Student Name: Alison Johnson

Southwestern Oregon Community College Nursing Program

Nursing 110
Foundations of Nursing: Health Promotion

Clinical Evaluation Tool

Nursing 110 Clinical Evaluation Tool

Student Name: Alison Johnson

Clinical Week

Compete
ncy (C)
Course
Outcomes
(CO)

C9
CO 1, 2

Dates

Applies concepts and theory to clinical practice in client

care and written assignments:
1. Collects data and conducts a health assessment on a
client.
2. Analyzes and interprets the data/assessment findings.

C4
C3
C4
C1,2
C1,
CO3
C3,
CO8
C2

4
10/2
7

AVA

AVA

AVA

AVA

CFD

N/A

S
S

S
S

S
S

S
S

N/A

N/A

10/6

5
11/3

Prioritizes health problems.

Develops a plan of care that considers the individual,
family, age of client, developmental stage, psychosocio-cultural issues, and/or learning needs.
Evaluates and reflects on plan of care.

N/A

Uses therapeutic communication with patients and agency

staf

Recognizes cultural issues and interact with clients in

culturally sensitive ways

Uses research and evidence to support clinical decision

making

N/A

Utilizes resources as needed

5.

C3

3
10/2
0

6
11/1
0

Attendance: P=Present, A=Absent, T=Tardy

3.
4.

C 8, CO
5
C 6,7,8
CO 1,4
C10,
CO2
C6,
CO2
C9,
CO2

2
10/1
3

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 selfdevelopment.
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.

CC

7
11/17

8
11/2
4

9
12/1

Makeup

C4,
CO8

10. Attends and participates at post-conference.

Instructor Initials
Student Initials

PW
AJ

PW
AJ

PW
AJ

PW
AJ

PW
AJ

Key: C=Competency, CO=Course Outcome

2

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.

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)

Avamere; Day one; No passwords to find info on patients but oriented to facility and patients.
Basic care today with blood glucose checks done, some physical therapy observation.
Pamela Wick RNCMSN
Avamere; Blood glucose checks done, bed making and baths done. Still minimal information
regarding patient information but beginning to talk about assessments and performing skin
assessments.

Student
Initials

AJ

AJ

Pamela Wick RNCMSN

AJ
3

Avamere; Beginning to obtain patient information, basic ADLs attended to. Good
communication with your patient and with the staf.
Pamela Wick RNCMSN
Avamere; Collected information on your patient to begin building a care plan, see noted on care
plan for more insight. Good communication with your peers and with staf. Good day.
Pamela Wick RNCMSN
Charleston Fire Department; Great day; You did an excellent job working with the patients that
came in, thank you for the hypoglycemic poster and for the attentiveness to the patrons
Pamela Wick RNCMSN

AJ

AJ

9
Clinic
al
Makeup
9/1/09: rev 05062011: reviewed 9/2014 sw