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Evaluations>EvaluationReview

Evaluations FinalClinicalEvaluationFormRevised4/2016
Evaluations OBClinical(12/13/2016)
Experience Wertheimer,Ellie(ellie2@health.usf.edu)

Changepassword Evaluator:Schweikert,Annie(annie.schweikert@gmail.com)

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5Outstanding:ExceedsStandards
Exhibitsaboveaverageperformanceofnursingcareforthislevelstudent.Thestudentis
proactive,selfdirected,andconsistentlyengagedinlearningneedsminimalguidanceis
knowledgeableandappropriatelyincorporatesknowledgewithskills.Studentisproactiveand
selfdirectedinapproachtolearning.

4Satisfactory:MeetsStandards
Exhibitsaverageperformanceofnursingcareforthislevelstudent.Functionswithminimum
guidance.Demonstratesadequateknowledgeandrequiresminimumassistanceinapplying
knowledgetoskills.Recognizeslearningopportunitiesbutmayrequireassistanceinutilizing
them.

3Minimal
Exhibitsminimalperformanceofnursingcareforthislevelstudent.Functionssafelywith
moderateguidance.Demonstratesminimalknowledgeandrequiresmoderateassistancein
applyingknowledgetoskills.Requiressomedirectioninrecognizingandutilizinglearning
opportunities.Oftenfocusesonthetaskorownbehavior,notonthepatient.

2Unsatisfactory
Requiresintenseguidancefortheperformanceofactivitiesatasafelevel.Clinicalperformance
reflectsdifficultyintheprovisionofnursingcare.Demonstratesgapsinnecessaryknowledgeand
requiresfrequentoralmostconstantassistanceinapplyingknowledgetoskills.Requiresfrequent
anddetailedinstructionsregardinglearningopportunities.Focusesprimarilyonthetaskorown
behavior,notonthepatient.

1UnsafetoPractice
Isunsafetopracticewithoutconstant,intenseguidance.Frequentlylacksnecessaryknowledge
andskillsandunabletointegratetheseintopractice.Requiresconstantdetailedinstructions
regardinglearningopportunitiesandisoftenunabletoutilizethem.Attemptsactivityorbehavior,
yetisunabletocomplete.Focusesentirelyonthetaskorownbehavior,notthepatient.

StandardICommunication

1.Communicatespertinentinformationregardingthepatient'scondition/concernto
healthteammembers.
2.Communicateseffectivelyinwrittenform(NursingProcessWorksheetisorganized
andcomplete)
3.Communicateseffectivelyinverbalform.
4.Initiates,maintains,andterminatesthenursepatientrelationshipusingprinciplesof
therapeuticcommunication.
5.Functionsasanadvocateforthepatient/familyandcommunicatesfamilyneedsto
othermembersofthehealthcareteam.
6.Examinesthedynamicinteractionsbetweenthepatient,family,community,and
society.
7.Initiatesdiscussiontoidentifyandresolveinterpersonalproblemsthatimpactcare.
8.Usesinterpersonalskillstoenhancepatient/familycopingabilities.
9.Discussestheethicalissuesandapproachestheethicaldilemmasthatconfrontthe
patient/familyandappropriatelydiscussesexperiencewithfaculty/preceptor.
10.Delegatesappropriatelytopatientcaretechnician,family,orotherteammembers.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
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3 Minimal

2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIKnowledge

1.Appliesknowledgeofhumanities,physicalandsocialsciences,andnursingwhen
providingpatientcare.
2.Appliesknowledgeofsocial,cultural,andgeneticfactorstothecareofdiverse
populations.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIAttitude

1.Consistentlydemonstratesprofessionalbehaviorasindicatedbypreparednessfor
rounds,contributingsubstantivelytopostconferences,respectingstaff,facultyand
preceptorsincommunicationandtone.
2.Providesclinicalobjectivestopreceptorasdeterminedinpreconference.
3.Preparednessfortheclinicaldayasindicatedbytimelyarrivaltoclinicalinthe
requireddresscode.
4.Focusedattentionduringpostconferencetopeersaswellasfaculty.
5.Isactivelyengagedinandseeksoutopportunitiesforlearning.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIISafety

1.Doesnotmakejudgmental,discriminatory,orprejudicialstatementstothepatient,
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1.Doesnotmakejudgmental,discriminatory,orprejudicialstatementstothepatient,
staff,orfaculty.
2.Appliesprincipalsofuniversalprecautions,practicesspecificisolationtechniques,
andteachesthereasonsforuniversalprecautions.
3.Assessespatientsforfallriskandappliesprinciplesofsafepatienthandling.
4.Maintainsthepatient'sphysicalsafetybyprotectingthepatientfromharm.
5.Maintainsmedicalandsurgicalasepsiswhendoingproceduresrequiringsterile
technique.
6.Properlyidentifiestechniquesandteachesthereasonsforuniversalprecautions.
7.Validatestheaccuracyandappropriatenessofordersfornursing/medicalcareprior
toinitiatingcare.
8.Implementsordersaccuratelyandefficiently.
9.Isabletoidentifypotentialsignsandsymptomsofanemergentmedicalcondition
andpromptlyreportschangesinthepatient'shealthstatustopreceptorand/orclinical
facultymember.
10.Adaptsskillperformanceusingprinciplesoftheorywhennecessary.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIIINursingProcess:Assessment

1.Identifiesdatafromthehistoryandphysicalassessmenttoformulateappropriate
nursingdiagnoses.
2.Identifiesthepatient'shealtheducationneeds.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIIINursingProcess:Diagnosis

1.Synthesizeshistoryandassessmentdataaswellasdiagnosticresultsintothe
developmentofnursingdiagnoses.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice
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1 (CommentRequired) UnsafetoPractice

StandardIIINursingProcess:Plan

1.Integratespsychosocialneedsintocareplan,identifiesappropriateresourcesforthe
planofcare,andincorporateshealtheducationintothecareplan.
2.Identifiesmeasurable,expectedpatientoutcomesthatarerealisticandindividualized
tothepatient.
3.Identifiesthedischargeplanningprocessandneedsofthepatientuponadmission
andthroughoutthehospitalization.
4.Demonstratesjudgmentindecisionmakingandprioritysetting.
5.Usesappropriatecollaborativeresourcestopersonalizethenursingcarethepatient
receives.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIIINursingProcess:Intervention/Implementation

1.Demonstratesunderstandingoftheprinciplesunderlyingnursingactionsappropriate
forthestudentatthispointinthecurriculum.
2.Performsskillsaccordingtoagencypolicyandprocedureandclinicallabguidelines.
3.Implementsthewrittenactionplan/protocolconsideringtheprioritiesforeach
assignedpatient.
4.StandardIIINursingProcess:Intervention/Implementation
5.Implementsateachingplanbasedonscientificknowledgeandutilizesresources
appropriately.
6.Incorporatesevidencebasedresearchintonursingpractice.
7.Practicesindividualizedandculturallycompetentcare.
8.Initiatesappropriatereferralsasneeded.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

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StandardIIINursingProcess:Evaluation

1.Evaluatesthepatient'sresponse/outcometotheintervention.
2.Utilizessubjectiveandobjectivedatatorevisenursingactions(asappropriateforthe
studentatthatlevelofthecurriculum).
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIIINursingProcess:Organization

1.Providesorganized,coordinated,andprioritizednursingcareforthepatientswitha
rangeofhealthproblems.
2.Organizestimeandresourceseffectivelyandefficiently.
3.Gathersandorganizesequipmentnecessaryforpatientcare/procedures.
4.Identifiesandseeksappropriateresourcesduringpatientcareprovision.
5.Completesthedailyclinicalassignmentinatimelymanner.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

StandardIIINursingProcess:Documentation

1.Appropriatelydevelopslongandshorttermpatientorientednursingcaregoalsbased
onpatientassessmentandscientificprinciplesofnursingpractice.
2.Documentsproblemsandnursingcaregoalsinthepatientrecord(withcosignature).
3.Identifiesanddocumentsnursingactions/ordersinitiatedinimplementingtheplanof
care.
4.Correctlyentersdataintothepatientrecordinatimelymannerperagencyprotocol.
5.Assuresprivacyofthepatientrecordatalltimes.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

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StandardIIINursingProcess:CriticalThinking

1.Utilizescriticalthinkingskillstoprioritizepatientneedsbasedonthepatient
assessment.
5 (CommentRequired) Outstanding:ExceedsStandards
4 Satisfactory:MeetsStandards
3 Minimal
2 (CommentRequired) Unsatisfactory
1 (CommentRequired) UnsafetoPractice

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