Student Name:

Rachelle Johnson

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:

.
Compete
ncy (C)
Course
Outcome
s
(CO)

C9
CO1,2,
5

CO4

C8

Clinical Week
4
5
6
7

Dates

10/6

10/1
3

10/2
0

10/2
7

11/3

11/1
0

Attendance: P=Present, A=Absent, T=Tardy

Facility/Unit

ICU

MCU

REU

PSU

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

11/1
7

11/2
4

12/1

N/A

CFD

ED

REU

LDR
P

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/O

N/A

Makeup

C 6,7,8
CO1
C5
CO3
C10,
CO2
C6, CO
C4
C9
CO1

agency staff.
Recognize cultural issues and interact with clients in
culturally sensitive ways.
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.

N/A

S
S

S
S

S
S

S
S

S
S

S
S

S
S

S
S

S
3

C9,
CO1
C3

C4
C3
C4
C1, 2
C1
C8
C3
C2
C4

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.
7. Maintains patient confidentiality.
8. Documentation of client care is accurate and
relevant and consistent with agency policy
9. Completes and submits assignments on time.
10.Organizes and manages time effectively.
11.Attends and participates at post-conference.

Instructor Initials
Student Initials
Key: C=Competency, CO=Course Outcome

S
S
S

S
S
S

S
S
S

S
S
S

S
S
N/A

S
S
S

S
S
S

S
S
S

JT
RJ

JT
RJ

JT
RJ

JT
RJ

PW
RJ

JT
RJ

JT
RJ

JT
RJ

Make-up

Week

Instructor include comments that are positive, areas that need improvement or are
unsatisfactory. Reference the course outcomes listed in the syllabus and/or the OCNE
Competencies from the Nursing Student Handbook (Date/Sign all entries)

Rachelle, you had a very interesting clinical day. I feel that you were able to reassess your
nursing interventions with your patient's changing condition and that you adapted easily with
changing units. I noticed that you were asking questions and paying close attention to your
patient's needs. Your care plan and patho paper are complete and pertinent to your patient,
good job
Jenny Tausch RN MSN PCCN 10/12/15
Rachelle, caring for someone who does not interact much can make finishing a care plan
difficult. I feel that you were able to accurately identify her needs, and keep her safe from
harm, this does demonstrate competency 1. Your care plan and pathophysiology paper were
complete and pertinent to your patient. I made very few comments on them. Keep up the
good work, and continue looking for ways to increase your learning.
Jenny Tausch RN MSN PCCN 10/19/15
Rachelle, you were able to manage your time and care for both of your patients. You had a
successful catheter placement that you did perfectly. The staff on REU complimented your
ability as a student. By speaking with the RN on the patient's blood sugar and making a
decision to hold the medication you met competency 9, making sound clinical judgements.
This was a great clinical day for you, I hope that you enjoyed it.
Jenny Tausch RN MSN PCCN 10/26/15
I had very few comments on your care plan, nicely done This was a successful week for
you, as you were able to care for both of your patients and spend time with each one. Your

Student
Initials

RJ

RJ

RJ

RJ

burn patient needed some extra attention and education and you were able to provide that
for her (competency 7). You are progressing well as a student, and each week you are
becoming more confident in the clinical setting. Keep up the good work Rachelle.
Jenny Tausch RN MSN PCCN 11/1/15
Community caf; You took charge immediately with the first year students instructing what
they are to do, very nicely done. You were clear and directional, be sure that throughout the
shift, day or whatever time frame you are leading, you check in frequently with your team to
be sure that they dont have questions and are accomplishing what you want them to
accomplish. Well done. Your shot administration was very well done. You gave thought in
what you did, making sure the arm was limp for comfort, took your time and did a wonderful
job.
Pamela Wick RN
Rachelle, I am so glad that you had a wonderful learning experience in the emergency
department. It sounds like you were able to see and do many new things (competency 3).
Your reflection paper was complete and well done. I did not have any comments for it. This
was a successful clinical rotation for you.
Jenny Tausch RN MSN PCCN 11/12/15
Rachelle, It is unfortunate that both of your patients were discharged this clinical. However,
you were able to adapt to the changes and pick up another assignment without hesitation. I
had very few comments for your care plan so I did not return you a copy, what I can say, it
make sure to add some subjective data to your assessments. This was a successful clinical
day for you, I hope that you felt it beneficial.
Jenny Tausch RN MSN PCCN 11/22/15

N/A

Rachelle, I am glad that you had an interesting rotation through LDRP. It sounds like there
was a lot going on. I have enjoyed having you in my clinical group, and I know that you will
do great next term!
Jenny Tausch RN MSN PCCN 12/1/15

Clinica
l
Make-

Communi
ty Caf
RJ

RJ

RJ

RJ

up
9/2/09: revised 5/06/11 sw