Student Name: Skyler Walton

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.
 2

Nursing 221 Clinical Evaluation Tool Student Name: Skyler Walton

Midter
Final
2 3 4 5 6 m 7 8 9 10 Eval
Eval
Compete
Jan Jan
QSEN ncy 01/24/ 01/31/ 2/7/1 2/14/1 2/21/1 2/28/1
Compete (C) Dates 10,20 17,
17 17 7 7 7 7
17 2017
n-cies: Course
(KSA) Outcomes Attendance: P=Present, A=Absent,
P P P P P P P P
(CO) T=Tardy
SHOR
Facility/Unit REU MCU RES ER MCU
T STAY
OR ICU

C9 Applies concepts and theory to clinical

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

S S S S S S S S
changes and symptoms
5. Regularly monitors clients level of
comfort and ability to manage S S S S S S S S
symptoms and symptom distress
6. Prioritizes health problems. S S S S S S S S
7. Develops and uses evidence-based
S S S S S S S S
individualized interventions
8. Develops a plan of care that considers
the individual, family, age of client,
functional issues associated with co-
morbidities, developmental stage, S S NA S S NA S S
psycho-socio-cultural issues, capacity
for and engagement in self-health
care, and/or learning needs.
9. Evaluates and reflects on plan of care
S S S S S S S S
for clients with chronic conditions.
CO5, 6 Develops discharge plans in collaboration
with client, family, and other members of S S NA S S NA NA S
the health care community.
 C8 Uses therapeutic communication with

ionalismProfess-KSA: EBPKSA: KSA: Teamwork & Collaboration

S S S S S S S S
patients and agency staff.
C6, 7, 8 Recognize cultural issues and interact
S S S S S S S S
with clients in culturally sensitive ways.
C5
CO5
Collaborates with other members of the
health care team to provide comfort and S S S S S S S S
symptom management.

C10
Uses research and evidence to support
CO2 S S S S S S S S
clinical decision making.
C6, CO4 Utilizes resources as needed. S S S S S S S S
C4 Able to identify/define leadership skills for
S S S S S S S S
nurse's role
C9, CO
1 Exhibits critical thinking skills when
S S S S S S S S
prioritizing 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

CO1 accountability for professional behavior: S S S S S S S S

1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope,
S S 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 S S S S S S
stressful situations in a calm and
 dependable manner.
C1 7. Maintains patient confidentiality. S S S S S S S S
C8 8. Documentation of client care is
accurate and relevant and consistent S S S S S NA NA 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 MPP MPP MPP MPP MPP MPP MPP MPP
Student Initials SW SW SW SW SW SW SW SW

Instructor Comments (Include Date/Signature) Stud

ent
Week Initia
ls
January 10, 2017: Todays clinical was on REU with a patient with a chest tube. You observed a portacath deaccess. You
performed well in clinical, professionally and confidently. You sought out ways to help others and took initiative to learn more.
Good job!
2 Michelle Pringle, RN-BC, BSN

3
January 17, 2017: Todays clinical was in MCU with a patient with intractable pain and another with tube feedings. You spoke with
a doctor to get orders and did a great job. You perform well in clinicals professional and courteous. Continue to seek out skill
opportunities.
Good job
Michelle Pringle, RN-BC, BSN
 January 24th, 2017: Todays clinical was with Resource and you spent a lot of time in the ED and RME. You did a great job of
reassuring a patient and were kind and patient with her son. Nicely done! I would like to see you gain more confidence in
trusting yourself you got this!!
4
Michelle Pringle, RN-BC, BSN

January 31st, 2017: Todays clinical was in the ED, again you showed professionalism and courtesy at the bedside and genuine
concern for your patients well being. Your desire to help people shines through and is truly admirable. You did a great job. Be
sure to look for more opportunities for skills. Good job!
5
Michelle Pringle, RN-BC, BSN

February 7, 2017: Todays clinical was on MCU. You learned a lot today about antibiotics (Red Man syndrome) and you accessed a
chest port and got it on the first try EXCELLENT job!! You have terrific bedside manner, however you are still a little hesitant
with patient care. You will have to touch your patients and assist them in changing all of this can be done while maintaining
6 their privacy. You will gain more confidence as you do it more! Great job today!
Michelle Pringle, RN-BC, BSN

Midte
rm
Eval
February 14, 2107: Todays clinical was in short stay. You continue to advocate for your patient and are a part of the team. Its
challenging to practice skills on patients who are already anxious! But that is a skill in and of itself, and you will get better at it.
You did a great job today!
7 Michelle Pringle, RN-BC, BSN

February 21st, 2017: Todays clinical was spent in the OR. Excellent job on your care plan, and reflection; you truly
soaked in a lot of information, and saw a lot of surgeries! Great job, Im glad you had a good experience.
7 Michelle Pringle, RN-BC, BSN
8

9 February 28th, 2017: Great job in ICU today! I think the MOST important thing I can teach you in this wonderful career is
B.R.E.A.T.H.E. As soon as you feel overwhelmed, stop and breathe!! You took wonderful care of your patient today; its hard to
see people suffer and you were a true advocate for her. Well done. You also did a lot of skills and learned about feeding tubes
and meds. Busy but fulfilling day!
Michelle Pringle, RN-BC, BSN
 10

Final
Eval

12/12/12, updated 12/16sw

5