Student Name:

Adam

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

C6, C7,
C8/
O1
C10/O2

Adam

Clinical Week
1

4/9
p
PS
U

4/16
P

4/23
P

4/30
P

5/7
p

5/14

5/21
p

REU

MCU

PSU

Recognizes cultural issues and interact with

clients in culturally sensitive ways

Uses research and evidence to support

clinical decision making

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 populations.

PSU

Make
-up

C6/O2
C9/O2

C3/O

Competen
cy
(C)
Course
Outcomes
(O)
C9/O2

C3/O

C4

C3

C4
C1, C2

C1/O3
C3
C2
C4

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).

Make
-up

Demonstrate responsibility and

accountability for professional
behavior:
2. Performs safely in clinical.
2. Prepared for clinical (Appropriate
attire, appropriate tools such as
stethoscope, skills list, evaluation tool,
assessment tools).
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.

Instructor Initials
Student Initials

mjs

mjs

mjs

mjs

mjs

mjs

Clinical
Week

Student

Instructor Comments (Include Signature)

Initials
Cares for patient that becomes comfort care. Identified changes in care plan and patient
AN
throughout shift. Caring approach for patient transitioning. Works closely with RN to advocate
for best care of patient.
MSperry BSN RNc
Adapts to new unit REU- cares for patient with nephrostomy tubes and skin break down.
Accurately identifies priority care planning and does thorough
assessment-------------------------------------------------------MSperry BSN RNc

AN

AN

Cares for STEMI identifies 2 of 3 top dx for patient and is improving on goal setting and
interventions. Nice patient centered
care!----------------------------------------------------------------------------------------------------------MSperry
RNc
Cares for post-surgical hip fracture. Prioritizes nursing diagnosis and is patient centered with
approach- nice interventions and
reflections-----------------------------------------------------------------------------------------MSperry RNc

AN

Very thorough assessment documentation. Applies information to care plan and reflects on
care planning. Prioritizes care and identifies better approaches from original plan. Nicely
done---------------------MSperry RNc

AN

AN
6

OCNE Conference - no clinical

Post operative joint patient. Identifies priority dx and interventions. Work on DAR note
formatting and use. Use your time to practice additional skills on the unit so you are
comfortable with your new knowledge---MSperry RNc

AN

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