+++++++++

UniversityofSouthFlorida
CollegeofNursing
MidSemester(date):09/28/2014
Final:10/29/2014
Other:___

Undergraduate
Clinical Performance Evaluation Mental Health
Nursing
Student: Vivarian Moulton

Date:

October 29, 2014

Faculty Evaluator (print name and title):

Irene Bembry,MSN, RN

Setting: St. Josephs Behavioral Health

Center
Course Name & Number: NUR3535L

General Evaluation Criteria:

Satisfactory = Performs mental health nursing skills and professional behavior safely and accurately is
observed without supportive cues or with only occasional supportive or directive cues. Applies theoretical
knowledge accurately without supportive cues or with only occasional supportive cues.
Needs Improvement = Performs safely and accurately each time mental health nursing skills and professional
behavior is observed with frequent supportive or directive cues OR performs safely under supervision, but is
not always accurate Applies principles but needs direction to identify application. Focuses primarily on their
own behavior, not on the patient.
Unsatisfactory = Performs mental health nursing skills and professional behavior in an unsafe manner; or is
unable to demonstrate mental health nursing skills and or professional behavior. Requires continuous
supportive and directive cues. Performs in an unskilled manner; lacks organization. Appears frozen, unable to
move, or non-productive. Unable to identify or apply mental health nursing principles. Attempts activity or
behavior, yet is unable to complete. Focuses entirely on own behavior, not on the patient.

Signature of Faculty
Irene Bembry,MSN,RN
University of South Florida College of Nursing Page 1 of 11
Revised for mental health nursing clinical on 1/07 from medical surgical nursing
performance evaluation 12/28/06 from 8/12/05 revision
/var/www/apps/conversion/tmp/scratch_5/313405938.doc

Signature of Student

Vivarian Moulton

University of South Florida College of Nursing Page 2 of 11

Revised for mental health nursing clinical on 1/07 from medical surgical nursing
performance evaluation 12/28/06 from 8/12/05 revision
/var/www/apps/conversion/tmp/scratch_5/313405938.doc

The points illustrated in each section of this evaluation are intended to be examples and are not inclusive of all
requirements to achieve a satisfactorily clinical evaluation.

Faculty

Mid-

Final
N

I. Professionalism/Accountability*****

1. Contacts the clinical faculty member if there are problems that inhibit the learning process
This refers to conflict with facility staff and/or patients. Examples of problems include a student that unable to
complete the assignment or objectives

2. Adheres to policies regarding clinical attendance, promptness and attire as specified by faculty and/or agency
These expectations are outlined in the formal Student Expectations as described in the syllabus. In addition
clinical agencies may have different requirements as far as uniform, shoes, nails, body piercing and hair color,
and background checks. Each student will need to adhere to the policies set forth by their teams institution as
well as those of USF CON.

4. Maintains confidentiality of patients at all times

With the exception of formal post conferences and private student/faculty educational experiences, students
should refrain from discussing patients. Students must adhere to hospital policy and HIPAA guidelines

5. Report errors/incidents promptly to the faculty member and appropriate staff and personnel
In the instance of a medication error in a clinical agency the student needs to comply with the agency rules for
making out incident reports, in addition the clinical faculty and the TC need to be notified immediately and a
plan of action will need to be developed. In the event the student omits relaying this type of information to the
faculty the student will be removed from the clinical site, pending an investigation.

6. Completes assignment prior to reporting off the unit

This includes completing all tasks as well as reporting the patients condition, e.g. glucose, vital signs, etc.
Students are allowed to leave their floor only within the guidelines set forth by their clinical faculty member.
Students should never leave the floor without approval from their preceptor.

7. Incorporates legal and ethical parameters of practice into actions

X
Expectations are adopted from the ANA code of Ethics and Florida State Board of Nursing - Nurse Practice Act

8. Makes ongoing evaluation of performance and progress that contributes to personal and professional growth
Students are expected to complete the weekly journal entry. Students will be expected to make ongoing
thoughtful assessments of their progress. Students are expected to actively participate in post conference
discussions.

9. Demonstrates attitudes and behaviors compatible with accepted norms of professional decorum as defined by
the clinical faculty and preceptor (ANA code of ethics 1.1, 1.5)

3. Submits written assignments as specified by clinical faculty (within the guidelines of the course syllabus)

*****Overriding area of concern an unsatisfactory score in any one area of the Professionalism/Accountability
category will result in a failing grade for this course.

U S

Student
U S

II. Organization Skills

N
N
N
U S
U S
U
I
I
I

1. Identifies either verbally or in writing pertinent data to describe actual or potential health problems of the
assigned patient(s) ( includes history, physical/psychosocial assessment, lab data, diagnostic tests)
By week four students should be able to give an organized description of patients with whom they are
interacting. The student will communicate patient data as indicated in an identifying statement as noted on
the case study guidelines as well as the patients mutiaxial diagnosis as indicated in the clients record, the
student should systematically describe the patients mental status exam.

2. Targets appropriate individuals who have an impact on the patients presenting situation
This includes family and significant others as well as members of the interdisciplinary team; the nursing student
should recognize the roles of the physician, nurse practitioner, interns, residents, charge nurse, staff RN, LPN, X
PCT, and ancillary staff such as phlebotomy, radiology , transporters, clergy, social workers and any other
healthcare team member that contribute to the care of the patient

After week four students will provide a more in-depth and detailed report of the patient(s), that includes
rationales for procedures, interpretation of basic lab work and pertinent tests, medications and side effects.
In addition students should be able to identify nursing diagnoses and interventions appropriate for patient
care. Written work should be organized and reflect a higher level of critical thinking.

3. Identify cues in presenting situations that suggest higher potential for occurrence of problems in activities of
daily living (ADLs) and Global Assessment of Function (GAF) dysfunction or deficits in external resources.

By week four Makes inferences on the ability of patients to perform ADLs and GAF. Students should
be able to make recommendations for future care and resources. Critical thinking questions: What type
of care will this patient need when they leave here? Who will care for them? What assistive devices
might they need? How are they going to get them? What is there family/home life like? Who is the
primary care provider? Mental health provider?
After week four Identifies patient care needs and understands the principals of insurance (e.g. DME,
HMO, & PPO). The student communicates with other team members to identify patient resources.

4. Gathers and organizes information from staff report, the chart and client interaction necessary for successful
implementation of identified mental health nursing interventions for each assigned client.
***** Unsatisfactory in 2 or more of these areas, or needs improvement in 3 or more of these areas will result in
course failure.

III. Patient Assessment

U S

U S

1. Identifies data from history and physical to formulate appropriate nursing diagnoses.
2. Synthesizes history and assessment data as well as diagnostic results into development of nursing diagnoses.

3. Able to prioritize nursing diagnoses based on Maslows Hierarchy.

4. Identifies patients psychosocial as well as physiological needs, integrates psychosocial needs into care plan and
identifies appropriate resources.

5. Identifies patients health education needs, incorporates health education into care plan.

6. Identifies measurable expected patient outcomes, expected patient outcomes are measurable, realistic and
individualized to the patient.

7. Demonstrates understanding of the principles underlying nursing actions appropriate for the student at this point in
X
the curriculum.

***** Unsatisfactory in 2 or more of these areas, or needs improvement in 3 or more of these areas will result in
course failure.
N
N
N
U S
U S
U
I
I
I

IV. Nursing Skills/Interventions

1. Evaluates the patient's response to the nursing/medical actions performed.

a. Utilizes critical thinking skills to prioritize patient needs based on the patients response.

b. Evaluates the outcome of the intervention.

2. Utilizes subjective and objective data to revise their nursing actions

3. Identifies the discharge planning process and needs of the patient upon admission.

a. Student is aware of the discharge planning process and needs.

b. Student assesses the discharge planning needs of the patient upon admission.

N
/
A

4. Performs mental health nursing skills according to agency policy and procedure and lab instruction, adapts
performance using principles of theory when necessary.
***** Unsatisfactory in 2 or more of these areas, or needs improvement in 3 or more of these areas will result in
course failure.

N
N
N
U S
U S
U
I
I
I

V. Safety*****

1. Contributes to a patient care environment free from emotional jeopardy.

b. The student does not make judgmental, discriminatory, or prejudicial statements to the patient, staff, or faculty.
X
For example: Its not my fault you smoked 3 packs of cigarettes a day and now have COPD.

c. The student does not in anyway demonstrate disrespect or inappropriate behavior to the patient, staff, or
faculty. For example: Youre my teacher, not my preceptor, I dont want you in the room watching me.
A raised voice, or yelling, from a student is at all times considered inappropriate and disrespectful. Using a
cell phone (sending text messages or speaking) for personal use while in the clinical setting, Reading a
newspaper at the nurses station, or dozing off in group or in sight of patients.

N/
A

N
/
A

N
/
A

N
/
A

N/
A

a. Utilizes effective therapeutic communication when talking with patients, staff, and faculty.

2. Applies appropriate principles of Universal Precautions, and when applicable:

Isolation Precautions, and utilizes appropriate body mechanics in patient care

Demonstrates proper body mechanics when moving a patient

Demonstrates appropriate and accurate use of gown, gloves, masks, and goggles or face shield

Identifies patients requiring specific isolation techniques and wearing the appropriate personal

protective equipment
Able to identify, apply and teach the reasons for universal precautions, isolation precautions and
appropriate body mechanics.

3. Maintains a patient care area free from physical or environmental hazards at all times. The student maintains
the patients physical safety by protecting the patient from harm.
4. Recognizes and reports changes in patients health status promptly to preceptor and/or clinical faculty member.
a) The student is able to identify potential signs and symptoms of the of an emergency medical or mental
health condition
6.

b) The student identifies a patient at risk for falling.

the student recognizes a physically or mentally impaired patient at risk for falling.

the student recognizes medication risks or other higher level risks for falling.

*****Overriding area of concern an unsatisfactory score in any one area of the safety category will result in a

failing grade for this course.

VI. Documentation

1. Implements the written action plan/protocol considering the priorities for each assigned client. Implements a
teaching plan based on scientific knowledge and utilizes resources appropriately.

N
N
N
U S
U S
U
I
I
I
X

2. Records relevant assessment/observations/actions on all appropriate nursing records and/or written

X
X
assignments in a timely manner per agency protocol.
a) Student uses proper medical terminology in a concise, clear, and thorough manner.
b) Student uses correct spelling and appropriate medical abbreviations
***** Unsatisfactory in 2 or more of these areas, or needs improvement in 3 or more of these areas will result in course failure.

X
X

N
N
N
U S
U S
U
I
I
I

VII. Evaluation

1. Demonstrates judgment in decision-making and priority setting.

2. Initiates, maintains, and terminates nurse-client relationship using principles of therapeutic communication.

a. The student functions as an advocate for the patient/family and communicates family needs to other members
of the health care team.
X

N
/
A

b. The student initiates appropriate referrals as needed.

n/
A

N
/
A

c. The student examines the dynamic interactions between the patient, family, community, and society.

d. The student initiates discussion to identify and resolve interpersonal problems that impact on care.

e. The student uses interpersonal skills to enhance patient/family coping abilities.

appropriately discusses experiences with their faculty and fellow students. The student analyzes the experience
from an ethical standpoint.

4. The student applies knowledge of humanities, physical and social sciences, and nursing when providing nursing
care. The student incorporates evidence based research into nursing practice.

3. The student discusses the ethical issues and approaches to ethical dilemmas that confront the patient/family.
The student identifies an ethical dilemma or issue which has occurred during clinical time. The student

5. The student examines the impact of culture and ethnicity on the patient/family.
The student practices individualized care and demonstrates sensitivity to the familys cultural and ethnic needs
and uses appropriate resources to personalize the nursing care the family receives.

***** Unsatisfactory in 2 or more of these areas, or needs improvement in 3 or more of these areas will result in
course failure.

Comments:
Mid-term Faculty
Ms.Moulton, has demonstrated a willingness to learn and participate in all learning opportunities. She has met the criterion for Nursing 3535L.

Final Faculty:The student has been an engaged student. She has always enlisted the hospital staff with questions about protocol and policy. She
Also noted an error in our intake paperwork. She is an excellent student.

Mid-term Student

Final Student:
It has been an amazing opportunity being on the units an observing and interacting with patients who I otherwise wouldnt have approached
Outside of this facility. One thing that could be improved on is possibly being able to help give medications to patients once we pass check offs;
This will help cement our knowledge from labs.

Overall Rating:

Satisfactory (S)

Needs Improvement

The ANA code of ethics is available to view on-line at http://www.nursingworld.org/ethics/code/protected_nwcoe303.htm

The 2005 Florida State Nursing Statutes are available to view on-line at http://www.flsenate.gov/Statutes/index.cfm?
App_mode=Display_Statute&Search_String=&URL=Ch0464/PART01.HTM

Unsatisfactory