Student Name:

Skyler Walton

Southwestern Oregon Community College Nursing Program

Nursing 111
Foundations of Nursing in Chronic Illness 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 111 Clinical Evaluation Tool

Student Name:

Clinical Week

Compete
ncy (C)
Course
Outcome
(CO)

Dates
Attendance: P=Present,
A=Absent, T=Tardy

C9
CO 1, 2

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 a chronic illness
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-sociocultural issues, and/or
learning needs.
5. Evaluates and reflects on
plan of care.

Facility/Unit

1/12

1/19

1/26

2/2

2/9

2/16

2/23

3/1

BAH/MC
U

BAH/RE
U

BAH/PS
U

BAH/MC
U

BAH/RE
SP

BAH/PS
U

BAH/MC
U

BAH/PS
U

NI

NI

NA

NI

10

Makeup

C1,
CO4
C5,
CO5

C8,
CO6
C4,
CO7

C6, 7, 8
CO2
C10

C6

Applies ANA Code of Ethics

in care of chronically ill
Identifies roles and functions
of members of the health
care team involved in
providing care for the
chronically ill.
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.
Recognizes cultural issues
and interact with clients in
culturally sensitive ways
Uses research and evidence
to support clinical decision
making
Utilizes resources as needed

NA

NA

S
3

Competen
cy (C)
Course
Outcome
(CO)

C9, CO2

Demonstrates responsibility and accountability

for professional behavior:
1. Performs safely in clinical.

10

Makeup

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 self-development.
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 post-conference.

C3

C4
C3
C4
C1
C1
C3
C2
C4

Instructor Initials
Student Initials

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

ST

ST

ST

ST

ST

ST

ST

ST
4

Week
1

Instructor Comments (Include Date/Signature)

1/12- Good start.

1/19 Good work. Look at your plan of care. Work to make your

outcomes measurable.

1/26 You had a good week.

2/2. Good work Skyler. Please work on you plan of care. Measurable
and needs to support your outcome.

2/9 Good work. It appears that you had a good experience with
respiratory. They are a great part of the care team.

2/16 Your plan of care needs some additional work. Your desired
outcomes should be addressed by your interventions. Your
interventions must be achievable, measurable and obtainable.

2/23 Your care plan started out great. Then it went back to what you
have been doing. Continue to work on your care plans.

3/1 Your care plan needs some work. Good assessment. You had a
good week.

9
Revised 12/09/15sw
5