Course: ADN 140 Nursing Fundamentals FORMATIVE

DES MOINES AREA COMMUNITY COLLEGE

NURSING PROGRAM PRACTICUM EVALUATION

The practicum evaluation tool is used to document the students progress towards meeting practicum competencies
for the course. The evaluation is applicable to all practicum settings where a clinical instructor is present including,
but not limited to, acute care, long-term care, and community. When attending simulated clinical experiences, a tool
specifically designed to evaluate students in simulation will be utilized. The simulation evaluation tool scores will be
incorporated into the students summative practicum evaluation.

The practicum evaluation tool is divided into formative and summative sections. The emphasis during formative
evaluations is on monitoring progress/improvement towards achievement of criteria, whereas summative is a final
evaluation to determine if performance criteria have been met. The student is expected to retain the skills and
abilities of performance criteria achieved in previous courses.

FORMATIVE EVALUATIONS will be completed once (1 time) per week/practicum setting. If the student is in more
than one (1) practicum setting in a week, a formative evaluation will be completed for each practicum setting.
Additional formative evaluations may be completed at the discretion of the instructor. Formative evaluations include
student self-evaluation and instructor feedback. The performance criteria for the formative part of the evaluation
tool are:

SP (Satisfactory Progress) student demonstrates steady, consistent performance related to

identified clinical competencies. Student will receive the number score associated with the
competency.

NI (Needs Improvement) student needs to demonstrate more independent performance of clinical

competency on a continuing basis. Student requires much or repeated assistance/redirection and
requires verbal and/or physical cueing from instructor.
Student will receive a zero (0) for the competency.

Total score and percent will be calculated for each formative evaluation. A percentage of 79 or less requires a
remediation plan. Remediation may be required at the discretion of the instructor at any time regardless of the
percentage.

The SUMMATIVE EVALUATION will be completed at the end of the course. Percent for each formative evaluation
will be totaled and divided by the number of formative evaluations in the course.

In order to pass the practicum component of this course, the student must achieve a total average percentage of 78
or greater.

A total average percentage of 78 or less will result in a failure for the course. The performance criteria for the
summative part of the evaluation tool are:

S (Satisfactory) total average of 78% or greater

U (Unsatisfactory) total average of less than 78%

Completion of the current course requires meeting both practicum competencies and theory components
successfully.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

DES MOINES AREA COMMUNITY COLLEGE

NURSING PROGRAM PRACTICUM EVALUATION
ADN 140 Nursing Fundamentals FORMATIVE EVALUATION

Student ___________Cassidy Vlieger______________ Term ______1____________

Date(s) __4.4.17-4.5.17______________ Clinical Location ___Valley View Village_______________

Using the sub competencies (listed under each Global Concept) as a guide, student will provide one
example of how he/she met each of the seven global concepts. Student needs to address a different sub
competency each week.
Do not use any patient specific identifiers (name, initials, room number).

Communication

S NI
1. Communicates in a respectful manner. 5 0
2. Identifies common nonverbal and verbal therapeutic communication skills. 5 0
3. Identifies appropriate boundaries to develop a therapeutic nurse client relationship. 5 0
4. Identifies barriers to effective communication. 1 0
5. Utilizes appropriate documentation for care provided to clients with guidance. 1 0
Total Possible Points 17
Total points Achieved 17
Student examples and discussion of how Global concept was met:

Communication throughout the day with my residents was great. I was able to really explain what I was going to do
for the assessments so that they really understood. Communication with the staff was okay. I got along well and
could easily ask questions to the med aids on the first day and then I could really easily talk to and ask questions to
the cna on the second day. I felt better talking to everyone and more connected when talking to everyone on the
second day in the skilled facility. I felt like the atmosphere was really relaxed and welcoming.
Good job finding staff willing to share information with you and help you answer questions.

Safe Practice

S NI
1. Uses principles of safe practice with guidance from faculty or staff 5 0
2. Follows infection control principles. 5 0
3. Recognizes special precautions for safe client care. 5 0
4. Identifies how to prevent injury to self and client. 5 0
5. Identifies how to report safety issues 1 0
Total Possible Points 21
Total points Achieved 21
Student examples and discussion of how Global concept was met:

I always assisted my resident on day one with a gait belt and made sure that I had someone help me when
transferring her to the wheelchair, bathroom, and into her chair as she was an assist x 2. I also made sure that both
rooms where organized and picked up so that neither one of my residents fell or hurt themselves.
Excellent. Way to utilize a gait belt to keep your resident safe as well as yourself. Good job asking for help when
you needed to transfer your resident that was an assist of 2.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Nursing Process

S NI
1. Collects and identifies client problems based on data collected 5 0
2. Implements nursing plan of care in a timely manner 5 0
3. Identifies goals/expected outcomes and interventions 1 0
4. Identifies the effects of nursing interventions on the client 1 0
Total Possible Points 12
Total points Achieved 12
Student examples and discussion of how Global concept was met:

I looked through both my residents charts to find out more information about why there were at valley view. I also
worked through daily goals with both of my residents and made sure that the goals that were in place was
something that they had help to choose.
Great job. It is important to look at the charts to learn more about your residents, especially if they dont tell you
everything. Setting goals that are realistic and attainable for the residents is important, good job discussing these
with your residents.

Care Across the Life Span

S NI
1. Individualizes assessment based on age of client. 5 0
2. Identifies specific communication skills appropriate for developmental level of the client. 5 0
3. Adapts nursing cares to meet the needs of clients across the life span. 1 0
4. Recognizes individual teaching needs across the life span. 1 0
Total Possible Points 12
Total points Achieved 12
Student examples and discussion of how Global concept was met:

We were in a long term care and skilled facility for both days. For me both of my residents were elderly. With this
information I was able to understand what they needed for their age group and also could make my assessment
more individualized for both of them. This helped when pinpointing my more focused areas of concerns which I
based off if there was any pain or if there was something in their charts that I really needed to be aware of.
Great job individualizing the care you gave each resident.

Professionalism

S NI
1. Identifies and follows related policies and procedures with guidance. 10 0
2. Identifies personal behaviors that have a positive or negative effect on client care. 5 0
3. Identifies role within the healthcare team. 1 0
4. Participates in clinical post-conferences/debriefing with direction. 5 0
Total Possible Points 21
Total points Achieved 21
Student examples and discussion of how Global concept was met:

I showed up early both days and was dressed in the appropriate attire and made sure that I had all my equipment
that I would need for the day. I also had a positive attitude throughout both days and really had fun at valley view. I
was able to see a little more clearly the roles of delegating from RN to CNA to even the students that were all there
that day.
Way to be on time each day at clinical. Thank you for your participation during post conference. Continue to keep
yourself busy during the day and interact with the residents.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Culture

S NI
1. Demonstrates respect for the cultural beliefs and practices of others. 5 0
2. Is aware of personal cultural beliefs, values, and practices that may influence care 5 0
delivery.
3. Recognizes how culture impacts health behaviors of individuals. 1 0
4. Demonstrates understanding of what is culture 1 0
Total Possible Points 12
Total points Achieved 12
Student examples and discussion of how Global concept was met:

I was in a facility where there were residents not just patients. I could clearly see that each resident was different.
Maybe not by culture but by what they had around their rooms. This also helped me get to know my residents better
because it told me a little more about them individually. I did however in the morning ask both residents what they
were comfortable with me doing and what they werent comfortable with. Neither of them minded doing things to
help them. However, my resident on day 2 was way more independent and wanted as little help as possible. This
was something she really wanted honored.
Good job asking them those questions! And way to honor and respect their wishes.

Health Promotion

S NI
1. Identifies how health behaviors relate to client condition. 2 0
2. Identify available community and facility resources. 1 0
3. Collects health promotion information during assessments. 2 0
Total Possible Points 5
Total points Achieved 5
Student examples and discussion of how Global concept was met:

I was able to ask lots of questions about both of my residents and find out what I needed to know about both. I was
able to look through charts and figure out what I could plan for the day that would help with making them feel a little
better. I was also able to collect information during the assessments that I think made it easier to plan out the day.
Excellent. This is helpful to you and to the resident.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Total Points for each Concept:

Communication _17___/17

Safe Practice _21___/21

Nursing Process _12___/12

Care Across the Life Span _12___/12

Professionalism _21___21

Culture _12___/12

Health Promotion _5___/5

Total Points Achieved ___100__/100 = _________100__________%

78% or higher = Satisfactory

Less than 78% = Requires remediation

Student Identified Strengths:

Really got to know my residents and had a lot of fun doing it.
Asked a lot of questions and got great feedback from staff and peers.

Student Identified Areas for Growth:

Still a little unsure what to do in downtime when patient is resting. Need to work on that.

Faculty comments:

Areas of Strength:
Good job communicating with residents and staff members. Keep asking questions, you will keep learning new
things if you keep asking questions. You participated when prompted and were hands on when possible.

Identify Areas for Growth.

We will continue to work on head to toe assessments so the flow becomes easier. Practice your placement of the
stethoscope, be sure that you listen with the stethoscope on the skin and are listening to the valves of the heart in
the right places. Also, critical thinking and prioritization will come with practice, but continue to work on
strengthening these skills. For example, when your resident tells you that she is dizzy and short of breath, your
priority vital sign shouldnt be her temperature. Continue asking questions when these scenarios come up.

Faculty Name____Kali Gleason, RN__________________________ Date__4/9/17______________

Revised 7/2016, 12/2016