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Standard I--Communication
1. Communicates pertinent information regarding the patient's condition/concern to
health team members.
2. Communicates effectively in written form (Nursing Process Worksheet is organized
and complete)
3. Communicates effectively in verbal form.
4. Initiates, maintains, and terminates the nurse-patient relationship using principles
of therapeutic communication.
5. Functions as an advocate for the patient/family and communicates family needs to
other members of the health care team.
6. Examines the dynamic interactions between the patient, family, community, and
society.
7. Initiates discussion to identify and resolve interpersonal problems that impact
care.
8. Uses interpersonal skills to enhance patient/family coping abilities.
9. Discusses the ethical issues and approaches the ethical dilemmas that confront
the patient/family and appropriately discusses experience with faculty/preceptor.
10. Delegates appropriately to patient care technician, family, or other team members.
5 (Comment Required) Outstanding: Exceeds Standards
4
Minimal
Standard I-Knowledge
1. Applies knowledge of humanities, physical and social sciences, and nursing when
providing patient care.
2. Applies knowledge of social, cultural, and genetic factors to the care of diverse
populations.
5 (Comment Required) Outstanding: Exceeds Standards
4
Minimal
Standard I-Attitude
1. Consistently demonstrates professional behavior as indicated by preparedness for
rounds, contributing substantively to post conferences, respecting staff, faculty and
preceptors in communication and tone.
2. Provides clinical objectives to preceptor as determined in pre-conference.
3. Preparedness for the clinical day as indicated by timely arrival to clinical in the
required dress code.
4. Focused attention during post conference to peers as well as faculty.
5. Is actively engaged in and seeks out opportunities for learning.
5 (Comment Required) Outstanding: Exceeds Standards
4
Minimal
You have a positive attitude and are eager to learn. You actively sought out learning opportunities
and shared those experiences during post conference with your peers. For example, you shared
what you learned about ITP.
Standard II-Safety
1. Does not make judgmental, discriminatory, or prejudicial statements to the patient,
staff, or faculty.
2. Applies principals of universal precautions, practices specific isolation techniques,
and teaches the reasons for universal precautions.
3. Assesses patients for fall risk and applies principles of safe patient handling.
4. Maintains the patient's physical safety by protecting the patient from harm.
5. Maintains medical and surgical asepsis when doing procedures requiring sterile
technique.
6. Properly identifies techniques and teaches the reasons for universal precautions.
7. Validates the accuracy and appropriateness of orders for nursing/medical care
prior to initiating care.
8. Implements orders accurately and efficiently.
9. Is able to identify potential signs and symptoms of an emergent medical condition
and promptly reports changes in the patient's health status to preceptor and/or
clinical faculty member.
10. Adapts skill performance using principles of theory when necessary.
5 (Comment Required) Outstanding: Exceeds Standards
4
Minimal
Minimal
You are able to critically think to formulate appropriate priority nursing diagnoses based on your
assessment and the patient's history
Minimal
Minimal
guidelines.
3. Implements the written action plan/protocol considering the priorities for each
assigned patient.
4. Standard III-Nursing Process: Intervention/Implementation
5. Implements a teaching plan based on scientific knowledge and utilizes resources
appropriately.
6. Incorporates evidence based research into nursing practice.
7. Practices individualized and culturally competent care.
8. Initiates appropriate referrals as needed.
5 (Comment Required) Outstanding: Exceeds Standards
4
Minimal
Minimal
Minimal
Minimal
Minimal
Comments:
It was a pleasure getting to work with you during your pediatric rotation. Thank you for your hard work
and participation. Best of luck as you complete your preceptorship next semester!
Kayleigh Shelton has reviewed the above evaluation on 6/29/2016 and has provided the
following comment:
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