Student Name: Sara Pape

Southwestern Oregon Community College Nursing Program

Nursing 110
Foundations of Nursing: Health Promotion

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 110 Clinical Evaluation Tool Student Name: Sara Pape
. Clinical Week
Mid-
Final
Competenc 2 3 4 5 6 Term 7 8 9 10 Eval
Eval
y (C)
QSEN
Course 10/ 10/ 10/ 11/ 11/
Competencies Dates 10/3 10/10 11/3 11/7 11/21 12/1
(KSA) Outcomes 17 23 31 14 28
(CO)
Attendance: P=Present, A=Absent, T=Tardy P p p p p p p
Facility/Unit LC LC LC LC LC LC LC
C9 Applies concepts and theory to clinical practice in client
CO 1, 2 care and written assignments:
1. Collects data and conducts a health assessment on a na na na s s s s s s s
KSA: Patient Centered Care

client.
2. Analyzes and interprets the data/assessment findings. na na na s s s s s s s
3. Prioritizes health problems. na na na s s s s s s s
4. Develops a plan of care that considers the individual,
family, age of client, developmental stage, psycho- na na na s s s s s s s
socio-cultural issues, and/or learning needs.
5. Evaluates and reflects on plan of care. na na na s s s s s s s
C 8, CO
KSA: Teamwork

Uses therapeutic communication with patients and agency

& Collaboration

5 staff s s s s s s s s s s
C 6,7,8
Recognizes cultural issues and interact with clients in
CO 1,4 culturally sensitive ways s s s s s s s s s s
C10, Uses research and evidence to support clinical decision
KSA:
EBP

CO2 making s s s s s s s s s s
C6, CO2 Utilizes resources as needed s s s s s s s s s s
C9, CO2 Demonstrate responsibility and accountability for
professional behavior: s s s s s s s s s s
1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire, appropriate
tools such as stethoscope, skills list, evaluation tool, s s s s s s s s s s
assessment tools).
C4 3. Takes initiative in making decisions and assuming
s s s s s s s s s s
Informatics, Professionalism

responsibility for decisions.

C3 4. Looks for opportunities for continued learning and self-
development. s s s s s s s s s s
C4 5. Identifies behaviors and attitudes influencing
professional behavior. s s s s s s s s s s
KSA: Safety,

C1,2 6. Demonstrates growth in coping with stressful situations

in a calm and dependable manner. s s s s s s s s s s
C8, 9 7. Documents accurately and thoroughly within the health
record where applicable to clinical setting s s s s s s s s s s
 C1, CO3 8. Maintains patient confidentiality. s s s s s s s s s s
C3, CO8 9. Completes and submits assignments on time. s s s s s s s s s s
C2 10. Organizes and manages time effectively. s s s s s s s s s s
C4, CO8 11. Attends and participates at post-conference. s s s s s s s s s s
Instructor Initials mjs mjs mjs mjs mjs mjs mjs mjs mjs mjs mjs
Student Initials SP SP SP SP SP SP SP SP SP SP SP
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. Reference the course outcomes listed in the Student Initials
Week syllabus, the OCNE Competencies from the Nursing Student Handbook and/or the QSEN competencies (Date/Sign all entries)

2 SP
See handwritten CET
Excellent skin assessment documentation. Acknowledges client fatigue and allows for rest period. Nice patient centered
3 SP
care. Looks for opportunities to practice skills and nice communications skills today. Great job
Does assessments on assigned patient. Beginning documentation skills. Be cautious of where scope and practice are at
this time. The musculoskeletal assessment has not been done in lab yet so it is a patient safety issue to perform in clinical. SP
4
Very good job assisting patients, staff and classmates. Nice beginning nursing dx statement.

5 No Clinical SP

Beginning care planning and documentation this week. Eager to learn and looks for new opportunities during the clinical
6 day. Continue working on making your care plans patient centered and specific. Great collaboration with staff and SP
classmates
Sara has demonstrated increased confidence during the beginning of this term. She is eager to learn and works well with
Midterm SP
staff and classmates. She is developing an understanding of the nursing process and documentation.
Complete care prep with 3 nursing dx. Beginning prioritization in care. Reflects on care. Continue working on the
7 evaluation of the care plan itself and how to bring it to a patient centered focus. Very nice interaction with patient and SP
staff.
Beginning to prioritize 3 care plans. Assessment documentation is continuing to improve with more indepth data. Be sure
8 to evaluate you plan of carehow did it workwhat went well, what would you change and how. This is the type of SP
response you need at the end of your care plan. Great team work today!
Continues to improve in documentation of assessment information. Becoming more indepth. Practice use of your medical
terminology for charting purposes. Care lan continues to show improvement in prioritization and patient centeredness. SP
9 Practice be specific and measurable with goals and interventionsrather than importance of proper footwear state
shoes with Velcro closure and non-skid soles. Very nice collaboration and teamwork today!
Care plan in beginning stages of prioritization. Continue practicing application of all data that will support your plan.
10 Documentation becoming more patient centered and focused. Very nice communication with staff and classmates. SP
 Sara has continued to grow in skill and confidence this term. She provides patient centered care that is beginning to
prioritize as are her care plans. Documentation of her assessments has grown this term and her physical assessments are SP
Final
thorough. Good communication with staff and classmates.