Divis ion

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Department ofJtlursing

Weekly/Summative Stu dent

Studentr

t $(l(!l

S = Satisfactory

Cli

nical Performance Evaluation

9\t!9tr ,

N = Needs lmprovement

- F all 201 4

Location:
,,
,,
,, _ctinicat
(*) Denotes critical behaviors
U = Unsatisfactory

Students who fail to show progress through the semester will be given a remediation plan. Failure to progress may
result in in the student being placed on probation or failure of the course.

Analyze the effectiveness of the plan of care usihg'the,nursing,process (sLo I,

GE 3)

Student

lnstructor

Self'
Eval'
's/N/u

Eval of
Student

Collects evidence related to clinical practice from appropriate resources.

*Demonstrates acourate patient
assessment skills.
lntegrates knowledge of evidence-based theory from nursino and other disciolines to olan care.
Determines an individualized plan of care based on patient assessmenl
Establishes appropriate rtursing diagnoses based on patient assessment.
'Prioritizes patient care based on assessment.
*lmplements qaqe according to
established plan and desired outcomes.
*Evaluates patient response to care
and revises plan as needed.

'

'

slN/u'

<-

<l-

s-\,

Student, .lnstructor
Self''
EValoJ

Eva[]

SINIU
Participates actively in all aspects of the clinical exoerience.
Discusses patient's plan of care with instructor.
Demonstrates professional appearance and demeanor.
Engages in self-reflection and communicates learning needs to instructorloleceotor.
Completes assignments as reguired and submits on time
Organizes time efficientlv.

Outcome 3

Implement:nursing oare'that considers the uniqueness of various cultures,

backgrounds, and belief systems (sLo 3, GE 6)
"Respects pafients' rights with reqard to their dionitv and human worth.
Demonstnates ability to develop and maintain therapeutic relationships with people from
diyerse backgrounds.
Qonsiders patient values, cultural chqracteristics and religious differences when itlanninq care.
Demonstrates caring behaviors

Outcome
---.-- 4

Contribute to multidisciplinary teams to provide patient-centered cafe (slo4, GE

1)

Documentspatientcareaccuratelyandirratimelymannerusi

-5

\
J
)

C\

s
C

-\

s'
Student
Self-,
Eval

lnstructor

s/N/u

S/Nlu',

EVal of

Student

.s

q.

Student

lnstructorr

Self-'

Eval of
Student,
S/NIU

EvaI:
51N/U

ldentifies patienUfamily health education needs and implements oatieni ieacttino.

Student
$/N/U:

record.

Applies therapeutic communications skills.

pernqnstratesinitiativeinassistingpeersandhealthcareteammem6effi

S
c-

Seeks input from patient, inqtruclor, peers, and healthcare team

*Updates instructor
and healthcare team regarding changes in the patientts conUition in a
timely manner.
-Demonstrates professional communication skills usinq SBAR.

.\

.\
t-\

iffi

Outcome 5

lmplement nursing care based on scientific evidence. (sLo 5, GE 2)

s
\)

Student I lnstructor
Self- I Evalof

Eva[

s/N/u I
N242 Clinical Eval Approved: 81281201 4

I Student

s/N/u