Student Name:

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

Nursing 221 Clinical Evaluation Tool

Student Name:

.
Compete
ncy
(C)
Course
Outcome
s
(CO)

C9
CO 1, 2,
3

Rachelle Johnson

Clinical Week
1

Dates

1/15/1
6

1/21/1
6

1/28/1
6

2/4/1
6

2/11/1
6

2/18/1
6

2/25/1
6

3/3/1
6

3/10/1
6

Attendance: P=Present, A=Absent,

T=Tardy

n/a

Facility/Unit

PSU

LDRP

No
clinica
l

REU

OR

Resour
ce

OPI

ICU

APU

Applies concepts and theory to clinical

practice in client care and written
assignments:
1. Conducts evidence-based health
assessment
2. Collects and monitors a variety of data
3. Analyzes and interprets the
data/assessment findings in increasing
complex chronic conditions.
4. Recognizes pathophysiological changes
and symptoms
5. Regularly monitors clients level of
comfort and ability to manage
symptoms and symptom distress
6. Prioritizes health problems.
7. Develops and uses evidence-based
individualized interventions
8. Develops a plan of care that considers
the individual, family, age of client,
functional issues associated with comorbidities, developmental stage,
psycho-socio-cultural issues, capacity
for and engagement in self-health care,
and/or learning needs.
9. Evaluates and reflects on plan of care
for clients with chronic conditions.

Makeup

CO5, 6

C8
C6, 7, 8
C5
CO5
C10
CO2
C6,
CO4
C4

Develops discharge plans in collaboration

with client, family, and other members of
the health care community.
Uses therapeutic communication with
patients and agency staff.
Recognize cultural issues and interact with
clients in culturally sensitive ways.
Collaborates with other members of the
health care team to provide comfort and
symptom management.
Uses research and evidence to support
clinical decision making.

Utilizes resources as needed.

Able to identify/define leadership skills for

nurse's role

S
3

Compete
ncy
(C)
Course
Outcome
s
(CO)

C9, CO
1

C9,
CO1
C3
C4
C3
C4
C1,2

Makeup

Exhibits critical thinking skills when prioritizing

and delegating patient care.
Demonstrate 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.

C1
C8

7. Maintains patient confidentiality.

8. Documentation of client care is accurate and
relevant and consistent with agency policy
9. Completes and submits assignments on time.
10. Organizes and manages time effectively.
11. Attends and participates at post-conference.

C3
C2
C4

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

TF
RJ

TF
RJ

TF
RJ

TF
RJ

TF
RJ

TF
RJ

TF
RJ

TF
RJ

Week

Instructor include comments that are positive, areas that need improvement or are
unsatisfactory. Reference the course outcomes listed in the syllabus and/or the OCNE
Competencies from the Nursing Student Handbook (Date/Sign all entries)

Student
Initials

1/14/16: Rachelle- You had a successful day in clinic today, with two patients on PSU. You performed an I&O
catheter on an anatomically difficult female patient and did wonderfully at this. Your care plan was solid, with
inclusion of the corrections we had discussed during the clinical day and at post conference. Again, your patho
paper was quite well done! You successfully met all clinical day outcomes & competencies, as noted above.
Tracy Fawns, RN, MSN.Ed

RJ

1/21/16: Rachelle- My time was limited with you in clinical today, but the feedback I received from the staff was very
positive. You successfully passed all clinical day outcomes and competencies.
Tracy Fawns, RN, MSN.Ed

RJ

1/28/16: No clinical; instructor absent.

RJ

2/4/16: Today was on REU with two patients who both were similar (yet different) with chest pain/cardiac

RJ

3
4

complications. I was able to spend more time observing your interactions with staff and patients today and you were
quite professional, mindful, and efficient. Your upbeat and positive attitude is a delight to observe and I can see that
it puts the people around you at ease. Your day changed spontaneously with a visit to the cardiac cath lab to view
stenting of your patient, and a pacemaker insertion with another patient. Your care plans were excellent. As far as
the clinical day outcomes and competencies, these were all successfully passed as noted above. Nicely done,
Rachelle.
Tracy Fawns, RN, MSN.Ed

2/11/16: OR observation today. As you heard from Melissa (OR nurse) and I early in the day, nursing is really about
being flexible. Things change so fast! And, you were completely flexible with the change in the surgical procedures
you would be watching during your day. This does add an element of anxiety, as you were unfamiliar with all
aspects of the surgical procedures that you hadnt been scheduled to watch, but you did wonderfully. Your care prep
was very good, and even added an additional 4th nursing diagnosis when you woke up because you had been
thinking about your patient all night. You successfully passed all clinical day competencies and outcomes (noted
above), and you were very professional, cheerful, safe, and mindful during your clinical day.
Tracy Fawns, RN, MSN.Ed

RJ

2/18/16: Another day of being completely flexible! Your day started with resource, to APU, to the cath lab, and back
to resource. Your cath lab patient would have gone back to ICU after procedure for STEMI. However, she passed on
the table and you were not able to follow her. Instead, you were able to follow the ICU RN as he transitioned to
resource RN for the day. You had a busy day, with a lot of great experiences, and a couple of great questions by you
that prompted a hospital-wide investigation into best practice and procedure standards. This is still ongoing. You
did wonderful and remained professional and enthusiastic throughout the day.
Tracy fawns, RN, MSN.Ed

RJ

2/25/16: Well, a rather quiet day on OPI, unfortunately, for you. I was hoping for a port access. Sometimes these
types of days can be very rich in education and information, and I hope that was the case for you. There is always
so much to learn. Your care plan was very well done, even though there was not a whole lot of information about
your patient for you to gather. You still did great! Well done, Rachelle. Im excited to see you become a nurse in the
very near future!
Tracy Fawns, RN, MSN.Ed

RJ

3/3/16: A great learning environment for you today in ICU with an intubated patient with a poor prognosis, and with
family at bedside. Your collaboration and communication with the RN was wonderful, your professionalism was spot
on, and your care was safe and mindful. I did get the chance observe you administer medication through an OG
tube, which was done perfectly. You noticed a safety risk involving the patient ID band not placed on the patient.

RJ

While ICU intubated patients are in restraints and there is little room for the band, policy and safety procedures still
remain the same. We placed the ID band on the patient with confirmation from the family. Well done with this
insight.
Tracy Fawns, RN, MSN.Ed

3/10/16: Your last clinical! Well done this term, Rachelle. Today was a load-and-go with no care plan. This will
somewhat represent what its like during practicum with no knowledge of your patient the night before. Hopefully
this was good taste of what it will be like as an RN when you have to prioritize patient care on the fly. It has been
wonderful to see you translate your knowledge to patient care this term. You successfully passed all aspects of
clinical outcomes and competencies for this day. Nicely done!
Tracy Fawns, RN, MSN.Ed

12/12/12: sw, rev 12/6/14sw

RJ