NURS 253 STUDENT SELF-ASSESSMENT

EVALUATION OF PERFORMANCE OCCURS AT WEEK 4 and/or ongoing (if required), WEEK 7 (Midterm), Week 11 AND WEEK 15 (Final)
NOTE: Students who are experiencing difficulties that could result in an unsatisfactory in Week 7 or Week 15 will be expected to do a self-evaluation and receive
a preceptor and faculty evaluation in Week 4 and/or week 11, and as required.

PLEASE CIRCLE

S = SATISFACTORY

COMPETENT AND SAFE PRACTICE WITHIN A LEGAL

AND ETHICAL FRAMEWORK
1. Model safe, competent, and ethical practice in
compliance with legal and regulatory frameworks
and the policies and procedures of the practice
setting.
i.
ii.
iii.

iv.
v.
vi.
vii.
viii.

ix.

Comply with regulatory standards, relevant legislation

and the practice settings policies and procedures.
Act in a professional, responsible, ethical and
accountable manner.
Use the three factor and decision making frameworks
to determine strengths and limitations and when to
collaborate and consult with other professionals.
Integrate evidence-informed practice and a theory
based approach into nursing care.
Assess practices and risk management principles and
take action to ensure safety of clients, self, and others.
Question and clarify unclear orders or directions and
when uncertain.
Question, clarify or challenge questionable orders,
decisions or actions by others.
Respond in a professional manner to situations in
which there is unsafe, unacceptable or unprofessional
behavior.
Demonstrate understanding about the role of the nurse
within health care.

Week 4

ND = NEEDS DEVELOPMENT
S

ND

U = UNSATISFACTORY

Comments

I am satisfactory in complying with regulatory standards and company policies and

procedures. I also would ask questions and clarify unclear orders with my preceptor and
other team members.

Student signature and date

Week 7 S ND U

Preceptor signature and date

Comments

I act in a very professional manner by making sure I am properly attired and on time for
clinical practice. I also take responsibilities for errors by reporting immediately to my
preceptor..

Student signature and date

Week 11 S ND U

Preceptor signature and date

Comments

Student signature and date

Week 12

S ND

Student signature and date

Preceptor signature and date

Comments

Preceptor signature and date

ACCURATE AND RELEVANT COMMUNICATION

2. Communicate using strategies and technology
to effect accurate and timely information sharing
including data, research, and other information.
i.

Contribute to team sharing and discussions.

ii.

Document clearly, accurately, concisely in a timely

manner using written and electronic methods.

iii.

Use effective communication techniques when

reporting relevant information and providing feedback
to the appropriate members of the interprofessional
heath care team.

iv.

Evaluate and refine techniques used to communicate

and share information with clients and the
interprofessional health care team.

v.

Ensure privacy and confidentiality.

vi.

Use technology to retrieve information including

research and other date and to obtain and forward
information both within and outside the practice setting.

-+
Week 4

ND

Comments

I am satisfactory in accurate and relevant communication because I would document on

EMR and communicate verbally to preceptor and health team when necessary.

Student signature and date

Week 7 S ND U

Preceptor signature and date

Comments

Student signature and date

Week 11

ND

Preceptor signature and date

Comments

I use appropriate body language, facial expression, tone of voice and maintain eye contact
when communicating with client and health care team.

Student signature and date

Week 12 S ND U

Preceptor signature and date

Comments

Student signature and date

Preceptor signature and date

CARING RELATIONAL PRACTICE

Week 4

ND

Comments

I am satisfactory in caring relational practice because I was able to collaborate with preceptor and health care
team in a very respectful manner.

Student signature and date

Preceptor signature and date

3. Engage in relational practice that is

caring, compassionate and respectful.
i.

ii.

iii.

iv.

Establish therapeutic caring, compassionate,

and culturally safe relationships with clients
and health care team members.
Establish a caring environment that supports
clients in meeting their needs and outcomes,
managing their illness, or experiencing a
peaceful death
Demonstrate therapeutic use of self to foster
client well-being.
Utilize relational knowledge and skills, and

Week 7

ND

Student signature and date

Comments

Preceptor signature and date

Week 11

ND

Comments

Student signature and date

Preceptor signature and date
Week 12 S

ND

Comments

Student signature and date

Week 4

Preceptor signature and date

ND

Comments

LEADERSHIP AND ADVOCACY

4. Act as a leader and an advocate to empower
clients, self, the interprofessional health care team
and to further the profession.
i.

Evaluate and refine leadership skills to develop

solutions, resolve conflict, create a positive work

I am satisfactory in leadership and advocacy because I am able to accept feedback from

peers and members of the interprofesssional health care team which helps to
strengthen my areas of weaknesses.

Student signature and date

Preceptor signature and date

ii.

iii.
iv.
v.
vi.

vii.
viii.

environment and organizational culture, and to

strengthen advocacy role.
Provide feedback to peers and accept feedback from
peers and members of the interprofessional health care
team.
Advocate for clients, self, others, and quality practice
environment.
Support clients rights for self-determination and choice.
Respond appropriately to unsafe, unacceptable, and
unprofessional behaviors.
Demonstrate public protection and acting in the
interests of the public through collaboration and
consultation with other members of the
interprofessional health care teams.
Contribute to the creation of quality practice strategies
and solutions.
Assign, supervise, teach as appropriate, and provide
feedback to unregulated care providers (UCPs) in
collaboration with the interprofessional health care
team.

Week 7

ND

Comments

Student signature and date

Week 11 S ND U
-

Student signature and date

Week 12 S
U

Preceptor signature and date

Comments

Preceptor signature and date

Comments

Student signature and date

PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY

AGREED EXPECTED OUTCOMES

5. Integrate the nursing process into all aspects of

nursing care and across diverse practice settings.
i.

Formulate clinical judgments that meet clients unique and

changing health needs and priorities, outcomes, and overall

Week 4

ND

Preceptor signature and date

Comments

I use clinical judgment to assess, prioritize needs, outcomes and appropriate nursing
intervention. I also manage time, work load and physical resources, making sure all
rooms are filled will supplies to provide efficient care to clients.

Student signature and date

Preceptor signature and date

ii.
iii.
iv.
v.

vi.

vii.

viii.

condition and incorporate these into evolving plans of care.

Devise evidence-informed plans of care that are holistic and
client centered.
Use clinical judgment to assess clients, prioritize needs,
outcomes, and nursing interventions.Collaborate in the evaluation, refinement and modification
of plans of care.
Safely and competently perform treatments and use
techniques, and technology autonomously and in
collaboration with clients and members of the
interprofessional health care team.
Collaborate with the clients across the lifespan and with
members of the interprofessional health care team to create
a client centered plan of care that is articulated with
competence both in writing and orally.
Use awareness of own knowledge and skills, the three
factors of nurse, client and environment and the practice
decision-making framework to guide practice.
Manage workload, time, and physical resources to provide
effective, efficient and ethical care.

Week 7 S

ND

Comments

Student signature and date

Week 11 S ND U

Preceptor signature and date

Comments

Student signature and date

Preceptor signature and date

Week 12

Student signature and date

Comments

Preceptor signature and date

Week 4
QUALITY ASSURANCE: CONTINUE AND IMPROVE
COMPETENCE

ND

Comments

I am satisfactory in quality assurance: continue and improve competence because I take

responsibility in seeking feedback for colleagues and peers and learning opportunities that
foster professional education.

6. Engage in Quality Assurance consistent with the

regulatory framework.
i.

ii.

iii.
iv.

v.

vi.

Act in the best interests of clients and protect clients

from harm through collaboration and consultation with
other members of the interprofessional and health care
teams and by through competent and safe practice.
Commit to Quality Assurance practice to identify
strengths and areas for professional growth and in
accordance with the regulatory framework (CNO).
Create, implement, and evaluate a learning plan
consistent with the Quality Assurance program (CNO).
Assume responsibility to seek out feedback for
colleagues and peers and learning opportunities that
foster professional development.
Consistently review nursing research and information
about health care to improve competence and to
support clients
Develop professional responses to health care system
changes resulting from advances in research,
technology, and changes in societal and political
forces.

Student signature and date

Week 7 S ND U

Student signature and date

Week 11 S ND U

Preceptor signature and date

Comments

Preceptor signature and date

Comments

Student signature and date

Week 12 S ND U

Preceptor signature and date

Comments

Student signature and date

Preceptor signature and date

USE CRITICAL THINKING, PROBLEM-SOLVING and

DECISION-MAKING EFFECTIVELY
7. Use critical thinking, problem solving and decision
making skills to meet the health care needs and
expected outcomes of clients.
i.
ii.

iii.
iv.

v.
vi.
vii.

Week 4

ND

Comments

I integrate knowledge gained from studies and past clinical placement experiences into
nursing practice to provide safe and competent care.

Use critical thinking to inform decision making in all

aspects of nursing care.
Student signature and date
Preceptor signature and date
Use clinical judgment to assess and refine
Week
7
S
ND
U
Comments
assessments in collaboration
withINTERPROFESSIONAL
the interprofessional
COLLABORATIVE
PRACTICE:
HEALTH Week 4 S ND U
Comments
health
care
team,
formulate
nursing
diagnoses, plan
CARE TEAMS
nursing interventions, and outline evaluative criteria.
Evaluate and refine critical thinking, problem solving,
I am satisfactory in collaborative practice because I demonstrate respect to the role
and decision-making skills.
8.
Collaborate
and consult
withofclients
and
the
Integrate
knowledge
from variety
nursing,
health,
and competences
of the Interprofessional
health care teams.
Student signature
and date of all members
Preceptor
signature and date
interprofessional
health
care
team
to
provide
comprehensive
and other theory into nursing practice to provide safe
Week 11 S ND U
Comments
and competent
holistic health
care.care in a complex and changing
Prioritize effectively.
environment.
Demonstrate professionalism, responsibility, and
accountability.
Use critical thinking, the practice decision-making
Preceptor signature and date
Collaborate
withthe
clients
and members of the interprofessional
framework and
nurse-client-environment
framework Student signature and date
Student signature and date
Preceptor signature and date
Week 12 S ND U
Comments
health
care
teamjudgments
to determine
mutually agreed health
to inform
clinical
andneeds,
practice.
outcomes, approaches to care, and to evaluate care.
Week 7 S ND U
Comments
Contribute as a member of the interprofessional and health care
teams to respond to changing client needs and outcomes.
Consult with and seek out assistance from members of the
interprofessional health care team.
Student signature and date

Preceptor signature and date

Use teamwork, consensus building, and conflict resolution and

leadership skills to meet expected client outcomes.
Integrate effective, collaborative, and consultative strategies to
meet clients needs within a changing environment.
Respect the unique role and competencies of all members of the
interprofessional health care team.
Collaborate as a member of the interprofessional health care team
to respond to changes in nursing knowledge and practice and in
the health care environment.

Student signature and date

Week 11

ND

Preceptor signature and date

Comments