Survey: CLINICAL_EVAL_NURS3030_FINAL_Cohort0524-FA22

Reviewer: Preceptors (Jensen, Karen)

Reviewee: Students (Honeycutt, Tessa)
Survey Period: 12/8/2022
Completed: 12/13/2022 9:37:50 AM MT

2. Professional Practice
SAFETY
â–º Practices in a safe manner that minimizes the risk to patient, self and others.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Establishes and maintains safe working environment.

Recognizes physiological and psychological changes in patients and adjusts patient interventions.
Demonstrates awareness of contraindications and precautions of patient intervention.
Ensures the safety of self, patient and others throughout the clinical interaction
Requests assistance when necessary.
Uses acceptable techniques for safe handling of patients.
Demonstrates knowledge of facility safety policies and procedures.
Comments: Utilizing the appropriate amount of supervision and guidance in learning safety policies
and procedures was able to consistently practice in a safe manner.

3. Professional Practice
SAFETY
â–º Practices in a safe manner that minimizes the risk to patient, self and others.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

4. Professional Practice
PROFESSIONALISM
â–ºDemonstrates professional responsibility and accountability for nursing judgments and actions.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Demonstrates initiative (e.g., arrives prepared, offers assistance, seeks learning opportunities)
Is punctual and dependable.
Wears attire consistent with expectations of the practice setting.
Demonstrates integrity in all interactions.
Exhibits caring, compassion, and empathy in providing services to patients.
Maintains productive working relationships with patients, families, CI, and the interdisc. team)
Establishes realistic short and long-term goals in a plan for clinical experience.
Seeks out additional learning experiences to enhance clinical and professional performance.
Accepts feedback without defensiveness.
Seeks feedback from clinical instructor related to clinical performance.
Identifies strengths and limitations in clinical performance.
Provides effective feedback to CI related to clinical/teaching mentoring.
Participates in self-assessment to improve clinical and professional performance.
Uses self-evaluation, ongoing feedback from others, and reflection to conduct regular ongoing...
Provides to and receives feedback from peers regarding performance, behaviors, and goals.
Acknowledges and accepts responsibility for and consequences of his or her actions.
Accepts responsibility for continuous professional learning.
Discusses professional issues related to nursing practice.
Comments: Conducted herself in a professional manner in all noted interactions and she was able to
make this a quality learning experience by taking advantage of all learning opportunities.

5. Professional Practice
PROFESSIONALISM
â–ºDemonstrates professional responsibility and accountability for nursing judgments and actions.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

6. Professional Practice
ETHICS
â–ºPractices in a manner consistent with established legal and professional standards, ethical guidelines, and
Christ-like behavior.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Places patient’s needs above self-interests.

Abides by policies and procedures of the practice setting (e.g., OSHA, HIPAA, etc.)
Maintains patient confidentiality.
Adheres to legal practice standards including all federal, state/province, and institutional regulat
Identifies ethical or legal concerns and initiates action to address the concerns.
Displays generosity as evidenced in the use of time and effort to meet patient needs.
Recognize the need for health care to underserved and underrepresented populations.
Strive to provide patient/client services that go beyond expected standards of practice.
Comments: Practiced consistently in an ethical manner irregardless of the complexities of the
situation and abided by all facility policies and procedures.
7. Professional Practice
ETHICS
â–ºPractices in a manner consistent with established legal and professional standards, ethical guidelines, and
Christ-like behavior.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

8. Professional Practice
COMMUNICATION
â–ºCommunicates verbally, nonverbally and electronically in a professional and timely manner.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Communicates, verbally and nonverbally, in a professional and timely manner.

Selects the most appropriate person(s) with whom to communicate.
Communicates respect for the roles and contributions of all participants in patient care.
Listens actively and attentively to understand what is being communicated by others.
Demonstrates professionally and technically correct written and verbal communication without
jargon.
Communicates using nonverbal messages that are consistent with intended message.
Engages in ongoing dialogue with professional peers or interdisciplinary team members.
Interprets and responds to the nonverbal communication of others.
Evaluates effectiveness of his/her communication and modifies communication accordingly.
Seeks and responds to feedback from multiple sources in providing patient care.
Adjust style of communication based on target audience.
Communicates with the patient using language the patient can understand (translator, level of educ.)
Comments: Quality interactions with patients/ families and the interdisciplinary team resulted from
professional communications both verbally and nonverbally with all.

9. Professional Practice
COMMUNICATION
â–ºCommunicates verbally, nonverbally and electronically in a professional and timely manner.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

10. Patient Management
CLINICAL JUDGMENT
â–ºApplies current knowledge, theory, clinical reasoning and the patients’ values and perspectives in patient
management.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Presents a logical rationale (cogent and concise arguments) for clinical decisions.
Makes clinical decisions within the context of ethical practice.
Utilizes information from multiple data sources to make clinical decisions.
Recognizes when POC and interventions are ineffective, identifies areas for change, and implements.
Selects interventions based on the best available evidence, clinical expertise, and patient preferen
Assesses patient response to interventions using credible measures.
Integrates patient needs and values in making decisions in developing the plan of care.
Clinical decisions focus on the whole person rather than the disease.
Recognizes limits (learner and profession) of current knowledge, theory, and judgment in pt mgmt.
Comments: Clinical decisions were made with the appropriate amount of supervision and guidance
from her preceptors resulting in quality patient care.

11. Patient Management

CLINICAL JUDGMENT
â–ºApplies current knowledge, theory, clinical reasoning and the patients’ values and perspectives in patient
management.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

12. Professional Practice

CULTURAL COMPETENCE
Adapts delivery of nursing services with consideration for patients’ differences, values, preferences, and needs.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Incorporates an understanding of the implications of indiv. and cultural diff. and adapts behavior.
Commun. with sensitivity by consider. differ. in race/ethn., rel., gender, age, sex. orient., disab.
Provides care in a nonjudgm. manner when the pts’ beliefs and values conflict with ind. beliefs.
Discovers, respects, and regards individ. differ., prefer., values, life issues, and emotional needs
Values the sociocultural, psych., and economic influences on pts and responds accordingly.
Is aware of and suspends own social and cultural biases.
Comments: Culturally competent nonjudgmental care provided to her patients without bias
irregardless of the complexity of their sociocultural situation.
13. Professional Practice
CULTURAL COMPETENCE
Adapts delivery of nursing services with consideration for patients’ differences, values, preferences, and needs.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

14. Patient Management

NURSING PROCESS
Establishes and implements a plan of care that is safe, effective, patient/family-centered, and evidence-based.
Assessment: Collects and analyzes data from the patient assessment (history, systems review, diagnostic tests and
findings from other care providers) to make clinical judgments.
Planning (Plan of Care): Establishes an individualized plan of care in collaboration with the patient, family, and the
health care delivery team, which is consistent with the assessment.
Implementation: Implements interventions to meet the specific needs of the patient, families, communities and
groups.
Evaluation: Evaluates the effectiveness of nursing care interventions; revises, and reprioritizes the plan of care.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Performs a complete nursing assessment which meets the requirements of the clinical setting
Performs regular reassessments based on patient status; reflects the status of the pt and the family
Reviews health history from patients and other sources
Incorporates physiological, psychological, sociocultural, economic and life-style factors.
Recognizes signs and symptoms that would preclude interventions due to contraindications.
Analyzes and interprets the results and determines a need for further assessment or referral
Clusters assessment data to identify nursing diagnoses/problems.
Sets short- and long-term outcomes that are specific, measurable, achievable, relevant and timely.
Selects interventions based on the best available evidence and patient preferences.
Identifies the resources needed to achieve the goals and refers the patient in a timely fashion.
Correctly identifies patients before intervention according to agency policy.
Implements interventions according to agency policy.
Adapts care to meet the unique developmental, cultural, and spiritual issues of the patient and fami
Maintains patient privacy & dignity.
Implements facility HIPPA plan as well as NNU Standards for patient protection & rights
Monitors and periodically re-evaluates the plan of care.
Recognizes when POC and interventions are ineffective, identifies areas needing change.
Implements required changes according to evaluation.
Communicates changes to patient, family and the health care team.
Comments: Utilizing the nursing process and the appropriate amount of supervision and guidance
from her preceptors was able to provide efficient patient care.
15. Patient Management
NURSING PROCESS
Establishes and implements a plan of care that is safe, effective, patient/family-centered, and evidence-based.
Assessment: Collects and analyzes data from the patient assessment (history, systems review, diagnostic tests and
findings from other care providers) to make clinical judgments.
Planning (Plan of Care): Establishes an individualized plan of care in collaboration with the patient, family, and the
health care delivery team, which is consistent with the assessment.
Implementation: Implements interventions to meet the specific needs of the patient, families, communities and
groups.
Evaluation: Evaluates the effectiveness of nursing care interventions; revises, and reprioritizes the plan of care.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

16. Patient Management

DOCUMENTATION
Produces quality documentation, including patient charting in a timely manner to support the delivery of nursing
services.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Selects relevant information to document the delivery of care.

Documents all aspects of care including changes to, and communication with team.
Produces documentation that follows guidelines and format required by the practice setting.
Documents patient care consist. with guidelines and require. of regulatory agencies and payers.
Documents all necessary info. in an organized manner that demonstrates sound clinical
decisionmaking
Produces documentation that is accurate, concise, timely and legible.
Utilizes terminology that is professionally and technically correct.
Comments: Documentation became more efficient over the semester in the facility's charting system
with the guidance of her preceptor. Assignments consistently were concise and timely.

17. Patient Management

DOCUMENTATION
Produces quality documentation, including patient charting in a timely manner to support the delivery of nursing
services.
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

 18. Professional Practice
DELEGATION
Directs and supervises personnel to meet patient’s expected outcomes according to legal standards and ethical
guidelines.
Provide comments based on the performance dimensions including supervision/guidance, quality, complexity,
consistency, and efficiency. May select from the Indicators of Performance listed below for this competency. Please
provide a description of how the student demonstrated selected Indicators of Performance (may direct to a specific
anecdotal note entry).​

Determines those services that can be delegated according to law, policies,codes of ethics.
Supervises the tasks delegated according to law, policies,codes of ethics.
Monitors the outcomes of patients receiving care delivered by other support personnel.
Demonstrates respect for the contributions of other support personnel.
Comments: Minimal delegation opportunities for junior med surg, consistently demonstrates respect
for all members of the healthcare team.

19. Professional Practice

DELEGATION
Directs and supervises personnel to meet patient’s expected outcomes according to legal standards and ethical
guidelines
Rate this student's clinical performance based on the Indicator's of Performance and comments above:
This rating is for the students performance for this evaluation period only. For a midterm and final evaluations- this
rating is from start of semester until present. Do not consider previous or concurrent clinical performance.

Intermediate Performance [3 pts]

Significant Concerns?: None

Mean: 3.00 of 6 Points: 3 Score: 50.0%

20. SUMMATIVE COMMENTS

Given this student’s level of academic and clinical preparation and the objectives for this clinical experience, identify
strengths and areas for further development. If this is the student’s final clinical experience, comment on the
student’s readiness to practice as a registered nurse.

NOTE: After completion of this evaluation, the student and clinical instructor will meet to review both the self-
evaluation and the CI's evaluation of the student. This will become part of the student's record and may be accessed
by the student and nursing faculty.

Strengths: Eager to learn, compassionate and empathetic, ethical, professional Areas for further
development: Continue to work on expanding your knowledge base and take advantage of all learning
experiences

Total points for all rating scale questions: 27 (Each main question equally weighted)
Mean percentage score for all rating scale questions: 50.0% Response as of 2/25/2024 2:40:03 PM MT