1

NURS 253 PRECEPTOR FEEDBACK

WRITTEN PERFORMANCE FEEDBACK OCCURS AT WEEK 7 AND WEEK 15
NOTE: Preceptors complete this written feedback form in Week 7 (Mid-term Evaluation) and Week 15 (Final

Evaluation). In Week 4 a discussion of student learning to date occurs; students who Need Development or
are Unsatisfactory in Week 4, 11 or as required, receive written feedback using this form which is submitted to
the Professor/Clinical Teacher.

LEARNING
INDICATORS THAT LEARNING HAS OCCURRED:
OUTCOME
Students will be able
to:
COMPETENT AND SAFE PRACTICE WITHIN A LEGAL AND ETHICAL
FRAMEWORK
i.
1. Model safe,
competent,
and ethical
practice in
compliance
with legal
and
regulatory
frameworks
and the
policies and
procedures
of the
practice
setting.

ii.
iii.

iv.
v.

vi.
vii.
viii.

ix.

Comment

Comply with regulatory standards, relevant

legislation and the practice settings policies and
procedures.
Act in a professional, responsible, ethical and
accountable manner.
Use the three factor and decision making
frameworks to determine strengths and limitations
and when to collaborate and consult with other
professionals.
Integrate evidence-informed practice and a theory
based approach into nursing care.
Assess practices and risk management principles
and take action to ensure safety of clients, self,
and others.
Question and clarify unclear orders or directions
and when uncertain.
Question, clarify or challenge questionable orders,
decisions or actions by others.
Respond in a professional manner to situations in
which there is unsafe, unacceptable or
unprofessional behavior.
Demonstrate understanding about the role of the
nurse within health care.

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY
WEE
K
4

WEE
K
7

WEE
K
11

WEE
K 14

S
S
S
S
S
S
S
S
S

Heidi continues to demonstrate and understand nursing skills and appears

always interested in learning and acquiring new skills. Heidi was able to
report decreased urinary output of a patient and correctly use the bladder
scanner to measure the retention of urine, and with doctor's order perform
bladder irrigation under supervision and continue to monitor. (Assess,
plan, implement and evaluate).

2
LEARNING
OUTCOME
Students will be able
to:

INDICATORS THAT LEARNING HAS OCCURRED:

ACCURATE AND RELEVANT COMMUNICATION

i.
2. Communicate
ii.
using strategies
and technology iii.
to effect
accurate and
timely
information
iv.
sharing
including data,
research, and
v.
other
vi.
information.

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY
WEEK WEE
WEE
WEEK
4
K
K
14
7
11

Contribute to team sharing and discussions.

Document clearly, accurately, concisely in a timely
manner using written and electronic methods.
Use effective communication techniques when
reporting relevant information and providing
feedback to the appropriate members of the
interprofessional heath care team.
Evaluate and refine techniques used to
communicate and share information with clients and
the interprofessional health care team.
Ensure privacy and confidentiality.
Use technology to retrieve information including
research and other date and to obtain and forward
information both within and outside the practice
setting.

Comments
Written documentation by Heidi is clear, precise and noted in the appropriate area ETR
(electronic transfer report). Heidi is also able to give verbal and written report to oncoming
nurse. Heidi uses Medtech to document under worklist of all the care that was performed for
the day for each patient. Heidi ensures and maintains patients' privacy and confidentiality. At
the end of her shifts, Heidi discards all her assigned work sheets in the designated bins at the
nursing station (shred-it).

S
S
S

S
S
S

3
LEARNING
OUTCOME
Students will be
able to:

INDICATORS THAT LEARNING HAS OCCURRED:

CARING RELATIONAL PRACTICE

i.
Establish therapeutic caring, compassionate, and
3. Engage in
culturally safe relationships with clients and health
relational
care team members.
ii.
Establish a caring environment that supports
practice that is
clients in meeting their needs and outcomes,
caring,
managing their illness, or experiencing a peaceful
compassionate
death
and respectful.
iii.
Demonstrate therapeutic use of self to foster client
well-being.
iv.
Utilize relational knowledge and skills, and ethical
principles to support clients and to interact with
health care providers
v.
Use self-awareness to identify the effects that
beliefs, values, and personal experiences have on
relational practice.
vi.
Collaborate with clients, members of the
interprofessional and health care teams; and,
consult appropriately.
vii.
Uphold practices and systems that support the
diversity of clients and of the interprofessional
health care team.
viii.
Provide effective client education.

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY
WEEK
WEEK WEEK WEEK
4
7
11
14

S
S
S
S
S
S
S
S

Comments
Heidi continues to be a part of the health care team and advocate with the ability to get along
with others. Heidi takes action necessary to ensure patient safety which also notes very
confused and sometimes aggressive patients on our unit. Heidi is encouraged to not take
unnecessary risk, however her very positive and supportive altitude is always comforting to the
patients. Heidi's soft spoken voice also contributes to a calm and positive response from
patients, and their visiting families, and also other members of the health care team.

4
LEARNING
OUTCOME
Students will be able
to:

INDICATORS THAT LEARNING HAS OCCURRED:

LEADERSHIP AND ADVOCACY

i.
Evaluate and refine leadership skills to develop
4. Act as a leader
solutions, resolve conflict, create a positive work
and an advocate
environment and organizational culture, and to
to empower
strengthen advocacy role.
ii.
Provide feedback to peers and accept feedback
clients, self, the
from peers and members of the interprofessional
interprofessiona
health care team.
l health care
iii.
Advocate for clients, self, others, and quality
team and to
practice environment.
further the
iv.
Support clients rights for self-determination and
profession.
choice.
v.
Respond appropriately to unsafe, unacceptable,
and unprofessional behaviors.
vi.
Demonstrate public protection and acting in the
interests of the public through collaboration and
consultation with other members of the
interprofessional health care teams.
vii.
Contribute to the creation of quality practice
strategies and solutions.
viii.
Assign, supervise, teach as appropriate, and
provide feedback to unregulated care providers
(UCPs) in collaboration with the interprofessional
health care team.

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY
WEEK
4

WEEK
7

WEEK
11

WEEK
14

S
S
S
S
S
S
S
S

Comments
Heidi seek appropriate help for confused patients by requesting and consulting with other staff
members when necessary. This enhances good relationship with patients and is also a safety
precaution. Heidi also worked with PSW's working as a sitter for one of her patient. Heidi is able
to take report from the assigned PSW and provide appropriate feedback to the PSW. Heidi
respects client's choice and continues to support and encourage independence.

5
LEARNING
OUTCOME
INDICATORS THAT LEARNING HAS OCCURRED:
Students will be
able to:
PLANS OF CARE: MEET CLIENTS NEEDS AND MUTUALLY AGREED
EXPECTED OUTCOMES
i.
Formulates clinical judgments that meet clients
5. Integrate the
unique and changing health needs and
nursing process
priorities, outcomes, and overall condition and
into all aspects
incorporates these into evolving plans of care.
ii.
Devise evidence-informed plans of care that are
of nursing care
holistic and client-centred.
and across
iii.
Use clinical judgment to assess clients, prioritize
diverse practice
needs, outcomes, and nursing interventions.
settings.
iv.
Collaborate in the evaluation, refinement and
modification of plans of care.
v.
Safely and competently perform treatments and
use techniques, and technology autonomously
and in collaboration with clients and members of
the interprofessional health care team.
vi.
Collaborate with the clients across the lifespan
and with members of the interprofessional
health care team to create a client centered plan
of care that is articulated with competence both
in writing and orally.
vii.
Use awareness of own knowledge and skills,
the three factors of nurse, client and
environment and the practice decision-making
framework to guide practice.
viii.
Manage workload, time, and physical resources
to provide effective, efficient and ethical care.

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY
WEEK
WEEK WEEK WEEK
4
7
11
14

S
S
S
S
S
S

S
S

Comments
Heidi is able to care for her assigned patients and deliver adequate nursing care in an
appropriate time. Heidi has expressed she has never inserted a foley catheter before and we
were very excited to finally have the opportunity to insert a foley catheter in both male and
female. Heidi has also discontinued a foley catheter under supervision and changed foley bags.
It was a good learning experience for Heidi as she has never performed the procedure before.

6
LEARNING
OUTCOME
INDICATORS THAT LEARNING HAS OCCURRED:
Students will be
able to:
COLLABORATIVE PRACTICE: INTERPROFESSIONAL HEALTH CARE
TEAMS
i.
Collaborate with clients to determine needs,
6. Collaborate and
mutually agreed health outcomes, approaches to
consult with
care, and to evaluate care.
ii.
Contribute as a member of the interprofessional
clients and the
and health care teams to respond to changing
interprofessiona
client needs and outcomes.
l health care
Consult with and seek out assistance from
team to provide iii.
members of the interprofessional health care
comprehensive
team.
and holistic
iv.
Use teamwork, consensus building, and conflict
health care in a
resolution and leadership skills to meet expected
complex and
client outcomes.
changing
v.
Integrate effective, collaborative, and consultative
environment.
strategies to meet clients needs within a changing
environment.
vi.
Respect the unique role and competencies of all
members of the interprofessional health care
team.
vii.
Collaborate as a member of the interprofessional
health care team to respond to changes in nursing
knowledge and practice and in the health care
environment.

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY
WEEK
WEEK WEEK WEEK
4
7
11
14

S
S
S
S
S
S
S

Comments
During Heidi's clinical experience she has demonstrated teamwork and collaborative strategies
in order to meet and exceed client's needs. Heidi works well with the health care team on the
6WEST unit and often consult with other members so that expected outcome for each client is
met. Heidi has good communication skills and understands the importance of communication in
the nursing care.

7
LEARNING
OUTCOME
Students will be
able to:

INDICATORS THAT LEARNING HAS OCCURRED:

QUALITY ASSURANCE: CONTINUE AND IMPROVE COMPETENCE

i.
Act in the best interests of clients and protect
7. Engage in
clients from harm through collaboration and
Quality
consultation with other members of the
Assurance
interprofessional and health care teams and by
consistent with
through competent and safe practice.
ii.
Commit to Quality Assurance practice to identify
the regulatory
strengths and areas for professional growth and in
framework.
accordance with the regulatory framework (CNO).
iii. Create, implement, and evaluate a learning plan
consistent with the Quality Assurance program
(CNO).
iv. Assume responsibility to seek out feedback for
colleagues and peers and learning opportunities
that foster professional development.
v. Consistently review nursing research and information
about health care to improve competence and to
support clients
vi. Develop professional responses to health care
system changes resulting from advances in
research, technology, and changes in societal and
political forces.

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY
WEEK
4

WEEK
7

WEEK
11

WEEK
14

Comments
Heidi has identified and is aware of her strengths and areas of improvements. Heidi continues
to study nursing theories in order to use critical thinking in a clinical setting. Heidi is very eager
to learn and is excited to obtain new nursing skills including insertion and discontinuation of
foley catheter, peg feed, tracheostomy care.
Heidi assist members of the health care team to remove and accompany patients in and out of
bed, and from bed to the chair in a safe and effective manner and prevent any falls and or
injuries during the transfer of patients while using standard walker and when necessary ceiling
lift.

LEARNING
OUTCOME
Students will be able

INDICATORS THAT LEARNING HAS

OCCURRED:

S = SATISFACTORY
ND = NEEDS DEVELOPMENT
U = UNSATISFACTORY

S
S
S
S
S
S

to:
USE CRITICAL THINKING, PROBLEM-SOLVING and DECISION-MAKING
EFFECTIVELY
i.
Use critical thinking to inform decision
8. Use critical
making in all aspects of nursing care.
thinking, problem
ii.
Use clinical judgment to assess and refine
solving and
assessments in collaboration with the
decision making
interprofessional health care team, formulate
skills to meet the
nursing diagnoses, plan nursing
health care needs
interventions, and outline evaluative criteria.
and expected
iii.
Evaluate and refine critical thinking, problem
outcomes of
solving, and decision-making skills.
clients.
iv.
Integrate knowledge from variety of nursing,
health, and other theory into nursing practice
to provide safe and competent care.
v.
Prioritize effectively.
vi.
Demonstrate professionalism, responsibility,
and accountability.
vii.
Use critical thinking, the practice decisionmaking framework and the nurse-clientenvironment framework to inform clinical
judgments and practice.

WEEK
4

WEEK
7

WEEK
11

WEEK
14

S
S

S
S
S
S
S

Comments
Heidi demonstrates the ability to use clinical judgement to assess and work collaboratively with
the health care team. She continues to practice and implement nursing diagnoses, plan nursing
interventions, and evaluations. She is able to efficiently document using Medtech under nursing
notes. Heidi reports patient behaviour and events in a timely manner.