Student Name:

Brooke Reavis

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

Student Name:

Brooke
pg. 2

QSEN
Compet
encies:
(KSA)

Clinical Week

Compet
ency (C)
Course
Outcom
es
(CO)

Dates
Attendance: P=Present, A=Absent, T=Tardy
Facility/Unit

KSA: Patient Centered Care

C9
CO1,
2, 5

CO4
C8

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.
Develops discharge plans in collaboration with client,
family, and other members of the health care
community.
Uses therapeutic communication with patients and
agency staff.

MidTer
m
Eval

10/
4

10/
11

10/
18

10/
25

11/
1

11/
3

P
BA
H
ps
u

P
BA
H
mc
u

P
BA
H
FB
C

BA
H
ICU

BA
H
ED

NI

S
S

S
S
S

10

Fina
l
Eval

11/
8

11/
15

11/
22

11/
29

10/
4

N/A

P
BA
H
AP
U

P
BA
H
RE
U

S
S

N/A

N/A

S
S
S

pg. 3

KSA: Safety, Informatics, Professionalism KSA: Professionalism

EBP KSA: KSA: Teamwork & Collaboration

C
6,7,8
CO1
C5
CO3

Recognize cultural issues and interact with clients in

culturally sensitive ways.

N/
O

S
S

S
Collaborates with other members of the health care
team to provide comfort and symptom management.

C10,
CO2
C6,
CO
C4

Uses research and evidence to support clinical

decision making.

Utilizes resources as needed.

Able to identify/define leadership skills for nurse's

role

C9
CO1

Exhibits critical thinking skills when prioritizing and

delegating patient care.

N/
O
N/
O

C9,
CO1

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.

C3
C4
C3
C4
C1, 2

S
S
S
S
S
S

C1

7. Maintains patient confidentiality.

C8

8. Documentation of client care is accurate and

relevant and consistent with agency policy

C3

9. Completes and submits assignments on time.

10. Organizes and manages time effectively.

S
S

NI
S

S
S

S
S

C2

S
S

S
S

S
S

pg. 4

C4

11. Attends and participates at post-conference.

Instructor Initials
Student Initials

JT
BR

JT
BR

JT
BR

JT
BR

JT
BR

JT
BR

JT
BR

JT
BR

JT
BR

Key: C=Competency, CO=Course Outcome, QSEN=Quality and Safety Education for Nurses, KSA=Knowledge, Skills & Attitudes (QSEN
Competencies)

Week

Instructor include comments that are positive, areas that need improvement or are unsatisfactory.
Reference the course outcomes listed in the syllabus, the OCNE Competencies from the Nursing Student
Handbook and/or the QSEN competencies (Date/Sign all entries)
Brooke, this week you cared for a post op patient on PSU. I feel that you were actively seeking new skills to practice
and new things to learn demonstrating competency 3. You were able to work well with the staff and with the other
students on the floor demonstrating excellent teamwork. I did have some comments on your care plan for you to
consider, I feel that your assessments were lacking some and that you need to chart your nursing notes in DAR
format. Overall, this was a good week for you; continue looking for ways to improve yourself as a student.
Jenny Tausch RN MSN PCCN 10/9/2016
Brooke, this week you were able to care for two patients on the Medical Care Unit. I feel that you were able to meet
their needs effectively. I had very few comments on your care plans, some of it was spelling errors, try to watch those,
as it looks unprofessional. One of your patients needed extra attention and was taking up a great deal of your time,
you ensured to provide her with safe and compassionate care, meeting competency 7. This was another successful
week for you.
Jenny Tausch RN MSN PCCN 10/14/2016
Brooke, this week you rotated through the Family Birth Center and was able to care for a post op mom and her new
baby. I feel that you were able to communicate effectively with the nursing staff in to collaboratively care for these
patients (competency 5). Your care plan was complete and pertinent to your patient; I had very few comments on it.
However, you did turn in the wrong care plan at first, so I did give you an NI for completing your assignment on time.
Jenny Tausch RN MSN PCCN 10/22/16
Brooke, this week you were able to help care for an extremely critical patient in the ICU. This patient was familiar with
you, and you were able to remain professional, respectful, and ensured her confidentiality (competency 1). You were
able to see a variety of different things during this rotation, and practiced as a member of the team by assisting staff.
Your care plan was complete and pertinent to your patient. This was a wonderful learning experience for you; I hope
that you feel the same.
Jenny Tausch RN MSN PCCN 10/27/2016
Brooke, this week you were able to spend your clinical rotation in the Emergency Department. Your reflection was
complete and well done. It sounds as if you had quite the experience there. I feel that you were actively seeking out

Student
Initials

BR

BR

BR

BR

BR
pg. 5

Midter
m

skills to practice and new engaging in intentional learning (competency 3). I feel that you are becoming more
confident in your skills and in yourself as a nursing student.
Jenny Tausch RN MSN PCCN 11/5/2016
Brooke is doing well in the clinical setting. She is able to care for two patients, she looks for skills to practice, and she
is able to manage her time effectively. I feel that she is progressing well as a student.
Jenny Tausch RN MSN PCCN 11/3/2016
Instructor out of town.

Jenny TauschRN MSN PCCN 11/5/2016

Brooke, this week you were able to spend your rotation in the Acute Psychiatric Unit. Your reflection page was
complete and well done. It sounds as if you got a good picture of how the unit works and how different the nursing
care is. I glad that you enjoyed it there, and that you were able to learn from it.
Jenny Tausch RN MSN PCCN 11/20/2016
Brooke, this week you were able to care for two patients on the REU. You easily adapted to changing your assignments
after both of your patients were discharged and you took on two new patients with ease. Your care plan was well done
and your assessments were complete even though you only had an hour with him before he was discharged. I feel this
was a challenging week for you, and that you were able to perform as needed, (competency 9). Nice job this week,
keep up the good work.
Jenny Tausch RN MSN PCCN 11/24/2016

BR
BR
BR

BR

10

Final
9/2/09: revised 5/06/11, rev 8/2/16 sw

pg. 6