Student Name: Mitali G

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.
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Nursing 111 Clinical Evaluation Tool Student Name:

. Clinical Week
Make-
2 3 4 5 6 7 8 9 10 up
Compete
Dates 1/14 1/21 1/28 2/4 2/11 2/18 2/25
ncy (C)
Course Attendance: P=Present, A=Absent, T=Tardy p p p p p p p
Outcome BAH
(CO)
BAH- BAH- BAH- BAH- BAH- BAH-
Facility/Unit -
MCU MCU MCU PSU REU MCU
PSU
C9 Applies concepts and theory to clinical practice
CO 1, 2 in client care and written assignments:
s s s s s s s
1. Collects data and conducts a health
assessment on a client with a chronic illness
2. Analyzes and interprets the data/assessment
s s s s s ni s
findings.
3. Prioritizes health problems. s s s s s s s
4. Develops a plan of care that considers the
individual, family, age of client,
s s s s s ni s
developmental stage, psycho-socio-cultural
issues, and/or learning needs.
5. Evaluates and reflects on plan of care. s s ni u s s ni
C1, Applies ANA Code of Ethics in care of chronically
CO4 s s s s s s s
ill
C5, Identifies roles and functions of members of the
CO5 health care team involved in providing care for s s s s s s s
the chronically ill.
C8, Uses therapeutic communication with patients
CO6 s s s s s s s
and agency staf
C4, Recognizes potential legal and ethical issues
CO7 related to client autonomy across the lifespan in s s s s s s s
at risk populations.
C6, 7, 8
Recognizes cultural issues and interact with
CO2 s s s s s s s
clients in culturally sensitive ways
C10 Uses research and evidence to support clinical
s s s s s s u
decision making
C6 Utilizes resources as needed s s s s s s s

Competen
cy (C)
Make-
Course 2 3 4 5 6 7 8 9 10 up
Outcome
(CO)
C9, CO2 Demonstrates responsibility and accountability
for professional behavior: s u s s s s s
1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope, skills s s s s s s s
list, evaluation tool, assessment tools).
C4 3. Takes initiative in making decisions and
s s s s s s s
assuming responsibility for decisions.
C3 4. Looks for opportunities for continued learning
s s s s s s s
and self-development.
C4 5. Identifies behaviors and attitudes influencing
s s s s s s s
professional behavior.
C1 6. Demonstrates growth in coping with stressful
s s s s s s s
situations in a calm and dependable manner.
C1 7. Maintains patient confidentiality. s s s s s s s
C3 8. Completes and submits assignments on time. s s s s s s s
C2 9. Organizes and manages time efectively. s s s s s s s
C4 10.Attends and participates at post-conference. s s s s s s s
Instructor Initials MJS MJS MJS mjs mjs mjs mjs
Student Initials MRG MRG MRG MRG MRG MRG MRG
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Week Instructor Comments (Include Date/Signature)

First clinical in acute care. Orients to unit and facility. Works well with staf and classmates. MRG
1 Appropriately identifies primary dx. Cares for 1
patient-----------------------------------------------------------------------------MSperry MSN RNc
Cares for patient and works well with staf. Remember you must have an instructor present MRG
when you do a skill until you are checked of in lab and clinical as being safe with the skill.
Performing a subq injection must be done with and instructor until you are signed of. This is
2 currently out of your scope and practice. I do applaud you for your integrity, honestly and
ethics!! Letting me know about this should true professionalism As we move forward, if you
are ever in doubt, please text me----------------------------------------------------------------MSperry MSN
RNc
Identifies and advocates for self in student nurse role. Stays within scope of practice- nicely MRG
done. Be sure you reflect on your care plan and how your in plan worked. This is a critical
3
piece of being a nurse. Begin prioritizing dx and interventionswhat is most
acute------------------------------------------------------------------ MSperry MSN RNc
Cares for patient with generalized weakness. Patho paper is written based on disease be MRG
sure to include integration of patient assessments, labs, medication and other data in your
paper. You did not reflect on any of your diagnosis or outcomes- this is an important piece of
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nursing care and diagnosis. Be sure to complete this important component. You must also
include how your patient responded to each interventionnot what the intervention was
meant to doif you need help please see me-------------------------------- MSperry MSN RNc
 Cares for post-surgical patient with septic bursitis- identifies nursing dx and prioritizes goals. MRG
5 Nice assessment and data collection. Improving on Care plan and
prioritization--------------------------------------- MSperry MSN RNc
Cares for cardiac patient with EF of 20%- identifies 3 nursing dx and improving in patient MRG
centered plan. Be very careful when analyzing your data. Your patient was diuresing due to
fluid over load encouraging fluids will put them back into an overload condition and weaken
6 the heart furtherBe sure your assessment data and data used in your assessment and
through your paperwork are the same there were many instances that contradicted
themselves.--------------------------------------------------------------------------------------------------------
MSperry MSN RNc
Cares for respiratory patient this week. Pathophysiology of paper is thorough but not MRG
integrated with patient. This is a step that is mandatory and I have asked to integrate
previously. Improving in assessment documentation. Be sure NOT to use symbols such as
7 <,>,and =, these are not allowed per the Joint Commision. Work on your reflection- look
further into you care plan and reflect on what would work better and what worked very
well----------
MSperry MSN RNc

Revised 12/09/15sw
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