Student Name:

Rachelle Johnson

Southwestern Oregon Community College Nursing Program

Nursing 112
Foundations of Nursing in Acute Care I

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.

Nursing 112 Clinical Evaluation Tool

Student Name:

.
Compete
ncy
(C)
Course
Outcomes
(O)
C9/O1,
O2

C1/O3
C5/O3

C8/O5
C4/O4

C6, C7,
C8/
O1
C10/O2

Rachelle Johnson

Clinical Week
1

4/16

4/23

4/30

5/7

5/14

5/21

REU

MCU

PSU

PSU

psu

Recognizes cultural issues and interact with

clients in culturally sensitive ways

Uses research and evidence to support

clinical decision making

Dates
Attendance: P=Present, A=Absent, T=Tardy
Facility/Unit
Applies concepts and theory to clinical
practice in client care and written
assignments:
1. Collects data and conducts a health
assessment on a client with an acute
condition.
2. Analyzes and interprets the
data/assessment findings.
3. Prioritizes health problems.
4. Develops a plan of care that considers the
individual, family, age of client,
developmental stage, psycho-socio-cultural
issues, and/or learning needs.
5. Evaluates and reflects on plan of care.
Apply ANA Code of Ethics to care of
patients with acute conditions/processes.
Identifies roles and functions of members of
the health care team involved in providing
care for acute conditions/processes.
Uses therapeutic communication with
patients and agency staf
Recognizes potential legal and ethical issues
related to client autonomy across the
lifespan in at risk populations.

4/
9
P
PS
U

Make
-up

C6/O2
C9/O2

C3/O

Competen
cy
(C)
Course
Outcomes
(O)
C9/O2

C3/O

C4

C3

C4
C1, C2

C1/O3
C3
C2
C4

Utilizes resources as needed

Demonstrate responsibility and
accountability for professional behavior:
1. Performs safely in clinical.
2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope, skills
list, evaluation tool, assessment tools).

Make
-up

Demonstrate responsibility and

accountability for professional
behavior:
2. Performs safely in clinical.
2. Prepared for clinical (Appropriate
attire, appropriate tools such as
stethoscope, skills list, evaluation tool,
assessment tools).
3. Takes initiative in making decisions
and assuming responsibility for
decisions.
4. Looks for opportunities for
continued learning and selfdevelopment.
5.Identifies behaviors and attitudes
influencing professional behavior.
6. Demonstrates growth in coping
with stressful situations in a calm and
dependable manner.
7. Maintains patient confidentiality.
8. Completes and submits
assignments on time.
9. Organizes and manages time
efectively.
10. Attends and participates at postconference.

Instructor Initials
Student Initials

mjs
RJ

mjs
RJ

mjs
RJ

mjs
RJ

mjs
RJ

mjs
RJ

mjs
RJ

Clinical
Week

Instructor Comments (Include Signature)

First clinical- works with post op infection. Identifies top 3 nursing dx and implements
appropriate interventions for patient, very thorough assessment noted great
job!------------------------------------------------------MSperry BSN RNc

Student
Initials

RJ

Does well in acute care- care plan is prioritized and patient centered. Interacts well with
fellow students and staf, looks for skills and helps as needed on the
unit---------------------------------------------------------------MSperry RNc

RJ

Nicely donereview some of your nursing dx and see if there may be more appropriate ones
fatigue vs activity
intolerance-------------------------------------------------------------------------------------------------------------MSperry RNc

RJ

RJ

Cares for patient with NGT identifies top priority dx- be sure to be patient centered and
specific. Include all data to support your diagnosis not just one
item.--------------------------------------------------------------------MSperry BSN RNc

RJ

Cares for patient with diverticular disease. Be sure to slow down and look at your care
planning. Make it more specific to your patient and measurable. Be objective in goals, data
and interventions. -----------Msperry RNc

RJ
6

OCNE Conference - No clinical

Post traumatic hemothorax patient with chest tube to gravity. Identifies priority dx and very
thorough assessment, Work on DAR chartingyou need to show the response to your action.
Nicely done -------------MSperry RNc

RJ

12/08/12: sw, reviewed 3/30/15sw

5