James Madison University School of Nursing

Practicum Evaluation Tool

Student: Emily Suprynowicz Instructor: K. Weeks
Site: SRMH PCU Course #: NSG 356L Term: Fall 2017 Spring Date:
Direct Patient Care: Simulation: Observation: Precepted:
Missed Clinical Hours: Other: Total Clinical Contact Hours:

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Daily Clinical Evaluation
– Formative Evaluation
Exceeds Meets NI Exceeds Meets NI Exceeds Meets Ni Exceeds Meets NI Exceeds Meets NI Exceeds Meets NI

Clinical Preparation (SLO

1,2,3) □ x □ □ x □ □ x □ □ x □ □ x □ □ x □
Critical Thinking Skills
(SLO 1,2) □ x □ □ x □ □ □ x □ x □ □ x □ □ x □
Clinical Technical Skills
and Safety (SLO 1,2) □ x □ □ x □ □ □ x □ x □ □ x □ □ x □
Priority and Organization
Skills (SLO 1,2,3,4) □ x □ □ x □ □ □ x □ x □ □ x □ □ x □
Professionalism
(Appearance, Punctual, x □ □ x □ □ x □ □ x □ □ x □ □ x □
Accountable, Reliable,
Accepting Constructive
Feedback) (SLO 5,6)
Teamwork,
Collaboration, and □ x □ □ x □ □ x □ □ x □ □ x □ □ x □
Advocacy (SLO 2,3,4,5,6)
Actively Participates in
Post Conference □ x □ □ x □ □ x □ □ x □ □ x □ □ x □
Activities and Other
Clinical Assignments
(SLO 1,2,4,5,6,7)
Instructor initials
KW KW KW KW KW KW
Student initials
ES ES ES ES ES ES
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 Formative Feedback/Narrative

Week 1 This is the first day on unit. Thank you for ready to go by 0615. Will continue to work on SBAR and plan of care for patient. Think about what
priority assessments and plan of care for the patient you will be caring for. Will be linking in lecture material to bedside. Worked well with other students.
Good practice today. Heard aortic murmur. Did complete care on pt. See the difference when pt is shaved, hair washed and combed along with bath.

Week 2 Intense day. Had pt that was having abdominal complications. Saw the intraprofessional collaboration (and not so much collaboration) and how
nurses have to advocate for the safety of their patients. Able to see pt intubated, bronchoscopy and CT of abdomen. Pt with NGT, as well as, chest tube.
Did not have med pass; however, did witness other students’ med pass. Did well interacting with patient, family and staff. Continue prepping meds and
thinking about what you need. Be sure to get your vital signs, blood sugars and am care done early (before 10 am). Cont. to work on SBAR and pulling
pertinent information together about your patient.
Week 3 Pre planning was adequate. Be sure to pull concepts in from lecture to the bedside. Take the feedback in post conference and work on future plan
of care. As I said, I do not care how you do it to remind yourself. Able to do foley care. Understand that if you have a foley the care needed. Work on
workflow and incorporating the basics and higher concepts. Good job with taking accountability with your learning.

Week 4 much better week this week. Greatly improved with pre planning and care. Understood ETOH use, meds to treat and CIWA. Remember the
culture of safety in regards to patient safety and your own safety including needles. Practice in open lab and go through all the steps to delivering
injections to reinforce muscle memory. SBAR improving – always work on to make clear and concise.

Week 5 Be sure to include the VATS in SBAR as part of the situation. How many days post op (POD). Pt has loose stools, being on antibiotics, want to test
for ? C diff. Noted BNP – heart failure complicates the surgery aspect. See the importance of foley care especially with a patient with loose stools. Cont to
work on SBAR and skills practice, especially needle safety.

Week 6 Had complex pt today with anasarca. Need to identify IV bags upon initial assessment and looking at the IV bag, date on IV tubing, rate, dose and
then check IV. Understood this principle. Cont to work on this throughout next semester to prepare you for fourth semester.

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 Summative Evaluation
Student Learning Outcomes
Pass/Fail
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.
Clinical Objectives: 1,2,3,5

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.
Clinical Objectives: 1,2,3
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.
Clinical Objectives: 4
Communication: Use effective communication and information technology to communicate interpersonal and health care information.
Clinical Objectives: 4,6
Professional Role Development: Enhance professional role development.
Clinical Objectives: 4,6
Ethical and Professional Values: Engage in activities to promote self-awareness, self-growth, ethical accountability and legal responsibility in
the practice of nursing.
Clinical Objectives: 3
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.
Clinical Objectives: 1,2,3
Final Grade
Skills performed (if applicable)
Instructor comments:

Student comments:

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