Student Name: Jason Villavicencio

Southwestern Oregon Community College Nursing Program

Nursing 111
Foundations of Nursing in Chronic Illness I







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 111 Clinical Evaluation Tool Student Name: Jason Villavicencio

. Clinical Week
Competency
(C)
Course
Outcome
(CO)
1 2 3 4 5 6 7 8 9
Make-up
Dates 1/14 1/21 1/28 2/4 2/11 2/18 2/25 3/4 3/11
Attendance: P=Present, A=Absent, T=Tardy P P P P P P P P P
Facility/Unit PSU 3C 3D IMCU PSU IMCU 3D IMCU 3D
C9
CO 1, 2
Applies concepts and theory to clinical practice in client care
and written assignments:
1. Collects data and conducts a health assessment on a
client with a chronic illness
S S S S S S S S S

2. Analyzes and interprets the data/assessment findings. S S S S S S S S S

3. Prioritizes health problems. S S S S S S S S S
4. Develops a plan of care that considers the individual,
family, age of client, developmental stage, psycho-socio-
cultural issues, and/or learning needs.
S S S S S S S S S


5. Evaluates and reflects on plan of care. S S S S S S S S S
C1, CO4
Applies ANA Code of Ethics in care of chronically ill S S S S S S S S S
C5, CO5 Identifies roles and functions of members of the health care
team involved in providing care for the chronically ill.
N/O S S S S S S S S

C8, CO6 Uses therapeutic communication with patients and agency
staff
S S S S S S S S S

C4, CO7 Recognizes potential legal and ethical issues related to client
autonomy across the lifespan in at risk populations.
N/O S S S S S S S S

C6, 7, 8
CO2

Recognizes cultural issues and interact with clients in
culturally sensitive ways
NA S S S S S S S S

C10 Uses research and evidence to support clinical decision
making
N/O S S S S S S S S

C6
Utilizes resources as needed S S S S S S S S S

3


Competency
(C)
Course
Outcome
(CO)
1 2 3 4 5 6 7 8 9
Make-
up
C9, CO2 Demonstrates responsibility and accountability for
professional behavior:
1. Performs safely in clinical.
S S S S S S S S S
C3 2. Prepared for clinical (Appropriate attire, appropriate
tools such as stethoscope, skills list, evaluation tool,
assessment tools).
S S S S S S S S S
C4 3. Takes initiative in making decisions and assuming
responsibility for decisions.
S S S S S S S S S
C3 4. Looks for opportunities for continued learning and self-
development.
S S S S S S S S S
C4 5. Identifies behaviors and attitudes influencing
professional behavior.
S S S S S S S S S
C1 6. Demonstrates growth in coping with stressful situations
in a calm and dependable manner.
S S S S S S S S S
C1
7. Maintains patient confidentiality. S S S S S S S S S
C3
8. Completes and submits assignments on time. S S S S S S S S S
C2
9. Organizes and manages time effectively. S S S S S S S S S
C4
10. Attends and participates at post-conference. S S S S S S S S S
Instructor Initials JT JT JT JT JT JT JT JT JT
Student Initials JV JV JV JV JV JV JV JV JV
4






Week Instructor Comments (Include Date/Signature)
1
Jason, unfortunately I was unable to spend much time with you during this clinical rotation. However, that being
said, you took it upon yourself to seek out opportunities to observe the RN in completing skills and caring for
patients. I feel that you did perform safely in clinical and that you were able to ask questions from the nurses on
the floor.
Jenny Tausch RN MSN PCCN 1/18/2014
JV
2
I feel that this week I was able to spend more time observing you in the clinical setting. Each time I entered the
unit, I found you emerged in some type of learning experience. You were seeking out opportunities to learn and
asking the nurses questions regarding charting and patient care. I also sensed that you were becoming more
comfortable in the clinical setting. Keep looking to learn and asking questions as this will only assist you in
becoming a more competent confident student nurse.
Jenny Tausch RN MSN PCCN 1/26/2014
JV
3
Jason, I can tell that you are paying attention to my feedback and making changes each week. It is obvious that you
are making progress and beginning to put the pieces together. Remember this does come with time and the more
you learn in lecture the easier this will become. Nice job on your assessments and interventions. Continue looking
for ways to improve yourself and for new learning opportunities.
Jenny Tausch RN MSN PCCN 2/2/2014
JV
4
It sounds like you had an exciting week, getting to see an LP and caring for a really sick patient. I think that you did
well under the circumstance. You patient could not communicate with you, yet you were concerned about his
comfort and ensured he was safe. These patients are so fascinating to me, as once his body begins to process the
toxins he might clear up and become alert and oriented again. I feel that you care plan and patho paper was
appropriate. Nice job this week, keep up the good work.
Jenny Tausch RN MSN PCCN 2/8/2014
JV
5
Jason, you have such a great attitude when it comes to the clinical setting. I believe that you have had to start over
more than once due to discharges and you are always willing to do the work. It is important to have that kind of
attitude in nursing as we always face changes. You did trip up a little this clinical and I believe this was a good
lesson for you, as now you understand just how easy it is to make a mistake. Take this as a learning event, and
grow from it.

Jenny Tausch RN MSN PCCN 2/16/2014
JV
6
Jason, it seems like you had a good clinical experience this week. I feel that your care plan was appropriate and
detailed. Your assessments are very good and organized. I made a comment on your patho paper, just something
to think about for these types of patients in the future. Keep looking for opportunities to grow and new things to
learn
Jenny Tausch RN MSN PCCN 2/22/2014

JV
7
Jason, I love that you are so flexible and adaptable to changes in the clinical setting. I believe that you said "making
lemonade" this is such a great attitude in nursing. You have a good attitude regarding change and are always
willing to help others. I only hear good things from the nursing staff from you. Continue this way and you will do
well as a nurse
Jenny Tausch RN MSN PCCN 3/1/2014
JV
8
Jason, I feel that you are performing well in clinical and that you always have a good attitude. I did make a few
comments on your care plan and patho paper just trying to help you tie things together.
Jenny Tausch RN MSN PCCN 3/8/2014
JV
9
Jason, the staff on 3D were very pleased to have your help during this clinical rotation. This shows how much of a
team player you are. I like that you catch yourself and can take responsibility for your actions. This is so important
in nursing. You did great this term, good luck next term.
Jenny Tausch RN MSN PCCN 3/13/2014
JV
9/1/09sw: revised 20110102kw, revised 12/17/12sw 5