Student Name: Tanya Johnson

Southwestern Oregon Community College Nursing Program

Nursing 112
Foundations of Nursing in Acute Care 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 112 Clinical Evaluation Tool

Student Name: Tanya Johnson

.
Compete
ncy
(C)
Course
Outcomes
(O)
C9/O1,
O2

C1/O3

C5/O3

C8/O5
C4/O4

C6, C7,

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 an acute condition.
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.
Apply ANA Code of Ethics to care
of patients with acute
conditions/processes.
Identifies roles and functions of
members of the health care team
involved in providing care for
acute conditions/processes.
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

Make
-up

n/a
/

4/7/1
5

4/14/1
5

4/28/1
5

5/5/1
5

5/12/1
5

5/19/1
5

5/26/1
5

6/2/1
5

5/30/1
5

MCU

MCU

MCU

PSU

MCU

REU

REU

COMM

NA

NA

NA

NA

NA

NA

NO

N/O

N/O

C8/
O1
C10/O2
C6/O2
C9/O2

C3/O

Competen
cy
(C)
Course
Outcomes
(O)
C9/O2

C3/O

C4

C3

C4
C1, C2

interact with clients in culturally

sensitive ways
Uses research and evidence to
support clinical decision making
Utilizes resources as needed
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).

NO

Make
-up
1

Demonstrate responsibility and

accountability for professional
behavior:
2. 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

NO

C1/O3

7. Maintains patient confidentiality.

C3

8. Completes and submits

assignments on time.
9. Organizes and manages time
efectively.
10. Attends and participates at postconference.

C2
C4

Instructor Initials
Student Initials

NA

RSF
TRJ

RSF
TRJ

X
X

RSF
TRJ

RSF
TRJ

RSF
TRJ

RSF
TRJ

RSF
TRJ

SW
TRJ

Clinical
Week

Instructor Comments (Include Signature)

Student
Initials

N/A
TRJ

Just a reminder from post clinical: Read and apply the example, How to Write a Patho.
Expand the intended action of your med list to include a brief summary of how the
medication works brief . You do not need to list PACU meds if you are accepting a post
surgical patient when those meds will be discontinued on the floor. If you have questions
about med orders or the pyxis, call pharmacy for additional help this constitutes learning to
use your resources and will be important as you begin to work independently as a licensed
nurse. Communicate with the MD even if you feel he/she will get irritated RNs need
parameters to be complete, etc. Avoid risk for diagnosis unless you have covered all other
patient needs with your previous nursing diagnosis. Make sure the lab interpretation and
nursing considerations with meds apply with your patient. List your antidotes for narcotics
especially and always check for allergies with antibiotics (and all meds).
Nice week
Tanya!.........................................................................................................................................
..RSF
TRJ

Tanya,
Care plan looks pretty goodI would like to see more reflection on your nursing diagnosis
and interventions is there anything you would do diferently? Was it a good diagnosis
why? Not appropriate? Why?.......................RSF

ABSENT

Tanya,
I was very pleased with your overall care plan well
done!..................................................................................................RSF

TRJ

TRJ

See feedback
provided
...RSF
TRJ

See feedback
provided
...RSF

TRJ

Tanya,
Your care plans continue to develop in competency. Your nursing diagnosis and interventions
are flowing out of your understanding of the integrated pathophysiology. Well
done!......................................................................RSF
Tanya,
I have enjoyed having you this term. You demonstrate a true eagerness to learn and
understand the nursing process. I have been able to observe you applying that new
understanding to the creation of your care plan. Well done and good luck next
year!.................................................................................................................................RSF

12/08/12: sw, reviewed 3/30/15sw

5

TRJ