Student Name:

Quinlyn R. Deming

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.

pg. 2

Nursing 222 Clinical Evaluation Tool

Student Name:

Clinical Week
2

QSEN
Compet
encies:
(KSA)

Compet
ency (C)
Course
Outcom
es
(CO)

KSA: Patient Centered Care

C9
CO1,
2, 5

CO4

Dates

Oct
4th

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

Facility/Unit

BAY
H
-OR

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.

MidTer
m
Eval

Oct
11t
h
P
BAH
MC
U

Oct
18t
h
P

Oct
25t
h
P

BAH
REU

BAH
- ER

BAH
REU

BAH
REU

BAH
REU

11/
1
P

7
Nov
15t
h
P

10

Fina
l
Eval

Nov
22
P

NA

NA

NS

NO

Y
pg. 3

KSA:
EBP KSA:
Professionalism

KSA: Teamwork &

Collaboration

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

KSA: Safety, Informatics, Professionalism

C3
C4
C3
C4
C1, 2

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.

NA

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.

C4

11. Attends and participates at post-conference.

Y
pg. 4

Instructor Initials
Student Initials

MP
P
QD

MP
P
QD

MP
P
QD

MP
P
QD

SW
QD

MP
P
QD

MP
P
QD

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

Week

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)

OCT 4TH, todays clinical was in the perioperative setting. You got to see a couple of surgeries and following one patient.
Im happy you enjoyed it!
Good Job! You passed your clinical this week.
Michelle Pringle, RN-BC, BSN

Oct 11th, 2016: todays clinical was with a patient with encephalitis. You assessed an iv that was no longer usable, and
spoke with physicians for orders. You are doing great, You have a kind and caring bedside manner. Good Job
You passed your clinical this week.
Michelle Pringle, RN-BC, BSN

Oct 18th, 2016: Todays clinical was in REU with two patients, one with a gi bleed and the other with ARF. You
administered IV push medications and learned the importance of closely monitoring the patient when pushing a
cardiac med. The nurse you worked with only had good things to say. Good job on your care plan and evaluations. You
passed your clinical this week.
Michelle Pringle, RN-BC, BSN

5
6

Student
Initials

Oct 25, 2016: Todays clinical was in the ER. You got to see a STEMi and watch an angiogram with stents! I know you
enjoy cardiology so Im glad you had this experience. You maintained professionalism and calm even in a chaotic
environmentgood job!
You passed your clinical this week.
Michelle Pringle, RN-BC, BSN
11-1-2016: Provided excellent patient-centered care on both of your patients as evidenced by advocating for and
pg. 5

treating your patients nausea and by recognized need for change in client care on your client on comfort
care..S. Walker, RN

Midter
m

Nov 15, 2016: Todays clinical on REU you used a lot of your critical thinking skills and thought things out carefully
nicely done. Bedside manner is kind and nurturing. You looked back in your patients history, again applying critical
thinking. Good job!
Michelle Pringle, RN-BC, BSN

Nov 22nd, 2016: Todays clinical in REU was a busy morning with your two patients; you maintained calm and
professionalism. Excellent care and care plans! Good job!
Michelle Pringle, RN-BC, BSN

9
10

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

pg. 6