Student Name:

Jai Lee Saldivar

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

Clinical Week
4
5
6
7

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

10/8
/15
P

10/1
5/15
P

10/2
2/15
P

10/2
9/15
P

Facility/Unit

PSU

PSU

PSU

PSU

Dates

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.

Jai Lee Saldivar

8

abs
ent

12/3
/15
P

11/5
/15
P
Res
ourc
e

11/1
2/15
P

11/1
9/15
P

REU

OR

LDR
P

n/a

n/o

n/o

Makeup

C8
C 6,7,8
CO1
C5
CO3
C10,
CO2
C6, CO
C4
C9
CO1

Uses therapeutic communication with patients and

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/o

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.

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

TYF

TYF

TYF

TYF

TYF

TYF

TYF

Instructor Initials TYF

Make-up

Student Initials

JLC
S

JLC
S

JLC
S

JLC
S

JLC
S

JLC
S

JLC
S

JLC
S

Key: C=Competency, CO=Course Outcome

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)

Student
Initials

10/8/15: Jai Lee- The first week back to clinical after having all summer away from patient care and thinking
about all that it entails is very difficult. I am very mindful of that fact. So, given that, I think you had a
successful clinical day. Your demeanor with your patient was very good. Your care plan needs a bit of work:
Expand on the pathophysiology to include integration of your patients systemic issues, social issues, lab
values, comorbidities, medications, plan of care, etc Most interventions (medications, nursing care, etc)
lead to some action taking place (either bad or good), so evaluate how each of the multiple factors affecting
your patient might play a part in a potential cascading of events. Really look at the patient as a whole,
including everything inside & outside of the admission diagnosis/surgical intervention. For next week, we will be
bumping up to two patients, so start thinking about how to think like a nurse managing what you see in front
of you and what you might see due to what care/interventions the patient is getting. Keep in check with me to
make sure you are feeling like you understand what this means. Well done, and keep it up!
Tracy Fawns, RN, MSN.Ed

JLCS

10/15/15: Another solid clinical for you. You do need to work on the casualness of your writing and spruce it up
a bit to be more scholarly with fewer abbreviations. Thatll come with practice. Your patient care was excellent,
as was your time management. You seemed to do quite well. Continue working on this. Some days will go better
than others, so get a plan now to manage your time effectively (using a nursing brain to jot pertinent pt info on,
planning your actions ahead of time for your patients, etc). You will be going to 4 patients by the time you are
in your practicum. So, get solid management practices down now. You are well on your way. You are displaying

JLCS

quite professional behavior and you successfully met all of the above outcomes for your clinical day. Well done.
Tracy Fawns, RN, MSN.Ed

10/22/15: Jai Lee- Well done today! You seemed to do well with two patients today. It is a continual process to
get your groove with managing the care of two patients. Some days, as you know, will just go better than
others. You always seem very calm and collected. I sensed that the pain management of your burn patient was
stressful for you. It is sometimes very emotional to see someone in pain and feel like there is not much you can
do. Remember to come to terms with your emotions and work through them so that you can take care of
yourself and well-being. This is so important as a nurse. Remember the self care assignment you did your first
term during nursing school? This is what that was all about to learn how to take good care of yourself and
work through the stress that every nurse faces. I know you know this and I think you do a very good job at this,
but it is helpful to have a reminder every once in awhile. Dont forget about yourself. Your care plans are
coming along very nicely! You successfully met all clinical outcomes for today, as noted above.
Tracy Fawns, RN, MSN.Ed

JLCS

10/29/15: Another successful day for you. Your care plans are continuing to get better & better. Keep it up. Your
clinical day was managed well as far as time, professionalism, and safe care. You successfully met all of the
above outcomes, as noted.
Tracy Fawns, RN, MSN.Ed

JLCS

11/5/15: Observation and participating with the resource nurse today. I was given some great feedback about
your enthusiasm, professionalism, and competence with patient care.
Tracy Fawns, RN, MSN.Ed

JLCS

11/12/15: Jai Lee- Today you had a busy day on REU. One of your patients required tube feedings, which I
observed you doing, including checking the residual and using the new pump at the hospital. You did well with
this. This was a patient who was very ill and had a lot going on. Your time management went well with two
patients. You met all clinical and course outcomes/competencies for the day. Your care plan is improving weekly.
Tracy Fawns, RN, MSN.Ed

JLCS

11/19/15: OR Observation today.

JLCS

7
8

Holiday.

12/3/15: LDRP While your originally scheduled patient wound up not being scheduled on clinical day for the Csection, you handled it professionally and moved on. You did quite well in clinical today, remaining enthusiastic,

JLCS

professional, and competent. You successfully met all above clinical outcomes for the day.
Tracy Fawns, RN, MSN.Ed

Clinica
l
Makeup
9/2/09: revised 5/06/11 sw