Student Name: Megann Voth

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.

2
Nursing 112 Clinical Evaluation Tool Student Name: Megann Voth

Clinical Week.
Midter Final
Competenc 2 3 4 5 m 6 7 8 9 10 Eval
QSEN y Eval
Competencie (C) 4/1 4/1 4/2 5/1 5/2 5/3
Dates 4/4
1 8 5
4/27 5/2 5/9
6 3 0
6/1
s Course
(KSA) Outcomes Attendance: P=Present, A=Absent, T=Tardy P p p P p p p P
(O) MC MC
Facility/Unit U U
REU PSU REU psu mcu PSU

C9/O1, Applies concepts and theory to clinical practice s

O2 in client care and written assignments:
1. Collects data and conducts a health s s s s s s s s s
assessment on a client with an acute
condition.
2. Analyzes and interprets the data/assessment s s
s s s s s s s s
findings.
KSA: Patient Centered Care

3. Prioritizes health problems. s s s s s s s s s s

4. Develops a plan of care that considers the s s
individual, family, age of client,
s s s s s s s s
developmental stage, psycho-socio-cultural
issues, and/or learning needs.
5. Evaluates and reflects on plan of care. s s s s s s s s s s
C1/O3 Apply ANA Code of Ethics to care of patients s s
s s s s s s s s
with acute conditions/processes.
C6, C7, s s
Recognizes cultural issues and interact with
C8/ s s s s s s s s
clients in culturally sensitive ways
O1
C4/O4 Recognizes potential legal and ethical issues s s
related to client autonomy across the lifespan s s s s s s s s
in at risk populations.
C5/O3 Identifies roles and functions of members of the s s
health care team involved in providing care for s s s s s s s s
acute conditions/processes.
C8/O5 Uses therapeutic communication with patients s s s s s s s s s s
and agency staf
 QI, KSA: KSA: Teamwork & Collaboration

C10/O2 Uses research and evidence to support clinical s s

s s s s s s s s
decision making
Safety
EBP,

C6/O2 s s
PCC, QI KSA:

Utilizes resources as needed s s s s s s s s

Competenc
QSEN y
Midter
Competencie (C) Final
s Course
2 3 4 5 m 6 7 8 9 10 Eval
Eval
(KSA) Outcomes
(O)
C9/O2 s s
Informatics, Professionalism KSA: Safety,

Demonstrate responsibility and accountability

for professional behavior: s s s s s s s s
1. Performs safely in clinical.
C3/O 2. Prepared for clinical (Appropriate attire, s s
appropriate tools such as stethoscope, skills s s s s s s s s
list, evaluation tool, assessment tools).
C4 3. Takes initiative in making decisions and s s
s s s s s s s s
assuming responsibility for decisions.
C3 4. Looks for opportunities for continued s s
s s s s s s s s
learning and self-development.
C4 5. Identifies behaviors and attitudes s s
s s s s s s s s
influencing professional behavior.
C1, 6. Demonstrates growth in coping with s s s s s s s s s s
C2 stressful situations in a calm and
dependable manner.
 C8, 9 7. Documents accurately and thoroughly within the s s
s s s s s s s s
health record where applicable to clinical setting
C1/O 8. Maintains patient confidentiality. s s
s s s s s s s s
3
C3 9. Completes and submits assignments on s s
s s s s s s s s
time.
C2 10. Organizes and manages time efectively. s s s s s s s s s s
C4 11. Attends and participates at post- s s
s s s s s s s s
conference.
mj mj mj mjs mj mj mj mjs
Instructor Initials mjs mjs mjs
s s s s s s
Student Initials MV MV 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)
 Instructor include comments that are positive, areas that need improvement or are unsatisfactory. Studen
Wee t
Reference the course outcomes listed in the syllabus, the OCNE Competencies from the Nursing Student
k Handbook and/or the QSEN competencies (Date/Sign all entries)
Initials

1st clinical this term. Cares for pt with aspiration pneumonia and respiratory failure. Able to assess dobhof tube and MV
recognizes neuro changes in patient requiring a rapid response. Very calm during incident and continued to collect
2 data. We will continue to work on DAR notes vs Summary
Care plan is prioritized with excellent reflections. MSperry RN
Has patient with recent fall and rhabdomyolysis, Nice assessment documentation very thorough. Prioritizes nursing MV
dx to fit patient after assessment and includes patient centered interventions. Continue to work on DAR formatting
3 please see exampleVery nice job and strong patient advocacy MSperry RNc

Cares for homeless pt this week with exacerbation of CHF. Documents assessment findings and uses to develop MV
patient centered care plan. Progressing in prioritization of care plan based on patient presentation and Maslows
4 Hierarchy. Continue working with goals and interventions. Too many goals can be hard to achieve stay with one and
work towards that when resolved move onto the next goal. Nice communication with patient and identification of
real needs, i.e. shelter, safe medication storage, food. MSperry RNc
Cares for post-surgical patient this weekreceiving high praise of care from patient. Continues to work on MV
prioritization of nursing dx and interventions more comfortable in the student nurse role and scope and practice.
5 Assessment data is well documented and beginning to integrate into care plans. MSperry RNc

Megann has shown growth this term in confidence, patient approach, and care planning, Her assessments are MV
Midter thorough and documented well.
m
Evaluati
Developing DAR charting format and prioritization of care. Evaluations are indepth and reflective. Works very well
on with staf, patients and class mates MSperry RNc

Cares for new stroke patient with hx of past CVA and multiple co-morbidities. Prioritizes care and then adapts care to MV
patient and family desires on day of care, bringing a patient centered approach. Care plan continue to improve in
6 priority of dx and interventions. Very good communication skills this week with dysphasic patient and with family
members. Nice job MSperry RNc
MV
7 No Clinical

Identifies change in priority dx after baseline assessment evaluates and reflects on change. Assessment MV
documentation is thorough.be sure to bring this data to your care planning, Good prioritization of care plans---the
8 peripheral perfusion may have been #1since angio was done this evening and wounds/poss amputation is d/t the
poor perfusion. Continue working on making goals specific and measurable Very nice reflections and evaluations
Msperry RN
Cares for cancer pt admitted with pneumonia/ Learns new labs values and continues to improve in prioritization of MV
nursing dx and interventions.
9 Provides patient centered care and is pro-active in meeting patients needs. Works as a team on the unit assisting
with care of other patients when not engaged with primary patient. MSperry RN
 Begins clinical as a Load and Go gathering data, medications, and testing on day of care. Prioritizes care planning MV
throughout the shift and applies nursing process for care that is patient centered. Evaluates interventions and patient
10 responses and adapts to achieve best patient outcomes. Nice communication with patient this evening. It has been a
great pleasure watching you grow this term. Melissa
Continues to improve and grow throughout the term- prioritizes dx and continues to grow in prioritization of MV
Final
Eval
interventions. Documentation skills are improving and appears more confident in clinical practice. Looks for skills to
perform and new challenges. Meeting OCNE level 1 Benchmarks
3/07/17: sw
5