Student Name: Jessica McElravey

Southwestern Oregon Community College Nursing Program

Nursing 111
Foundations of Nursing in Chronic Illness I

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.
 2

Nursing 111 Clinical Evaluation Tool Student Name: Jessica

Midterm Final
2 3 4 5 6 Eval 7 8 9 10 Eval
1- 2-10- 2- 2- 3-
Compete 1- 1- 2-2- 2-9- 3-2-
QSEN Dates 26- 17 16- 23- 10-
ncy (C) 12 19 17 17 17
Competenci 17 17 17 17
Course
es Attendance: P=Present, A=Absent,
Outcome
(KSA) P P P P P P P P P
(CO) T=Tardy
BA BA BA BA BA SWO BA BA BA
Facility/Unit BSH
H H H H H CC H H H
C9 Applies concepts and theory to clinical S
CO 1, 2 practice in client care and written
assignments:
S S S S S S S S S
1. Collects data and conducts a health
assessment on a client with a chronic
KSA: illness
Patient 2. Analyzes and interprets the
S S S S S S S S S S
Centered data/assessment findings.
Care 3. Prioritizes health problems. S S S S S S S S S S
4. Develops a plan of care that considers S
the individual, family, age of client,
S S S S S S S S S
developmental stage, psycho-socio-
cultural issues, and/or learning needs.
5. Evaluates and reflects on plan of care. S S S S S S S S S S
KSA: C1, Applies ANA Code of Ethics in care of S
Professionali
CO4 S S S S S S S S S
sm chronically ill
C5, Identifies roles and functions of members S
KSA: CO5 of the health care team involved in S S S S S S S S S
Teamwork &
providing care for the chronically ill.
Collaboratio
n C8, Uses therapeutic communication with S
S S S S S S S S S
CO6 patients and agency staf
KSA: Safety, C4, Recognizes potential legal and ethical S S S S S S S S S S
Professionali
CO7 issues related to client autonomy across
sm
 the lifespan in at risk populations.
KSA: C6, 7, 8 S
Teamwork & Recognizes cultural issues and interact
CO2 S S S S S S S S S
Collaboratio with clients in culturally sensitive ways
n
KSA: C10 Uses research and evidence to support S
EBP S S S S S S S S S
clinical decision making
KSA: C6 S
Professionali Utilizes resources as needed S S S S S S S S S
sm

Compete
QSEN
ncy (C) Midter
Competenc Final
ies
Course 2 3 4 5 6 m 7 8 9 10 Eval
Outcome Eval
(KSA)
(CO)
Informatics, Professionalism KSA: Safety,

C9, Demonstrates responsibility and S

CO2 accountability for professional behavior: S S S S S S S S S
1. Performs safely in clinical.
C3 2. Prepared for clinical (Appropriate S
attire, appropriate tools such as
S S S S S S S S S
stethoscope, skills list, evaluation tool,
assessment tools).
C4 3. Takes initiative in making decisions S
and assuming responsibility for S S S S S S S S S
decisions.
C3 4. Looks for opportunities for continued S
S 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 S S
influencing professional behavior.
C1 6. Demonstrates growth in coping with S
stressful situations in a calm and S S S S S S S S S
dependable manner.
C1 7. Maintains patient confidentiality. S S S S S S S S S S
C3 8. Completes and submits assignments S S S S S S S S S S
on time.
 C2 9. Organizes and manages time S
S S S S S S S S S
efectively.
C4 10. Attends and participates at post- S
S S S S S S S S S
conference.
Instructor Initials PW PW PW PW PW PW PW PW PW PW
Student Initials JM JM JM JM JM JM JM JM JM
4

Week Instructor Comments (Include Date/Signature)

BAH MCU; 1st day, orienting to floor and unit. Blood sugar testing and registration completed. JM
2 Pamela Wick RNMSN eD
BAH PSU; busy day. Assessment done, sub q inj. Given and A.M meds given. Skills done well. Your care plan is JM
developing, see comments. Over-all you are starting to make those connections with your hard work good job.
3
Pamela Wick RNMSN eD
JM
BAH-PSU; Today was a great learning day. You saw a perfect example of a poorly adjusted
youth who really needed something beyond the medical world, she needed psycological
supportand probably beyond that. She was a challenge, but in this situation you needed to
be very careful to keep emotion out of her care and just realize she is trying to survive. Your
4 care was good, I think she probably related to you. We DCd an IV catheter on another
patient. Your skills are well done. Your care plan is coming along, I think you are seeing the
light and making some good connections. See comments in your care plan, and ask if you
have questions.

Pamela Wick RNMSN eD

 MCU-You were able to give meds, and skills were done safely. Your patient kept you busy. Your care plan is really JM
looking good. You need a little more patho. in the beginning of the actually disease process, what you have is
good just more patho in the one area. Your Assessment and DAR note is good. Your nursing dx. Are good also.
5 Keep up the hard work. You have a great bedside manner and a respectful nice relationship with your peers.

Pamela Wick RNMSN eD

PSU- You are bright and cheerful and so ready to give care, this is so appreciated by the patient and staf, good JM
job. You are safe with your skills and giving medications. You have shown that you consistently observe the 5
rights of medications while giving. Do be sure to work on the 3 rd with the emphasis on teaching. See comment
6 on your care plan, you are doing well with this.

Pamela Wick RNMSN eD

Midterm eval; Great job jog so far this term Jessica. You are meeting all of the competencies, you are safe, your
Midter
care plan is coming along and advancing as required. Your bedside care is thoughtful with good insight.
m Continue the good care and hard work.
Evaluat
ion
Pamela Wick RNMSN eD
MCU- This was an interesting case, but you did a good job with her, maybe your previous early patient assisted JM
you in understanding this patient better? Well she didnt require a lot of physical things she also required more
psychosocial stuf. See comment related to your DAR, the assessment on your care plan. It coming along good
7 job.

Pamela Wick RNMSN eD

REU- Busy day with new learning opportunities; Your patient kept us busy. You did a great job. Your care plan is JM
good. See comments on DAR note and the response related to the nitro given in your interventions. Everything
coming along nicely. Remember to teach with your medication administration including dosage and timing so
8 the patient is well taught.

Pamela Wick RNMSN eD

REU- Very busy day with medications and procedures with your patient. You did a great job, it was a great time JM
to get a lot of skills done and understand how they look at the bedside. You were safe and instructed
appropriately. Your plan looks really good it is coming along really nicely, I did not leave any comments to
9 review, so excellent job.

Pamela Wick RNMSN eD

10 PSU- You have done a good job this term with your care of the patient, safe medication teaching and handling. JM
Your bedside care is safe and thoughtful. You have met the competencies for this term. You have been
 respectful to the staf and have had a lot of good insight into your patient as we progressed through the term,
great job. Your care plan was done well and your assessments were also well done.

Pamela Wick RNMSN eD

Final
Eval
Revised 12/12/16sw
5