Student Name:

Mitaliben R.Gor

Southwestern Oregon Community College Nursing Program

Nursing 222
Foundations of Nursing: Acute 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 222 Clinical Evaluation Tool

Student Name:

KSA: Patient Centered Care

QSEN
Comp
etenci
es:
(KSA)

Comp
etenc
y (C)
Cours
e
Outco
mes
(CO)

C9
CO1
,2, 5

Mitali

Clinical Week
MidTerm
Eval

Dates

Oct
4th

Oct
11th

Oct
18

Oct
25th

11/1
/16

Nov
15th

Attendance: P=Present, A=Absent,

T=Tardy

Facility/Unit

BAH
PSU

BAH
- ER

BAHMCU

BAH
LDR
P

BA
H
ICU

BAY
-MC
U

Applies concepts and theory to clinical practice in

client care and written assignments:
Conducts evidence-based assessment, using
age, developmental and culturally appropriate
communication skills
Collects and monitors a variety of data
Analyzes and interprets the data/assessment
findings in increasing complex acute conditions.
Recognizes pathophysiological changes and
symptoms
Regularly monitors clients level of comfort and
ability to manage symptoms and symptom
distress
Prioritizes health problems.
Develops and uses evidence-based
individualized interventions
Develops a plan of care that considers the
individual, family, age of client, developmental
stage, psycho-socio-cultural issues, and/or
learning needs.
Evaluates and reflects on plan of care for
clients with acute conditions.

10

Final
Eval

KSA: Safety, Informatics, Professionalism

ProfessionalismKSA:EBPKSA: CollaborationKSA: Teamwork &

CO4

Develops discharge plans in collaboration with

client, family, and other members of the health
care community.
Uses therapeutic communication with patients and
agency staff.

NO

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.

C10, Uses research and evidence to support clinical

CO2 decision making.

Utilizes resources as needed.

Able to identify/define leadership skills for nurse's

role

C9
CO1

Exhibits critical thinking skills when prioritizing and

delegating patient care.

C9,
CO1

Demonstrate responsibility and accountability for

professional behavior:
Performs safely in clinical.
Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope, skills
list, evaluation tool, assessment tools).
Takes initiative in making decisions and
assuming responsibility for decisions.
Looks for opportunities for continued learning
and self-development.
Identifies behaviors and attitudes influencing
professional behavior.
Demonstrates growth in coping with stressful
situations in a calm and dependable manner.

C8
C
6,7,
8
CO1
C5
CO3

C6,
CO
C4

C3
C4
C3
C4
C1,
2

C1

Maintains patient confidentiality.

C8

Documentation of client care is accurate and

relevant and consistent with agency policy

C3

Completes and submits assignments on time.

C2

Organizes and manages time effectively.

C4

Attends and participates at post-conference.

MPP

MPP

MPP

SW

MPP

MRG

MR
G

MRG

Instructor Initials MPP

Student Initials

MRG

MRG

MRG

Key: C=Competency, CO=Course Outcome, QSEN=Quality and Safety Education for Nurses, KSA=Knowledge, Skills & Attitudes
(QSEN Competencies)

Week

Instructor include comments that are positive, areas that need improvement or are unsatisfactory.
Reference the course outcomes listed in the syllabus, the OCNE Competencies from the Nursing Student
Handbook and/or the QSEN competencies (Date/Sign all entries)
OCT 4TH, 2016: Todays clinical was with postoperative total hip arthroplasty patient. You had the opportunity to do an
i/o cath too and did a great job. You also did a lot of post-operative teaching and learned how important it is for home
care and the importance of hip precautions. Good job!
You passed your clinical this week.
Michelle Pringle, RN-BC, BSN
OCT 11TH, 2016: Todays clinical was in the emergency room and you got to see and do lots of exciting things. You were
observant and notified physicians when needed. You take initiative to do skills and tasks; this is admirable and
impressive! AND you got to see a broken toe!!! Great Job!!!
You passed your clinical this week.
Michelle Pringle, RN-BC, BSN

Student
Initials

MRG
10/04/1
6

MRG
10/18/1
6

MRG

OCT 18TH, 2016: Todays clinical was on MCU with two patients, one with meningitis and the other with Parkinsons. You
observed changes in your Parkinsons patient with her medication, and did some IV push medications. Your bedside
manner is professional and friendly. You also displayed critical thinking skills and prioritizing. Nicely done!
You passed your clinical this week.
Michelle Pringle, RN-BC, BSN

Oct 25th, 2016: Todays clinical was in LDRP. You had a busy shift. The nurses were happy with your performance, and I
know you did a great job. Youre always looking for more learning opportunities, its a delight to watch! ICU next
week!?

10/25/1
6

MRG
11/01/1
6

You passed your clinical this week.

Michelle Pringle, RN-BC, BSN

11-1-2016: Nice job in the ICU today. Please see comments on patient care prep. When documenting client behavior
be very specific. State exactly what was observed and avoid vague terms or phrases such as appears to be which
cast doubt on what you wrote.S. Walker, RN

MRG
11/08/1
6

Midter
m

8
9
10
Final

Nov 15, 2016: Todays clinical was in MCU with two patients. You gave central line medications and educated the
patient regarding diet. The patient and family was delighted with your care and had wonderful things to say about you
the following day! Good Job!
Michelle Pringle, RN-BC, BSN

MRG
11/15/1
6

9/2/09: revised 5/06/11, rev 8/2/16 sw