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NURSING 3020 Clinical Evaluation

Clinical  Evaluation  Process  Nursing  3020  
Instructions    
 

The  Mid-­‐Term  Evaluation  will  be  completed  by  students  at  the  mid-­‐point  of  the  clinical  placement  to  assist  students  to  take  
inventory  of  their  current  development  and  assist  them  to  make  plans  for  future  clinical  practice.  The  student  will  use  a  
reflective  process  to  help  assess  progress  in  meeting  established  program,  year,  and  course  objectives.  The  student  will  submit  
an  electronic  copy  of  the  Mid-­‐Term  Evaluation  document  to  the  clinical  instructor  prior  to  the  formal  mid-­‐term  student  
evaluation.  Because  the  document  is  to  be  completed  electronically,  the  student  and  instructor  can  take  as  much  space  as  
they  need  to  provide  appropriate  evidence  and  feedback.  
 
After  receiving  the  student’s  Mid-­‐Term  Evaluation,  the  clinical  instructor  will  complete  the  comment  section  providing  
feedback  and  evaluation  of  the  student’s  progress.  The  clinical  instructor  will  provide  suggestions  for  improvement.    The  
instructor  will  place  a  check  in  the  “S”  column  if  progress  is  satisfactory,  and  in  the  “U”  column  if  progress  is  unsatisfactory.  If  
a  student  demonstrates  unsatisfactory  progress  at  mid-­‐term,  the  student  and  instructor  will  develop  a  Learning  Plan  outlining  
strategies  in  which  the  student  will  engage,  along  with  clear  expectations  that  must  be  met  for  the  successful  completion  of  
the  course.  The  course  professor  may  be  involved  in  developing  the  learning  plan.    
 
The  student  and  instructor  should  save  and  print  a  copy  of  the  mid-­‐term  evaluation.  Printed  copies  must  be  submitted  to  the  
course  professor  within  a  week  of  completion.    
 
At  the  end  of  the  rotation,  students  will  complete  a  Final  Evaluation.  Students  will  use  a  new  copy  of  the  evaluation  template  
to  archive  their  achievements  and  areas  for  future  development.  The  student  will  submit  an  electronic  copy  of  their  final  
evaluation  to  the  instructor;  this  will  help  the  instructor  complete  an  assessment  of  the  student.    
 
In  order  to  complete  the  final  evaluation,  the  clinical  instructor  will  provide  additional  evidence  by  completing  the  comment  
section,  providing  feedback  and  evaluating  the  student’s  progress.  The  clinical  instructor  will  collect  evidence  in  the  form  of  
the  student  self-­‐assessment,  comments  of  the  health  care  team  members,  patient  input,  student  submissions  (including  
portfolios)  and  observations.  A  summary  of  achievement  as  well  as  implications  for  future  learning  should  be  included  in  this  
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      The  Year  Lead.  if   applicable.       Students  and  instructors  will  complete  both  the  mid-­‐term  and  final  clinical  evaluation   documents  electronically.NURSING 3020 Clinical Evaluation document.  The  signed  copy  must  be  returned  to  the  TFSON  within  10  days.    A  printed  and  signed  copy  should  follow  within  10  days  of  the  evaluation  meeting.  The  completed  document  is  to   be  printed.  shared  with  the  student  and  signed.    An  electronic  copy  of  the  completed  (student  and  instructor)  final   evaluation  should  be  submitted  to  the  course  professor  within  48  hours  of  the  final  evaluation   delivery.   y   2 .  lab  instructor.  and/or  course  professor  will  assess  the  completion  of  the  Learning  Center  Component.  The  attendance  section  and  record  of  completed  hours  is  to  be  filled  in  completely.

NURSING 3020 Clinical Evaluation     NURS  3020H     Clinical  Evaluation       (Check  one)  Midterm  ___Final  _____✓  ___     Student  Name:  Melissa  Amos     Clinical  Instructor:  John  Corso     Missed  Clinical  Hours:  0                Missed  Lab  Hours:  0         3 .

 and  by  identifying.  caring  and  culturally  safe  relationships  with  clients  and  health  care  team  members  based   upon  relational  boundaries  and  respect.   Graduates  will  contribute  to  a  culture  of  safety  by  demonstrating  safety  in  their  own  practice.  evidence-­‐informed   interventions  and  outcome  measures.  communities  and  populations)  in  a   variety  of  settings.  groups.  collaborative  assessment.   Graduates  will  be  prepared  to  provide  nursing  care  that  includes  comprehensive.   Graduates  are  prepared  to  work  with  people  of  all  ages  and  genders  (individuals.  families.   Graduates  will  be  able  to  enact  advocacy  in  their  work  based  on  the  philosophy  of  social  justice.     Graduates  continuously  use  critical  and  scientific  inquiry  and  other  ways  of  knowing  to  develop  and  apply  nursing  knowledge  in  their   practice.  and  mitigating  risk  for   patients  and  other  health  care  providers   Graduates  will  establish  and  maintain  therapeutic.   Graduates  will  demonstrate  leadership  in  professional  nursing  practice  in  diverse  health  care  contexts.NURSING 3020 Clinical Evaluation     Program  Goals   Graduates  are  generalists  entering  a  self-­‐regulating  profession  in  situations  of  health  and  illness.   Graduates  will  effectively  utilize  communications  and  informational  technologies  to  improve  client  outcomes.           4 .

 The  patient  rated  their  pain  as  a  5/10   while  under  the  influence  of  medication  and  a  7/10  an  hour  before  the   next  dose  was  to  be  administered.NURSING 3020 Clinical Evaluation Objectives 1   Explain the experience of acute illness in individuals receiving care in acute setting       Progress Indicators/Evidence Midterm  self-­‐     Almost  all  the  patients  that  I  have  cared  or  helped  to  care  for  at  this  point   in  my  clinical  rotation  appear  to  experience  a  loss  of  independence.     Midterm  Clinical  Instructor     Melissa  has  shown  progress  in  explaining  the  relationship  between  a   patient’s  diagnosis  and  their  co-­‐morbidities   -­‐she  ensures  her  pre-­‐clinical  is  put  into  her  own  words  that  allow  her   understanding  of  diagnosis  to  be  easier  explained  to  her  patients   -­‐demonstrates  an  understanding  of  medications  and  their  use  with  her   patients   Final  Self   -­‐  Caring  for  patients  with  various  conditions  with  the  aim  to  better   understand  the  experiences  of  those  in  acute  care     -­‐  Researching  medications  and  procedure  in  order  to  better  understand   the  needs  of  the  acute  care  patients     -­‐  Researching  underlying  conditions  to  understand  if  the  patient’s   behaviors/symptoms  are  a  result  of  possible  complications  or  if  they  are   normal  for  the  patient  individually.  A   patient  that  I  cared  for  seemed  to  have  a  very  difficult  time  after  their   surgery.  This  patient  attempted  to  cope   by  reading.  sleeping  or  entertaining  visitors.  Even  under  the  influence  of  multiple  pain  relievers  this  patient  still   experienced  a  great  deal  of  pain.  The  patient  stated  that  the   pain  interfered  with  his  ability  to  focus  on  tasks  because  the  pain  was  too   great.  The  patient  had  undergone  a  total  knee  replacement  and  was   experiencing  a  great  deal  of  pain.     S U S     5 .  The  patient  was  using  their  PCA  but   was  still  experiencing  a  great  deal  of  pain.

 In  addition  to  this  it  was  evident  that  the  patient  did  not   like  the  use  of  the  catheter.   as  it  was  a  task  they  were  used  to  performing  by  themselves.  The  inability  to  feel  the  limb  after   surgery  due  to  the  medication  is  not  unusual  and  despite  asking  why  they   did  not  have  feeling  they  were  not  concerning.  so  they  did  not  feel  the  need  to  use  the  PCA  as  they  could   not  feel  any  pain.   The  patient  had  undergone  a  variety  of  surgeries  in  the  past  and  was  used   to  the  post  operative  procedure.  infection  and  relating  the  vitals  to   her  patient’s  admission  and  diagnosis   Final  Self   -­‐  I  have  developed  a  firm  understanding  of  common  symptoms  as  a  result   of  surgery  and  feel  confident  identify  deviations  from  these  normals.  PE.  For   example  I  am  aware  of  normal  drainage  from  a  hemovac.  I  believe  that  the  patient  was  not  coping  well   with  the  lose  of  independence  that  they  felt  by  needing  assistance  to  void.  The  experience  in  acute  care  did  not  appear  to  have  an   impact  on  the  individuals  relationships  with  others.  As  the  patient  had  only  had  surgery  in   the  morning  of  that  day  the  block  was  still  affecting  their  body.     Midterm  Clinical  instructor    Melissa  is  prepared  to  do  her  assessments  with  a  stethoscope  and  pen   and  paper  and  ensures  she  understands  normal  results  that  allow  her  to   understand  any  abnormal  values   -­‐she  then  ensures  she  treats  the  abnormal  values  within  her  scope  of   practice  whether  it  is  to  replace  O2  on  her  patient  or  report  to  her  clinical   instructor  or  a  nurse  immediately   -­‐researched  signs/symptoms  of  DVT.NURSING 3020 Clinical Evaluation 2   Interpret critical aspects of the person’s experience of acute Midterm  Self   illness in relation to common signs and symptoms.  However  the  patient  was  not  using  the  PCA.  this   was  most  likely  due  to  the  blocking  agent  interfering  with  pain   transmission. and impact on individual and family relationships   In  my  fourth  week  of  clinical  I  had  a  patient  that  had  recently  undergone  a   total  knee  replacement. responses to treatment. patterns of coping.  This  individual  appeared  to  handle  the  event  well.  Overall  the  patient  was   coping  well  post  surgery.  The  patient   appeared  to  have  strong  social  supports  in  the  form  of  family   relationships.  was  using  a   catheter  and  was  not  using  the  PCA.  The   patient  had  no  feeling  in  his  leg  below  the  incision  site.  ooze  on   dressings  and  adverse  reactions  to  morphine       S     6 .

    Midterm  Self     I  have  demonstrated  knowledge  of  common  medical  treatments  and  their   possible  complications  through  head  to  toe  assessments.  With  each   patient  I  look  for  common  post  surgical  complications  resulting  from  their   surgery.     -­‐  I  continue  to  look  for  common  post  operation  complications  that  affect   patients  paying  specific  attention  to  concerns  related  to  my  patient   -­‐  I  have  developed  a  firm  understanding  of  the  common  orthopedic   operations  and  how  to  care  for  them  within  my  scope  of  practice       7 .  For  example  when  the  patient  has  undergone  a  knee   replacement  surgery  I  look  for  CMS  in  the  affected  leg  and  compare  it   bilaterally  to  the  non  affected  leg.  tenderness  and  activity  intolerance     -­‐I  have  also  witnessed  and  have  a  better  understanding  of  various  coping   strategies  used  by  patients  after  surgery  and  this  will  help  me  to  care  for  a   variety  of  other  patients  in  my  future  as  I  know  have  a  larger  bank  of   knowledge  to  draw  upon.  redness.  For  example  I  understood  the  effects  of  Parkinson’s  before  caring  for   a  patient  with  this  condition  to  understand  what  may  complicate  care  so   that  I  could  anticipate  possible  difficulties.     Midterm  Clinical  Instructor   researches  any  surgeries  he  patients  may  have  had   -­‐researches  their  co-­‐morbidities  to  further  understand  the  complications   that  may  occur  with  her  patients   -­‐researches  clinical  lab  values  and  attempts  to  link  them  to  her  patient’s   diagnosis  and  co-­‐morbidities   Final  Self   -­‐  I  have  researched  the  conditions  that  my  patients  have  ahead  of  time  or   in  clinical  in  order  to  understand  complications  that  may  arise  in  their   care.   swelling.  and  tenderness  below  the  site  of  the  surgery.NURSING 3020 Clinical Evaluation 3   Identify common medical treatments and potential consequences/complications of selected acute illnesses       -­‐  I  am  aware  of  common  complications  and  there  signs  such  as  DVT.    I  also  look  for  signs  of  DVT  such  as   swelling.  redness.

IV medication administration. neurological assessment.   as  well  as  empty  and  remove  hemovac  drains  from  patients.  GI.  urinary.  respiratory  and   integumentary  assessments. philosophical frameworks.     -­‐  I  have  properly  performed  and  charted  neurological  and  cardiac   assessments  on  patients  and  consulted  with  the  staff.    I  have  also  demonstrated  the  ability  to  do  a  complete  head  to   toe  assessment  including  neurological.  cardiac. blood component therapy. competent. Apply relevant nursing models. rapidly changing conditions. evidence-based.  If  the  patient  is  not   comfortable  having  a  student  provide  care  it  would  be  unethical  for  me  to   continue  care. Demonstrate therapeutic use of self 3.   cleaned  the  wounds  using  aseptic  techniques  and  reapplied  a  new   dressing.  my  peers  as  well  as   the  instructor  to  make  sure  that  I  am  properly  charting  and  performing   the  assessments.     Midterm  Self     S     Whenever  I  am  introduced  to  a  new  patient  I  introduce  myself  as  well  as   state  that  I  am  a  nursing  student. holistic nursing practice with clients with acute illness 1.  which  she  has  demonstated  well   -­‐demonstrated  improving  skills  and  an  increasing  skill  base  for  acute   patients   Final  Self     -­‐  I  have  demonstrated  my  ability  to  use  IV’s  within  my  scope  and  the   hospital  policy   -­‐  I  have  properly  performed  wound  care  on  a  variety  of  patients  including   those  with  knee  and  hip  surgeries  as  well  as  TURP  maintenance.  apply  mepores. pulmonary care including chest tubes and tracheotomy.  I  make  it  clear  that  I  am  a  student  in   order  to  represent  myself  properly  and  to  make  sure  that  the  patient  is   comfortable  with  a  student  providing  care.  as  I  have  to  respect  the  patient’s  right  to  choose  for   8 . initiating IVs.     Midterm  Clinical  Instructor     -­‐  ensures  she  is  prepared  for  clinical  by  completing  her  labs  so  that  she  is   better  prepared  for  sterile  dressings. cardiac assessment and rhythm strips. peri-operative care.  I   do  not  introduce  myself  as  a  nurse. wound care. TPN and central lines. and resuscitation   5   Under the supervision of a Registered Nurse.  I  used   the  ADU  under  the  supervision  of  my  instructor  to  dispense  medications   that  I  then  administered  to  the  appropriate  patient.NURSING 3020 Clinical Evaluation 4   Demonstrate selected nursing and collaborative interventions related to clinical pathways. demonstrate safe. theories and evidence 2.  In  addition  to  this  I   have  also  demonstrated  the  ability  to  remove  dressings.  On  multiple   occasions  I  have  removed  dressings  or  zimmer  splints  from  patients. Engage with patients in an ethical and culturally safe manner Midterm  Self     S     During  the  fourth  week  of  placement  I  demonstrated  that  I  know  how  to   properly  administer  IV  medications  as  well  as  other  medications.  I  do  this  in  order  to  practice  ethically.

  For  example  when  a  patient  asks  me  about  something  that  the  nurse   would  know.  Some  examples  of  this  include  explaining  the  purpose  of   deep  breathing  coughing  exercises.     Midterm  Clinical  Instructor    -­‐  by  witnessing  her  practice. Demonstrate reliability themselves.   researching  the  medications  she  was  dispensing  was  done  before   9 . Understand and anticipate emerging bio-psychosocial needs of persons with acute illness and apply this knowledge to care: a.  updating   the  nurse  about  any  changes  in  patient  status.  I  do  this  by  assisting  them  walking  and   encouraging  them  to  weight  bear  if  tolerated.  This  allows  me  to   plan  for  the  typical  interventions  that  may  be  necessary  and  implement   them  into  my  plan  of  care. Plan appropriate nursing care b.  In  addition  to  this  I  aim  to  help  the  patient  regain   as  much  mobility  as  tolerated.     I  demonstrate  health  promotion  behavior  by  educating  the  patients  that  I   am  working  with. Engage with patients and families to identify health-related situational challenges b.     After  the  time  spent  on  the  unit  I  now  feel  as  though  I  can  predict  the   needs  of  the  patient  to  some  degree.   -­‐charting  and  documentation  is  improving  each  week  during  clinical   -­‐she  seeks  out  opportunities  to  improve  her  knowledge  base  and  skill  set   -­‐medications  were  done  properly  and  within  her  scope  of  practice.  but  I  do  not  I  ask  said  nurse  and  report  the  answer  back  to   the  patient.  go  to  physiotherapy  and  should  be  weight   bearing  as  tolerated.NURSING 3020 Clinical Evaluation 4. Evaluate client response to nursing care 5. Work with patients and families to create reasonable and effective solutions 6.  By  this  I  mean  that  I  understand   what  the  normal  level  of  mobility.  and  pain  should  be  for  a   patient  that  underwent  knee  or  hip  surgery  recently.   ensuring  all  patient  and  patient  identifiers  were  checked  at  all  times.  For  example  I  know  that  typically  a  knee   replacement  patient  post  op  day  1  will  typically  have  the  dressing   removed  for  the  first  time.     I  demonstrate  accountability  and  reliability  by  charting  regularly. Demonstrate patient advocacy 7. Demonstrate health promotion and illness prevention practices a.  she  is  aware  of  her   patient’s  needs  and  necessary  requires  to  improve  and  with  more  practice   she  will  become  much  more  confident. Demonstrate accountability 8. Predict outcomes of nursing care c.  calf  pumps  and  other  exercises.  and  following  through  on   promises  made  to  the  patient  and  agreements  reached  with  the  nurse.  sedation.  it  is  readily  apparent  that  Melissa  has  a  good   base  of  theory  to  draw  from  in  her  clinical  placement.  By   informing  the  patients  of  the  reasoning  behind  these  exercises  I  am  able   to  hopefully  prevent  the  formation  of  DVTs  which  can  commonly   occurring  after  surgery.

    -­‐I  have  theories  examined  in  the  corresponding  course  to  help  improve  my   practice.  and  asked  the  patient  if  they  would  like   privacy.  explained  that  I  was  going  to  do  an   assessment  on  the  patient.  I  did  this  to  allow  the  individual  to  make  the  decision  instead  of   making  it  myself.     Midterm  Self     S     While  interacting  with  a  patient  I  also  had  to  interact  with  their   family/friends.  Initially  I  entered  the  room  and  introduced  myself  to  the   other  individuals  in  the  room.NURSING 3020 Clinical Evaluation 6   Critically appraise own practice in relation to nurse- client/family interactions and as a member of the health care team administration   Final  Self   -­‐  I  have  interacted  with  patients  and  their  families  to  understand  possible   needs  they  might  have  related  to  their  care  in  the  hospital  as  well  as   outside  of  the  hospital.  Not  only  do  I  feel  like  this  helped  me  to  maintain  the   patient’s  autonomy  I  also  feel  that  it  helped  to  form  a  trusting  relationship   with  both  the  patient  and  their  family/friends.  and  because    I  am   10 .  For  example  I  inform  the  nurse  of  an  pertinent  information   regarding  the  patient  or  their  condition.  My  actions  showed  respect   for  the  patient  as  well  as  the  other  individuals  which  is  a  key  factor  in  the   development  of  a  healthy  relationship.     -­‐  Charting  on  other  patients  as  well  as  my  own  when  I  perform  tasks  that   should  be  charted  such  as  drainage  amounts  or  dressing  changes.   As  a  member  of  the  health  care  team  I  feel  that  I  behave  in  the  proper   manner.   -­‐  I  have  followed  protocols  administering  medications  and  providing   patient  care.  I  feel  that  this  helps  the  nursing  staff.  For  example  I  have  gone  with  a  nurse  when  she  changed  a   PCA  pump  to  help  understand  the  protocol  but  did  not  touch  the  pump   myself.     -­‐  I  have  sought  out  opportunites  form  the  nursing  staff  in  order  to  help  my   practice  evolve.  Additionally  I  ask  the  nursing  staff  if  there  is  anything  they  might   need  help  with.  I  also  give  report  at  the  end  of   shift.  I  have  also  witnessed  a  variety  of  home  care  visits   in  the  hospital  to  understand  some  of  the  possible  barriers  the  patients   may  face  when  they  return  home.  In  the  future  I  could  be  more   forceful  in  announcing  myself  to  the  family/friends.

 For  example  while  I  was  team  leader  a  student  was  doing  her   first  dressing  without  the  clinical  instructor.  Additionally  I  was   able  to  share  different  ways  of  performing  the  task  that  I  found  more   comfortable  for  myself.  In  week  3  I  was  the  team  leader  for  my  clinical  group.  offering  to  do  vitals  or  care  in  order  to  reduce   the  nurses  work  load  and  let  them  focus  on  patients  with  more  focused   care.  or  help  other  nurses  performing  tasks  that  I  am  not  able   to.  The  other  student  did  do  the  dressing  change  individually   however  I  helped  to  make  her  more  comfortable  by  confirming  that  she   was  doing  it  properly  whenever  she  was  concerned.       Midterm  Self   S     I  have  participated  in  developing  my  skills  as  a  nurse  by  acting  as  team   leader.NURSING 3020 Clinical Evaluation 7   Participate in professional development based on reflective practice and critical inquiry available  by  me  taken  it  upon  myself  to  reduce  the  workload  of  these   nurses  they  are  able  to  spend  more  time  with  patients  that  may  need   their  care  more.     -­‐  I  have  worked  with  the  staff  to  help  care  for  my  own  patient  as  well  as   other  patients  on  the  floor.  while  she  was  confident  in  her   ability  to  perform  the  skill  she  asked  me  to  come  along  with  her  to  the   patients  room.   Final  Self   -­‐  I  interact  with  patients  and  family  members  in  a  respectful  and   understanding  matter.     -­‐  I  continue  to  consult  with  the  nursing  staff  regarding  patient  information   and  any  variations  in  status  and  consult  with  them  about  any  concerns  I  or   the  patient  has.  help  them  with   any  tasks  that  they  may  need  a  second  person  for  and  act  as  a  source  of   information.       Midterm  Clinical  Instructor   -­‐    all  pre  and  post  clinicals  are  handed  in  on  time  and  done  properly   -­‐Melissa  works  well  within  her  peer  group.  While  in  this   position  I  had  to  gather  report  from  all  the  other  students.  explaining  what  I  am  able  to  with  my  knowledge   and  scope  of  practice  and  when  I  do  not  feel  confident  in  my  knowledge  I   use  the  resources  available  to  me  to  provide  the  patient  with  the   appropriate  information.  By  doing  this  I  was  reflecting  on  my  own   11 .  staff  nurses  and   multidisciplinary  team.

 This  relates  to  professional  development     as  I  had  to  seek  out  information  regarding  the  medications  such  as:  route   of  administration.     In  addition  to  this  I  have  also  administered  medications  to  patients  under   the  supervision  of  my  instructor.NURSING 3020 Clinical Evaluation experiences  of  dressing  changes.  After   administering  these  medications  I  then  had  to  critically  look  at  the   resulting  vitals  in  order  to  eliminate  adverse  effects.  shoes  are  proper.  This  experience  helped  me  develop  the  skill  to  share  my   knowledge  with  other  students/peers  and  overall  improve  my  ability  to   perform  in  the  professional  setting.  nails  and  hair  well  groomed  and  off  the  collar.  Her  uniform  is   clean.  contraindications.  sharing  what  I  learned  from  critically   appraising  these  situations  with  my  peer  and  help  my  peer  develop  her   own  skill  set.       Clinical  Instructor  Comments  (All  areas  marked  as  unsatisfactory  must  have  a  comment)       12 .   She  reports  to  work  on  time  and  ready  to  work   -­‐her  written  work  is  progressing  each  week  in  it’s  depth  and  precision.     Midterm  Clinical  Instructor     -­‐  Melissa  displays  a  professional  appearance  while  on  A5.   flow  chart  is  clear  and  Melissa  is  demonstrating  some  confidence  in   completing  it   -­‐she  obtains  and  accepts  positive  feedback  and  incorporates  it  into  her   future  work   Final  Self   -­‐  Since  midterms  I  have  been  able  to  chart  without  consulting  my   instructor  beforehand  and  feel  much  more  comfortable  performing   charting  on  my  patient  as  well  others  on  the  floor   -­‐  I  continued  to  administer  medications  under  the  supervision  of  my   instructor     -­‐  After  the  submission  of  my  first  reflection  I  have  attempted  to  apply   what  I  learned  to  my  clinical  practice   -­‐  I  continue  to  attempt  develop  skills  learned  in  placement  throughout  my   work  and  apply  these  skills  during  new  experiences.  dosages  and  adverse  effects.

 looks  for  help  when  needed  and  answers  call   bells  for  the  staff.  2014       13 .  She  is  gaining  confidence  in  her  own  abilities.             Signature  of  Instructor___________________________________________________   Date    _____________________________       Signature  of  Student:  Melissa  Amos   Date  November  17th.NURSING 3020 Clinical Evaluation Melissa  is  progressing  well  in  this  half  of  clinical.  She  helps  her  peers  when  she  is  done  her  own  work.  She  needs  to  seek  opportunities  to  improve  on  these  gains  during  the  second  half  of   the  semester.