Student Name:

Alison___________

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:

Alison
pg. 2

QSEN
Compet
encies:
(KSA)

Clinical Week

Compet
ency (C)
Course
Outcom
es
(CO)

KSA: Patient Centered Care

C9
CO1,
2, 5

CO4
C8

MidTer
m
Eval

Dates

10/6

10/
13

10/
20

10/
27

11/
3

11/
4

Attendance: P=Present, A=Absent,

T=Tardy

Facility/Unit

PSU

OR

RE
U

Re
sp

ICU

ED

PS
U

n/o

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.

11/
10

11/
17

11/
24

10

Fina
l
Eval

pg. 3

KSA:
EBP KSA: KSA: Teamwork & Collaboration
Professionalism
KSA: Safety, Informatics, Professionalism

C
6,7,8
CO1
C5
CO3

C10,
CO2
C6,
CO
C4
C9
CO1
C9,
CO1
C3
C4
C3
C4
C1, 2

Recognize cultural issues and interact with clients

in culturally sensitive ways.

n/o

Collaborates with other members of the health

care team to provide comfort and symptom
management.

Uses research and evidence to support clinical

decision making.

Utilizes resources as needed.

Able to identify/define leadership skills for nurse's

role
Exhibits critical thinking skills when prioritizing and
delegating patient care.
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.

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.

C2

10. Organizes and manages time effectively.

s
s

s
s

s
s

s
s

s
s

s
s

s
s

s
s

pg. 4

C4

11. Attends and participates at post-conference.

Instructor Initials
Student Initials

s
mjs
AJ

mjs mjs mjs

AJ

AJ

AJ

mj
s
AJ

mjs
AJ

mjs mjs mjs

AJ

AJ

AJ

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

Week
2

Midter
m

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)
First clinical this term- works with cancer patient post surgically. Identifies primary nursing dx and appropriate
interventions- Nice pathophysiology paperWelcome back!Msperry RNc

Student
Initials

OR rotation this week able to stay with 1 patient from admit until end of shift. Identifies top priority nursing dx for
pre-op, intra-op and post op. Nice reflection around OR experience. Also able to observe additional intubations, and
procedures. MSperry RNc
Pt with Afib RVR and PE today. Nice reflections on care plans that prioritize care with patient centered data and
adaption of plan to those priorities. Improving on data documentation and collection. DAR charting is developing.
--------------------------------------------Msperry RNc
Works with RT today-doe nebulizers, EKG and focused respiratory assessments. Care plan is prioritizedwatch goals
keep them specific and realistic. Nice reflection Msperry RNc
Cares for ventilated patient in ICU this week. Identifies primary respiratory, cardiac and infection for patient as well as
verbalizes basic care dx such as skin integrity impairment. Works well with ICU staff, healthcare team and patient.
Able to administer IV push medications and subq
medications.------------------------------------------------------------------------------------------------------------------------------------------------MSperry RNc
Alison has grown this term she is confident in her role and does not hesitate to ask questions or research
information. She adapts easily to changing units and is able to care for 2 pt with good time management. -----MSperry RNc
pg. 5

7
8
9

ED rotation this week. Adapts well to environment and does not hesitate to assess patients, perform skills, and help
team. Able to sign off IV push medications and IV starts today. Nice reflection and nursing interventions for patients.
--------------------------------------------- MSperry RNc
Cares for 2 patients on PSU this clinical. Identifies need to re-prioritize patients after physical care and assessments
and adapts care plans accordingly. Nice reflections and patient centered
interventions----------------------------------------------------------------------------MSperry
Happy Thanksgiving!

10

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

pg. 6