student
Initials

BP

BP

Pamela Wick RNCMSN

BP
3

Avamere; Obtaining more information and learning to think about nursing diagnosis. Continuing
to provide basic care to your patient. Great job with communication with the patient your peers
and the staf.
Pamela Wick RNCMSN
BP

Avamere; Continuing to expand your care plan, great job with your care today. Read over your
care plan for understanding, be sure to use form for nursing diagnosis so it will prompt you
where you need to document.
Pamela Wick RNCMSN
Charleston fire department; Great day, you did an exceptional job,

BP

Pamela Wick RNCMSN

Avamere; Continuing to provide basic care to your patient, practicing your head to toe.
Beginning to gather information relative to your patient from the charts to formulate a care
plan. Care plan beginning to take shape. Obtained a blood sugar on your patient. Observed in
physical therapy. Continue to practice your assessments.

BP

Pamela Wick RNC MSN Ed.

Avamere; Care plan needs to be updated after your clinical day with your new interventions.
During the day you are following through on your care plan and then reevaluating to make the
care plan better. Very nice job with your interactions with your patients, you are calm and
supportive.

BP

Pamela Wick RNC MSN Ed.

Community Caf; Thank you for you survey, Good reflections.
8

Pamela Wick RNC MSN Ed.

Avamere; Last day today, discussed nursing diagnosis and updated for your care plan today.
Completed your head to toe assessment, very nicely done. Continue to work on combining
information to afect your patho, what comorbidities efect the disease process up front, then
how do the co-morbitities efect the healing process. Great term we will see you next term
Pamela Wick RNC MSN Ed.

Clinic
al
Makeup
9/1/09: rev 05062011: reviewed 9/2014 sw

BP

BP