Math Exam # 1 ____________ NCP#1 ____ Overall Total Points________

Math Exam # 2 ___________ NCP#2_____ Grade _________

Math Exam #3 ___________ IPR: _____ CENTRAL TEXAS COLLEGE Letter Grade _________
ASSOCIATE DEGREE NURSING PROGRAM
CLINICAL EVALUATION TOOL

CLINICAL INSTRUCTOR Edna Garza-Escobedo

CLINICAL EDUCATION Wesleyan Nursing Home - Georgetown

STUDENT NAME:
DATES OF CARE:
PROVIDER OF CARE DATES 3/10 3/22 3/24 3/29 3/31 4/5 4/7 4/12 4/14 4/19 4/21

1. Apply the nursing process appropriately.

*2. Provide safe, effective, individualized nursing care.

3. Document all relevant information in a clear, concise manner.

4. Demonstrate facilitative communication techniques.

5. Develop and implement teaching plans for clients & their families concerning promotion, maintenance, and
restoration of health.
6. Use clinical data and current literature as a basis for decision making in nursing practice.
COORDINATOR OF CARE
1. Collaborates effectively with other health care members.

2. Coordinates human and material resources for the provision of care for clients and their families.

3. Functions within the organizational framework of various structured health care settings in planning and
providing care for clients and their families.

MEMBER OF A PROFESSION
* 1. Assume accountability and responsibility for the quality of nursing care provided to clients and families.

2. Act as a client advocate to promote the provision of quality health care for clients and their families.

3. Participate in activities that promote the development and practice of nursing.

*4. Follow policies of the clinical agency, ADN program and CTC.
*MEDICATION EXPERIENCE (Pass or Fail)

Alternate learning experience

Total # Points=
Total Clinical Points
3 Pts = Supervised (S) 2 Pts = Assisted (A) 4 Pts = 1 Pt = Provisional (P) 0 Pts. = Dependent
Independent (I)
FACULTY COMMENTS:

STUDENT COMMENTS:

STUDENT SIGNATURE: _____________________________________ INSTRUCTOR SIGNATURE:__________________________________