Student Name:

Molly

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 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.

Nursing 111 Clinical Evaluation Tool

Student Name:

Compete
ncy (C)
Course
Outcome
(CO)

C9
CO 1, 2

C1,
CO4
C5,
CO5
C8,
CO6
C4,

Molly

Clinical Week
2

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

1/14
p

1/28
P

2/4
p

2/11
P

2/18
p

2/25
p

Facility/Unit

BAH
-PSU

1/21
p
BAHMCU
PED
S

BAHRT

BAHMCU

BAHMCU

BAHMCU

BAHREU

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

ni

ni

ni

ni

10

Makeup

CO7
C6, 7, 8
CO2
C10
C6

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
Utilizes resources as needed

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.

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
s

10

Makeup

Instructor Initials
Student Initials

mjs

mjs

mjs

mjs

mjs

mjs

mjs
4

Week
1

Instructor Comments (Include Date/Signature)

First day in acute care facility. Orients to unit and facility. Works with staf and teammates
while caring for 1 patient
Prepares care plan for patient and reflects on outcomes--------------------------------------------------MSperry MSN RNc
Cares for teenager with CP and pressure ulcers. Accurately identifies nursing dx and provides
excellent care, even preventing an additional pressure ulcer. Focus care planning to patient,
being specific and measurable in their care.
----------------------------------------------------------------------------------------------------------------------------MSperry MSN RNc
Observes RT today during rounds through hospital. Does care plan on one patient seen
during the day and identifies how RT assessments vary from nursing. Also identifies how RT
plays a key role in interdisciplinary team for respiratory
patients------------------------------------------------------------------------------------------- MSperry MSN RNc
Adapts care planning to new patient day of clinical due to original pt discharge. Continue to
work on making goals and interventions specific and measurable to your patient. Also use
data to prioritize dx and interventions. Identify interventions that work with your dx and data
to resolve the problemmobility interventions with mobility problems. I am available to help
you with any questions or make an appointment with your advisor.----------------------- MSperry
MSN RNc

Cares for elderly woman with pleural efusion and melena. Identifies top dx and reflects on
need to have actual problem rather than risk for as primary. Improving on assessments and
DAR. Work on reflecting in your care plan. Not just the interventions but how your plan
changed with your patient. Include how you would change goals to be more patient specific
after assessing them------------------------------------------------------------- MSperry MSN RNc
Works with septic patient today- continuing practicing prioritizing your care plan- I did not
see a plan for the infective process. Be sure that your goals and interventions work with your
nursing dxie: if you have a gas exchange problem- focus intervention on respiratory rather
than mobility or pain. If you need help with this please see me or your advisorthis is an
area you are struggling in.--------------------------------------MSperry MSN RNc
First day on REU cares for respiratory failure patient. Be sure to include co-morbidities in
you care prep- Improving in care planning and assessment
documentation------------------------------------------ MSperry MSN RNc

9
Revised 12/09/15sw
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