Student Name:

Rachelle Johnson

Southwestern Oregon Community College Nursing Program

Nursing 110
Foundations of Nursing: Health Promotion

Clinical Evaluation Tool

2

Nursing 110 Clinical Evaluation Tool

Student Name:

.
Compete
ncy (C)
Course
Outcomes
(CO)

C9
CO 1, 2

C 8, CO
5
C 6,7,8
CO 1,4
C10,
CO2
C6,
CO2
C9,
CO2
C3
C4
C3
C4
C1,2
C1,
CO3

Rachelle Johnson

Clinical Week
1

Dates

10/09

10/16

10/23

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

Facility/Unit

P
BCV

P
BCV

P
BCV

4
10/30/
14
P
BCV

P
BCV

6
11/1
3
P
BCV

7
11/2
0
P
BCV

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

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

Utilizes resources as needed

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.
3. Prioritizes health problems.
4. Develops a plan of care that considers the individual,
family, age of client, developmental stage, psychosocio-cultural issues, and/or learning needs.
5. Evaluates and reflects on plan of 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.
7.

Maintains patient confidentiality.

5
11/6

9
12/4
P
BCV

Makeup

C3,
CO8
C2
C4,
CO8

8.

Completes and submits assignments on time.

9.

Organizes and manages time efectively.

10. Attends and participates at post-conference.

KLC
RJ

KLC
RJ

KLC
RJ

PW
RJ

PW
RJ

PW
RJ

PW
RJ

PW
RJ

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

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)

10/09/14- PASS- Great job on your first week of clinicals. You were assigned to work with an
uncooperative CAN and made the best of your clinical day. You were able to complete goals set
for the day and communicated well with staf.

Student
Initials

RJ

Krista Lou Cook RN, BSN

10/16/14 PASS- This week you had the opportunity to follow a nurse on the floor. You were
able to pass of CBG checks and vital sign monitoring. You also were able to complete cardiac,
EENT, and skin assessments. You worked well fellow students and staf while looking for
opportunities to practice nursing skills. C9 CO 1-2, C8 CO 5, C6 CO 2, C3-4

RJ
10-2114

Krista Lou Cook RN, BSN

10/23/14- PASS- Another great week in clinicals. You were able to complete a thorough head to
toe assessment and help other caregivers in the facility. Your care plan was well done. It was
been a pleasure working with you the past few weeks. Keep going strong, you have a wonderful
future ahead of you!

RJ
10-2614

Krista Lou Cook RN, BSN

4
10-30-14 Your assessments, medication implications and nursing diagnosis care plan were very
nicely done, good job. See areas for comments. You have a great relaxed manner that puts your

RJ
11-5-14

patients at ease, this is a great benefit. You are very thoughtful in your actions which will help
you along the way. We identified a safety risk with your patient, Im glad that you identified this
and followed through with it
Pamela Wick RN MSN

11/6/14
I can see that you are getting a better grasp of the care plan with diagnosis, and interventions.
We still need to work on the medications efects and assessment. You will progress to 3 nrsg dx
over the next couple of weeks. With a UTI dx I usually think first of things like skin integrity,
because someone who is older may become incontinent due to the UTI, fluid balance, the
patient may be dehydrated d/t decreased fluid intake d/t pain. So just to give you some ideas as
you look at your diagnosis without information from the patient you can draw some conclusions.
You are a very caring person which comes through with your diagnosis, your interactions with
family, clients, staf and peers. Good job today

RJ
12-1114

Pamela Wick RN MSN

11/13/14
This is the care plan that we went over in depth at the shot clinic, be sure to go over those
things we talked about and ask questions as needed to deepen that understanding. You are
doing a great job, in just 6 weeks time you are able to make some conclusions about your
patient and make some decisions regarding care. Good job. Medication administration is a
challenge in this setting, but with careful review and attention to triple checking, you can
accomplish safe administration and patient teaching, so remember adaptation is everything.

RJ
12-1114

Pamela Wick RN MSN

7

11/20/14
Catholic Church shot clinic. Slow but still full of time to absorb the clients we saw, the info that
needs to be given before and after the shot. Education surrounding blood pressures and general

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12-1114

health questions. We also had time to look at your care plan in depth. Thank you for you
reflection. Good job..

HOLIDAY
12/4/14
Very slow today at the nursing home with few admits. Good job on your care plan. You always
bring joy to your patients, and a smile to their face, good job!!!

Pamela Wick RN MSN

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

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