Student Name: Megann Voth

Southwestern Oregon Community College Nursing Program

Nursing 110
Foundations of Nursing: Health Promotion

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 weekly 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 weekly 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 110 Clinical Evaluation Tool Student Name: Megann Voth

. Clinical Week
Mid
-
Ter Final
2 3 4 5 6 m
7 8 9 10 Eval
Eva
Compet
l
ency (C)
QSEN
Course OC OC OC NO NO NO
Competenc OCT NO 11/1
ies
Outcom Dates T0 T1 T V 5
V V
es 18 V08
(KSA) 4 1 25 01 22 29
(CO)
Attendance: P=Present, A=Absent,
P P P P P P P P P
T=Tardy
Med
Facility/Unit LC LC LC LC LC LC Clas LC
s
C9 Applies concepts and theory to clinical practice
CO 1, in client care and written assignments:
S S S S S S NA NA S
KSA: Patient Centered Care

2 1. Collects data and conducts a health

assessment on a client.
2. Analyzes and interprets the
data/assessment findings.
S S S S S S NA NA S
3. Prioritizes health problems. NA NA S S S S NA NA S
4. Develops a plan of care that considers the
individual, family, age of client,
developmental stage, psycho-socio-cultural
NA NA S S S S NA NA S
issues, and/or learning needs.
5. Evaluates and reflects on plan of care. NA NA S S S S NA NA S
C 8,
KSA: Teamwork & Collaboration

Uses therapeutic communication with patients

CO 5 and agency staf
S S S S S S NA NA S

C 6,7,8
CO 1,4
Recognizes cultural issues and interact with
clients in culturally sensitive ways
S S S S S S NA NA S

pg. 3
 C10,

EBP KSA:
Uses research and evidence to support clinical
CO2 decision making
S S S S S S NA NA S
C6,
Utilizes resources as needed S S S S S S NA NA S
CO2
C9, Demonstrate responsibility and accountability
CO2 for professional behavior: S S S S S S NA NA S
1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope, skills S S S S S S NA NA S
list, evaluation tool, assessment tools).
Informatics, Professionalism KSA: Safety,

C4 3. Takes initiative in making decisions and

assuming responsibility for decisions.
S S S S S S NA NA S
C3 4. Looks for opportunities for continued
learning and self-development.
S S S S S S S S S
C4 5. Identifies behaviors and attitudes
influencing professional behavior.
S S S S S S S S S
C1,2 6. Demonstrates growth in coping with
stressful situations in a calm and S S S S S S S S S
dependable manner.
C8, 9 7. Documents accurately and thoroughly
within the health record where applicable to S S S S S S NA NA S
clinical setting
C1,
8. Maintains patient confidentiality. S S S S S S NA NA S
CO3
C3, 9. Completes and submits assignments on
time.
S S S S S S S S S
CO8
C2 10. Organizes and manages time efectively. S S S S S S S S S
C4,
11. Attends and participates at post-conference. S S S S S S NA NA S
CO8
Instructor Initials CD CD CD CD CD CD SW CD CD
Student Initials MV MV MV MV MV MV MV MV MV
Key: C=Competency, CO=Course Outcome, QSEN=Quality and Safety Education for Nurses, KSA=Knowledge, Skills & Attitudes (QSEN
Competencies)

pg. 4
 Instructor include comments that are positive, areas that need improvement or are unsatisfactory. Student
Initials
Week 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)

Very pleasant to patients and is very respectful to staf and residents. Uses learned labs skills
2
appropriately. Bed making good. Vital signs good. Capillary Blood Glucose good. Job well done.

Very pleasant to patients and is very respectful to staf and residents. Uses learned labs skills
appropriately. Skin assessment was good. Speaking to the patients while assessing them about
3
what you are doing or things they may be interested in can keep the often awkward moments at
a minimum. Good job!

4 Great job. Neuro was good and EENT.

pg. 5
 5 Great job again. Good musculoskeletal.

Nice work with listening to respiratory sounds. Able to apply lab skills to clinical situation. Good
6
job and great participation.

Midte
rm

7 GOOD JOB

11/15/2016 Attended class at Baycrest: Safe Medication Administration in Older Adults. Your written work
addressed the objectives well and demonstrates use of reflection (Comp 2, Level I-self-analysis of
professional behaviors), engaging in intentional learning (Comp 3, Level 1-attitudes towards learning,
8
active learning), and Comp 4, Level 1 Attends meetings, participates and identifies role within the team.
S. Walker,
RN, MSN

9 Great participation. Good assessments. Care plan looks good.

10

Final

9/1/09: rev 05062011: reviewed 9/2012 sw, rev 8/2/16 sw

pg. 6