Student Name: Brooke Reavis

Southwestern Oregon Community College Nursing Program

Nursing 221
Foundations of Nursing: Chronic 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 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.
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Nursing 221 Clinical Evaluation Tool Student Name: Brooke Reavis

Compete Midter
Final
QSEN ncy 2 3 4 5 6 m 7 8 9 10 Eval
Eval
Compet (C)
en-cies: Course Dates 1/12 1/19 1/26 2/2 2/9 2/16 2/23
(KSA) Outcomes Attendance: P=Present, A=Absent, T=Tardy p p p p p p p
(CO) Facility/Unit LDRP APU SS OR ICU OPI PSU

C9 Applies concepts and theory to clinical practice na

CO 1, 2, in client care and written assignments:
s na na s s s s
3 1. Conducts evidence-based health
assessment
2. Collects and monitors a variety of data s na na s s s na s
3. Analyzes and interprets the s na na na
data/assessment findings in increasing s s s s
complex chronic conditions.
4. Recognizes pathophysiological changes and s na na na
s s s s
symptoms
KSA: Patient Centered Care

5. Regularly monitors clients level of comfort s na na na

and ability to manage symptoms and s s s s
symptom distress
6. Prioritizes health problems. s na na s s s na s
7. Develops and uses evidence-based s na na na
s s s ni
individualized interventions
8. Develops a plan of care that considers the s na na na
individual, family, age of client, functional
issues associated with co-morbidities,
s s s s
developmental stage, psycho-socio-cultural
issues, capacity for and engagement in self-
health care, and/or learning needs.
9. Evaluates and reflects on plan of care for s na na
s s s s s
clients with chronic conditions.
CO5, 6 Develops discharge plans in collaboration with s
client, family, and other members of the health s s s s s s s
care community.
C8 Uses therapeutic communication with patients s s
s s s s s s
and agency staff.
C6, 7, 8 Recognize cultural issues and interact with s s s s s s s s
clients in culturally sensitive ways.
 C5 s s

EBP KSA: KSA: Teamwork & Collaboration

CO5

Collaborates with other members of the health

care team to provide comfort and symptom s s s s s s
management.

C10 Uses research and evidence to support clinical s s

s s s s s s
CO2 decision making.
ionalism Profess- KSA:

C6, s s
Utilizes resources as needed. s s s s s s
CO4
C4 Able to identify/define leadership skills for s s
s s s s s s
nurse's role
C9, CO s s
Exhibits critical thinking skills when prioritizing
1 s s s s s s
and delegating patient care.

Compete
ncy
Midter
(C) Final
Course
2 3 4 5 6 m 7 8 9 10 Eval
Eval
Outcomes
(CO)

C9, Demonstrate responsibility and

KSA: Safety, Informatics, Professionalism

s s
CO1 accountability for professional behavior: s s s s s s
1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire, s s
appropriate tools such as stethoscope,
s s s s s s
skills list, evaluation tool, assessment
tools).
C4 3. Takes initiative in making decisions and s s
s s s s s s
assuming responsibility for decisions.
C3 4. Looks for opportunities for continued s s
s s s s s s
learning and self-development.
C4 5. Identifies behaviors and attitudes s s s s s s s s
influencing professional behavior.
 C1,2 6. Demonstrates growth in coping with s s
stressful situations in a calm and s s s s s s
dependable manner.
C1 7. Maintains patient confidentiality. s s s s s s s s
C8 8. Documentation of client care is s s
accurate and relevant and consistent s s s s s s
with agency policy
C3 9. Completes and submits assignments on s s
s s s s s s
time.
C2 10.Organizes and manages time s s
s s s s s s
effectively.
C4 11.Attends and participates at post- s s
s s s s s s
conference.
Instructor Initials mjs mjs mjs mjs mjs mjs mjs mjs
Student Initials BR BR BR BR BR BR BR BR

Week Instructor Comments (Include Date/Signature) Student

Initials
1st clinical this term. Able to observe 2 births- 1 vaginal and 1 c-section. Excellent job with care prep and care planning. BR
2 Watch use of subjective terms like normal appears/ Work on objective charting and documentation. Very thorough
and complete assessments and nice prioritization of care plans and interventionsMSperry RNc
Clinical observation in APU this week. Very nice reflection and considerations for this area! Great communication skills BR
3 with staff, classmates and clients MSperry RNc

Spends day with short stay starts IV, prepares patient for OR or short stay procedures. Nice acknowledgement of BR
patients desire vs orders and advocating for the patient! Many positive comments by staff today Nice job! MSperry
4 RNc
 Observes in OR this week and provides care plans for pre-intra and post-operative patient. Nice reflections on BR
interventions and care planning and adapting those you felt did not fit. I am very glad this was a good experience for
5 you---MSperry RNc

Begins day with 2 patients on REU and after discussion with instructor, primary nurse, and ICU nurse- follows priority BR
patient with transfer to ICU. She is able to perform Trach care and suctioning, Peg tube care, feeding and medications
6 administration, and work on different forms of communication. Care plan is patient centered and reflections do address
changes that should be made. Nice integrated patho and work with staff!
MSperry RNc
Midte Brooke has continue to grow the first half of this term in confidence, skills, and patient advocacy. She is always looking BR
for new knowledge and approaches and seems to enjoy her new role. Continue growing in your care planning and
rm documentation. You have a very positive approach to everything and this is reflected in the units you are in and your
Eval patients. MSperry RNc
OPI todayable to access port and assist in blood transfusion. Very nice reflection with patient care planning focused BR
7 on safe outcomes! These meet many of your level II benchmarks MSperry RNc

Cares for 2 patients on PSU. Prioritizes care between the 2 and develops patient centered care plans. Continue BR
improving in being measurable and specific. Watch subjective terms that could be open to interpretationbe objective
8 and bring this to your interventions and goals. Very nice reflections on changing of priority on dx after assessments
and adapting care MSperry RNc

10

Final
Eval

12/12/12, updated 12/16sw

5