Clinical Performance

Evaluation
Student Name: Section: Date:

Instructor: Clinical Area:

Scoring Guidelines:
● 4: Exceptional proficiency, consistently demonstrates mastery of technical skills with minimal
supervision.
● 3: Competent proficiency, demonstrates skills accurately and independently most of the time.
● 2: Developing proficiency requires occasional guidance and supervision to perform skills accurately.
● 1: Limited proficiency, demonstrates basic understanding but often requires significant supervision and
support.
● 0 = Unable to demonstrate/verbalize knowledge or understanding of component

Competenc
Observation
y Grading
s Scale
Category
I. Arrived on time, dress code followed, name badge and CPR card on; with tools 4 3 2 1 0
and paperwork
Member
Practices within Scope of Practice - follows facility policies/procedures/rules. 4 3 2 1 0
of a Consistently demonstrates professional characteristics and values such as 4 3 2 1 0
Professio altruism, human dignity,
n truth, justice, freedom, equality, demeanor and appearance.
Complete required documentation as assigned by instructor, i.e. vital signs, flow 4 3 2 1 0
sheets, nurses notes, etc
Demonstrates professional communication skills with all staff members, peers, 4 3 2 1 0
and instructors. Exhibits
use of therapeutic communication skills with all clients and family members.
Delivers culturally-sensitive care across the life-span to all patients and family 4 3 2 1 0
members.
Demonstrates ability to maintain professional boundaries. 4 3 2 1 0
Seeks out learning experiences/proper instruction from instructor 4 3 2 1 0
Maintains confidentiality/follows HIPPA guidelines 4 3 2 1 0
Accepts constructive criticism in positive manner 4 3 2 1 0
II. Collects and documents subjective and objective data related to Maslow's 4 3 2 1 0
Provider Hierarchy of Needs (first three
levels) and pathophysiology of patient's diagnosis
of
Student transfers skills and material learned from other classes such as A & P to 4 3 2 1 0
Patient clinical situation at hand
- to better provide care to patient
Centere Demonstrates ability to obtain accurate vital signs using a manual BP cuff. 4 3 2 1 0
d Care Recognizes and reports
abnormalities to designated facility nurse and nursing instructor
Identifies three (3) basic needs or problems for the patient and/ or family. 4 3 2 1 0
Incorporate a need into a complete NANDA statement
Demonstrates knowledge and understanding of principles of infection control 4 3 2 1 0
Demonstrates ability to perform ADLs. Accurate performance of any checked-off 4 3 2 1 0 N
 skill. A
III. Recognizes need for and seeks assistance from instructor if practice requires 4 3 2 1 0 N
Patient behaviors or judgments outside of individual knowledge and expertise. A
Safety Recognizes need for and seeks training/ orientation from
Advocat instructor for unfamiliar patient care situations
Demonstrates consistent ability to complete steps A-E and X-Z. Consistently, 4 3 2 1 0 N
e accurately identifies patient A
Maintains environmental safety. Prepares and uses correct equipment for 4 3 2 1 0 N
intended purpose A
Consistently follows standard precautions. Maintains physiological safety. 4 3 2 1 0

Identifies and reports incidents/accidents/observations of safety concerns and /or 4 3 2 1 0 N

abnormal findings to A
instructor and nurse
Directly reports off to staff nurse and instructor before leaving unit for any reason 4 3 2 1 0
Implements and respects Patient's Bill of Rights 4 3 2 1 0
IV. Member Coordinates and communicates care to be performed with patient, family, and 4 3 2 1 0
Health Care interdisciplinary team
Team Demonstrates respect for privacy and dignity of patients. 4 3 2 1 0

Grades for day: Clinical: ____/100

Comments: