Student Name: Sklyer Walton

Southwestern Oregon Community College Nursing Program

Nursing 222
Foundations of Nursing: Acute Care II

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 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 grade of U, the faculty will review the students
performance and determine whether or not the student will be dismissed from the program.

Nursing 222 Clinical Evaluation Tool

Student Name:

Skyler W.
pg. 2

QSEN
Compet
encies:
(KSA)

Clinical Week

Compet
ency (C)
Course
Outcom
es
(CO)

KSA: Patient Centered Care

C9
CO1,
2, 5

CO4
C8

MidTer
m
Eval

Dates

10/
4

10/
11

10/
18

10/
25

11/
1

11/
3

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

Facility/Unit

BA
H
reu

BA
H
ED

P
BA
H
PS
U

P
BA
H
mc
u

P
BA
H
AP
U

Applies concepts and theory to clinical practice in

client care and written assignments:
1. Conducts evidence-based assessment, using age,
developmental and culturally appropriate
communication skills
2. Collects and monitors a variety of data
3. Analyzes and interprets the data/assessment
findings in increasing complex acute conditions.
4. Recognizes pathophysiological changes and
symptoms
5. Regularly monitors clients level of comfort and
ability to manage symptoms and symptom
distress
6. Prioritizes health problems.
7. Develops and uses evidence-based individualized
interventions
8. Develops a plan of care that considers the
individual, family, age of client, developmental
stage, psycho-socio-cultural issues, and/or
learning needs.
9. Evaluates and reflects on plan of care for clients
with acute conditions.
Develops discharge plans in collaboration with client,
family, and other members of the health care
community.
Uses therapeutic communication with patients and
agency staff.

10

11/
8

11/
15

11/
22

11/
29

N/A

P
BA
H
res
o

Fina
l
Eval

BA
H
ICU

S
S

S
S

N/A

N/A

N/A

S
S
S
S

S-

N/
O

N/
O

pg. 3

KSA: Safety, Informatics, Professionalism KSA: Professionalism

EBP KSA: KSA: Teamwork & Collaboration

C
6,7,8
CO1
C5
CO3

Recognize cultural issues and interact with clients in

culturally sensitive ways.

N/
O

N/
O

S
S

N/
O

C10,
CO2
C6,
CO
C4

Uses research and evidence to support clinical

decision making.

Utilizes resources as needed.

S-

Able to identify/define leadership skills for nurse's

role

N/
O

N/
O

C9
CO1
C9,
CO1

Exhibits critical thinking skills when prioritizing and

delegating patient care.
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).
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.

C4
C3
C4
C1, 2

S
Collaborates with other members of the health care
team to provide comfort and symptom management.

C3

S
S
S
S
S

C1

7. Maintains patient confidentiality.

C8

8. Documentation of client care is accurate and

relevant and consistent with agency policy

C3

9. Completes and submits assignments on time.

10. Organizes and manages time effectively.

SS

SS

S
S

S
S

C2

S
S

S
S

S
S

pg. 4

C4

11. Attends and participates at post-conference.

Instructor Initials JT
Student Initials SW

JT
SW

JT
SW

JT
SW

JT
SW

JT
SW

JT
SW

JT
SW

JT
SW

Key: C=Competency, CO=Course Outcome, QSEN=Quality and Safety Education for Nurses, KSA=Knowledge, Skills & Attitudes (QSEN
Competencies)

Week

Instructor include comments that are positive, areas that need improvement or are unsatisfactory.
Reference the course outcomes listed in the syllabus, the OCNE Competencies from the Nursing Student
Handbook and/or the QSEN competencies (Date/Sign all entries)
Skyler, this week you cared for a complex patient on REU. I feel that I was not able to spend a lot of time with you.
Your care plan was completed and pertinent to your patient. I did have comments on it for you to consider, please take
a look at those. I would like to see you work some on your confidence level as well.
Jenny Tausch RN MSN PCCN 10/10/2016
Skyler, this week you were able to spend your clinical day in the Emergency Department. I feel that you were actively
looking for learning opportunities and that you were collaborating with the nursing staff to provide care to the
patients. I read your reflection and did not have any comments on it for you. I did give you an S- on submitting
assignments on time, as you did not submit your initialed evaluation back to me. Please remember to do this every
week.
Jenny Tausch RN MSN PCCN 10/15/2016
Skyler, this week you cared for two patients on PSU. I feel that you were able to meet their needs and to collaborate
with the nursing staff in order to provide safe care to both of them (competency 5). I did have some comments on
your care plan for you to consider, please take a look at those. I also gave you an S- for submitting your work, as you
submitted a blank evaluation form. Please double check that you are initialing and uploading the correct evaluation
form each week.
Jenny Tausch RN MSN PCCN 10/22/16
Skyler, this week you cared for two patients on the Medical care unit. You were able to meet their needs and provide
safe care. Your care plan was complete; I had a few comments on it for you to view. I feel that you are progressing as a
student, and that you are continuing to look for learning opportunities (competency 3). I would like to see you manage
your time better. I realize that you are ensuring that all of your tasks are complete and that your patients are well
cared for, however, you do need to work on getting out on time.
Jenny Tausch RN MSN PCCN 10/29/2016
Skyler, this week you were able to rotate through the Acute Psychiatric Unit. You were able to see how the staff
manages the unit and care for the patients. I read your reflection and feel that you were able to see how the care is
different; however you were a bit lacking on the DSM diagnosis. I did suggest a couple of sites for you to view and the

Student
Initials

pg. 5

Midter
m

unit has a book that goes into great detail. I am pleased that you were able to overcome your apprehensions and learn
from this rotation.
Jenny Tausch RN MSN PCCN 11/5/2016
Skyler is progressing as a student. I feel that he does struggle somewhat with time management at times, however it
is because he is ensuring that what he is doing is correct and complete. He is very respectful with his patients and
does spend time communicating with them.
Jenny Tausch RN MSN PCCN 11/3/2016
Instructor out of town

Jenny Tausch RN MSN PCCN 11/5/2016

Skyler, this week you were able to see a number of interesting things. I feel that you were able to adapt quickly to the
change in your assignment from being with the resource nurse to helping in ICU then back to being with the resource.
I did notice that you were assisting in the RRT by going to get equipment. Your reflection page was complete; I did not
have any comments on it for you. This was an exciting learning clinical day for you.
Jenny Tausch RN MSN PCCN 11/21/2016
Skyler, this week you were able to rotate through the ICU. With the RN, you cared for a critically ill patient. You did
work well with the intern and with the RN in giving medications, ensuring the patient was comfortable, and assisting
with other patients (competency 5). You were able to practice a number of skills this week and become more
comfortable in the clinical setting. Your care plan was complete and pertinent to your patient. I had a comment
regarding your discharge plan, please take note of that.
Jenny Tausch RN MSN PCCN 11/24/2016

10

Final
9/2/09: revised 5/06/11, rev 8/2/16 sw

pg. 6