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Evaluations Community Clinical Evaluation
Evaluations NUR4636_Hernandez_Spring2017Eval (4/10/2017)
Experience Tran, Tiffany (txtran2@health.usf.edu)

Change password Evaluator: Hernandez, Ivonne (ihernand@health.usf.edu)

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5=Excellent
4=Very Good
3=Satisfactory
2=Fair
1=Poor
N/A=Not Applicable
Students must achieve a 3 or higher in each component of the safety standard.

Standard I--Professionalism and Accountability: Communication

Demonstrates therapeutic interviewing skills with individuals, families, or groups.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard I--Professionalism and Accountability: Communication

Exhibits cultural sensitivity in interpersonal relationships with clients, families,
groups, and agency staff.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
Standard I--Professionalism and Accountability: Knowledge
Takes initiative to acquire new knowledge and skill in providing care to individuals,
families or groups in the community.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard I--Professionalism and Accountability: Knowledge

Uses knowledge of community assets and needs to act as change agency with
individuals, families, or groups in the community.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard I--Professionalism and Accountability: Attitude

Arrives promptly each clinical day.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
Standard I--Professionalism and Accountability: Attitude
Reports on and off to preceptor, agency contact, and / or faculty each day.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard I--Professionalism and Accountability: Attitude

Presents and maintains professional appearance and demeanor.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard I--Professionalism and Accountability: Attitude

Interacts appropriately with multi-disciplinary / interdisciplinary professional and
paraprofessional health and health-related personnel.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard I--Professionalism and Accountability: Attitude

Communicates regularly with preceptor and / or faculty to seek advice and guidance
and to plan and coordinate clinical time and activities.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard II--Safety
The student maintains the community populations physical safety by protecting the
agencys clients from harm.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard II--Safety
The student does not make judgmental, discriminatory, or prejudicial statements to
the community agencys population, staff or faculty.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
Standard II--Safety
The student validates the accuracy and appropriateness of orders, plan of care,
and/or agencys policies prior to initiating nursing care.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard II--Safety
The student implements nursing skills with proficiency and safety.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard II--Safety
The student adapts skill performance using principles of theory when necessary.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
Standard III--Nursing Process: Community Assessment Skills
Assists / performs client, family, or population-based assessments in collaboration
with agency staff.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Assessment Skills

Appraises the effects of socio-economic, cultural, environmental, and political factors
that influence health.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Diagnosing

Analyzes data from agency, staff, client, or population-based sources to identify a
need for a Service Learning Project.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
Standard III--Nursing Process: Community Planning
Assists / develops health plans for clients, families, and groups in the agency or
community.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Planning

Assists / develops a comprehensive written plan for implementing a health education,
health promotion, health service, or other project to benefit individuals, families, or
groups associated with the agency.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Planning

Incorporate disease prevention, risk reduction, health promotion, and health
restoration in plans of care for clients, families, or groups in the community.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
Standard III--Nursing Process: Community Planning
In collaboration with community agency, plan a Service Learning Project.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Interventions

Assists / performs therapeutic interventions for diverse groups across the life span.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Interventions

Assists / refers individuals, families and groups to other health and welfare sources.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
Standard III--Nursing Process: Community Interventions
Assists / performs health education or health promotion to families or groups.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Interventions

Implements Service Learning Project.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Tiffany did an incredible job providing her SLP to the CNA class at Wharton High School. The teacher
was so pleased that she asked her to present to her next class. Tiffany shared her journey to
choosing the nursing career and served as a great role model.

Standard III--Nursing Process: Community Evaluation

Discusses client care outcomes with community agencys population, faculty or/and
staff.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable
 Standard III--Nursing Process: Community Evaluation
Appraises client, family, or group responses to health teaching / health promotion.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Standard III--Nursing Process: Community Evaluation

Evaluates impact of service learning project on individuals, families, groups, or
agency.
5 Excellent
4 Very Good
3 Satisfactory
2 Fair
1 Poor
N/A Not Applicable

Tiffany Tran has reviewed the above evaluation on 4/21/2017 and has provided the
following comment:

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