Student Name: Megann Voth

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.

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Nursing 222 Clinical Evaluation Tool Student Name: Megann Voth

. Clinical Week
Mid-
Final
2 3 4 5 6 Term 7 8 9 10 Eval
Eval
Competen
QSEN
cy (C) 10/ 10/ 10/ 10/ 11/ 11/ 11/ 11/ 12/
Competen Dates 10/3
10
N/A
cies:
Course 17 24 31 1 7 14 28 3
Outcomes
(KSA)
(CO) Attendance: P=Present, A=Absent, T=Tardy P P P P P - P P P
BAH BAH - BAH BAH BAH
Facility/Unit REU MCU
BAH BAH BAH
PSU OPI FBC
C9 Applies concepts and theory to clinical practice in client care and S
CO1,2, written assignments:
5 1. Conducts evidence-based assessment, using age, S S S S S S S S
developmental and culturally appropriate communication
skills
2. Collects and monitors a variety of data S S S S S S S S S
3. Analyzes and interprets the data/assessment findings in
S S S S S S S S S
increasing complex acute conditions.
KSA: Patient Centered Care

4. Recognizes pathophysiological changes and symptoms S S S S S S S S S

5. Regularly monitors clients level of comfort and ability to
S S S S S S S S S
manage symptoms and symptom distress
6. Prioritizes health problems. S S S S S S S S S
7. Develops and uses evidence-based individualized S
interventions
S S S S S S S S
8. Develops a plan of care that considers the individual, family, S
age of client, developmental stage, psycho-socio-cultural S S S S S S N/A S
issues, and/or learning needs.
9. Evaluates and reflects on plan of care for clients with acute S
conditions.
S S S S S S N/A S
CO4 Develops discharge plans in collaboration with client, family, and S
other members of the health care community.
N/O S S S S S S S
C8 Uses therapeutic communication with patients and agency staff. S S S S S S S S S
KSA: Teamwork &
Collaboration

C 6,7,8 Recognize cultural issues and interact with clients in culturally S

CO1 sensitive ways.
N/O S S S S S S S
C5 Collaborates with other members of the health care team to S
CO3 provide comfort and symptom management.
S S S S S S S S

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 C10, S
KSA:
EBP
CO2 Uses research and evidence to support clinical decision making. S S S S S S S S
C6, CO S
KSA: Professionalism

Utilizes resources as needed. S S S S S S S S

C4 S
Able to identify/define leadership skills for nurse's role N/O N/O S S S S S S
C9 Exhibits critical thinking skills when prioritizing and delegating S
patient care.
N/O N/O S S S S S S
CO1
C9, Demonstrate responsibility and accountability for professional S
CO1 behavior: S S S S S S S- S
1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire, appropriate tools S
such as stethoscope, skills list, evaluation tool, assessment S S S S S S S S
tools).
C4 3. Takes initiative in making decisions and assuming S
KSA: Safety, Informatics, Professionalism

responsibility for decisions.

S S S S S S S S
C3 4. Looks for opportunities for continued learning and self- S
development.
S S S S S S S S
C4 5. Identifies behaviors and attitudes influencing professional S
behavior.
S S S S S S S S
C1, 2 6. Demonstrates growth in coping with stressful situations in a S
calm and dependable manner.
S S S S S S S S
C1 7. Maintains patient confidentiality. S S S S S S S S S
C8 8. Documentation of client care is accurate and relevant and S
consistent with agency policy
S S S S S S S S
C3 9. Completes and submits assignments on time. S S S S S S S S S
C2 10. Organizes and manages time effectively. S S S S S S S S S
C4 11. Attends and participates at post-conference. S S S S S S S S S

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

pg. 4
 Instructor include comments that are positive, areas that need improvement or are unsatisfactory. Reference the course outcomes listed in Student
Week the syllabus, the OCNE Competencies from the Nursing Student Handbook and/or the QSEN competencies (Date/Sign all entries) Initials

Megann, this week you cared for a patient on the Rapid Evaluation Unit. Your care plan is extremely detailed and pertinent to your patient. I did MV
make some comments on it for you. During this rotation, you were actively utilizing your resources to understand your patient's diagnoses,
2 treatment plan, and her discharge needs. You were also actively seeking out learning opportunities by viewing the telemetry and conversing with
the RN. This was a good week for you; continue to look for ways to increase your confidence level.
Jenny Tausch RN MSN PCCN 10/8/2017
Megann, this week you cared for a patient on the Medical Care Unit. You were able to work with the nurse and assist in discharging the patient MV
home. I feel that this week you were actively looking for skills to practice and working with the nurse to ensure the best discharge plan possible for
3 the patient. Your care plan was nicely done, I had very few comments on it for you, continue to look for ways that you can narrow it down to be
more specific to your patient.
Jenny Tausch RN MSN PCCN 10/15/17
Great job. You did very well with your reflection. You used opportunity to find new experiences. Nicely done this week. MV
Celia Dolan RN, MSN 10/25/17
4

Marvelous work. You are doing great in seeking out new opportunities for experiences. Good patient-nurse relationship. Good work. MV
Celia Dolan RN, MSN 10/25/17
5

Nice job. Your critical thinking skills are developing well. Making good progress in patient-nursing relationships appropriately. Exellent. MV
Celia Dolan RN MSN 11/1/17
6

These past few weeks you have used critical thinking skills nicely. You are developing great new skills and working well with the RNs. Patient-nurse MV
relationships are good. Keep up the good work!
Midterm Celia Dolan RN MSN 11/1/17

Megann- this week you cared for two patients on the Post-Surgical Unit. You were able to see a variety of new things including a wound vac change MV
and get to practice some with a colostomy. I feel that you evaluating learning situations and sharing new learning with your peers. Your care plans
7 were complete and well done. I had very few comments on them for you. This was a good week for you, continue to look for ways to improve
yourself in the clinical setting as a student and as a future nurse.
Jenny Tausch RN MSN PCCN 11/11/2017
Megann- this week you rotated through Outpatient infusion. There was some confusion regarding some skills thus the S- on performing safely in MV
clinical. However, I am taking some responsibility for that, as we did discuss it and we did do it together. Lesson learned for both of us Overall,
you had an amazing day there and was able to get so much practice with PICC lines, blood products, and IV starts. I feel this is a great place for
8 students to get comfortable with their skills. Your reflection paper was nicely done; I did not have any feedback for you on that. Great job this
week, keep up the good work and continue to look for ways to improve yourself as a student and future nurse.
Jenny Tausch RN MSN PCCN 11/16/2017

pg. 5
 MV
9
MAKE UP
Megann, this week you were able to spend the day in the Family Birth Center. You were interested in learning from the staff, you were actively MV
seeking learning opportunities, and you were genuinely interesting in learning the nursing care on the unit. I understand that this is your future
10 interest, and I think that you will find it rewarding.
Jenny Tausch RN MSN PCCN 12/3/2017
Megann has progressed well over the term; she actively looks for skills to practice. She is always prepared for clinical and participated in post MV
Final clinical. I feel that she takes feedback and is willing to be an active part of the team.
Jenny Tausch RN MSN PCCN 12/3/2017
9/2/09: revised 5/06/11, rev 8/2/16 sw

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