Student Name:

Amanda Lindstrom

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.

Nursing 111 Clinical Evaluation Tool

Student Name:

.
Compete
ncy (C)
Course
Outcome
(CO)

C9
CO 1, 2

C1,
CO4
C5,
CO5
C8,
CO6
C4,
CO7

Clinical Week
Dates
Attendance: P=Present, A=Absent, T=Tardy
Facility/Unit
Applies concepts and theory to clinical practice
in client care and written assignments:
1. Collects data and conducts a health
assessment on a client with a chronic illness
2. Analyzes and interprets the data/assessment
findings.
3. Prioritizes health problems.
4. Develops a plan of care that considers the
individual, family, age of client,
developmental stage, psycho-socio-cultural
issues, and/or learning needs.
5. Evaluates and reflects on plan of care.
Applies ANA Code of Ethics in care of chronically
ill
Identifies roles and functions of members of the
health care team involved in providing care for
the chronically ill.
Uses therapeutic communication with patients
and agency staf
Recognizes potential legal and ethical issues
related to client autonomy across the lifespan in
at risk populations.

1/14
P
BAH
MCU

1/21
P

1/28
P

2/4
P

2/11
P

2/18
P

2/25
P

BAHPSU

BAHPSU

BAHMCU

BAHPSU

BAHPSU

BAHRT

ni

ni

ni

ni

ni

ni

ni

na

ni

ni

ni

ni

ni

ni

ni

10

Makeup

C6, 7, 8
CO2
C10
C6

Recognizes cultural issues and interact with

clients in culturally sensitive ways
Uses research and evidence to support clinical
decision making
Utilizes resources as needed

n/o

n/o

ni

ni

ni

ni

na

ni

ni

ni

ni

ni
3

Competen
cy (C)
Course
Outcome
(CO)

C9, CO2

C3

C4
C3
C4
C1
C1
C3
C2
C4

Demonstrates 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.
7. Maintains patient confidentiality.
8. Completes and submits assignments on time.
9. Organizes and manages time efectively.
10.Attends and participates at post-conference.
Instructor Initials
Student Initials

ni

ni

ni

ni

n/o

n/o

n/o

ni

s
s
s
s

s
s
s
s

s
s
s
s

s
s
s
s

s
s
s
s

s
s
s
s

s
s
s
s

s
s
ni
s

mjs
AKL

mjs
AKL

mjs
AKL

mjs
AKL

mjs
AKL

mjs
AKL

mjs
AKL

AKL

10

Makeup

Week
1

2
3

Instructor Comments (Include Date/Signature)

First clinical in acute care. Orients to unit and facility. Works with staf and team mates- care
for 1 patient and identifies nursing
dx.--------------------------------------------------------------------------------------MSperry MSN RNc

AKL

Cares for patient on post surgical unit. Identifies nursing diagnosis and provides personal
cares. Be very careful when describing assessments, and patient behavior. All must be
objectiveassumptions and judgmental phrase should not be included.
--------------------------------------------------------------------------------- MSperry MSN RNc

AKL

I am very concernedyou seem to make several judgmental statement in your care plan and it is
only half complete. Please take the time to follow instructions and complete your care plan and care
prep forms. You mentioned you had worked with an agitated patient about their discharge and
explained it was the doctors fault as they had not come in to sign discharge. As discussed in post
clinical this is not therapeutic communication nor is it supporting your teamyou set your physician
up for patient dissatisfaction over something out of their control. I see this also in your care planning
when you state Goal was realistic and could I believe it could have been attained if pt. had been in
agreement to treatment. As noted on care plan this is judgmental and controllingcare plans MUST
be patient centered meaning we look at what they can do to reach the agreed upon goal.

AKL

Being accountable for actions and decisions is mandatory for the nursing professiontelling the
patient it is due the physicians action and blaming the incompletion of a goal on patient cooperation
are not being accountable for your own actions but blaming others.
The assessment you completed Is vague and subjective be sure to chart objectively.
Lab values must be linked to patient patho/diagnosis and integrated in your care-

Care plan is incomplete- AEB statement are missing and related to statements included medical dx
Please see me or your advisor you need help in these areas and we want to see you progress
OCNE competencies 1 core values, 2 reflection, 5, collaboration, 7- relationship-centered care, 8
therapeutic communication, 9 sound clinical judgment, and 10 using best available evidence
were not present in this care plan or you care of the day these are very important areas of nursing
and in safe patient care----------------- MSperry MSN RNc

There continues to assumptions in your chartingwork on being objective and not

interjecting your thoughts into your assessments and care planning. You need to really look
at your data and begin to recognize how your assessments integrate into your patients
health. exampleyour patient had renal labs, decreased urine output, concentrated urine
yet you did not identify the key nursing dxurinary elimination or electrolyte imbalances.
Your patient was using auxiliary muscles to breath and on continuous O@ monitoring; yet
Gas exchange impairment was not a part of your dx. Use your resourcescare plan book,
internet, school reference books to help you. I recommend you begin working with myself,
your advisor or a classmate to help you begin focusing these care
plans.-------------------------------------------------------------------------------------------------------------MSperry MSN RNc

AKL

Cares for COPD patient- identifies gas exchange as primary dx. Continue working on
integrating patho- using lab values, medications, testing as well as assessment data with
your disease process. Continue working on your documentationyou are including nurse
charting in with your assessments and being very wordy with charting and assessment
information. Practice being clear and concise in all of your nursing assessments and charting.
Watch interventions- you included interventions that have been shown to cause more harm
and have been outdated. Use current resources or ask if you are not
sure----------------------------------------- MSperry MSN RNc

AKL

I see improvement on charting your assessment- there is less nurse charting and more
objective datacontinue removing this additional information from your assessment. Be
objective in your charting and DAR. Be sure to use 2 resources to look up information
especially medications. You indicated you would call the doctor about an interaction between
ocuvite and lovenox yet when I investigated I found no interaction between the 2
medications in 4 sources. When care planning be sure to identify what is the biggest issue of
the day.. if patient is having hyper active tones and BP is stable yet you have a UA with 4+
blood, 2+ protein, WBC in urine and greater than 200 elevated leuk ester, IV ABX, and
Serum WBCs at 17.1 with abdominal paininfection is definitely where you should be
focused. Remember patients change.. reflect on this in your evaluation of your care plan.
You are improving on reflecting on your interventions..now reflect on the prioritizing and how
you would change the plan to be patient
center---------------------------------------------------------------------------------------------MSperry MSN RNc
Follows RT this week. Does paper on likeness and diferences in disciplines- very nicely doneand one care plan on a patient seen today. Improving on incorporating more data to support
dx. During post conference I noted that you were unfocused - please stay on topic during our
post conference time together as a group. During post clini9cal conference time it is an
important to stay focused and bring all pieces together. Continually bringing up a topic, such
as noted poor practice, is negative and distracting. I noticed I was required to redirect you at
least 3 times today. I did not see a reflection on your care plan this week or how your patient
responded--------------- MSperry MSN RNc
Cares for elderly woman with shingles and cognitive issues, Does med pass but does not
recognize the need to crush larger pills nor asked pt how they would like to take pills. An
assumption was made that the pt took all pills at once when in reality she wanted them 2-3
at a time with potassium crushed. Did not recognize the distress pt was feeling taking her
levothyroxine with all other medications. This was a huge issue to patient--- taking the time
to listen and validate would has reduced escalated behavior.
Failed to see significance of IV fluid with potassium added- did not correlate potassium level
with need to add more supplement K+. Please slow down and focus on nursing care- critical
thinking and best practice
Be sure your supporting data is present if it is part of your goallook for the priority dx that
is causing the other 2nutrition would not be a primary although it is in the top 3
anxiety ..although present would be resolved once #1 priority is resolvedHow we prioritize

AKL

AKL

AKL

care greatly efects how are patients progress in health.-----------------------MSperry MSN RNc
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Revised 12/09/15sw
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