Student Name: Jessica McElravey

Southwestern Oregon Community College Nursing Program

Nursing 221
Foundations of Nursing: Chronic 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 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 student’s 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 student’s performance and determine whether or
not the student will be dismissed from the program.

2
Nursing 221 Clinical Evaluation Tool Student Name: Jessica McElravey

Midterm Final
Competency 2 3 4 5 6 Eval 7 8 9 10 Eval
QSEN
(C) 2/7 3/13
Competen- Dates 1/16 1/23 1/30 2/6 2/13 2/20 2/27 3/6 3/13
Course
cies: Attendance: P=Present, A=Absent, T=Tardy P P P P P P P P P
Outcomes
(KSA) BAH BAH BAH BAH BAH BAH BAH BAH BAH BAH BAH
(CO) Facility/Unit PSU OR ICU CATH ED APU OPI FBC PSU

C9 Applies concepts and theory to clinical practice in client

CO 1, 2, care and written assignments: S S S S S S S S S S S
3 1. Conducts evidence-based health assessment
2. Collects and monitors a variety of data S S S S S S S S S S S
3. Analyzes and interprets the data/assessment findings
S S S S S S S S S S S
in increasing complex chronic conditions.
4. Recognizes pathophysiological changes and symptoms S S S S S S S S S S S
KSA: Patient Centered Care

5. Regularly monitors clients’ level of comfort and ability

S S S S S S S S S S S
to manage symptoms and symptom distress
6. Prioritizes health problems. S S S S S S S S S S S
7. Develops and uses evidence-based individualized
S S S S S S S S S S S
interventions
8. Develops a plan of care that considers the individual,
family, age of client, functional issues associated with
co-morbidities, developmental stage, psycho-socio- S S S S N/A S S S S S S
cultural issues, capacity for and engagement in self-
health care, and/or learning needs.
9. Evaluates and reflects on plan of care for clients with
S S S N/A N/A S S S S S S
chronic conditions.
CO5, 6 Develops discharge plans in collaboration with client,
S S S S N/A S S S S S S
family, and other members of the health care community.
C8 Uses therapeutic communication with patients and agency
S S S S S S S S S S S
KSA: Teamwork &

staff.
Collaboration

C6, 7, 8 Recognize cultural issues and interact with clients in

S S S S S S S S S S S
culturally sensitive ways.
C5 Collaborates with other members of the health care team
S S S S S S S S S S S
CO5 to provide comfort and symptom management.
C10 Uses research and evidence to support clinical decision
KSA:
EBP

CO2 S S S S S S S S S S S
making.
C6, CO4 Utilizes resources as needed. S S S S S S S S S S S
ionalism
Profess-

C4 Able to identify/define leadership skills for nurse's role S S S S S S S S S S S

KSA:

C9, CO 1 Exhibits critical thinking skills when prioritizing and

S S S S S S S S S S S
delegating patient care.
3
 Competency
(C)
Midterm Final
Course 2 3 4 5 6 Eval 7 8 9 10 Eval
Outcomes
(CO)

C9, CO1 Demonstrate responsibility and accountability for

professional behavior: S S S S S S S S S S S
1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope, skills list, S S S S S S S S S S S
evaluation tool, assessment tools).
KSA: Safety, Informatics, Professionalism

C4 3. Takes initiative in making decisions and assuming

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

4
 Instructor Comments (Include Date/Signature) Student
Week Initials
Jessica, this week you cared for post-op patient on the Post-Surgical Unit. Your made my suggested changes on your care plan and followed up with JM
your evaluations and DAR note. Your assessments were nicely done and complete, overall, nice job. I noticed that this week you took on a mentor
2 type role with a first year nursing student. This demonstrates leadership in the health care setting and meeting competency 4. This was a
productive week for you, continue to seek out ways to improve yourself as a nursing student and future nurse.
Jenny Tausch MSN RN PCCN 1/18/2018
Jessica, this week you rotated through the Operating Room. Your care plan prep and reflection paper were compete, pertinent to your patient, and JM
3 nicely done. You participated in post clinical and turned in your work on time. This was a successful week for you.
Jenny Tausch MSN RN PCCN 1/24/2018
Jessica, this week with the RN you cared for a critical patient in the Intensive Care Unit. Your care plan was good and very detailed. You were able to JM
practice some skills meeting competency 3 and are starting to become more comfortable in the clinical setting. This was a good learning experience
4 for you this week.
Jenny Tausch MSN RN PCCN 1/31/18
Jessica, this week you were able to observe in the Cardiac Cath lab. You care prep and your post reflection was nicely done, and I did not have any JM
comments on it for you. As you were in the cath lab all day I was unable to spend any time with you, but it sounds as if you had a very interesting
5 day.
Jenny Tausch MSN RN PCCN 2/7/2018
Jessica, this week you spend the day in the Emergency Room. Your reflection paper was complete; I did not have any comments on it for you. I feel JM
that you were able to meet your goals today and that you were able to practice a number of skills. You stated in you reflection paper that you
6 worked well with the nurse staff by using verbal communication skills, competency 8.
Jenny Tausch MSN RN PCCN 2/15/2018
Jessica writes the most detailed care plans; they are always complete and well done. She is able to care for her patients and does ask questions. I JM
Midterm
feel that she does practice safely and that she is cautious in the clinical setting. I do not have any concerns regarding her performance at this time.
Eval Jenny Tausch MSN RN PCCN 2/7/2018
Jessica, this week you rotated through the Acute Psychiatric Unit. You were a bit apprehensive at first, but then settled right in. You were able to JM
develop a rapport with your patient and with the nursing staff, meeting competency 8. Your care plan and reflection paper were nicely done, I did
7 not have any comments on them for you.
Jenny Tausch MSN RN PCCN 2/21/2018
Jessica, you were able to spend the day in Outpatient Infusion this week. You did get to practice a number of IV skills and you did get more JM
comfortable with PICCs and Ports. You did learn a lot about using policies and best practice guidelines this week, competency 10. Your careplan was
8 complete and pertinent to your patient; this was a productive week for you, keep up the good work.
Jenny Tausch MSN RN PCCN 2/28/2018
Jessica, this week you spent the day in the Family Birth Center with in induction. Sorry that you were unable to see a birth, however, you did get to JM
9 see some other fun things. I feel that Nice job on your care plan; I did not have any comments on it for you.
Jenny Tausch MSN RN PCCN 3/7/2018
Jessica this week you spent the day on the post-surgical unit. This has been a good term for you, you have progressed well and have grown as a JM
10 student. I have enjoyed you in my clinical group and wish you well in your career as an RN.
Jenny Tausch MSN RN PCCN 3/13/2018
Jessica does well in the clinical setting. She has progressed well and has become a lot more confident caring for her patients. She is efficient, is able JM
Final
to manage her time well and I feel is ready for the practicum.
Eval Jenny Tausch MSN RN PCCN 3/13/2018
12/12/12, updated 12/16sw 5