XYZ School Clinical Evaluation tool

Clinical Performance Evaluation Tool

Student Name
Ashley Cuoco

Faculty Name Semester 2

Ilana Rabinowitz
Studentmustobtaina3 (75%) and a yes (Y) in allcompetenciesatthe final evaluation for the course.

Core Competencies Score

Students will begin to develop critical thinking abilities utilizing the nursing process in the roles of communicator and
caregiver. Students will learn principles of professional nursing practice and provide direct care to individuals in a
variety of settings while recognizing the diverse uniqueness of individuals with health alterations.

I. Patient-Centered Care
a. Begin to develop an individualized plan of care with a focus on assessment and planning utilizing the 3
nursing process. Begin to Interpret and utilize patient assessment data to modify patient care.
b. Demonstrate caring behaviors. Communicate effectively with client. 2
c. Conduct a basic assessment while eliciting patient values, preferences, needs, with respect for diversity. 3
d. Deliver care based on beginning knowledge of pathophysiology with respect for individual values, 3
preferences, needs, and diversity.
e. Assess the presence and extent of pain and suffering. 3
f. Demonstrate beginning competency in skills. 4
II. Teamwork and Collaboration
a. Develop effective communication skills with all appropriate members of the healthcare team 2
b. Begin to develop collaboration skills in working with the inter-disciplinary team members to address 2
client care needs
c. Participate in pre and post conferences to identify patient needs and methods to deliver care more 2
effectively for the next interaction.
d. Demonstrate awareness of own strengths and limitations as a team member. 2
e. Initiate requests for help when appropriate to situation. 2
III. Evidence-Based Practice
a. Begin to understand the concept of evidence-based practice in determining best clinical practice 3
b. Begins to utilize evidenced-based resources for clinical learning and practice 4
IV. Quality Improvement
Begin to deliver care in a timely and efficient manner. 3
Begin to identify areas and information in the health care setting about processes/projects to improve care 3
(QI).
Begin to understand the importance of variance reporting in how it impacts patient care protocols and risk 3
prevention. For example: Fall Risk
V. Safety
a. Integrate effective use of technology and standardized practices that support safety. 4
b. Implement strategies to reduce risk of harm to self or others. 3
c. Begin to recognize and report abnormal findings 4
d. Recognize and adhere to national patient safety guidelines that affect outcomes for patients and families. 3
e. Perform clinical procedures demonstrating appropriate knowledge and skill. 3
f. Examine the healthcare environment to determine patient and family safety needs 3
*ContentbaseduponQSEN Competencies andKSA’s.
Developed 6/2016
g. Develop the awareness of the impact of unsafe practices by self and others and communicate findings to 2
appropriate healthcare providers.
h. Organize client care in a timely, effective, and safe manner 3
VI. Informatics
a. Navigate the patient written/electronic health record to plan patient care and monitor changes in patient 2
status.
b. Begin to document clear and concise responses to care in the patient written/electronic health record as 3
appropriate to the clinical setting.
c. Manage data, information, and knowledge of technology in an ethical manner. Protect confidentiality of 3
electronic health records.
VII. Professionalism
a. Recognize and begin to demonstrate core professional values (caring, altruism, autonomy, integrity, 3
human dignity, and social justice).
b. Maintain professional behavior and appearance. 3

c. Provide evidence of preparation for clinical learning experiences. 3

d. Comply with the Code of Ethics, Standards of Practice, and policies and procedures of XYZ University, 3
School of Nursing and clinical agencies.
e. Accept constructive criticism and participate in plan of action for improvement. 2
f. Maintain a professional attitude when interacting with inter-disciplinary team members, faculty, and 2
fellow students.
g. Arrive to clinical experiences at assigned times. 3
h. Demonstrate professional behaviors 2
i. Accept individual responsibility and accountability for nursing interventions, outcomes, and other 2
actions.
j. Engage in constructive self-evaluation. 2
k. Assume responsibility for learning. 3
TOTAL SCORE ( of128 points possible) 105

*See clinical evaluation tool guidelines for full descriptions of grades 1-4

(Exemplar must include correlating core numbers I-VII and knowledge, skills, and attitude letter (KSA))
4-exceeds expectations 3-meets expectations 2-below expectations 1-does not meet expectations

Faculty Comments:

You have shown that you have the knowledge and comprehension necessary to care for your patients. However, you
appear to lack therapeutic communication skills and teamwork. It is important for you to communicate with the team
and read through your orders prior to caring for your patients. The way in which you deliver your care is just as
important as the actual care you give.

* Please note there is usually a signature page for faculty in addition to student comments and signature

*ContentbaseduponQSEN Competencies andKSA’s.

Developed 6/2016
Ashley is a second semester nursing student currently taking her first Med/Surg class. Ashley demonstrates exceptional
skills in the classroom; receives As and Bs on all exams and assignments. She is able to show her understanding of the
content that was taught in the classroom when discussing her patients’ case and assessing her patients during clinicals.
She is able to identify abnormalities in her assessments and in the patient’s labs and is aware of what needs to be
communicated to the doctors. She is able to perform basic skills such as administering medications, inserting foley
catheters and changing a wound dressing with supervision. One issue that has been noticed is ineffective handwashing.
Ashley has to be constantly reminded when to wash her hands besides the obvious times when they are visibly soiled. It
has also been noted on several occasions that Ashley has poor bedside manner and communication skills. She appears
to lack compassion and patience when dealing with her patients. She speaks abruptly and does not take the time to
form a relationship with the patients. Although she is aware of the need to communicate her findings to the doctors, she
does not do this is a professional manner. I have heard her sound argumentative with the other nurses and staff
members.

Ashley has shown that she is able to utilize the electronic medical record system proficiently. However, on more than
one occasion she did not refer to the patient’s orders prior to assisting her patients. She also failed to ask for help or
confirm with the nurse that she is able to help the patient with their specific requests. One example is when a patient
asked to be helped out of bed and into the chair. Ashley immediately assisted this patient into the chair and the patient
fell. She was not aware that this patient was on strict bedrest since she did not look at her orders and did not speak with
the patient’s nurse. Another patient asked Ashley for something to eat and she gave the patient a sandwich. This patient
was scheduled for surgery that day and was NPO. The surgery had to be postponed until the following day.

Unfortunately, I will not be able to pass Ashley in the clinical portion of the class.

*ContentbaseduponQSEN Competencies andKSA’s.

Developed 6/2016