Student Name: Alison Johnson

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.

Nursing 111 Clinical Evaluation Tool

Student Name:

.
Compete
ncy (C)
Course
Outcome
(CO)

C9
CO 1, 2

C1,
CO4
C5,
CO5
C8,
CO6
C4,
CO7
C6, 7, 8

Alison

Clinical Week
2

Dates
Attendance: P=Present, A=Absent, T=Tardy
Facility/Unit
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
2. Analyzes and interprets the data/assessment
findings.
3. Prioritizes health problems.
4. Develops a plan of care that considers the
individual, family, age of client,
developmental stage, psycho-socio-cultural
issues, and/or learning needs.
5. Evaluates and reflects on plan of care.
Applies ANA Code of Ethics in care of chronically
ill
Identifies roles and functions of members of the
health care team involved in providing care for
the chronically ill.
Uses therapeutic communication with patients
and agency staf
Recognizes potential legal and ethical issues
related to client autonomy across the lifespan in
at risk populations.
Recognizes cultural issues and interact with

1/19

1/26

2/2

2/9

2/16

P
BAH

P
BAH

P
BAH

P
BAH

P
BAH

1/12/1
6
P
BAH

10

Makeup

CO2
C10
C6

clients in culturally sensitive ways

Uses research and evidence to support clinical
decision making
Utilizes resources as needed

S
3

Competen
cy (C)
Course
Outcome
(CO)

C9, CO2

C3

C4
C3
C4
C1
C1
C3
C2
C4

Demonstrates responsibility and accountability

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

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

S
S
S
S

PW
AJ

PW
AJ

PW
AJ

PW
AJ

PW
AJ

PW
AJ

10

Makeup

Week

Instructor Comments (Include Date/Signature)

AJ

PSU- Type 1 DM. Your patho is good, assessment is done well, some notes made on the medication page. Good
response to the labs, clinical note needs some work, nursing care plan coming along, some insights made. Good
rapport with the staff and your patients.

Pamela Wick RNMSN

AJ
2

REU; PE; You established your pyxis password gave your first medications. Your medication
administration was very good. Your care thorough out the day was also very good with good
attention to the details you outlined in your care plan.

Pamela Wick RNMSN

PSU- Benign colon polyps, anal bleeding; Meds given assessments completed, ADLS completed. Good
3

AJ

job on the care plan. Nice bedside manner and respectful to the staf.

Pamela Wick RNMSN

MCU- Conversion disorder w/ functional left hemiparesis; Care plan well done, you have a good grasp

of the concept. Nice bedside care with attention to ADLs, assessments and medication
administration. Was able to give insulin today, you have a good technique. Now familiar with the
insulin pen. Addendum 2-22-16 I thought you gave insulin to one of Johns (RN) patients either this
week or last, he scanned his badge since I couldnt.

Pamela Wick RNMSN

5

PSU- Small bowel obstruction; Your bedside care is very good, you are very focused and have a good
understanding of what and why you are doing the things you are doing. Your care plans are
thoughtful and well done. Meds given, assessments done, your understanding of the disease process
is developing. Continue to practicing teaching to your patients and sharing in a casual comfortable

Did not
do
insulin.
She was
discharge
d at noon
AJ

way, you are sometimes very quiet still especially as you get nervous. Very nice job on your care
plan.

Pamela Wick RNMSN

MCU- Good day Alison, you have a nice bed side manner and work very well with the staf.
Your understanding of the patient is good. Skills are done well. Your care plan this week was
very well done. You referred to unna boots and I wondered if you remembered why they are
used? We talked about it in class. Also in the last nursing diagnosis your K+ alteration, I
would want you to realize this would become an electrical problem for the heart and possibly
become the most important diagnosis d/t PVCs altering C.O. etc..

Pamela Wick RNMSN

7

9
Revised 12/09/15sw
5

AJ