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Evaluations - > Evaluation Review


Evaluations Final Clinical Evaluation Form--Revised 4/2016
Evaluations NUR 4636L (7/24/2016)
Experience Wright, Kimone (kimonewright@health.usf.edu)
Change password Evaluator: Jordan, Betty (ejordan2@health.usf.edu)
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5-Outstanding: Exceeds Standards


Exhibits above average performance of nursing care for this level student. The student is
proactive, self-directed, and consistently engaged in learning; needs minimal guidance; is
knowledgeable; and appropriately incorporates knowledge with skills. Student is proactive
and self-directed in approach to learning.

4-Satisfactory: Meets Standards


Exhibits average performance of nursing care for this level student. Functions with minimum
guidance. Demonstrates adequate knowledge and requires minimum assistance in applying
knowledge to skills. Recognizes learning opportunities but may require assistance in utilizing
them.

3-Minimal
Exhibits minimal performance of nursing care for this level student. Functions safely with
moderate guidance. Demonstrates minimal knowledge and requires moderate assistance in
applying knowledge to skills. Requires some direction in recognizing and utilizing learning
opportunities. Often focuses on the task or own behavior, not on the patient.

2-Unsatisfactory
Requires intense guidance for the performance of activities at a safe level. Clinical
performance reflects difficulty in the provision of nursing care. Demonstrates gaps in
necessary knowledge and requires frequent or almost constant assistance in applying
knowledge to skills. Requires frequent and detailed instructions regarding learning
opportunities. Focuses primarily on the task or own behavior, not on the patient.

1-Unsafe to Practice
Is unsafe to practice without constant, intense guidance. Frequently lacks necessary
knowledge and skills and unable to integrate these into practice. Requires constant detailed
instructions regarding learning opportunities and is often unable to utilize them. Attempts
activity or behavior, yet is unable to complete. Focuses entirely on the task or own behavior,
not the patient.

Standard I--Communication

1. Communicates pertinent information regarding the patient's condition/concern to


health team members.
2. Communicates effectively in written form (Nursing Process Worksheet is
organized and complete)
3. Communicates effectively in verbal form.
4. Initiates, maintains, and terminates the nurse-patient relationship using principles
of therapeutic communication.
5. Functions as an advocate for the patient/family and communicates family needs to

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other members of the health care team.


6. Examines the dynamic interactions between the patient, family, community, and
society.
7. Initiates discussion to identify and resolve interpersonal problems that impact
care.
8. Uses interpersonal skills to enhance patient/family coping abilities.
9. Discusses the ethical issues and approaches the ethical dilemmas that confront the
patient/family and appropriately discusses experience with faculty/preceptor.
10. Delegates appropriately to patient care technician, family, or other team
members.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice

Quiet, but mature excellent professional communication


demonstrated, BTJ


Standard I-Knowledge

1. Applies knowledge of humanities, physical and social sciences, and nursing when
providing patient care.
2. Applies knowledge of social, cultural, and genetic factors to the care of diverse
populations.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard I-Attitude

1. Consistently demonstrates professional behavior as indicated by preparedness for


rounds, contributing substantively to post conferences, respecting staff, faculty and
preceptors in communication and tone.
2. Provides clinical objectives to preceptor as determined in pre-conference.
3. Preparedness for the clinical day as indicated by timely arrival to clinical in the
required dress code.
4. Focused attention during post conference to peers as well as faculty.

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5. Is actively engaged in and seeks out opportunities for learning.


5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice

well-poised and engaged, BTJ


Standard II-Safety

1. Does not make judgmental, discriminatory, or prejudicial statements to the


patient, staff, or faculty.
2. Applies principals of universal precautions, practices specific isolation techniques,
and teaches the reasons for universal precautions.
3. Assesses patients for fall risk and applies principles of safe patient handling.
4. Maintains the patient's physical safety by protecting the patient from harm.
5. Maintains medical and surgical asepsis when doing procedures requiring sterile
technique.
6. Properly identifies techniques and teaches the reasons for universal precautions.
7. Validates the accuracy and appropriateness of orders for nursing/medical care
prior to initiating care.
8. Implements orders accurately and efficiently.
9. Is able to identify potential signs and symptoms of an emergent medical condition
and promptly reports changes in the patient's health status to preceptor and/or
clinical faculty member.
10. Adapts skill performance using principles of theory when necessary.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard III-Nursing Process: Assessment

1. Identifies data from the history and physical assessment to formulate appropriate
nursing diagnoses.
2. Identifies the patient's health education needs.
5 (Comment Required) Outstanding: Exceeds Standards

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4 Satisfactory: Meets Standards


3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard III-Nursing Process: Diagnosis

1. Synthesizes history and assessment data as well as diagnostic results into the
development of nursing diagnoses.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard III-Nursing Process: Plan

1. Integrates psychosocial needs into care plan, identifies appropriate resources for
the plan of care, and incorporates health education into the care plan.
2. Identifies measurable, expected patient outcomes that are realistic and
individualized to the patient.
3. Identifies the discharge planning process and needs of the patient upon admission
and throughout the hospitalization.
4. Demonstrates judgment in decision-making and priority setting.
5. Uses appropriate collaborative resources to personalize the nursing care the
patient receives.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice

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Standard III-Nursing Process: Intervention/Implementation

1. Demonstrates understanding of the principles underlying nursing actions


appropriate for the student at this point in the curriculum.
2. Performs skills according to agency policy and procedure and clinical lab
guidelines.
3. Implements the written action plan/protocol considering the priorities for each
assigned patient.
4. Standard III-Nursing Process: Intervention/Implementation
5. Implements a teaching plan based on scientific knowledge and utilizes resources
appropriately.
6. Incorporates evidence based research into nursing practice.
7. Practices individualized and culturally competent care.
8. Initiates appropriate referrals as needed.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard III-Nursing Process: Evaluation

1. Evaluates the patient's response/outcome to the intervention.


2. Utilizes subjective and objective data to revise nursing actions (as appropriate for
the student at that level of the curriculum).
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard III-Nursing Process: Organization

1. Provides organized, coordinated, and prioritized nursing care for the patients with
a range of health problems.

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2. Organizes time and resources effectively and efficiently.


3. Gathers and organizes equipment necessary for patient care/procedures.
4. Identifies and seeks appropriate resources during patient care provision.
5. Completes the daily clinical assignment in a timely manner.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard III-Nursing Process: Documentation

1. Appropriately develops long and short term patient oriented nursing care goals
based on patient assessment and scientific principles of nursing practice.
2. Documents problems and nursing care goals in the patient record (with co-
signature).
3. Identifies and documents nursing actions/orders initiated in implementing the plan
of care.
4. Correctly enters data into the patient record in a timely manner per agency
protocol.
5. Assures privacy of the patient record at all times.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory
1 (Comment Required) Unsafe to Practice


Standard III-Nursing Process: Critical Thinking

1. Utilizes critical thinking skills to prioritize patient needs based on the patient
assessment.
5 (Comment Required) Outstanding: Exceeds Standards
4 Satisfactory: Meets Standards
3 Minimal
2 (Comment Required) Unsatisfactory

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1 (Comment Required) Unsafe to Practice


Comments:

50, Kimone demonstrates above average performance of nursing care. She is self-directed, and consistently engaged in
learning; is reserved and mature, needs minimal guidance; is knowledgeable; and appropriately incorporates knowledge
with skills. During this clinical rotation Kimone grew tremendously with confidence in her practice.Dr. Jordan


Kimone Wright has reviewed the above evaluation on 7/30/2016 and has provided the
following comment:
Dr. Jordan, thank you so much for all the effort you had put into helping me get the
experience I got in St. Croix throughout this summer semester. I could not have asked for
more. I must admit that I have grown with confidence in my practice and I couldn't have
done this without your help. You were great! Thank you so much.


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