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LYNCHBURG COLLEGE
DEPARTMENT OF NURSING
BSN PROGRAM
Clinical Performance Evaluation Tool
Junior/Senior level

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Student Name

Faculty.

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Self Evaluation
Faculty Evaluation

Course:

Semester/Year

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Student must obtain a Satisfactory "S" grade in all competencies at the Final Evaluation to pass the Course.

Core Competencies
Focusing on wellness, health promotion, illness and disease management across
the life span in a variety of settings while recognizing the diverse uniqueness of
individuals, providing directed care to individuals with well-defined health
alterations, the student at the end of
, should be able to:

Midterm
S

Nl

Final
Nl
U

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Patient-Centered Care: Program Goal 2; Essential II, VII

Demonstrates respect and sensitivity for patient and family preferences, values
and needs in the provision of holistic care.
Demonstrates caring behaviors
Implements comprehensive, holistic care including patient values, preferences
and needs
Provides patient-centered, culturally sensitive care to individuals and or families
with chronic or acute illnesses within complex health care systems
Assesses the presence and extent of pain and suffering
Demonstrates beginning competency in skills

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Recognizes the boundaries of therapeutic relationships

Teamwork and Collaboration: Program Goal 3, 6 Essentials VI.

Communicates effectively with nursing and interdisciplinary team members to
meet patient and family needs, adapting own style to meet needs of patients,
teams and situations.
Follows communication and documentation practices that minimize risk
associated with handoffs among providers and across transitions in care utilizing
SBAR or agency guidelines
Identifies relevant data for communication with inter-professional team members

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Identifies intra and inter-professional team member roles and scopes of practice

Establishes professional relationships with team members

Identifies need for help when appropriate to situation

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Coordinates and delegates as appropriate the delivery of care for multiple

patients

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Evidence-Based Practice: Program Goal 1; Essential III.

Utilizes appropriate evidence-based practice resources within the context of

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'Content based upon QSEN Competencies and KSA's.

S = Satisfactory
D= Developing
Nl = Needs Improvement
U = Unsatisfactory

Core Competencies

Midterm
D Nl U

Final
Nl U

patient/family care
References clinical related activities with evidence-based literature
Understands the concept of evidence-based practice in determining best clinical
practice
Integrates legal-ethical and policy issues in the delivery of optimal health care

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Quality Improvement Program Goal 7&8; Essential V.

Delivers care in a timely and cost effective manner
Seeks information about processes/projects to improve care (Ql Quality
Improvement)
Identifies and questions inconsistencies in practice at the unit, department,
and/or agency levels

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Safety: Program Goal 2; AACN Essentials II

Incorporates scientific principles, theoretical, and developmental knowledge in
the performance of safe and effective care and performance of skills
Identifies and implements strategies to prevent and analyze errors, increase
safety, reduce risk, and support quality patient and family care
Demonstrates appropriate clinical decision making
Organizes multiple responsibilities and provide care in a timely manner
Demonstrates proficiency in performing comprehensive assessments of the
health status of diverse patients and families
Demonstrates knowledge and skill in the administration of medications using
standardized practice guidelines

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Informatics: Program Goal 4; AACN Essential III

Navigates the (electronic) health record for patient information where appropriate
for clinical setting
Documents clear and concise responses to care in the (electronic) health record,
where appropriate for clinical setting
Identifies information and clinical technology using critical thinking to collect,
process, and communicate data
Manages data, information, and knowledge of technology in an ethical manner
Protects confidentiality of (electronic) health records

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Professionalism: Program Goal 4, 8; Essential VIII

Demonstrates core professional values (caring, altruism, autonomy, integrity,
human dignity, and social justice)
Maintains professional behavior and appearance
Complies with the American Nurses Association Code of Ethics, Standards of
Practice, and policies and procedures of Lynchburg College, Department of
Nursing, and clinical agencies
Accepts constructive criticism and develops plan of action for improvement
Maintains a positive attitude and interact with inter-professional team members,
faculty, and fellow students in a positive, professional manner
Provides evidence of preparation for clinical learning experiences
Arrives to clinical experiences at assigned times
Accepts individual responsibility and accountability for one's own actions and
attitudes
Engages in self evaluation

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NRSG
'Content based upon QSEN Competencies and KSA's.
S = Satisfactory
D= Developing
Nl = Needs Improvement
U = Unsatisfactory

NRSG

Final Comments (Address Strengths and weaknesses)

Student Signature
Faculty Signature

S = Satisfactory
RATING SCALE

D= Developing

NI = Needs Improvement

U= Unsatisfactory

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Almost Never Requires (<10% of the time)

Direction

Guidance

Monitoring

Support

Satisfactory
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Almost Always Exhibits (>90% of the time)
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A focus on the client or system
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Accuracy, safety & skillfulness
Assertiveness and initiative
Efficiency and organization
An eagerness to learn
Developing
Occasionally requires (25% of the time)
Very often exhibits (75% of the time)

Direction
A focus on the client or system

Guidance
Accuracy, safety & skillfulness

Monitoring
Assertiveness and initiative

Support
Efficiency and organization
An eagerness to learn
Needs Im provement
Often requires (50% of the time)
Often Exhibits (50% of the time)

Direction
A focus on the client or system

Guidance
Accuracy, safety & skillfulness

Monitoring
Assertiveness and initiative

Support
Efficiency and organization
An eagerness to learn
Unsatisfactory
Very often requires (75% of the time)
Occasionally Exhibits (25% of the time)

Direction
A focus on the client or system

Guidance
Accuracy, safety & skillfulness

Monitoring
Assertiveness and initiative
Efficiency and organization

Support
An eagerness to learn
Note: ALL Criteria need to be MET at the Developing or Satisfactory Level by the end of the clinical experience (Any student performing at
the NI or Unsatisfactory level at the end of the assigned clinical hours will Not Pass the clinical component of the course and will receive a
Unsatisfactory in Clinical

'Content based upon QSEN Competencies and KSA's.

S = Satisfactory
D= Developing
NI = Needs Improvement
U = Unsatisfactory