Student Name:

Brooke Perry

Southwestern Oregon Community College Nursing Program

Nursing 111
Foundations of Nursing in Chronic Illness I

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.

Nursing 111 Clinical Evaluation Tool

Student Name:

.
Compete
ncy (C)
Course
Outcome
(CO)

C9
CO 1, 2

C1,
CO4
C5,
CO5
C8,
CO6
C4,
CO7
C6, 7, 8
CO2

Brooke

Clinical Week
Dates
Attendance: P=Present, A=Absent, T=Tardy
Facility/Unit
Applies concepts and theory to clinical practice
in client care and written assignments:
1. Collects data and conducts a health
assessment on a client with a chronic illness
2. Analyzes and interprets the data/assessment
findings.
3. Prioritizes health problems.
4. Develops a plan of care that considers the
individual, family, age of client,
developmental stage, psycho-socio-cultural
issues, and/or learning needs.
5. Evaluates and reflects on plan of care.
Applies ANA Code of Ethics in care of chronically
ill
Identifies roles and functions of members of the
health care team involved in providing care for
the chronically ill.
Uses therapeutic communication with patients
and agency staf
Recognizes potential legal and ethical issues
related to client autonomy across the lifespan in
at risk populations.
Recognizes cultural issues and interact with
clients in culturally sensitive ways

10

1/12
P
BAH

1/19
A
BAH

1/26
P
BAH

2/2
P
BAH

2/10
P
BAH

2/16
P
BAH

2/23
P
BAH

3/1
P
BAH

3/8
P
BAH

Makeup

C10
C6

Uses research and evidence to support clinical

decision making
Utilizes resources as needed

S
3

Competen
cy (C)
Course
Outcome
(CO)

C9, CO2

C3

C4
C3
C4
C1
C1
C3
C2
C4

Demonstrates 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. Completes and submits assignments on time.
9. Organizes and manages time efectively.
10.Attends and participates at post-conference.
Instructor Initials
Student Initials

10

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

PW
BP

Makeup

Week

Instructor Comments (Include Date/Signature)

BP

MCU- Dementia. Busy day with ADL care and assessments. Your patho is good, assessment is done well, some notes
made on the medication page. Good response to the labs, clinical note needs some work, nursing care plan coming
along, some insights made.

Pamela Wick RNMSN

BP
2

Sick

Pamela Wick RNMSN

BP

MCU- Acute Encephalopathy; Busy day with ADL care and assessments. Discussed diagnosis
with interventions planned. See comments on care plan prep.

Pamela Wick RNMSN

4

REU- Steroid induced myopathy; Accessed the Pyxis and established poassword.
Administered AM meds without difficulty. Educate patient r/t medication. Continue to work on
educating the patient r/t their meds so there is a comfortable flow.

BP

Pamela Wick RNMSN

5

REU-Sepsis; Your care plan was done well. Good job. See comments. Skills completed. ADL
care and assessments completed.

BP

Pamela Wick RNMSN

6

MCU- So your care plan patho was good but you didnt look at any of his co-morbidities or
other things that efect his life and recovery, such as; hes going home with his wife, will he
need continued insulin? How much care will the wife need to do? Since you stated it was fast
growing what is the outlook for him? Your assessments are well done. This was a difficult

BP

patient for the nursing diagnosis with all the chemo, you did ok. Your risk for skin integrity
was right on. Good job Brooke, you have a great bedside manner and your skills are solid.

Pamela Wick RNMSN

BAH-MCU Hepatic encephalopathy; big diagnosis, and good job with care today. You were
BP
able to give Insulin, double check insulin, give a B-12 injection, and yes you learned a lot with
your injection; always go for it entirely, if you do bounce of the skin change needles, and
never give up, remember its all about the attitude, she was unaware of what happened and
as long as you continue on with confidence the patient will not know you may have been a
bit insecure. Your nursing care prep is good. In the patho at the end instead of talking about
what will happen try to look at the patient, incorporate the labs and comorbidities and psych
social stuf and states what may be some of her barriers she may encounter, what difficulties
may her decisions in her personal life bring up, Is encephalopathy a distant memory or could
this happen soon again?

Pamela Wick RNMSN

8

PSU; Today you were able to hang an IVPB and you gave an Sub Q shot. Your skill set is good,
you have an excellent bedside manner. Continue to work on your teaching and showing your
patient in your charting.

BP

Pamela Wick RNMSN

9

Psu; Today was a busy day, you were able to DC an IOV and also give another IM injection
Great job. You were able to give the shot without any problem, a little nervous but you did
well. Good job with your charting.

Pamela Wick RNMSN

Revised 12/09/15sw
5

BP