Student Name:

Kara Sharrai

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.

Nursing 222 Clinical Evaluation Tool

Student Name:

Kara
pg. 2

QSEN
Compet
encies:
(KSA)

Clinical Week

Compet
ency (C)
Course
Outcom
es
(CO)

Dates
Attendance: P=Present, A=Absent, T=Tardy
Facility/Unit

KSA: Patient Centered Care

C9
CO1,
2, 5

CO4
C8

Applies concepts and theory to clinical practice in

client care and written assignments:
1. Conducts evidence-based assessment, using age,
developmental and culturally appropriate
communication skills
2. Collects and monitors a variety of data
3. Analyzes and interprets the data/assessment
findings in increasing complex acute conditions.
4. Recognizes pathophysiological changes and
symptoms
5. Regularly monitors clients level of comfort and
ability to manage symptoms and symptom
distress
6. Prioritizes health problems.
7. Develops and uses evidence-based individualized
interventions
8. Develops a plan of care that considers the
individual, family, age of client, developmental
stage, psycho-socio-cultural issues, and/or
learning needs.
9. Evaluates and reflects on plan of care for clients
with acute conditions.
Develops discharge plans in collaboration with client,
family, and other members of the health care
community.
Uses therapeutic communication with patients and
agency staff.

10/
4
P
BA
H
ps
u

10/
11
P
BA
H
RE
U

10/
18
P
BA
H
res
o

10/
25
P
BA
H
FB
C

11/
1
P
BA
H
mc
u

S
S

MidTer
m
Eval

10

11/
8
N/A

11/
15
P
BA
H
PS
U

11/
22
P

11/
29

S
S

N/
O

N/A

11/
3

S
S
S

Fina
l
Eval

BA
H
ED

S
NI

S-

NA

N/
O

NA

S
S
S

pg. 3

KSA: Safety, Informatics, Professionalism KSA: Professionalism

EBP KSA: KSA: Teamwork & Collaboration

C
6,7,8
CO1
C5
CO3

Recognize cultural issues and interact with clients in

culturally sensitive ways.

N/
O

S
S

S
Collaborates with other members of the health care
team to provide comfort and symptom management.

C10,
CO2
C6,
CO
C4

Uses research and evidence to support clinical

decision making.

Utilizes resources as needed.

Able to identify/define leadership skills for nurse's

role

C9
CO1

Exhibits critical thinking skills when prioritizing and

delegating patient care.

N/
O

N/
O
N/
O

C9,
CO1

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).
3. Takes initiative in making decisions and assuming
responsibility for decisions.
4. Looks for opportunities for continued learning
and self-development.
5. Identifies behaviors and attitudes influencing
professional behavior.
6. Demonstrates growth in coping with stressful
situations in a calm and dependable manner.

C3
C4
C3
C4
C1, 2

S
S
S
S
S
S

C1

7. Maintains patient confidentiality.

C8

8. Documentation of client care is accurate and

relevant and consistent with agency policy

C3

9. Completes and submits assignments on time.

10. Organizes and manages time effectively.

S
S

SS

S
S

S
S

C2

S
S

S
S

S
S

pg. 4

C4

11. Attends and participates at post-conference.

Instructor Initials
Student Initials

JT
KS

JT
KS

JT
KS

JT
KS

JT
KS

JT
KS

JT
KS

JT
KS

JT
KS

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

Week

5
6

Instructor include comments that are positive, areas that need improvement or are unsatisfactory.
Reference the course outcomes listed in the syllabus, the OCNE Competencies from the Nursing Student
Handbook and/or the QSEN competencies (Date/Sign all entries)
Kara, this week you cared for a very sick patient on PSU. You were able to practice a number so skills and able to
assist the RN with other skills. I observed you interacting with your patient, I noticed that you allowed her autonomy
and respected her family presence demonstrating competency 7. Your care plan was complete and pertinent to your
patient, however I did have some comments on it for you to consider. I noticed an inconsistency, so just be mindful of
that. Overall, this was a good week for you, and you were able to see and do a lot with this patient.
Jenny Tausch RN MSN PCCN 10/10/2016
Kara, this week you were able to care for two complex patients on REU. I feel that you were able to meet their needs
and provide safe care to both of them. As you noticed, time management and prioritizing becomes very important as
you increase your patient load. I did have some comments on your care plans for you to view.
Jenny Tausch RN MSN PCCN 10/15/2016
Kara, this week you were able to spend your clinical rotation with the resource nurses. This is a great way to see many
different aspects of the hospital and to see how patients flow from the emergency room to the medial floors. Your
reflection was nicely done, and I did not have any comments on it for you. I did not see that you turned in an initialed
evaluation tool this week, so I did give you an S- for submitting assignments.
Jenny Tausch RN MSN PCCN 10/22/2016
Kara, this week you rotated through the Family Birth Center. You were able to see a C-section and numerous other
things, actively seeking out new learning opportunities (competency 3). I felt that I was unable to spend a lot of time
with you due to all of the activity. I am glad that you had such an informative clinical day. Your care plan was complete;
I had a few comments on it for you to view.
Jenny Tausch RN MSN PCCN 10/28/2016
Kara this week you spent your rotation on the Medical Care Unit. You had some difficult changes with your
assignments and ended up caring for three different patients. You were able to work with the nursing staff to discharge
a patient and to accept another one without hesitation (competency 5). This is the way nursing is sometimes, and you
must be flexible and willing to accept changes. I feel that you were actively looking for skills to practice, and that you
were asking appropriate questions of the nursing staff. I had a few comments on your care plans for you to view.

Student
Initials

KS

KS

KS

KS

KS

pg. 5

Midter
m

Overall, this was a good week for you.

Jenny Tausch RN MSN PCCN 11/5/2016
Kara is doing well in the clinical setting. She is able to safely care for two patients, she easily adapts to changes when
her patient assignment. I feel that she asks questions when needed. She does look for skills to practice and new things
to see.
Jenny Tausch RN MSN PCCN 11/3/2016
Instructor out of town

Jenny Tausch RN MSN PCCN 11/5/2016

Kara, this week you were able to care for two interesting patients on the Post-Surgical Unit. You were able to meet
their needs and prioritize your time accordingly. Your care plans were complete and detailed. I noticed that you were
actively engaged in learning about your patients and asking questions regarding their care. This was a good week for
you Kara, keep up the good work and continue to look for ways to improve yourself as a student and to increase your
skill level.
Jenny Tausch RN MSN PCCN 11/20/2016
Kara, this week you were able to rotate through the Emergency Department. You were able to see a variety of things
and able to practice a number of skills. I feel this was a productive day full of learning opportunities. I did notice that
you were asking the nurse questions and appeared eager to learn (competency 3).
Jenny Tausch RN MSN PCCN 11/24/2016

KS

KS
KS

KS

10

Final
9/2/09: revised 5/06/11, rev 8/2/16 sw

pg. 6