Student Name:

Jason Villavicencio

Southwestern Oregon Community College Nursing Program

Nursing 221
Foundations of Nursing: Chronic Care II

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 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.

Nursing 221 Clinical Evaluation Tool

Student Name:

.
Compete
ncy
(C)
Course
Outcome
s
(CO)

C9
CO 1, 2,
3

CO5, 6

Jason Villavicencio

Clinical Week
1

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

1/15/1
5
P

1/22/1
5
P

1/29/1
5
n/a

2/5/1
5
P

2/19/1
5
P

2/26/1
5
A

3/5/1
5
P

3/12/1
5
P

Facility/Unit

PSU

MCU

OR

2/13/1
5
P
Traum
a

OR

Cath

ED

n/o

Dates

Applies concepts and theory to clinical

practice in client care and written
assignments:
1. Conducts evidence-based health
assessment
2. Collects and monitors a variety of data
3. Analyzes and interprets the
data/assessment findings in increasing
complex chronic conditions.
4. Recognizes pathophysiological changes
and symptoms
5. Regularly monitors clients level of
comfort and ability to manage
symptoms and symptom distress
6. Prioritizes health problems.
7. Develops and uses evidence-based
individualized interventions
8. Develops a plan of care that considers
the individual, family, age of client,
functional issues associated with comorbidities, developmental stage,
psycho-socio-cultural issues, capacity
for and engagement in self-health care,
and/or learning needs.
9. Evaluates and reflects on plan of care
for clients with chronic conditions.
Develops discharge plans in collaboration
with client, family, and other members of
the health care community.

Makeup

C8
C6, 7, 8
C5
CO5
C10
CO2
C6,
CO4
C4

Uses therapeutic communication with

patients and agency staff.
Recognize cultural issues and interact with
clients in culturally sensitive ways.
Collaborates with other members of the
health care team to provide comfort and
symptom management.
Uses research and evidence to support
clinical decision making.

n/o

Utilizes resources as needed.

Able to identify/define leadership skills for
nurse's role

3
Compete
ncy
(C)
Course
Outcome
s
(CO)

C9, CO
1

C9,
CO1
C3
C4
C3
C4
C1,2
C1
C8

Makesup

Exhibits critical thinking skills when prioritizing

and delegating patient 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 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. Documentation of client care is accurate and
relevant and consistent with agency policy

C3
C2
C4

9. Completes and submits assignments on time.

10. Organizes and manages time effectively.
11. Attends and participates at post-conference.

Instructor Initials
Student Initials

U
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

TYF

TYF

TYF

TYF

TYF

TYF

TYF

JV

jv

JV

JV

JV

JV

JV

JV

JV

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)

Student
Initials

1/15/15: You received a U due to not turning your care plan in on time. This is a terrible way to
start off a term and I hope that it will not become a pattern for you. Otherwise, your care of your
patient was very good. You seem attentive, safe, and genuinely concerned about good nursing
care. You were very professional. Aside from timeliness, you successfully passed all
competencies listed above for this clinical.
Tracy Fawns, RN, MSN

JV

1/22/15: You successful met all competencies and outcomes, as listed above. Your care plan was
complete and well thought out.
Tracy Fawns, RN, MSN

jv

1/29/15: Clinical canceled.

JV

2/5/15: OR. A surprise bonus day in the OR for you!

Tracy Fawns, RN

Jv

3
4

2/13/15: Trauma Simulation

Tracy Fawns, RN, MSN

JV

2/19/15: Jason Your care plan was well done. I did receive excellent feedback about you from
the staff in OR/PACU. They voiced that you are very competent in many aspects of nursing care,
and that you are enthusiastic, professional, and mindful of patient safety. Nice feedback! Well
done.
Tracy Fawns, RN, MSN

JV

2/26/15: Student absent.

JV

3/5/15: Cath Lab. I think you had a great experience in cath lab this week and were able to apply
a lot of your knowledge and skills here. You successfully met all competencies and outcomes this
week.
Tracy Fawns, RN, MSN

JV

3/12/15: Another great day for you in ED, where your IV skills shined and you were able to
participate in a lot of great experiences. I stood outside one of the exam rooms for a bit, and
listened while you talked to a patient (with a head trauma) and his family member. Your
therepeutic communication was spot on!
Tracy Fawns, RN, MSN

JV

12/12/12: sw, revised 12/6/14sw