Student Name: Quinlyn Deming

Southwestern Oregon Community College Nursing Program

Nursing 221
Foundations of Nursing: Chronic 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 weekly 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 weekly grade of U, the faculty will review the students
performance and determine whether or not the student will be dismissed from the program.
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Nursing 221 Clinical Evaluation Tool Student Name: Quinlyn

Midter
Compete Final
2 3 4 5 6 m 7 8 9 10 Eval
QSEN ncy Eval
Compet (C) Dates 1/10 1/17 1/24 1/31 2/7 2/1 2/14 2/21 2/28 3/7
en-cies: Course
Attendance: P=Present, A=Absent, T=Tardy P P P P P P P
(KSA) Outcomes
BAH BAH BAH BAH BAH BAH BAH
(CO) Facility/Unit PSU APU ICU ED REU PSU REU
C9 Applies concepts and theory to clinical practice
CO 1, 2, in client care and written assignments:
S S S S S S S S
3 1. Conducts evidence-based health
assessment
2. Collects and monitors a variety of data S S S S S S S S
3. Analyzes and interprets the
data/assessment findings in increasing S S S S S S S S
complex chronic conditions.
4. Recognizes pathophysiological changes and
S S S S S S S S
symptoms
KSA: Patient Centered Care

5. Regularly monitors clients level of comfort

and ability to manage symptoms and S S S S S S S S
symptom distress
6. Prioritizes health problems. S S S S S S S S
7. Develops and uses evidence-based
S S S S S S S S
individualized interventions
8. Develops a plan of care that considers the
individual, family, age of client, functional
issues associated with co-morbidities,
S S S S S S S S
developmental stage, psycho-socio-cultural
issues, capacity for and engagement in self-
health care, and/or learning needs.
9. Evaluates and reflects on plan of care for
S S S S S S S S
clients with chronic conditions.
CO5, 6 Develops discharge plans in collaboration with
client, family, and other members of the health S S S S S S S S
care community.
C8 Uses therapeutic communication with patients
S S S S S S S S
and agency staff.
C6, 7, 8 Recognize cultural issues and interact with S S S S S S S S
clients in culturally sensitive ways.
 C5

EBP KSA: KSA: Teamwork & Collaboration

CO5

Collaborates with other members of the health

care team to provide comfort and symptom S S S S S S S S
management.

C10 Uses research and evidence to support clinical

S S S S S S S S
CO2 decision making.
ionalism Profess- KSA:

C6,
Utilizes resources as needed. S S S S S S S S
CO4
C4 Able to identify/define leadership skills for
S S S S S S S S
nurse's role
C9, CO
Exhibits critical thinking skills when prioritizing
1 S S S S S S S S
and delegating patient care.

Compete
ncy
Midter
(C) Final
Course
2 3 4 5 6 m 7 8 9 10 Eval
Eval
Outcomes
(CO)

C9, Demonstrate responsibility and

KSA: Safety, Informatics, Professionalism

CO1 accountability for professional behavior: S S S S S S S S

1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope,
S S S S S S S S
skills list, evaluation tool, assessment
tools).
C4 3. Takes initiative in making decisions and
S S S S S S S S
assuming responsibility for decisions.
C3 4. Looks for opportunities for continued
S S S S S S S S
learning and self-development.
C4 5. Identifies behaviors and attitudes S S S S S S S S
influencing professional behavior.
 C1,2 6. Demonstrates growth in coping with
stressful situations in a calm and S S S S S S S S
dependable manner.
C1 7. Maintains patient confidentiality. S S S S S S S S
C8 8. Documentation of client care is
accurate and relevant and consistent S S S S S S S S
with agency policy
C3 9. Completes and submits assignments on
S S S S S S S S
time.
C2 10.Organizes and manages time
S S S S S S S S
effectively.
C4 11.Attends and participates at post-
S S S S S S S
conference.
Instructor Initials JT JT JT JT JT JT JT JT JT
Student Initials QD QD QD QD QD QD QD QD QD

Week Instructor Comments (Include Date/Signature) Student

Initials
Quinlyn, this week you cared for a post op patient on the Post-Surgical Unit. Your care plan and patho paper were QD
complete and pertinent to your patient. I really did not have any comments on it for you. During your skill check off, I
2 noticed that you had developed a rapport with your patient and that you appeared comfortable at the bedside. This
was a productive week for you, continue to look for ways to improve yourself in the clinical setting.
Jenny Tausch RN MSN PCCN 1/11/2017
Quinlyn, this week you rotated through our Acute Psychiatric Unit. You were able to witness how their nursing care QD
differs from the floor and how they manage the milieu. You participated in therapeutic communication with your
3 patient and allowed him time to communicate with you (competency 8). Your reflection paper was complete and well
done. I had no comments on it for you.
Jenny Tausch RN MSN PCCN 1/21/2017
 Quinlyn this week you rotated through the Intensive Care Unit and along with the RN cared for a critically ill patient. I QD
feel that you were actively seeking out learning opportunities and that you wanted to know how to care for this type of
4 patient. The staff stated that you did well and they were happy to have you on the unit. Your care plan was complete
and well done, nice job this week, keep up the good work.
Jenny Tausch RN MSN PCCN 2/1/2017
QD
5 Instructor out of town

Quinlyn this week you rotated through the Emergency Department. You were able to see how nursing care differs on QD
this unit and able to practice a number of skills. Your reflection paper was complete and well done; I did not have any
6 comments on it for you. This was a good week for you, keep up the good work.
Jenny Tausch RN MSN PCCN 2/12/2017
Midte Quinlyn is doing well in the clinical setting. She is always willing to learn and to take feedback. I feel that she safely
cares for her two patients. And will do well in the practicum.
rm
Eval Jenny Tausch RN MSN PCCN 2/1/2017
Quinlyn, this week you cared for two patients on the Rapid Evaluation Unit. You were able to manage your time QD
effectively and meet their needs. Your care plan was complete, well done, and I really did not have any comments on it
7 for you. You were able to spend some time with a central line and become more familiar with those. I feel this was a
productive week for you, continue to look for learning opportunities in the clinical setting.
Jenny Tausch RN MSN PCCN 2/18/2017
Quinlyn, this week you rotated through the Post-Surgical Unit and cared for two patients there. I feel that you were able
8 to manage your time and able to provide care to both of them. Your care plan and patho was complete and well done.
Jenny Tausch RN MSN PCCN 2/25/2017
Quinly, this week you cared for two patients on the Rapid Evaluation Unit. You were actively looking for skills to
practice and you were able to care for both of your patients effectively. Your care plan was complete and pertinent to
9 your patient; I had very few comments on if for you. I feel this was a productive week for you, continue to look for ways
to improve yourself as a student and future nurse.
Jenny Tausch RN MSN PCCN 3/4/2017

10

Final
Eval

12/12/12, updated 12/16sw

5