Bay College West

Helminen____________________

Student Name__Lynette

Associate Degree Nursing Program

_____Tina Flood_RN BSN_______________

Clinical Instructor

Clinical Evaluation l NURS 134

2016___________________

Semester: ___Winter
Clinical Site: __Dickinson County

Hospital__________________
Absence (s) ______0______________Tardy (s)
_____0________

Profile
Threaded
Concept
Human Needs

Nursing Process

Unsatisfac
tory
Performs a comprehensive nursing
assessment through analysis of
assessment data, physical assessment
data, lab and other diagnostic data
Evaluates for changes in health status and
begins to identify complex needs

Cultural
Competence

Integrates the impact of developmental,

emotional, cultural, religious, and spiritual
influences on health status

Nursing Process

Assesses for changes in health status and

identifies appropriate actions

Satisfact
ory

Needs
Improvement/Specifics

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Nursing Process

Analyzes patients response to

interventions

Nursing Process

Assess discharge needs and ability to

access community resources

Nursing Process

Evaluates patients response to

medications

Nursing Process

Recognizes trends in lab data and takes

appropriate nursing action

Communication

Assesses patient/support person(s)

learning ability, barriers, motivation to
learn, and learning needs prior to teachinglearning

Cultural
Competence

Communication

Implements steps in the teaching process

in increasingly complex patients.

Communication

Participates in meeting goals toward

discharge planning

Communication

Implements and evaluates teaching to

patients identified at risk for complications

Process
Caring
Interventions

Integrates the steps of the nursing process,

evidence-based practice, and critical
thinking in patient care

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Nursing Process

Identifies pathophysiology of the medical

surgical patient and relates to patient
situation

Informatics

Integrates evidence-based practice,

collected through technological resources
and other modalities, in decision-making.

Nursing Process

With assistance, utilizes nursing process

and critical thinking to prioritize and
organize care for one or more patients

Clinical
Judgment

Follows existing care plan to provide for

continuity of care

Professional
Behavior

Seeks guidance in evaluation of care

regimen outcomes

Professional
Behavior

With supervision, provides safe, evidencebased care.

Profession
Communication

Integrates cultural sensitivity throughout

the nursing process

Communication

Utilizes appropriate communication

channels to report relevant assessment
data

Communication

Communicates relevant and complex

information in a concise and clear manner

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to clients and healthcare team members

Clinical
Judgment

Reports medication side effects or

medication inaccuracies to appropriate
member of the health care team and
instructor in a timely manner

Communication

Establishes therapeutic communication

with patients

Communication

Utilizes verbal and nonverbal

communication skills while establishing
caring relationships

Informatics

Demonstrates intermediate computer

literacy related to patient care.

Nursing
Process

Demonstrates with minimal supervision the

ability to perform procedures/skills based
on facility guidelines

Professional
Behavior

Establishes and maintains caring

relationships with patients/support
person(s).

Clinical
Judgement

Safely administers medication with

minimal supervision

Nursing
Process

Evaluates patient response to medications

Professional
Behavior

Maintains human dignity

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Clinical
Judgement

Provides developmentally appropriate

nursing care

Clinical
Judgement

Evaluates for physiological & psychological

safety of patients

Clinical
Judgement

Functions as a patient advocate

Nursing
Process

Implements complex nursing interventions

based upon patient assessment

Profession
Professional
Behavior

Accepts ethical/legal responsibility for own

actions as expressed in ANA Code of
Nursing

Professional
Behavior

Demonstrates self-reflection by:

Examining own ideas, feelings, and

behaviors
Recognizing and accepting learning
opportunity

Professional
Behavior

Accepts responsibility for nursing care

given by self

Professional
Behavior

Maintains confidentiality of all healthcare

information

Professional
Behavior

Functions, with minimal supervision, in the

role of a professional nurse as a member of

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the healthcare team.

Professional
Behavior

Accurately documents nursing cares and

procedures

Professional
Behavior

Utilizes self-reflection for continued growth

in nursing practice.

Professional
Behavior

Demonstrates personal responsibility by:

Arriving on time
Informing both school and agency of
absence/tardiness
Adhering to school and agency dress
code
Following Student Handbook guidelines

Professional
Behavior

Demonstrates honesty in:

Documentation
Performance of skills (meds,
treatments, etc.)
Interaction with others
Clinical paperwork

Collaboration

Identifies and recognizes roles and

responsibilities of members of the health
care team and collaborates with the team
effectively

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Professional
Behavior

Collaborates with patient/family in setting

goals and evaluation

Managing Care

Provides evidence-based, cost effective

patient care

Informatics

Utilizes appropriate technology in provision

of care

Managing Care

Recognizes aspects of safe/unsafe

environment

Managing Care

Provides patient-centered nursing care

Professional
Behavior

Demonstrates beginning level of patient

management, leadership, and
organizational skills by: appropriate
delegation, accepting responsibility and
accountability for own actions, accepting
accountability and responsibility for
delegated nursing actions.

Professional
Behavior

With supervision, accepts legal/ethical

responsibility for nursing care. Follows
agency policy and procedures, functions
within legal scope of a nursing student,
shares pertinent information with agency
staff and instructor

Managing Care

Promotes the rehabilitation potential of the

patient

Managing Care

Maintains environment that supports

patient independence

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Additional Comments: Lynette has done well in clinic and should not have any problems continuing in her education
endeavor. She has good communication skills with her patients, peers, staff and instructor. Lynette prioritizes
patient care with minimal cueing. Efficiently managed care of one or two patients with completing assignments on
time and charts assessments in a timely manner. It has been a pleasure having you in clinic.

Concept Map (Circle) #1 Pass Fail

#2 Pass Fail

Dosage calculation quiz (Circle) #1 Pass Fail

#3 Pass Fail

#2 Pass Fail

Teaching and Discharge Plan (Circle) Pass Fail

I have reviewed the contents of this evaluation and fully understand its implications.
(Circle) Pass Fail Clinical Contract (Attach to Evaluation)
Student Signature: _______________________________________________________________

Date____________________

Clinical Instructor Signature: _______________________________________________________ Date____________________

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