Student Name:

Brooke Perry

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.

Nursing 112 Clinical Evaluation Tool

Student Name:

.
Compete
ncy
(C)
Course
Outcomes
(O)
C9/O1,
O2

C1/O3

C5/O3

C8/O5
C4/O4

Brooke

Clinical Week

Dates
Attendance: P=Present, A=Absent,
T=Tardy
Facility/Unit
Applies concepts and theory to clinical
practice in client care and written
assignments:
1. Collects data and conducts a health
assessment on a client with an
acute condition.
2. Analyzes and interprets the
data/assessment findings.
3. Prioritizes health problems.
4. Develops a plan of care that
considers the individual, family, age
of client, developmental stage,
psycho-socio-cultural issues, and/or
learning needs.
5. Evaluates and reflects on plan of
care.
Apply ANA Code of Ethics to care of
patients with acute
conditions/processes.
Identifies roles and functions of
members of the health care team
involved in providing care for acute
conditions/processes.
Uses therapeutic communication with
patients and agency staf
Recognizes potential legal and ethical
issues related to client autonomy
across the lifespan in at risk

4/5/1
6

4/12/1
6

4/19

4/26

5/2/16

5/10/
16

5/17

5/24

MCU

L/D

BAH
REU

BAH/
MCU

PSU

BAH/
REU

BAHREU

BAH/
APU

NI

NO

NO

N/O

N/O

N/O

Mak
e-up

populations.
C6, C7,
C8/
O1
C10/O2
C6/O2
C9/O2

C3/O

Competen
cy
(C)
Course
Outcomes
(O)
C4

C3

C4
C1, C2

C1/O3
C3
C2
C4

Recognizes cultural issues and interact

with clients in culturally sensitive ways
Uses research and evidence to support
clinical decision making
Utilizes resources as needed
Demonstrate responsibility and
accountability for professional
behavior:
1. Performs safely in clinical.
2. Prepared for clinical (Appropriate
attire, appropriate tools such as
stethoscope, skills list, evaluation
tool, assessment tools).

NO

NO

N/O

N/O

N/O

Make
-up

3. Takes initiative in making decisions

and assuming responsibility for
decisions.
4. Looks for opportunities for
continued learning and selfdevelopment.
5. Identifies behaviors and attitudes
influencing professional behavior.
6. Demonstrates growth in coping
with stressful situations in a calm
and dependable manner.
7. Maintains patient confidentiality.
8. Completes and submits
assignments on time.
9. Organizes and manages time
efectively.
10. Attends and participates at postconference.

NI

S+

Instructor Initials
Student Initials

SW
BP

PW
BP

mjs
BP

JT
BP

SW
BP

JT
BP

mjs
BP

JT
BP

Clinical
Week

Instructor Comments (Include Signature/Date)

4/5/16 Assigned to MCU. Excellent rapport with patient and health care staf (Comp #7, 8). Works well with the
health care team (Comp #5). Please see comments on your patient care prep, you had some spelling and
grammatical errors, your content was fine but appropriate spelling, grammar, etc. displays professionalism.
Also review the comments on your care plan, your outcomes were not all realistic and your third outcome didnt
have anything to do with your nursing diagnosis. If you are going to state administer medications be specific
about what medication you will administer specific to the nursing diagnosis and outcome. You did a nice job in
evaluating your interventions. Please let me know if you have any questions or if I can help you with your care
plan.S. Walker, RN
4/12/16 L/D; Excellent rapport with your patient and good interactions with staf. You have a great bedside
manner. Excellent job with the Zofran denigrating tablet you gave. When your patient started to desaturate this
is where your interventions would come into play, you needed to remember that was an option and apply or
perform rapidly (the I/s and positioning as stated on your 2nd diagnosis.) Please review the care plan for
suggestions and see your advisor for further assistance and follow up. I did give you an NI (Looks for
opportunities for continued learning and self-development) d/t you have not sought out any assistance to
improve or remediate even though you were given the opportunity to do so and a U (r/t Develops a plan of care
that considers the individual, family, age of client, developmental stage, psycho-socio-cultural issues, and/or
learning needs) d/t you have not improved in the understanding of outcomes related to the interventions and
how to evaluate those.

Student
Initials

BP

BP

Pamela Wick RN MSN

Improving on care planning and truly reflects on ways to improve. I am seeing a inconsistency in your data
collecting and use through the care plan. Be sure all data is the same throughout your paperin your
assessment you noted a regular rhythm and atrial fibrillation diagnosis yet in the Test area the ECG showed
a NSR with IVCD followed by your data in your care plan indication abnormal heart rhythm also an
inconsistency in level O2 sats should be 93% or 94% - with an end stage COPD pt this could be a big
diference. Continue practicing on being specific and measurable as well as prioritizing your care
planning--------------------------------------MSperry MSN RNc
Brooke, this week you cared for a complicated patient on MCU. Your care plan was complete and pertinent to
your patient. I had very few comments for you. I feel that you were looking for skills to practice; you attended
post conference, and turned in the required material on time. This was a good week for you. Continue to look
for ways to improve your skills and your confidence level.
Jenny Tausch RN MSN PCCN 4/29/16
5/2/16 Your tenacity and determination to improve on your care prep, care plan and skills is impressive. You are
demonstrating intentional learning in that you are seeking relevant knowledge and skills to improve your
practice (Comp #2, 3). You have an excellent rapport with the patient and work well with the staf (Comp 7,8).
Your evaluation of your care plan was well done...S. Walker, RN

BP

BP

BP

Brooke, this week you were able to provide total care for a patient on REU. You were also actively looking for
ways to improve your skills and confidence level in the clinical setting. This was a good week for you, I had very
few comments on your care plan, as it was complete and pertinent to your patient.
Jenny Tausch RN MSN PCCN 5/11/16
Cares for patient with active GI bleed- identifies priority dx for patient according to information in chart. In your
evaluation/reflection be sure to address if this is still the proper priority or if it has changed after meeting your
patient. Continue working on care planning, Include all data and address data in the interventions to help plan
flow easier. Nice improvements---------------------------------Msperry MSN RNc
Brooke, this week you were able to visit the Acute Psychiatric Unit. Your reflection paper was insightful and
complete. I did not have any comments on it. You spent a lot of time using therapeutic communication with
your patient. I feel that even though you were not able to practice clinical skills that you were still able to
observe a diferent type of nursing care. This was a good clinical rotation for you, keep up the good work.
Jenny Tausch RN MSN PCCN 5/24/16

9
12/08/12: sw, reviewed 3/30/15sw
5

BP

BP

BP