Student

Name: Kayt Geyer

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.

pg. 2

Nursing 222 Clinical Evaluation Tool

.

Student Name:

QSEN
Competen
cies:
(KSA)

Dates

Competen
cy (C)
Course
Outcomes
(CO)

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

Facility/Unit

C9
CO1,2,
5

KSA: Patient Centered Care

Applies concepts and theory to clinical practice in client care and

written assignments:
1. Conducts evidence-based assessment, using age,
developmental and culturally appropriate communication
skills
2. Collects and monitors a variety of data
3. Analyzes and interprets the data/assessment findings in
increasing complex acute 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, developmental stage, psycho-socio-cultural
issues, and/or learning needs.

KSA: Teamwork &

Collaboration

9.

Evaluates and reflects on plan of care for clients with acute

conditions.

Oct
4th
P
BAH
-
REG
U

Oct
11th
P

Oct
18th
P

Oct
25th
P

BAH

APU

BAH

REU

BAH
-
MCU

Clinical Week
6

MidTerm
Eval

11/1

BAH
ED

7
Nov
15
P
BAH
-
REU

10

Final
Eval

CO4

Develops discharge plans in collaboration with client, family, and

other members of the health care community.

C8

Uses therapeutic communication with patients and agency staff.

C 6,7,8
CO1

Recognize cultural issues and interact with clients in culturally

sensitive ways.

C5
CO3

Collaborates with other members of the health care team to

provide comfort and symptom management.

pg. 3

KSA:
EBP
KSA: Professionalism

C10,
CO2
C6, CO
C4
C9
CO1
C9,
CO1

KSA: Safety, Informatics, Professionalism

C3
C4
C3
C4
C1, 2

Uses research and evidence to support clinical decision making.

NO

Utilizes resources as needed.

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

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 selfdevelopment.
5. Identifies behaviors and attitudes influencing professional
behavior.
6. Demonstrates growth in coping with stressful situations in a
calm and dependable manner.

NO

C1

7.

Maintains patient confidentiality.

C8

8.

Documentation of client care is accurate and relevant and

consistent with agency policy

C3

9.

Completes and submits assignments on time.

C2

10. Organizes and manages time effectively.

C4

11. Attends and participates at post-conference.

MP
P
KG

MP
P
KG

MP
P
KG

MP
P

MP
P
Student Initials KG

Instructor Initials

SW

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

pg. 4

Week
2

5
6
Midterm

8
9
10

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)
TH
OCT 4 , 2016: Todays clinical was with a patient on REU with COPD; your bedside manner and explaining what you are doing for your patient is
excellent I observed this and this was mentioned to me by the sitter very well done! You also had interactions with doctor which helps to
increase your comfort level. AND you noticed that the patients blood pressure was out of control and you took care of it!! Great Job!!
You passed your clinical this week.
Michelle Pringle, RN-BC, BSN
TH
OCT 11 , 2016: Todays clinical was with two patients on APU; you participated well in both your patients care and spent time talking to them and
doing a thorough assessment, good job.
Your care plan was not turned in on time, so please be mindful of that!!
You passed your clinical today.
Michelle Pringle, RN-BC, BSN
th
Oct 18 , 2016: Todays clinical was with two patients on REU. Once again, I observed your confidence at the bedside; I think your experience as a
CNA helps tremendously. You also displayed some critical thinking skills and researched possible answers to your patients signs and symptoms.
Good job! You passed your clinical today.
Michelle Pringle, RN-BC, BSN
TH
OCT 25 , 2016: Todays clinical was on with two patients on MCU. You did LOTS of skills and did an excellent job at all of them! You are truly
wonderful at the bedside. Youre a critical thinker and observant. Wonderful job!
You passed your clinical today.
Michelle Pringle, RN-BC, BSN
11-1-2016: It was a pleasure working with you in the ED. You worked well and communicated therapeutically with the staff and patients. Your
eagerness to learn and improve on your skills and knowledge is impressiveS. Walker, RN




Nov 15, 2016: Firstly, I m truly sorry I missed your ED experience, I bet you were amazing!! See comments on care plan. As always, a pleasure
watching you grow and learn. Good Job!
Michelle Pringle, RN-BC, BSN

Student
Initials

KG

KG

KG

KG

KG

pg. 5

Final

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

pg. 6