Student Name: Tanya R Johnson

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 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 weekly grade of U, the faculty will review the students
performance and determine whether or not the student will be dismissed from the program.
 2

Nursing 221 Clinical Evaluation Tool Student Name: Tanya R Johnson

Midter
Final
Compete 2 3 4 5 6 m 7 8 9 10 Eval
QSEN ncy Eval
Compet (C) Dates 1/12 1/19 1/26 2/2 2/9 2/16 2/23 3/2
en-cies: Course Attendance: P=Present, A=Absent, T=Tardy P P P A P P P P
(KSA) Outcomes Palliati
Cath
(CO) Facility/Unit APU ED REU OPI OR
Lab
ve
Care
C9 Applies concepts and theory to clinical
CO 1, 2, practice in client care and written
3 assignments: na na s s
1. Conducts evidence-based health
assessment
2. Collects and monitors a variety of data na na s s
3. Analyzes and interprets the na na
data/assessment findings in increasing s s
complex chronic conditions.
4. Recognizes pathophysiological changes na na
s s
and symptoms
KSA: Patient Centered Care

5. Regularly monitors clients level of comfort na na

and ability to manage symptoms and s s
symptom distress
6. Prioritizes health problems. na na s s
7. Develops and uses evidence-based na na
s s
individualized interventions
8. Develops a plan of care that considers the na na
individual, family, age of client, functional
issues associated with co-morbidities,
developmental stage, psycho-socio- 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 na
na s s
clients with chronic conditions.
CO5, 6 Develops discharge plans in collaboration with na
client, family, and other members of the na s s
health care community.
 C8 Uses therapeutic communication with patients

EBP KSA: KSA: Teamwork & Collaboration

s s s s
and agency staff.
C6, 7, 8 Recognize cultural issues and interact with
s s s s
clients in culturally sensitive ways.
C5
CO5 Collaborates with other members of the health
care team to provide comfort and symptom s s s s
management.

C10 Uses research and evidence to support clinical

s s s s
CO2 decision making.
C6,
ionalism Profess- KSA:

Utilizes resources as needed. s s s s

CO4
C4 Able to identify/define leadership skills for
s s s s
nurse's role
C9, CO
Exhibits critical thinking skills when prioritizing
1 s s s s
and delegating patient care.

Compete
ncy
Midter
(C) Final
Course
2 3 4 5 6 m 7 8 9 10 Eval
Eval
Outcomes
(CO)

C9, Demonstrate responsibility and

KSA: Safety, Informatics, Professionalism

CO1 accountability for professional behavior: s s s s

1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope,
s s s s
skills list, evaluation tool, assessment
tools).
C4 3. Takes initiative in making decisions and
s s s s
assuming responsibility for decisions.
C3 4. Looks for opportunities for continued
s s s s
learning and self-development.
C4 5. Identifies behaviors and attitudes s s s s
influencing professional behavior.
 C1,2 6. Demonstrates growth in coping with
stressful situations in a calm and s s s s
dependable manner.
C1 7. Maintains patient confidentiality. s s s s
C8 8. Documentation of client care is
accurate and relevant and consistent s s s s
with agency policy
C3 9. Completes and submits assignments on
s s s s
time.
C2 10.Organizes and manages time
s s s s
effectively.
C4 11.Attends and participates at post-
s s s s
conference.
Instructor Initials mjs mjs mjs mjs mjs
Student Initials trj trj trj trj trj trj trj

Week Instructor Comments (Include Date/Signature) Student

Initials
1st clinical this term. Does observation in APU and is interactive with clients and staff. Nice reflections and identification trj
2 of need for strong communications skills in this area. MSperry RNc

ED observation todaynice write up on your chosen patient. It sounds like you learned quite a bit about trj
3 communication styles and professionalism. Review your data knowing what you now know and see how your care plan
evolved and why. I am glad you enjoyed the experience MSperry RNc
Cares for CVA pt this day/ Be sure to include the data to support your goal in your nursing dx statement. Nice trj
4 reflections and patho. MSperry RNc

5 Absent trj
 trj
6

Midte Tanya has continued to progress in her care planning. They continue to improve in patient centeredness, priority and trj
realistic outcomes. Continue to work on bringing more data to support your dx- this makes it stronger with goals and
rm interventions easily identified. Able to work with 2 patients and prioritize care.. works well with staff and recognizes
Eval when instructor support is needed Msperry
OR rotation- Completes OR observation for and care plan with nursing dx for preop, intraop and post op. Nice trj
reflections and observations. It sounds like you had a very good experience MSperry RNc
7

TanyaYou have not submitted your CET for the past few weeksPlease be sure this is submitted weekly. Spends this trj
8 week in Cath Lab and is able to observe a TEE. Does top 3 priority nursing dx for patient and care plans. Nice
reflections on your observations and patient situation. MSperry RNC

10

Final
Eval

12/12/12, updated 12/16sw

5