PRACTICUM EVALUATION TOOL TEMPLATE

DEPARTMENT OF NURSING
JAMES MADISON UNIVERSITY
Student:

Casey Hughes

Name of Preparer:

Melissa Leisen/Lisa Carmines

Practicum Site:

Well child experiences, UVA Medical Center and

Precious Time family homes

Course #: NSG
451L

Section #: 11

Date:

12/7/15

CLINICAL HOURS

Direct Patient Care:34

Simulation:3

Observation:0

Missed Clinical Hours:0

Precepted:0

Other:8 (orientation)

Grade

Total Clinical Contact Hours:45

Criteria: Students must achieve a passing rating in every outcome in order to pass a practicum course

Pass

Demonstrates satisfactory development of knowledge and skills. Objectives are met consistently and comprehensively, with progressive
independence and self-direction. Shows insight into strengths and areas for growth.

Fail

Mastery of skills and objectives inconsistent. Conduct is unsafe, unprofessional, offensive, or fails to maintain therapeutic alliance with clients or
resource personnel. Fails to construct or submit documentation in a professional or timely manner.
Outcomes/Objectives

Health Promotion/Illness Care: Provide health protection and promotion, risk reduction, disease prevention, illness
care, rehabilitation, and end of life care to diverse populations within a holistic framework in a variety of settings.

Rating
Pass/Fail

1.

Course Objectives: 2, 3, 4 & 5

Behaviors:
Identifies and/or implements developmentally appropriate health teaching based on patient and family needs.
Provides nursing care to children with acute and chronic conditions based on medical orders and established nursing plan of care.
Provide safe nursing care following agency policies.

pass

Student Name: Casey Hughes

NSG Section 11

Page 2 of 9

2. Critical Thinking: Synthesize knowledge, skills, and technology from the established practice and science of nursing,
the biological and psychosocial sciences, and the humanities to engage in critical thinking, clinical reasoning and the
nursing process in the care of clients.

pass

Course Objectives: 4 & 5

Behaviors:
Demonstrates ongoing comprehensive knowledge of child/family based on data collection.

Performs pediatric developmental, physiological and psychosocial assessments in a timely manner.

Implements developmentally appropriate interventions individualized for the child and family.
Analyzes and interprets patient data as demonstrated by written and verbal integration of pathophysiology, diagnostic tests,
medications and lab results.
Identifies and prioritizes appropriate nursing diagnoses using NANDA.
Establishes SMART (specific, measureable, achievable, relevant, time bound) goals and related interventions.
Evaluates effectiveness of interventions.
Identifies and immediately reports data which deviates from normal to appropriate staff and instructor and keeps instructor informed of
changing patient needs.

3. Therapeutic Relationships: Develop caring culturally competent relationships with clients that are sensitive to diverse
personal, socio-cultural, and environmental characteristics, which encourage clients to assume primary responsibility for
health care decisions, and in which the nurse functions as advocate and advisor.

pass

Course Objectives: 1, 3, 5, & 6

Behaviors:
Develops individualized plans of care, incorporating family structure, family dynamics, and home environment.
Implements independent and collaborative nursing interventions based on family and childs needs.

Provides developmentally appropriate play, communication and diversional activities to children.

Demonstrates sensitivity to culture, ethnicity, and religious beliefs through advocacy and respect for family decisions.

4. Communication: Use effective communication and information technology to communicate interpersonal and health
care information.
Course Objectives: 1, 3, & 6

Behaviors:
Communicates and listens effectively to family and child, incorporating developmental considerations and diverse needs.
Charts assessment and medications administered accurately and in a timely manner.
Keeps appropriate staff and instructor updated on activities performed and patient status, utilizing SBAR (situation, background,
assessment, recommendations) or IDEAL (Identify with 2 identifiers; Diagnosis and Current condition; Events or recent changes in
condition; Anticipated changes, what to watch for; Leave time for questions & clarification) format.
Interacts professionally and positively with instructor, staff, patient, family and peers.
Uses technology effectively and professionally only when required for patient care.

pass

Student Name: Casey Hughes

NSG Section 11

Page 3 of 9

5. Professional Role Development: Enhance professional role development.

pass

Course Objectives: 1, 3, 5, & 6

Behaviors:
Prioritizes and manages the care of 1 -2 pediatric patients and their family.
Demonstrates effective time management.

Demonstrates safety and competence in calculation, preparation and administration of medications to children
Can perform nursing skills with an understanding of their underlying concepts.
Accepts responsibility for RN role development.

6. Ethical and Professional Values: Engage in activities to promote self-awareness, self-growth, ethical accountability,
and legal responsibility in the practice of nursing.
Course Objectives: 6

Behaviors:
Respects the child and familys privacy and confidentiality.
Assists staff and peers when needed.
Identifies individual learning needs on an ongoing basis and seeks validation of strengths and weaknesses from instructor.
Documents in a legal, ethically sound, professional manner.
Accountable for mistakes.
Accepts constructive feedback.
Follows JMU and agency dress code.
Punctual
Adheres to agencys policies.
Current Practicum Documentation maintained.

7. Scholarship: Contribute to excellence in nursing care by scholarly contributions through discovery, integration,
application, and teaching. Contribute to excellence in nursing practice by identifying and critiquing research evidence
and integrating it with clinical practice, patient preference, cost-benefit, and existing resources.
Course Objectives: 2, 4, & 5
Behaviors:
Uses resources to promote learning and seeks out new learning opportunities.
Brings information to clinical for student/staff dissemination.
Evidenced based research presented in practice.

pass

Student Name: Casey Hughes

NSG Section 11

Page 4 of 9

Areas of strength:

Respects the child and familys privacy and confidentiality.

Assists staff and peers when needed.
While working with Precious Time family has accomplished and demonstrated strength in all the Therapeutic Relationship domains:
o Develops individualized plans of care, incorporating family structure, family dynamics, and home environment.
o Implements independent and collaborative nursing interventions based on family and childs needs.
o Provides developmentally appropriate play, communication and diversional activities to children.
o Demonstrates sensitivity to culture, ethnicity, and religious beliefs through advocacy and respect for family decisions.
Utilized age-appropriate assessments and care while in well-child setting as well as acute care

Areas for growth:

Charts assessment and medications administered accurately and in a timely manner.

o Was the documenter for simulation did not complete assessment or medication administration in SimChart as required.
The only thing documented was one set of vital signs.

SimChart grade: 80
MCAST final grade: 100
All Precious Time requirements completed and achieved a grade of 70% or higher:
This Practicum Evaluation Tool (PET) reflects a passing grade contingent upon successful completion of all Precious Time clinical hour and
paperwork requirements. The faculty will update the PET once all the requirements have been made. If not all requirements are met by
December 5th, the student may receive an incomplete or a clinical course failure dependent on the nature of the circumstances of not meeting
course requirements. Faculty will advise the student if the requirements are not fulfilled within the designated timeframe.

Simulation Pass/Fail: Did not meet all simulation objectives per role.

Final Grade:

Student Name: Casey Hughes

Date

Week 1
Date: 9/11

NSG Section 11

Page 5 of 9

Specific examples of how course objectives (See PET) were met. Include SLO Number in which
you are referencing.

I attended Ware elementary school on 9/11 to assist with vision screenings.

SLO1 I provided health promotion to elementary school by assisting in vision
screenings. These vision screening help elementary school children to do better in
school by assessing if they have any sort of vision problems. Helping with these
screening made me realize how important it is for schools to provide this sort of health
promotion because this may be the only time these children are assessed for a vision
problem. If the schools are able to assess their visual acuity they can intervene at this
young age so it does not impact their future education and health.
This is very true. I think many parents assume their young childs vision is fine if they
dont complain that they cant see well. The problem is that kids dont know what
normal vision is so they dont always realize things are blurry or that they should be
able to see it when they actually cant. In addition, many families dont have the money
for eye exams as not all health insurance covers vision. This is such a necessary service
that schools provide and Im glad that you could help with these screenings. (LC)
SLO3 I created therapeutic relationships with the elementary school children in order to
help with their vision screenings. I did this by talking to the children about their favorite
things to do, favorite class, how many siblings they have and other things that I could
relate to them about. Talking to them about their family made them more at ease and
also gave me an idea of what their home life is like. I also used games such as follow
the leader in order to get the children from one screening to the next in a timely manner.
It was interesting to see where these children were at developmentally just through
talking to them about everyday things.
It sounds like you used age and developmentally appropriate communication and
activities with these children. (LC)

SLO4 I used effective communication with the children by assessing their skill level and
describing instructions in a way that they could understand. I communicated how to do
the vision screenings. I also helped to bring the children to different screenings and back
to their classrooms.

Number of clinical hours by

classification (See Clinical
Hours Defined)
2 hours

Student Name: Casey Hughes

NSG Section 11

Page 6 of 9

SLO 6 I used professional values by helping the school nurse where I was needed. I
assisted with both vision screenings and walking children back to their classrooms when
it was needed. I acted in a professional manner with everyone at the elementary school
by respecting their rules. I also wore professional attire by going in my scrubs with my
name tag and hair up.

Week 2
Date: 9/18

I helped with hearing screenings at Nathaniel Greene ES. We tested

preschoolers ability to hear.
SLO2 critical thinking was used when we decided that we would use two
nursing student per one preschooler. One student would sit next to the child and help put
on the earphones, explain directions, and keep the child calm. The other student would
press the button for each sound level and then record whether or not the child could
hear. This process was much more effective because we were better able to help the
children. It was sometimes difficult to get the child to understand and follow the
directions for the hearing test.
When this occurred I would use SLO 4 communication by trying to connect with
the child. I would discuss what their favorite food or subject was to try and get them
more comfortable being around us. This was usually effective with the child and we
were able to complete most of the hearing screenings in a timely manner.
I was able to complete SLO7 scholarship by using information we learned in
class to apply to the hearing screenings. Sometimes children would understand the
directions of the hearing screening but they were just not able to hear the sound. In that
case they would have to see the nurse and many of them either had earwax in their ears
or had a cold that was preventing them from hearing at their best. If the child was
pulling on their ear or seemed to be sick it was likely that they could not hear the sounds
from the hearing test.
I completed the SLO6 of ethical and professional values by maintaining the
childrens privacy and not discussing anything outside of the nurses office. I also
arrived in my scrubs, with my name badge, and hair pulled up. I was professional with
the school nurse and teachers that assisted us with the screenings by helping with
anything they asked and thanking them at the end of the day.

4.5 hours

Student Name: Casey Hughes

NSG Section 11

Page 7 of 9

I accomplished SLO1 health promotion and illness care by using hand sanitizer
between each child we tested. This experience of testing both vision and hearing in
students was very beneficial to my pediatric clinical experience. I was able to perform
nursing skills as well as communicate and build relationships with the students.
Hearing well is so vital to a childs development and we often take this for granted.
Speech development relies on good hearing and often children who are speech delayed
are actually having hearing loss from things like ear wax or pressure from ear infections.
In addition, prior to diagnosing any sort of learning disability, it is important that
students can hear as often the reason they dont understand is they cant hear the
directions. This is a vital service the school offers and I am glad you were able to
participate. Good job with working in pairs to help make the children more
comfortable. (LC)
Week 3
Date: 10/16

I attended clinical at UVA.

SLO 7 scholarship was completed during this clinical. At the beginning of clinical we used the
library to look up information on our patient. I researched my patients diagnosis of PraderWilli syndrome and used the knowledge I learned in class to determine patient care goals and
priorities. I also looked up my patients medications in order to know the possible side effects
and the reason for use.
SLO 1 health promotion was completed throughout this clinical experience. I continued to
wash my hands before and after patient care and I used hand sanitizer throughout the day. I
used gloves when assisting the nurse practitioner in removing a patients picc line.
SLO 4 communication was accomplished throughout this clinical day. I remained in contact
with my patients nurse and updated her on vitals and anything the patient needed. I was sure
to ask the nurse if I could assist her with anything for my patients care. I also communicated
with the babys parents since they cannot speak for themselves. I was sure to follow the
parents wishes that I only assist with vitals and watch the nurse do the rest of the patients
care. I respected this wish of the parent because they have the right to refuse care and I want
to make the patient and their parents feel as comfortable as possible.
It is unfortunate that this family didnt let you be more involved in this babys care. I am glad
that you were able to interact with them and work in conjunction with the staff nurse to
perform care. (LC)

5 hours

Student Name: Casey Hughes

Week 4
Date: 10/23

NSG Section 11

Page 8 of 9

I attended clinical at UVA.

5 hours

SLO 5 professional role development was accomplished during this visit. I was able to manage
the care of one patient and use effective time management. I prioritized taking vitals and doing
my patient assessment as soon as we got on the floor. After finishing this assessment I
immediately documented my findings. I then demonstrated safe medication administration by
looking up my patients medications and calculating the safe range for their age group. I then
compared this to the patients medication orders in order to assure that they were in the
recommended dosage.
SLO 2 critical thinking was accomplished when I created SMART goals for my patient care plan.
I created these goals based on my patients demographics and past medical history and made
them attainable. I then evaluated the patient goals with the care that I provided. These SMART
goals helped me to prioritize my patient care and evaluate places for improvement. These
goals were documented in my SIM chart where I also utilizes NANDA to create a nursing
diagnosis specific to my patient. I then researched the pathophysiology of the medical
diagnosis and incorporated it into my SIM chart.
SLO 3 therapeutic relationships was accomplished by communicating with the patient and her
parents. I included the parents in the patient education. I encouraged the patient to consume
more fluids and taught the parents the importance of continuing to offer fluids to their
daughter. This allowed the parents to be involved in their daughters care and allowed me to
form a relationship with the family as a whole.
Good job. (LC)
Week 5:
Date: 11/6

I went to the 4T program at Harrisonburg High school from 8 am until 12.

SLO 1 health promotion and illness care was completed during this visit. I took care of a 3
month old baby. I fed the child and measured how much nutrition they received. I changed the
childs diaper using gloves and washing my hands thoroughly. The child was sick so I continued
to clean their nose and used proper hand washing after this as well. I was able to offer this
child a lot of nursing care and I learned about taking care of this child.
SLO 4 communication was accomplished during this visit. I continued to talk with other
workers in this program about certain childs needs. I also kept them up to date with anything

4 hours

Student Name: Casey Hughes

NSG Section 11

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happening with the children I was watching. They have a board with every childs feeding and
bathroom schedule and I kept that up to date with every child I assisted with.
SLO 3 therapeutic relationships. I was able to form relationships with many children in the day
care. My day ranged from playing with the children to feeding them and changing their
diapers. I feel as if I gained a lot from this experience. I was also able to see the family
dynamics of being a teen mom and how it affects their day. These moms come in during their
lunch and feed their children and spend some time with them. This was a very eye opening
experience for me because I was able to see what it is like for them to juggle both a child and
their schooling.
What a challenging situation to be a parent and a high school student. Im glad that you
recognized the level of commitment it takes to do that. Kudos to these students who manage
to juggle it all and have this supportive resource to care for their children. (LC)
Week 6
Date: 11/20

Pediatric simulation.
SLO 3 therapeutic relationships. During this simulation I was able to form a relationship with
the childs mother. I answered questions she had about her childs care and her illness. I was
able to discuss what was happening and I educated both the mother and child on how to
improve the childs health.
SLO 6 ethical and professional values were accomplished. I arrived on time in my scrubs, with
my name tag, hair pulled up with no jewelry or nail polish. I respected the simulation
equipment. I was able to give constructive criticism to both my own group and the group that
went before me. I feel as if I gained a lot of knowledge in pediatric care from this simulation.
Simulation is a great opportunity for learning. Giving and receiving constructive feedback is
not always easy. I wonder how you felt doing that. (LC)

3 hours