Student

Name: Jessica McElravey

Southwestern Oregon Community College Nursing Program

Nursing 110
Foundations of Nursing: Health Promotion

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 110 Clinical Evaluation Tool Student Name: Jessica McElravey
. Clinical Week
Mid-
Ter Final
2 3 4 5 6 m 7 8 9 10 Eval
Competen
cy (C) Eval
QSEN
Course OCT OCT OCT OCT NOV NOV NOV NOV
Competencies
Outcomes Dates 11/15
(KSA)
(CO)
04 11 18 25 01 8 22 29
Attendance: P=Present, A=Absent, T=Tardy P P P P P P P P P
Med
Facility/Unit LC LC LC LC LC LC Class
LC
C9 Applies concepts and theory to clinical practice in client
CO 1, 2 care and written assignments:
S S S S S S NA NA S
KSA: Patient Centered Care

1. Collects data and conducts a health assessment on a

client.
2. Analyzes and interprets the data/assessment findings. S S S S S S NA NA S
3. Prioritizes health problems. NA NA NA S S S NA NA S
4. Develops a plan of care that considers the individual,
family, age of client, developmental stage, psycho- NA NA S S S S NA NA S
socio-cultural issues, and/or learning needs.
5. Evaluates and reflects on plan of care. NA NA S S S S NA NA S
C 8, CO
KSA: Teamwork &

Uses therapeutic communication with patients and agency

S S S S S S NA NA S
Collaboration

5 staff

C 6,7,8
Recognizes cultural issues and interact with clients in
CO 1,4
culturally sensitive ways S S S S S S NA NA S

C10, Uses research and evidence to support clinical decision
KSA:
EBP

CO2 making NA NA S S S S NA NA S
C6, CO2 Utilizes resources as needed S S S S S S NA NA S
C9, CO2 Demonstrate responsibility and accountability for
professional behavior: S S S S S S NA NA S
Informatics, Professionalism

1. Performs safely in clinical.

C3 2. Prepared for clinical (Appropriate attire, appropriate
tools such as stethoscope, skills list, evaluation tool, S S S S S S NA NA S
KSA: Safety,

assessment tools).
C4 3. Takes initiative in making decisions and assuming
responsibility for decisions. S S S S S S S S S
C3 4. Looks for opportunities for continued learning and
self-development. S S S S S S S S S
C4 5. Identifies behaviors and attitudes influencing
professional behavior. S S S S S S S S S

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 C1,2 6. Demonstrates growth in coping with stressful
situations in a calm and dependable manner. S S S S S S NA NA S
C8, 9 7. Documents accurately and thoroughly within the
health record where applicable to clinical setting S S S S S S NA NA S
C1, CO3 8. Maintains patient confidentiality. S S S S S S NA NA S
C3, CO8 9. Completes and submits assignments on time. S S S S S S S NA S
C2 10. Organizes and manages time effectively. S S S S S S S S S
C4, CO8 11. Attends and participates at post-conference. S S S S S S NA NA S
Instructor Initials CD CD CD CD CD CD SW CD CD
Student Initials JM JM JM JM JM JM JM JM JM
Key: C=Competency, CO=Course Outcome, QSEN=Quality and Safety Education for Nurses, KSA=Knowledge, Skills & Attitudes (QSEN Competencies)

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Instructor include comments that are positive, areas that need improvement or are unsatisfactory. Reference the course outcomes listed Student Initials
Week in the syllabus, the OCNE Competencies from the Nursing Student Handbook and/or the QSEN competencies (Date/Sign all entries)
Very pleasant to patients and is very respectful to staff and residents. Uses learned labs skills appropriately. Bed making JM
good. Vital signs good. Capillary Blood Glucose good. Job well done.
2


Very pleasant to patients and is very respectful to staff and residents. Uses learned labs skills appropriately. Skin JM
assessment was good. Speaking to the patients while assessing them about what you are doing or things they may be
interested in can keep the often awkward moments at a minimum. Good job! J
3



Very good job today. Great neurological assessment. Good EENT. JM
4

Great job. Wonderful participation. JM
5

JM
Nice work with listening to respiratory sounds. Able to apply lab skills to clinical situation. Good job and great
6
participation.


Midterm

JM
7 Great participation. Nice assessment. Keep up the good work.

11-15-2016 Attended class at Baycrest: Safe Medication Use in the Older Adults. Your written work addressed the JM
objectives thoroughly and demonstrates use of reflection (Comp 2, Level I-use established procedures and forms, self-
8
analysis of professional behaviors) and engaging in intentional learning (Comp 3, Level 1-attitudes towards learning,
active learning). Very nicely done S. Walker, RN, MSN

9

pg. 5

 JM
10 Great participation. Good assessments. Care plan looks good.


Final

9/1/09: rev 05062011: reviewed 9/2012 sw, rev 8/2/16 sw

pg. 6