Course: ADN 140 Nursing Fundamentals FORMATIVE

DES MOINES AREA COMMUNITY COLLEGE

NURSING PROGRAM PRACTICUM EVALUATION

The practicum evaluation tool is used to document the students progress towards meeting practicum competencies
for the course. The evaluation is applicable to all practicum settings where a clinical instructor is present including,
but not limited to, acute care, long-term care, and community. When attending simulated clinical experiences, a tool
specifically designed to evaluate students in simulation will be utilized. The simulation evaluation tool scores will be
incorporated into the students summative practicum evaluation.

The practicum evaluation tool is divided into formative and summative sections. The emphasis during formative
evaluations is on monitoring progress/improvement towards achievement of criteria, whereas summative is a final
evaluation to determine if performance criteria have been met. The student is expected to retain the skills and
abilities of performance criteria achieved in previous courses.

FORMATIVE EVALUATIONS will be completed once (1 time) per week/practicum setting. If the student is in more
than one (1) practicum setting in a week, a formative evaluation will be completed for each practicum setting.
Additional formative evaluations may be completed at the discretion of the instructor. Formative evaluations include
student self-evaluation and instructor feedback. The performance criteria for the formative part of the evaluation
tool are:

SP (Satisfactory Progress) student demonstrates steady, consistent performance related to

identified clinical competencies. Student will receive the number score associated with the
competency.

NI (Needs Improvement) student needs to demonstrate more independent performance of clinical

competency on a continuing basis. Student requires much or repeated assistance/redirection and
requires verbal and/or physical cueing from instructor.
Student will receive a zero (0) for the competency.

Total score and percent will be calculated for each formative evaluation. A percentage of 79 or less requires a
remediation plan. Remediation may be required at the discretion of the instructor at any time regardless of the
percentage.

The SUMMATIVE EVALUATION will be completed at the end of the course. Percent for each formative evaluation
will be totaled and divided by the number of formative evaluations in the course.

In order to pass the practicum component of this course, the student must achieve a total average percentage of 78
or greater.

A total average percentage of 78 or less will result in a failure for the course. The performance criteria for the
summative part of the evaluation tool are:

S (Satisfactory) total average of 78% or greater

U (Unsatisfactory) total average of less than 78%

Completion of the current course requires meeting both practicum competencies and theory components
successfully.

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Course: ADN 140 Nursing Fundamentals FORMATIVE

DES MOINES AREA COMMUNITY COLLEGE

NURSING PROGRAM PRACTICUM EVALUATION
ADN 140 Nursing Fundamentals FORMATIVE EVALUATION

Student ________________Cassidy Vlieger_______________________ Term ____1__________

Date(s) __________3/28-3/29_____________ Clinical Location __Lamoni/Park Ave__________

Using the sub competencies (listed under each Global Concept) as a guide, student will provide one
example of how he/she met each of the seven global concepts. Student needs to address a different sub
competency each week.
Do not use any patient specific identifiers (name, initials, room number).

Communication

S NI
1. Communicates in a respectful manner. 5 0
2. Identifies common nonverbal and verbal therapeutic communication skills. 5 0
3. Identifies appropriate boundaries to develop a therapeutic nurse client relationship. 5 0
4. Identifies barriers to effective communication. 1 0
5. Utilizes appropriate documentation for care provided to clients with guidance. 1 0
Total Possible Points 17
Total points Achieved
Student examples and discussion of how Global concept was met:

For both locations, I was able to ask the teachers if there were any students that had any boundaries that
would make it a little more challenging to learn about the pillowcase project. None of the students did, but it was
good to know as a just in case. I also was able to pick out a couple different students when asking questions so as
not to make it feel like we were favoring one child. I talked to the teacher at the Park Ave elementary and was able
to ask what the students knew for a quiet symbol and I was able to explain to him exactly what we were going to do
with the class.

Safe Practice

S NI
1. Uses principles of safe practice with guidance from faculty or staff 5 0
2. Follows infection control principles. 5 0
3. Recognizes special precautions for safe client care. 5 0
4. Identifies how to prevent injury to self and client. 5 0
5. Identifies how to report safety issues 1 0
Total Possible Points 21
Total points Achieved
Student examples and discussion of how Global concept was met:

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Course: ADN 140 Nursing Fundamentals FORMATIVE

Nursing Process

S NI
1. Collects and identifies client problems based on data collected 5 0
2. Implements nursing plan of care in a timely manner 5 0
3. Identifies goals/expected outcomes and interventions 1 0
4. Identifies the effects of nursing interventions on the client 1 0
Total Possible Points 12
Total points Achieved
Student examples and discussion of how Global concept was met:

Care Across the Life Span

S NI
1. Individualizes assessment based on age of client. 5 0
2. Identifies specific communication skills appropriate for developmental level of the client. 5 0
3. Adapts nursing cares to meet the needs of clients across the life span. 1 0
4. Recognizes individual teaching needs across the life span. 1 0
Total Possible Points 12
Total points Achieved
Student examples and discussion of how Global concept was met:

With teaching elementary classes about being prepared for a natural disaster you have to be able to kind of
imagine yourself at that age and how you act. Then you can tailor your presentation to get the kids more involved. I
presented to fourth and fifth graders and both were great groups. They were very attentive and wanted to learn
more. We didnt use big words to describe things instead we used smaller words that they were more familiar with.

Professionalism

S NI
1. Identifies and follows related policies and procedures with guidance. 10 0
2. Identifies personal behaviors that have a positive or negative effect on client care. 5 0
3. Identifies role within the healthcare team. 1 0
4. Participates in clinical post-conferences/debriefing with direction. 5 0
Total Possible Points 21
Total points Achieved
Student examples and discussion of how Global concept was met:

Everyone in my group all arrived early to make sure that we had everything and that we had enough time to
get mentally prepared to present. I came in my costume for our team and made sure I had our pillowcase since that
was a huge piece of our presentation. I also made sure that I had the other pieces that were required like both
name badges and our stethoscopes. I also made sure that my attitude was upbeat and very cheerful when
presenting and when waiting for my turn. I also helped at the end when we graded all the quizzes from our class.

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Course: ADN 140 Nursing Fundamentals FORMATIVE

Culture

S NI
1. Demonstrates respect for the cultural beliefs and practices of others. 5 0
2. Is aware of personal cultural beliefs, values, and practices that may influence care 5 0
delivery.
3. Recognizes how culture impacts health behaviors of individuals. 1 0
4. Demonstrates understanding of what is culture 1 0
Total Possible Points 12
Total points Achieved
Student examples and discussion of how Global concept was met:

Health Promotion

S NI
1. Identifies how health behaviors relate to client condition. 2 0
2. Identify available community and facility resources. 1 0
3. Collects health promotion information during assessments. 2 0
Total Possible Points 5
Total points Achieved
Student examples and discussion of how Global concept was met:

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Course: ADN 140 Nursing Fundamentals FORMATIVE

Total Points for each Concept:

Communication ____/17

Safe Practice ____/21

Nursing Process ____/12

Care Across the Life Span ____/12

Professionalism ____21

Culture ____/12

Health Promotion ____/5

Total Points Achieved _____/100 = ___________________%

78% or higher = Satisfactory

Less than 78% = Requires remediation

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Student Identified Strengths:

Knew my part in the presentation

Attentive to the other presenters in my group
Helped out kids who had questions about things that were being presented

Student Identified Areas for Growth:

I could have moved around more during my part of the presentation instead of standing at the front. I think that
would have engaged the kids a little more.

Faculty comments:

Areas of Strength:

Identify Areas for Growth.

Faculty Name______________________________ Date________________

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Course: ADN 140 Nursing Fundamentals FORMATIVE

Revised 7/2016, 12/2016