Student Name:

Jason Villavicencio SN

Southwestern Oregon Community College Nursing Program

Nursing 222
Foundations of Nursing: Acute 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 222 Clinical Evaluation Tool

.
Competency
(C)
Course
Outcomes
(CO)

C9
CO1,2, 5

Villavicencio, Jason

Student Name:
1

Dates

10/7

10/14

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

Facility/Unit

Applies concepts and theory to clinical practice in client care and

written assignments:
1. Conducts evidence-based assessment, using age, developmental
and culturally appropriate communication skills
2. Collects and monitors a variety of data
3. Analyzes and interprets the data/assessment findings in
increasing complex acute 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, developmental stage, psycho-socio-cultural issues,
and/or learning needs.
9. Evaluates and reflects on plan of care for clients with acute
conditions.
CO4
Develops discharge plans in collaboration with client, family, and
other members of the health care community.
C8
Uses therapeutic communication with patients and agency staff.
C 6,7,8
Recognize cultural issues and interact with clients in culturally
CO1
sensitive ways.
C5
Collaborates with other members of the health care team to provide
CO3
comfort and symptom management.
C10, CO2 Uses research and evidence to support clinical decision making.
C6, CO
Utilizes resources as needed.
C4
Able to identify/define leadership skills for nurse's role
C9
Exhibits critical thinking skills when prioritizing and delegating
CO1
patient care.

Clinical Week
4
5
6

9
11/2
5/14
P
Cath
lab

10/
21
P

10/
21
P

11/
5
P

11/1
8/14
P

IMCU

PSU

CGS

REU

OPI

LDRP

NA

NA

NA

NA

S
S

S
S

S
S

S
S

NA
NA

S
S

S
S

NA

NA

NA

S
S
S

S
S
S

S
S
S

S
S
S

NA
S
NO

S
S
S

S
S
S

NA

Make-up

S3

C9, CO1

C3
C4
C3
C4
C1, 2
C1
C8
C3
C2
C4

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. 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.

Instructor Initials
Student Initials
Key: C=Competency, CO=Course Outcome

NO

NO

S
S
S

NI
NI
S

S
NI
S

S
S
S

S
S
S

S
S
S

S
S
S

DH
JV

DH
JV

LE
JV

DH

SW
JV

DH

DH

JV

JV

JV

Make-uSp

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)

You struggled this week. However, you did a good job deal with a difficult nurse. I look forward to seeing you back
on track next week.
Dustin Hawk RN, BSN, PCCN
C9 is a U bc you did not turn in your prep completed and that is considered being unsafe. C3 unfinished prep. Jason
your final care plan was great, but you need to turn in a compete prep. You are struggling with time management
this term, but I know you can pull it together. Keep working hard and it will come together soon.
Dustin Hawk RN, BSN, PCCN
Jason the care plan was well thought out with appropriate changes made to address patient safety. On the care
plan stay away from using vague words like some and diagnosing. Instead of saying thrush say, mucosa
pink/moist/white film. Under safety for nursing diagnose & charting include air mattress setting inflated for correct
wt. I noticed your attentiveness to patient comfort during a long wound mist procedure & ensuring pt pain was
controlled. Team work & communication was well executed with both staff and other nursing students. Printing off
your medication list from your care plan, writing down med times on it and having it in your pocket would help
further improve time management, med administration and serve as a quick reference. One med prompting
needed, organize medication administration times! The two pts thought you were professional, attentive and
caring. They liked that you were happy and smiled. Keeping working hard! Good job! Lisa Edwards RN
Your time management is improving, but keep working on mastering that skill. Rem to try and anticipate needs of
the pts, this will save you so much time. Good job with two very different pts, and admin iv drugs, you demo good
critical thinking skills.
Dustin Hawk RN, BSN, PCCN
11/4/2014 Worked in OPI. Met learning outcomes #3 & 5; competencies #5, 7.1, 8. Your reflection was a nice
overall picture of your day. When you are providing care to a client and implementing interventions, think about
the outcome - how did the client respond to your interventions (dependent or independent), etc. Dependent is an
order that the health care provider writes (give a medication or treatment), independent is what you decide to do
based on your assessment (provide a warm blanket, reposition the client to prevent pressure). We assess and then
implement and then evaluate the outcome. If the outcome wasnt what we hoped for then we need to re-evaluate
and change our plan. Your writing reflected on what you did, but you didnt address the outcome of what you did.
Determining the outcome is an important aspect of the RN role.
Susan Walker, RN 11/8/2014

Student Initials

JV

JV

JV

JV

JV

7
JV

PASS--You are meeting all the OCNE competencies this term. You have done a great job with improving on time
management and prioritization. It was great to see you excited about LDRP, and to put some of your fears aside.
Good job today.
Dustin Hawk RN, BSN, PCCN

JV
9

You ran late today, but did a great job notifying me. You have done a great job this term stepping up your skill level;
its only going to get better from here. Enjoy the break!
Dustin Hawk RN, BSN, PCCN

Clinical
Make-up
9/2/09: revised 5/06/11 sw