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HAMPTON UNIVERSITY SCHOOL OF

NURSING
DEPARTMENT OF UNDERGRADUATE NURSING
EDUCATION
Guidelines for
the
Clinical
Experience
Forms
Packet
First Edition, spring 20!
Reviewed August 2012
S"#tion
FACULTY EVALUATION OF STUDENT
PERFORMANCE
Instr$#tions %or Co&p'"ting C'ini#('
E)('$(tion
Daily Clinical Evaluation (Formativ!
Grading
Dai! Evauati"n F"r# Rating S$ae
Cini$a Tests
Assign#ents %Dai! $ini$a
re&uire#ents' Care
Pans
Additi"na Assign#ents
Cini$a Re#ediati"n
Mid(Ter# ) Fina Evauati"n
%Su##ative'
Fina Cini$a Evauati"n
C'ini#(' E)('$(tion For&
Clinical "our Ta#ulation an$ %ra$
Rcor$in& S't
S$&&(ti)" E)('$(tion Too'
Mid*T"r& C'ini#(' E)('$(tion
Fin(' C'ini#(' E)('$(tion
S"#tion 2
CLINICAL TOOLS (FACULTY ( STUDENT!
Ris+ M(n(g"&"nt Pro#"d$r"
C'ini#(' In#id"nt R"port
F(#$'t,*St$d"nt Cons$'t(tion R"#ord
C'ini#(' St$d"nt Agr""&"nt -Con.d"nti('it,
St(t"&"nt/
S"#tion !
CLINICAL DOCUMENTATION FORMS
STUDENTS
Ti&" Ass"ss&"nt Grid
R"port S0""t
Ti&" M(n(g"&"nt Grid
S#()"ng"r H$nt A#$t" C(r" S"tting
N$rsing St$d"nt R"port S0""t
S"#tion 1
END OF CLINICAL E)PERIENCE EVALUATION
FORMS
C'ini#(' F(#$'t, E)('$(tion
C'ini#(' Sit" E)('$(tion
St(2 E)('$(tion o% C'ini#('
E3p"ri"n#"s
St$d"nt E)('$(tion o% C'ini#('
E3p"ri"n#"s
S"#tion 4
CLINICAL S*ILLS C"EC*LIST ACROSS T"E
CURRICULUM
G$id"'in"s %or Using t0" C'ini#(' S+i''s
C0"#+'ist
S"#tion
FACULTY
EVALUATION
OF
STU5ENT PERFORMANCE
1. Instr$#tions %or Co&p'"ting C'ini#(' E)('$(tion
2. 5(i', C'ini#(' E)('$(tion
3. C'ini#(' Ho$r T(6$'(tion 7 Gr(d" R"#ording S0""t
4. S$&&(ti)" E)('$(tion Too'
5. Mid*T"r& C'ini#(' E)('$(tion
6. Fin(' C'ini#(' E)('$(tion
Instr$#tions %or Co&p'"ting C'ini#(' E)('$(tion
5(i', C'ini#(' E)('$(tion -For&(ti)"/
St$d"nts
1 Students are t" $"#*ete t+e t"* *"rti"n ", t+e dai! $ini$a evauati"n t""
ea$+ da! t+e! are in t+e $ini$a setting %i-e- a./ $ini$a agen$!' and su.#it
$"#*eted ,"r# t" t+e $ini$a ,a$ut! at t+e end ", t+e $ini$a da!-
2 Students #ust a$+ieve at east 012 "r .etter ,"r satis,a$t"r! $ini$a
*er,"r#an$e ea$+ $ini$a da!- Re#ediati"n is ne$essar! ,"r evauati"ns
re$eiving ess t+an 012-
F(#$'t,
C'ini#(' gr(d"s 8i'' 6" (ssign"d 6(s"d on t0" %o''o8ing9
Gr(ding
Cini$a *er,"r#an$e re*resents 012 ", t+e "vera $ini$a grade- Assign#ents %i-e-
d"$u#entati"n/ *r"3e$ts/ et$-'/ Nursing Care Pans/ and Cini$a tests %i-e- d"sage
$a$uati"ns/ *re ) *"st $ini$a $"#*eten$! assess#ent' re*resent 212 ", t+e
"vera $ini$a grade-
Gr(ding R$6ri#
Cont"nt P"r#"nt(g"
Cini$a Per,"r#an$e 012 %-01'
D"sage Ca$uati"n Test %First S$"re "n!' 12 %-01'
Cini$a Test %*re(*"st' 12 %-01'
Nursing Care Pan 12 %-01'
Assign&"nts -E3: do#$&"nt(tion -SIMC0(rt/, pro;"#ts/ 102 %-10'
Tot(' 1002
5(i', E)('$(tion For& R(ting S#('"
R(ting S#('" -S, NG, U/
T+is s$ae wi .e used t" assign a rating ,"r ea$+ ", t+e identi4ed $"#*eten$! areas
"n t+e Dai! Evauati"n F"r#5 Manage#ent ", Care/ Tea$+ing and 6earning/
Ps!$+""gi$a Integrit!/ D"$u#entati"n and C"##uni$ati"n/ 7eat+ Pr"#"ti"n and
Maintenan$e/ P+!si""gi$ Integrit!/ Nursing Pr"$ess and Caring Interventi"ns- As
ne$essar!/ Si#uated earning e8*erien$es #a! .e used ,"r $"#*eten$! assess#ent
%#a! n"t .e used "n a dai! .asis'- Ratings are assigned against ea$+ $"#*eten$!
inde*endent!- T" .e su$$ess,u/ Stu$nt+ +'oul$ aim ,or a $aily &ra$ o, -./ or
&ratr0
S S(tis%(#tor,( Fun$ti"ns as e8*e$ted ,"r t+e $ini$a eve-
NG
N""ds G$id(n#"( Is una.e t" *er,"r# s9is "r +as 9n"wedge de4$it in areas
e8*e$ted ,"r
$ini$a eve- Se, identi4es wea9nesses and *ra$ti$es sa,e! wit+ guidan$e-
U Uns(tis%(#tor, (Is una.e t" identi,! wea9nesses "r areas ", 9n"wedge de4$it-
Per,"r#s unsa,e
*ra$ti$e-
5(i', Gr(d" Co&p$t"
1 Cini$a ,a$ut! wi review student res*"nse in :Student Se$ti"n; ", ,"r#-
2 Fa$ut! wi assign ratings %S/ NG/ U' .ased "n identi4ed $riteria assigned t"
ea$+ $"#*eten$! %See
:C"#*eten$ies De4ned; se$ti"n ", ,"r#'-
3 Instru$t"r<Pre$e*t"r rating se$ti"n wi .e $"#*uted .! t+e $ini$a ,a$ut!-
1 Dai! grade is .ased "n a$+ieve#ent ", t+e = identi4ed $"#*eten$ies
"r Si#uated 6earning E8*erien$e-
2 T+e e8*e$ted eve ", a$+ieve#ent ,"r ea$+ ", t+e = $"#*eten$! areas
-Manage#ent ", Care/ Tea$+ing and 6earning/ Ps!$+""gi$a Integrit!/
D"$u#entati"n and C"##uni$ati"n/ 7eat+ Pr"#"ti"n and Maintenan$e/
P+!si""gi$ Integrit!/ Nursing Pr"$ess and Caring Interventi"ns' is
Sati+,actory (S!1 =<=-
3 Dai! grade is $"#*uted "n t+e nu#.er ", S>s assigned against ea$+
$"#*eten$!- A #a8i#u# ", = S>s $an .e a$+ieved dai!- Not"9 Ratings ", :Needs
Guidan$e %NG'; ) :Unsatis,a$t"r! %U'; wi +ave a negative i#*a$t "n t+e "vera
dai! grade-
4 E8a#*e5 5(i', Gr(d" Co&p$t(tion5 O, t+e = C"#*eten$! areas a
student re$eives ?(S>s/ 1(NG and 1(U- %ra$ calculation: < S=s> ? S=s
-possi6'"/ @ A4B -5(i', Gr(d"/:
5 Dai! grades are $"#*uted .ased "n $"#*eten$ies t+at are a**i$a.e ,"r
t+e earning e8*erien$e%s' ", t+e da!- Fa$ut! wi $r"ss "ut areas t+at d" n"t a**!
t" t+at da! and t+e dai! grade wi .e $"#*uted "n t+e identi4ed areas "n!-
E8a#*e5 I, a si#uated earning e8*erien$e is e#*"!ed ,"r t+e da! t+e grade wi
.e $"#*uted "n si#uati"n "n!- T+e student wi re$eive an S/ NG "r U- 1(S@1002
%Dai! Grade'-
6 Nu#.er and T!*e %Cini$a Si#uati"n %CS' "r Cini$a Agen$! %CA'' ", $ini$a
+"urs $"#*eted/ dai!/ wi .e re$"rded "n t+e :C'ini#(' Ho$r T(6$'(tion (nd
Gr(d" R"#ording S0""tC:
C'ini#(' T"sts
Students #ust su$$ess,u! $"#*ete a dos(g" #('#$'(tion t"st at t+e .eginning ",
ea$+ $ini$a $"urse/ "n! t+e 4rst grade wi .e re$"rded as a *art ", t+e "vera $ini$a
grade- T+e student wi "n! .e a"wed t+ree -!/ (tt"&pts to s$##"ss%$'', p(ss t0"
dos(g" #('#$'(tions t"st, wit+ a grade ", A0 "r +ig+er- Students w+" do not #eet
t+is re&uire#ent 8i'' not 6" a"wed t" $"ntinue in t+e $"urse-
Pre ) P"st Cini$a E8*erien$e evauati"n ", $ini$a s9is wi .e in t+e ,"r# ", return
de#"nstrati"n and<"r written test- T+ese tests #a! .e ad#inistered u*"n entr! int"
t+e $ini$a $"urse and as a *art ", t+e 4na $ini$a evauati"n-
Assign&"nts -5(i', #'ini#(' r"D$ir"&"nts/
1 As a *art ", $ini$a *er,"r#an$e/ students wi .e re&uired t" d"$u#ent a
*+!si$a assess#ent in SIMC'art "n an assigned $ient ea$+ da! %.ased "n 6eve
students #a! .e re&uired t" d"$u#ent "n #uti*e $ients'- Fa$ut! wi grade t+e
student>s d"$u#entati"n and assign a nu#eri$a grade using t+e SIMC'art
*r"gra# %Feed.a$9 "n student d"$u#entati"n $an .e d"ne wit+in t+e SIMC'art
*r"gra#-'-
2 Students wi .e re&uired t" d"$u#ent "n a *ri"rit! nursing diagn"sis t"
in$ude
identi4ed "ut$"#es %s+"rt<"ng(ter#' wit+ at east ? interventi"ns %1(".servati"n/
B(a$ti"ns and 1(tea$+ing' wit+ rati"nae state#ents and a**r"*riate $itati"n
d"$u#entati"n-
C(r" P'(ns
1 Students wi $"#*ete 2 $"#*re+ensive nursing $are *ans %One prior to
&idt"r& and "ne 2(8""+ prior to t0" "nd o% t0" s"&"st"r- Grading and
in$usi"n $riteria are esta.is+ed .! $ini$a ,a$ut! and $"urse eve-
Addition(' Assign&"nts
Ot+er dai! re&uire#ents #a! .e esta.is+ed .! $ini$a ,a$ut! and $"urse eve-
T+ese are uni&ue t" a *arti$uar $ini$a setting and at t+e dis$reti"n ", t+e ,a$ut!-
C'ini#(' R"&"di(tion
Students w+" d" n"t #eet t+e #ini#u# re&uired S$"re ", 012/ satis,a$t"r!
*er,"r#an$e/ in t+e $ini$a setting wi .e re&uired t" set u* a re#ediati"n *an wit+ t+e
$ini$a ,a$ut!<$ini$a a. staC wit+in tw" wee9s ", t+e identi4ed de4$it and #ust
de#"nstrate satis,a$t"r! *er,"r#an$e in t+e $ini$a setting t" re$eive a *assing grade
in t+e $"urse-
1 Fa$ut! wi initiate re#ediati"n *an using t+e F(#$'t,*St$d"nt Cons$'t(tion
R"#ord ,"und in t+is *a$9et- A $"*! ", t+e $"#*eted ,"r# wi .e #aintained in
student *er#anent re$"rd-
2 Fa$ut! wi #eet wit+ student t" dis$uss *an and ".tain student signature-
3 A ,""w u* #eeting is s$+edued "n$e student +as ,u4ed re&uire#ent%s' ", t+e
re#ediati"n *an-
Mid*T"r& 7 Fin(' E)('$(tion -S$&&(ti)"/
Midt"r& C'ini#(' E)('$(tion
1 Fa$ut! wi $"#*ete t+e 7USON Su##ative $ini$a evauati"n t"" ,"r
ea$+ student enr"ed in t+e $ini$a gr"u*-
2 Student and ,a$ut! wi $"#*ete t+e Midter# Evauati"n F"r#-
3 Cini$a Per,"r#an$e grade wi .e $a$uated .ased "n grades ,r"# t+e
Dai! Evauati"n F"r#s- Using t+e assigned *er$entages/ 4na grades wi .e
$a$uated .ased "n an average ", t+e Dai! Cini$a Per,"r#an$e/ D"sage
Ca$uati"n test/ Nursing Care Pans/ and Assign#ents-
E3(&p'"9 Mid(Ter# Grade Ca$uati"n
Cont"nt Gr(d" E(rn"d P"r#"nt(g" Co&p$t"d
Points
Cini$a Per,"r#an$e 0=-12 -01 1=-1A
D"sage Ca$ Test %1
st
atte#*t' =1-00 -01 B-21
Cini$a Test %*re(*"st' 100 -01 1-00
Nursing Care Pan 0B -01 D-0
Assign#ents %B'5 ?=/0B/0B/0?@
2A2 0D -10 0-D
2A2<B @ 0D %$"#*uted avg- ", B assign#ent
grades'
Tot(' -Mid*T"r& Gr(d"/ A?:?1 @
Gr(d" o%
ECC
Fin(' C'ini#(' E)('$(tion
Fa$ut! wi $"#*ete t+e 7USON Su##ative $ini$a evauati"n t"" ,"r ea$+
student
enr"ed in t+e $ini$a gr"u*<$"urse-
1 Fa$ut! wi $"#*ete t+e Fina Evauati"n ,"r# ,"r ea$+ student-
Students in*ut are "*ti"na %+ig+! re$"##ended'-
2 Cini$a Per,"r#an$e grade wi .e $a$uated .ased "n grades ,r"# t+e
Dai! Evauati"n F"r#s- Using t+e assigned *er$entages/ 4na grades wi .e
$a$uated .ased "n an average ", t+e Dai! Cini$a Per,"r#an$e/ D"sage
Ca$uati"n test/ Nursing Care Pans/ and Assign#ents-
HAMPTON UNIVERSITY
S$+"" ", Nursing
C'ini#(' E)('$(tion For&
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t+e #anage#ent ", $ients wit+ a$tua "r *"tentia
+eat+
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$ient $are
*r".e#s
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and
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$are se$"ndar! *reventi"n
( Pans/ "rganiFes/ dire$ts and evauates deiver! ",
nursing
( Per,"r#s *+!si$a assess#ent a$$"rding t"
S$+"" and
$are t" $ients wit+ $"#*e8 +eat+ $are needs in a
variet! ", agen$! standards
a$ute $are settings a'
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*rin$i*es ", ti#e
#anage#ent/ ( In$"r*"rates i,est!e $+"i$es in $are ", $ients
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$+anges P0,sio'ogi# Int"grit, E3p"#t"d J S
in $ients>
status Gasi$ Care and C"#,"rt
( Maintains $ient rig+ts
(Pans/ I#*e#ents/ and evauates $are in$usive
", $ients
( Maintains $ient $"n4dentiait! and *riva$! .asi$ $are and $"#,"rt needs
( Parti$i*ates in $"ntinuit! ", $are P+ar#a$""gi$a T+era*ies
( Identi4es 2rioriti+ -Calculates medication dosages accurately*
3 In$"r*"rates et+i$a and ega *rin$i*es -Teaches client about prescribed medications*
( Maintains sa,e $ient $are envir"n#ent -Administers medications safely per agency and School
policy *
T"(#0ing (nd L"(rning E3p"#t"d I S
-Manages intravenous infusions according to agency
( Evauates and *r"vides ,"r t+e edu$ati"na needs ",
adut
policy*
$ients wit+ $"#*e8 +eat+ $are needs and t+eir
,a#iies
(Evauates #edi$ati"n re$"n$iiati"n as
ne$essar!
( Parti$i*ate in a$tivities t+at *r"#"te *r",essi"na Redu$ti"n ", Ris9 P"tentia
deve"*#ent and *ers"na gr"wt+ -Incorporates client laboratory and diagnostic outcomes into
( Pursues t+e r"e ", t+e nurse as a $+ange agent client care
( Parti$i*ates in "n(g"ing edu$ati"na a$tivities t"
#aintain -Plans client care specific to diagnostic tests, procedures,
$"#*eten$!
and surgery
- eports changes! abnormalities in client status to faculty
( See9s new earning e8*erien$es
and staff*
( Parti$i*ates in $ini$a $"n,eren$es
Ps,#0o'ogi#(' Int"grit, E3p"#t"d I S - Performs therapeutic procedures according to standards of
(Integrates $ient $"*ing #e$+anis#s care*
( Integrates $ient su**"rt s!ste#s int" t+e *an ",
$are
- Performs focused assessments based on client status*
P+!si""gi$a Ada*tati"n
( De#"nstrates res*e$t ,"r $utura diversit!
(Pans and i#*e#ents $are ,"r $ients
e8*erien$ing
( Su**"rts $ient in situati"ns ", grie, and "ss
sta.e a$ute and $+r"ni$ aterati"ns in ."d!
s!ste#s
( In$"r*"rates $ient s*iritua and reigi"us needs in t+e
*an ",
,un$ti"n H
$are
(Parti$i*ates in *anning and i#*e#enting $are
,"r
( In$"r*"rates *rin$i*es ", stress #anage#ent int"
$ient $are
$ients e8*erien$ing unsta.e a$ute and
$+r"ni$
aterati"ns in ."d! s!ste#s ,un$ti"n<
une8*e$ted
t+era*euti$ res*"nses
5o#$&"nt(tion (nd Co&&$ni#(tions E3p"#t"d
I S N$rsing Pro#"ss E3p"#t"d I S
-Dis$ri#inates and t+"r"ug+! d"$u#ents assess#ent
data "n
( Evauates n"r#a vs- a.n"r#a assess#ent
4ndings
agen$! ,"r#s
utiiFing $riti$a t+in9ing
s9is
( Initiates $are *ans using agen$! ,"r#s w+en
a**r"*riate
( Ana!Fes $"#*re+ensive assess#ent data t"
deve"* a
( Inde*endent! d"$u#ents t+e $ients> res*"nses t"
t+e
*an ", $are using agen$!
,"r#s
e8*e$ted Out$"#es
( Pri"ritiFes nursing
diagn"ses
( R"e #"des *r",essi"na $"##uni$ati"n in a
intera$ti"ns
( Deve"*s individuaiFed e8*e$ted "ut$"#es
.ased "n
( See$ts a**r"*riate *r",essi"na $"##uni$ati"n
s9is t" nursing diagn"sis using agen$! ,"r#s
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Level _____
Student Name: _________________________ Instructor: __________________________ Facility:
___________________________________
Date: _____/____/_____ Course: NUR (V) __________ Direct Client Care ours: _______________ Score:
_________ !rade: _______
Ratin" #ey
S $ Satis%actory N! $ Needs !uidance (Only for midterm) U $ Unsatis%actory (Requires Comment) N& $
Not &''lica(le
)SS)N*I&L C+,-)*)NCI)S ,ID*)R, FIN&L C+,,)N*S
1. Collaborates with multi-disciplinary health team
members in the management of clients with actual or
potential health problems.
2. tili!es current technology to assess and pro"ide care.
#. $lans% organi!es% directs and e"aluates deli"ery of
nursing care to 2 adult clients with comple& health care
needs in a "ariety of acute care settings.
a. 'pplies principles of time management.
b. $rioriti!es tas(s.
c. Conducts rounds to identify changes in clients)
status.
*. +aintains client rights.
,. +aintains client confidentiality and pri"acy.
-. $articipates in continuity of care.
.. /dentifies 2rioriti+0
0. /ncorporates ethical and legal principles.
1. +aintains safe client care en"ironment.
)&L* -R+,+*I+N &ND ,&IN*)N&NC)
,ID*)R, FIN&L C+,,)N*S
client care.
2. /dentifies health 2creening re3 primary pre"ention and
secondary pre"ention.
#. $erforms physical assessment according to 2chool
and agency standards.
*. /ncorporates lifestyle choices in care of clients.
-S/C+S+CI&L IN*)!RI*/
Collects, analyzes, and prioritizes relevant physical, developmental, psychosocial, cultural, spiritual, and functional assessment data
to provide individualized patient care
1. /ntegrates client coping mechanisms.
2. /ntegrates client support systems into the plan of care.
3. 4emonstrates respect for cultural di"ersity.
4. 2upports client in situations of grief and loss.
5. /ncorporates client spiritual and religious needs in the
plan of care.
6. /ncorporates principles of stress management
into client care.
-/SI+L+!IC&L IN*)!RI*/
Basic Care and Comfort ,ID*)R, FIN&L C+,,)N*S
$lans% /mplements% and e"aluates care inclusi"e of
clients basic care and
comfort needs.
Pharmacological Therapies
Calculates medication dosages accurately.
5eaches client about prescribed medications
'dministers medications safely per agency and
2chool policy
+anages intra"enous infusions according to agency
policy
6"aluates medication reconciliation as necessary
Reduction of Risk Potential
/ncorporates client laboratory and diagnostic
outcomes into client care
$lans client care specific to diagnostic tests%
procedures and surgery
Reports changes7abnormalities in client status to
faculty and staff
$erforms therapeutic procedures according to
standards of care
$erforms focused assessments based on client status
Physiological Adaptation
$lans and implements care for clients
e&periencing stable acute and
chronic alterations in body systems function
$articipates in planning and implementing care for
clients e&periencing
unstable acute and chronic alterations in
body systems function7une&pected
therapeutic responses
Inte"rated -rocesses
NURSIN! -R+C)SS ,ID*)R, FIN&L C+,,)N*S
Utilizes the, critical thinking, nursing process evidence-ased information, and kno!ledge from the arts and "ciences
to support sound clinical decisions
1. 6"aluates normal "s. abnormal assessment findings
utili!ing critical thin(ing s(ills.
2. 'naly!es comprehensi"e assessment data to de"elop
a plan of care using
agency forms.
#. $rioriti!es nursing diagnoses.
*. 4e"elops indi"iduali!ed e&pected outcomes based on
nursing diagnosis
using agency forms.
,. 6"aluates clients) outcomes and re"ises plan of care in
an acute care setting
using agency forms.
-. /ntegrates research findings to pro"ide safe nursing
care for adult clients
with actual or potential health findings.
C&RIN! IN*)RV)N*I+NS ,ID*)R, FIN&L C+,,)N*S
Plan and implement nursing care in a safe, compassionate, culturally sensitive manner that preserves human dignity
and promotes gro!th of individuals and families
1. 2upports the adult client and the family in the dying
process.
2. +aintains a caring and therapeutic relationship with
clients and families in an
acute care setting.
#. 'ppraises opportunities to ser"e as a client7family
ad"ocate.
*. 4eli"ers care in a non-8udgmental% non-discriminating
manner that is
2ensiti"e to the client)s cultural di"ersity.
,. /mplement s an indi"iduali!ed% multi-disciplinary plan
of care for 2 adult
clients with actual or potential health problems.
-. /ntegrates comple& nursing s(ills safely with increased
autonomy for 2
adult clients.
a. $asses medications safely .
2. Correlates lab "alues% medications%
and signs7symptoms with
Clients) clinical diagnosis.
3.9otes changes in the clients) conditions% reports and
inter"enes as
/ndicated.
C+,,UNIC&*I+NS &ND D+CU,)N*&*I+N
Collaorate !ith individuals, families, and healthcare team memers in providing comprehensive, individualized patient care
Communicates effectively through veral, nonveral, !ritten, and technological means !ith individuals, families,
and healthcare team memers
1. 4iscriminates and thoroughly documents
assessment data on agency
:orms.
2. /nitiates care plans using agency forms when
appropriate.
3. /ndependently documents the clients) responses to
the e&pected
Outcomes.
4. Role models professional communication in all
interactions.
5. 2elects appropriate professional communication
s(ills to manage care
for clients and families.
1. Communicates with physicians and other
health care personnel to
address clients needs.
2. 'ssists the R9 in the interpretation and
transcription of physician)s
orders.
3.4eli"ers a comprehensi"e change of shift report.
4. Communicates effecti"ely "ia telephone% fa&
or computer.
5. /nteracts with clients) families to pro"ide
information and support.
6.;andles conflict appropriately.
*)&CIN!/L)&RNIN! ,ID*)R, FIN&L C+,,)N*S
Utilize teaching and learning processes to protect, promote, and maintain health for individuals and families across
the healthcare continuum
1. 6"aluates and pro"ides for the educational needs
of adult clients with
comple& health care needs and their families.
2. $articipate in acti"ities that promote
professional de"elopment and
personal growth.
3. $ursues the role of the nurse as a change agent.
4. $articipates in on-going educational acti"ities to
maintain competency.
5. 2ee(s new learning e&periences.
6. $articipates in clinical conferences.
SI,UL&*I+NS ,ID*)R, FIN&L C+,,)N*S
#dentify interdisciplinary team!ork in professional practice utilizing the nursing process$ #nclude ethical and safe care,
prolem solving and critical thinking$ %eral participation during pre- and post simulation e&perience during deriefing
1. 'ct with integrity% consistency% and respect for differing
"iews.
2. 'ssume the role of team member or team
leader based on the situation.
3. /ntegrate the contributions of others who play a role
in helping patient 7
family achie"e goals.
4. 2olicit input from other team members to
impro"e indi"idual% as well as
team performance.
5. :ollow communication practices that minimi!e
ris(s associated with
handoffs among pro"iders and across transitions
in care.
Pot"nti(' In%"#tion E3pos$r" In;$r, 5$ring C'ini#('
E8a#*es 6&amples
TG S",t tissue in3ur! %.urns/ $uts/ et$'
7IJ S9eeta<neur""gi$a in3uries
7e* C
E8*"sure t" $+e#i$as<t"8i$ e8*"sure
7e* A
Assaut<*+!si$a "r e#"ti"na
Needes sti$9s
NoL
N
G
e
6
HAMPTON UNIVERSITY
S$+"" ", Nursing
C'ini#(' In#id"nt
R"port
DATE
5
TIME5
EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
P6ACE
5 EEEEE
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DECSRIPTION5 EEEEEE
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Signature5 Tite5
Date
5 EEEEEE
7a#*t"n
Universit! 11 East T!er Street
7"urs ",
O*erati"n5
7eat+ Center 7a#*t"n/ JA 2D??= M"nda!(Frida!
010(020(1D11 =500a#(1500*#
Date: ______________________
Student Name: ____________________________ ID#: _______________________
Faculty: __________________________________ Course & Section:___________________
Nature of Concern (Circle): Theory Clinical Personal eferral
Descri!e Concern:
Referral/Recommendation(s):
"ttend class#clinical re$ularly De%elo& study Schedule
Punctual to class#clinical Increase 'uality study time
Partici&ate in class#clinical discussions "cti%ely &artici&ate in study $rou&
efer to class#course o!(ecti%es#sylla!us Consider decreasin$ &ersonal acti%ities
)se acti%e listenin$ s*ills Consider +or*in$ fe+er hours
Ta*e notes effecti%ely )se stress reduction techni'ues
Com&lete readin$#assi$nments !efore class Decrease test an,iety
Pre&are 'uestions for lecturer )se -Success .oo*/ study $uide
)se NC012 study $uide 'uestions )tili3e faculty office hours
)se math tutor4 Student Su&&ort Sr%cs eturn to s*ills la! for tutorin$
)se +ritin$ tutor4 Student Su&&ort Sr%cs e%ie+ clinical & critical !eha%iors
)se of soft+are testin$ &ac*a$es ("TI4 51SI) "&&ointment +ith Theory Instructor
De%elo& clinical or$ani3ational chart "&&ointment +ith Clinical Instructor
Su!mit &ractice care &lan "&&ointment +ith Nursin$ "dministrator
efer to Student 5and!oo* 1,it Inter%ie+
e%ie+ 6ideo(s) Name: 7ther:
Student Si$nature: __________________________ Date: __________________
Faculty Si$nature: ________________________ __ Date: __________________
s
e
0. Student Status 2tudent understands that 2tudent is not and will not be considered an employee of :acility or any of its
subsidiaries or affiliates by "irtue of 2tudent)s participation in the clinical learning acti"ities and shall not as a result of 2tudent)s
participation in the clinical acti"ities% be entitled to compensation% remuneration or benefits of any (ind.
2tudent 2ignature3 4ate3
/nstructor3 4ate3
S"#tion !
CLINICAL
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S$+"" ", Nursing
R"port S0""t
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HAMPTON UNIVERSITY
S$+"" ", Nursing
S#()"ng"r H$nt A#$t" C(r" S"tting
Date:<<<<<<<<<<<<<<<<<
ITEM LOCATION
C"de Cart
L"r9stati"n "n L+ees
StaC and Student S$+edues
C+art and C+art F"r#s
P"i$! and Pr"$edure Manuas
Medi$a Di$ti"nar!/ Re,eren$e
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Medi$ati"n ad#inistrati"n re$"rd
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C"des s*e$i4$ t" ,a$iit! %$"de .ue/ red/ .r"wn/
green/ e$t'
FIN5 THE FOLLOGING
Centra su**!
Dietar!
P+!si$a T+era*!
Cardi"*u#"nar!
Medi$a Re$"rds
Restr""#s
Jisit"rs "unge
S#"9ing area
C+a*e
E#*"!ees "unge
6aundr!
Mit$+en
C"n,eren$e<Cassr""#
Surger!
Ad#inistrati"n
End"s$"*!
StaC Deve"*#ent
HAMPTON UNIVERSITY
S$+"" ", Nursing
N$rsing St$d"nt R"port S0""t
P(ti"nt Roo& M
S,st"&s
Ass"ss&"nt
Neur""gi$a5
Pr"#($tions>Histor
,
Diagn"sis5
Res*irat"r!5
7ist"r!5
Aergies5
Cardi"vas$uar5
Fa Ris9N Oes N" RestraintsN Oes N"
Is"ati"nN
Oes
Gastr"intesti
na5
N"
C"de Status5
P'(n o% C(r"
Pending *r"$edures<tests5
Resuts ", *r"$edures<tests5
Standards ", $are5
Edu$ati"n
needs5
S#"9ing status5
Ja$$inati"n status5
P$rpos">5"sir"d
O$t#o&"
Anti$i*ated dis$+arge date5
Dis$+arge destinati"n5
End"$rine5
G""d Sugar5
Genit"urinar!5
Integu#entar!5
Mus$u"s9eeta5
S,st"&s
Ass"ss&"nt
Jita Signs ) Leig+t
EEEE GP EEEE GP
Ps!$+"s"$ia5
P P
T T
R R
Pain5
Sat2 Sat2
Stron$ly Disa$ree
Disa$ree 8
9
Course Title & Num!er N)(6) : ___________________
Clinical Site ___________________________
Clinical Faculty ___________________________
Semester#;ear ___________________________
Strongly Strongly
Disagree Disagree Neutral Agree Agree
1 2 3 4 5
o No
Comments:
<= >as faculty a%aila!le to student#staff +hen needed?
o ;es
o No
Comments:
@= Did students dis&lay initiati%e and &rofessionalism durin$ clinical e,&erience?
o ;es
o No
Course !itle: """" """ Semester and #ear: """" """
5os&ital: """ """" )NIT: "" """"""" S5IFT: "" """"
$lease e%aluate t&e indi%idual unit to '&ic& you 'ere
D
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e
S
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y
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a
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N
e
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r
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A
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A
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S
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g
l
y
assigned 'it& regard to t&e follo'ing criteria using a c&ec(
in t&e )o* t&at reflects your o+inion of t&is rotation,
-actors 1 2 3 4 5
)nit o&erations +ere or$ani3ed=
Comments:
esources +ere readily a%aila!le
Comments:
Personnel +ere friendly=
Comments:
Personnel +ere ea$er to assist=
Comments:
The e,&erience o!tained +as !eneficial to my education=
Comments:
0e%el of &atient care re'uired +as a&&ro&riate to my le%el of a!ility=
Comments:
.ould you consider t&is institution as a future em+loyer/ ___#es """No
Comments:
_______________________________________________________________________________
_____________________________________________________________________________
S"#tion 4
CLINICAL SHILLS
CHECHLIST
ACROSS
THE CURRICULUM
1. G$id"'in"s %or Us" o% C'ini#(' S+i''s C0"#+'ist
2. C'ini#(' S+i''s C0"#+'ist A#ross t0" C$rri#$'$&
G$id"'in"s %or Using t0" C'ini#(' S+i''s C0"#+'ist
1) Cini$a s9is $+e$9ist wi .e distri.uted in t+e Nursing F"undati"ns
*ra$ti$u# %NUR 21?' C"urse-
2) Students wi .e res*"nsi.e ,"r 9ee*ing tra$9 ", t+e $ini$a *a$9et
t+r"ug+"ut t+e se#ester-
3) At t+e end ", t+e ,"undati"ns *ra$ti$u# %NUR 21?'/ t+e ead ,a$ut! #e#.er
wi $"e$t t+e Cini$a *a$9ets ,r"# t+e students-
4) T+e ead ,a$ut! #e#.ers ", t+e F"undati"ns Pra$ti$u# %NUR 21?' wi +and(
"C t+e $ini$a *a$9ets t" t+e ead ,a$ut! ,"r t+e Adut Nursing Pra$ti$u#
%NUR DB?'-
5) T+e +and("C *r"$ess $"ntinues t+r"ug+"ut t+e $urri$uu#-
6) T+e ead ,a$ut! ,"r t+e Adut Nursing II *ra$ti$u# %NUR B1?' wi .e
res*"nsi.e ,"r retrieving a *a$9ets at t+e end ", t+e 4na $ini$a r"tati"n-
T+e ead ,a$ut! ,"r NUR B1? wi .e res*"nsi.e ,"r #a9ing sure *a$9ets are
4ed in t+e student>s *er#anent re$"rd/ "$ated in t+e S$+"" ", Nursing
OP$e ", A$ade#i$ Su**"rt-
7) On! Fa$ut!/ Ad3un$t Fa$ut!/ and *re$e*t"rs $an sign students "C "n t+e
s9is in t+e $ini$a setting-
8) In "rder ,"r t+e s9is t" .e #ar9ed as $"#*eted/ t+e ,a$ut! #ust date and
initia in t+e s*e$i4ed ."$9 ,"r ea$+ s9i $"#*eted-
9) Nursing s9is are re&uired t" .e de#"nstrated in t+e $ini$a s9is a./ at a
satis,a$t"r! eve ", *er,"r#an$e/ .e,"re t+e student is *er#itted t" *er,"r#
t+e s9i in t+e $ini$a setting-
10' Students w+" d" n"t satis,a$t"ri! $"#*ete t+e s9i #ust $"#*ete
re#ediati"n- Re#ediati"n #a! .e $"#*eted using #edia/ *ra$ti$e/ "r
reading- On$e re#ediati"n is $"#*ete/ t+e student #ust re(de#"nstrate t+e
s9i t" t+e nursing ,a$ut! #e#.er and *er,"r# t+e s9i satis,a$t"ri!- I, t+e
student is unsatis,a$t"r! t+e se$"nd ti#e/ "ne("n("ne re#ediati"n wit+
designated ,a$ut! is re&uiredQ
CLINICAL SHILLS
CHECHLIST
ACROSS
THE CURRICULUM
N(&"9 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
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2
Te#*
3
Puse
4
Res*i
5
6
7
1
2
3

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CLINICAL NURSING SHILLS
L(6 L(6 sit"
d(t">initi(' d(t">initi('
d(t">initi(
'

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CLINICAL NURSING SHILLS
L(6 L(6 sit"
COMMENT
S
d(t">initi(' d(t">initi(' d(t">initi('
M"ving ,r"# .ed t" $+air
M"ving .ed t" stret$+er
As"psis
7and was+ing te$+ni&ue
G"ig0t
Standing
6!ing %.ed'
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Ged t" w+ee$+airR w+ee$+air t"
.ed
C+air t" wa9erR wa9er t" $+air

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CLINICAL NURSING SHILLS L(6 L(6 sit"
COMMENT
S
d(t">initi(' d(t">initi(' d(t">initi('
o Det"id
o Jastus 6aterais
o S tra$t #et+"d
Su.$utane"us in3e$ti"ns
Intrader#a in3e$ti"ns
Pr"*er dis*"sa ", s!ringes and
#edi$ati"ns
R

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#edi$ati"ns
C+ange *ri#ar! IJ .ag
o Pigg! .ag
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o IJ Ius+
o Dis$"ntinuan$e ", IJ Iuid

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CLINICAL NURSING SHILLS
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L(6 L(6 sit"
COMMENT
S
d(t">initi(' d(t">initi(' d(t">initi('
e#"ti"na a.use
M(t"rn(' H"('t0
G"tte ,eeding
Greast ,eeding
E*idura #"nit"ring
Feta *resentati"n *"siti"n
Funda assess#ent wit+ F7T>s
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6a."r .reat+ing<rea8ati"n
6e"*"d>s #aneuvers

Ne"nata #edi$ati"n
ad#inistrati"n
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New."rn deiver! $are
Ora su$ti"ning

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L(6 L(6 sit"
COMMENT
S
d(t">initi(' d(t">initi(' d(t">initi('
P"st*artu# assess#ent
P"stura drainage< C7EST PT
Prenata urine S$reen
Rea8ati"n te$+ni&ues in$uding
6a#aFe $+id.irt+ te$+ni&ues
C"ve +it$+
Mu##!
Leig+ing dia*ers
F"e! $at+eter inserti"n %Adut'
PE5IATRICS
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COMMENT
S
d(t">initi(' d(t">initi(' d(t">initi('
Jita signs
Su$ti"ning $+id
Mist tent t+era*!
MENTAL HEALTH>PSYCHIATRY
Ris9 assess#ent
%Ideati"n<Pan<Means<Intent<ris9
,a$t"rs'
Sa,et! *re$auti"ns %sui$ide/
wit+drawa/ assaut'
A.use assess#ent %*+!si$a/
e$"n"#i$/ e#"ti"na'
Menta Status Assess#ent
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COMMENT
S
d(t">initi(' d(t">initi(' d(t">initi('
St"#a $are
Nas"tra$+ea su$ti"ning
Tra$+e"st"#! su$ti"ning
T"ta *arenta nutriti"n
PCA #"nit"ring
Let t" dr! dressings
Tra$+e"st"#! $are
F"e! inserti"n
o Mae
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7e#a$$ut
Nas"gastri$ tu.e inserti"n

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