Student Name: Molly Plowman

Southwestern Oregon Community College Nursing Program

Nursing 221
Foundations of Nursing: Chronic 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 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.
 2

Nursing 221 Clinical Evaluation Tool Student Name: Molly Plowman

Midter Fina
Compete 2 3 4 5 6 m 7 8 9 10 l
Eval Eval
QSEN ncy
Compet (C) 1/10/20 1/17/1 1/24/1 1/31/1 2/7/1 2/14/1 2/21/1 2/28/1 3/7/1
Dates 17 7 7 7 7 7 7 7 7
en-cies: Course
(KSA) Outcomes Attendance: P=Present, A=Absent,
P P P P P P P P P
(CO) T=Tardy
Facility/Unit MCU MCU ER RES FBC REU ICU MCU MCU
KSA: Patient Centered Care

C9 Applies concepts and theory to clinical

CO 1, 2, practice in client care and written
3 assignments: Y S S S S S S S S
1. Conducts evidence-based health
assessment
2. Collects and monitors a variety of
Y S S S S S S S S
data
3. Analyzes and interprets the
data/assessment findings in
Y S S S S S S S S
increasing complex chronic
conditions.
4. Recognizes pathophysiological
Y S S S S S S S S
changes and symptoms
5. Regularly monitors clients level of
comfort and ability to manage Y S S S S S S S S
symptoms and symptom distress
6. Prioritizes health problems. Y S S S S S S S S
7. Develops and uses evidence-based
Y S S S S S S S S
individualized interventions
8. Develops a plan of care that
considers the individual, family, age
of client, functional issues
associated with co-morbidities,
Y S S S S S S S NA
developmental stage, psycho-socio-
cultural issues, capacity for and
engagement in self-health care,
and/or learning needs.
9. Evaluates and reflects on plan of Y S S S S S S S NA
care for clients with chronic
conditions.
 CO5, 6 Develops discharge plans in
collaboration with client, family, and
Y S NA NA S S NI S NA
other members of the health care
community.
C8 Uses therapeutic communication with
EBP KSA: KSA: Teamwork & Collaboration

Y S S S S S S S S
patients and agency staff.
C6, 7, 8 Recognize cultural issues and interact
Y S S S S S S S S
with clients in culturally sensitive ways.
C5
CO5 Collaborates with other members of the
health care team to provide comfort and Y S S S S S S S S
symptom management.

C10 Uses research and evidence to support

Y S S S S S S NI S
CO2 clinical decision making.
ionalism Profess- KSA:

C6,
Utilizes resources as needed. Y S S S S S S S S
CO4
C4 Able to identify/define leadership skills
Y S S S S S S S S
for nurse's role
C9, CO
Exhibits critical thinking skills when
1 Y S S S S S S S S
prioritizing and delegating patient care.

Compete
ncy
Midter
(C) Final
Course
2 3 4 5 6 m 7 8 9 10 Eval
Eval
Outcomes
(CO)
KSA: Safety, Informatics,

C9, Demonstrate responsibility and

CO1 accountability for professional behavior: Y S S S S S S S S
Professionalism

1. Performs safely in clinical.

C3 2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope,
Y S S S S S S S S
skills list, evaluation tool, assessment
tools).
C4 3. Takes initiative in making decisions and Y S S S S S S S S
assuming responsibility for decisions.
 C3 4. Looks for opportunities for continued
Y S S S S S S S S
learning and self-development.
C4 5. Identifies behaviors and attitudes
Y S S S S S S S S
influencing professional behavior.
C1,2 6. Demonstrates growth in coping with
stressful situations in a calm and Y S S S S S S S S
dependable manner.
C1 7. Maintains patient confidentiality. Y S S S S S S S S
C8 8. Documentation of client care is
accurate and relevant and consistent Y S S S S S S S S
with agency policy
C3 9. Completes and submits assignments on
Y S S S S S S S S
time.
C2 10.Organizes and manages time
Y S S S S S S S S
effectively.
C4 11.Attends and participates at post-
Y S S S S S S S S
conference.
Instructor Initials MPP MPP MPP MPP MPP MPP MPP MPP MPP
Student Initials MP MP MP MP MP MP MP MP MP

Week Instructor Comments (Include Date/Signature) Student

Initials
January 10th, 2017: Todays clinical was with a patient on mcu that has a stroke. You did an excellent job of advocating MP
for the patient, and assisting her in goals and adls. You are courteous and professional. I hope to see you do more
clinical skills next week! Good job.
2
Michelle Pringle, RN-BC, BSN
 MP
January 17, 2017: Todays clinical was with two patients on MCU. You did a great job of managing your time while
providing thorough care of both patients. Feel free to change your care plan as needed. If you notice a problem that
3 should be addressed, add it to the care plan. You have excellent patient rapport and take initiative. Great Job!

Michelle Pringle, RN-BC, BSN

MP
th
January 24 , 2017: Todays clinical was in ER and you did an amazing job you grabbed opportunities and make
important observations. You have a wonderfully friendly and light demeanor and it transcends to the patient making
4 them comfortable and trusting. Great job!!!
Michelle Pringle, RN-BC, BSN

January 31st, 2017: Todays clinical was spent with the resource nurse. You did a great job and saw many things. I hope MP
this also gave you an idea of how interventions apply to care plans throughout the patients stay. You take initiative
and get your hands dirty great job!!
5
Michelle Pringle, RN-BC, BSN

MP
February 7, 2017: Todays clinical was in L&D with a new mom of twins. You observed the safety issue when the staff
got the twins mixed up! You have a very upbeat personality and this speciality of nursing would be a great fit for you,
especially since you really enjoyed it. Remember this experience of your clinicals and how much you loved it, this will
6 guide your career. Great Job!

Michelle Pringle, RN-BC, BSN

Midte
rm
Eval
MP
February 14th, 2017: Today you displayed cohesive teamwork, great job! You are intelligent, kind, and have a wonderful
upbeat personality.This is a huge asset in a very stressful career. You are a great team player; coworkers will be
7 delighted to have you on their team! See comment on your
Care plan.
Michelle Pringle, RN-BC, BSN

8 MP
February 21st, 2017: Todays clinical was in ICU with a high acuity, dependent patient. Great job on your care planskin
integrity is a huge concern for a quadriplegic or anyone whose movement is limited. There is always a discharge plan
discharge planning begins upon admission!! Great job today, you learned a lot and you were professional and
 appropriate at the bedside with mom. Good job!
Michelle Pringle, RN-BC, BSN

February 28th, 2017: Todays clinical was on MCU. Great job on your care plan and patho. See note on the care plan! MP
Question the doc if you feel something is not right they may have overlooked it. Great job today!
9 Michelle Pringle, RN-BC, BSN

March 7th, 2017: Great job on MCU today! Im glad you enjoyed your term; it was a pleasure and entertaining to be MP
your instructor! I think you would be great in LDRP as a career choice because of your upbeat personality; although
10 everyone needs to laugh, so keep it up. Good luck for the next chapter, Molly!
Michelle Pringle, RN-BC, BSN
Final
Eval

12/12/12, updated 12/16sw

5