Drexel University

College of Nursing & Health Professions

Undergraduate Nursing
Clinical Evaluation Form

Nursing 303- Women’s Health Nursing

Student’s Name _______________________________________________________________

Prepared by: __________________________________________________________________

Faculty member or Student
Title:

Clinical Agency/Unit:___________________________________________________________

Quarter: ________________________________ Year: _________________

Directions / Clinical Guidelines

Clinical Evaluation:

The student meets the clinical objectives of the course through clinical practicum and related learning
activities. Objectives are evaluated at the mid-term (formative) and end of the quarter (summative).
Formative Evaluation occurs throughout the instructional process and is diagnostic in nature. The faculty
member will provide continuous feedback to assist in correcting learning deficiencies. Summative
evaluation occurs at the end of the quarter. The faculty member will provide ongoing feedback and
documentation to assist the student in correcting learning deficiencies. The faculty member will provide
feedback on achievement of objectives. The same rating scale for clinical is used for all courses. Each of
the three rating designations is described below:

P – Pass
Consistently demonstrates satisfactory in clinical performance, skill, synthesis of learning and
application of nursing principles. Demonstrates ability to relate and apply knowledge at expected
level.

NI –Needs Improvement (For Use at Mid-Term evaluation only)

Performance is inconsistent, or minimally meets the standards for safe nursing practice,
additional review and remediation is recommended. Any grade of NI must be accompanied by a
written remediation plan developed by the Clinical Instructor. A Clinical Communication Form
or Clinical Warning Form, if warranted, will be issued to clarify expectations, provide objectives
and establish a timeline for progression to be accomplished by the student. The Clinical
Instructor will meet with the student to review the form and the required remediation plan and an
agreement with the timeline established for meeting an acceptable standard of performance. All
required clinical experiences and course objectives must be satisfied by the end of the course and
a grade of P (Pass) or F (Failure) will be assigned at the final evaluation

NO: Not Observed (For Use at Mid-Term evaluation only)

A grade of NO may be given at the midterm evaluation if the student has not been exposed to the
clinical experience required to meet course objectives. The clinical instructor will provide a
written comment for each grade of NO given at midterm. All required clinical experiences and

Revised 6/17/03
 course objectives must be satisfied by the end of the course and a grade of P (Pass) or F (Failure)
will be assigned at the final evaluation.
F – Failure
Demonstrates unsatisfactory clinical performance, consistency, skill, synthesis of learning and
application of nursing principles. Does not demonstrate ability to relate knowledge to clinical
situation at expected level.

Clinical evaluation is based on the student’s attainment of the course clinical objectives. All clinical
objectives are based on the BSN Program Outcomes.

In order to pass the clinical component of the course, a student must achieve a satisfactory rating in all
objectives by the end of the quarter. An unsatisfactory in any clinical objective at the end of the quarter will
result in clinical failure. The faculty clinical evaluation is final.

Attendance: Attendance is mandatory for the clinical practicum. Therefore, clinical absences may
jeopardize the student’s ability to achieve a satisfactory rating for the clinical performance. Any clinical
absence may be required to be made up at the discretion of the faculty. Repeated absences may result in
course failure. Students must notify faculty and nursing unit in the event of absence.

Clinical Behavior/Performance: The faculty member has the authority to remove a student from the
clinical area for unsafe clinical practice or inappropriate behavior.

Clinical Failure: Students whose performance is unsatisfactory in one or more objectives at the end of
the quarter will receive an Unsatisfactory for the clinical component of the course and will receive an “F”
(Failure) for the course regardless of the theory grade achieved.

Directions:

• Students will prepare a self-assessment of their perceived performance in the clinical practicum.
• Both the student and instructor will complete the clinical evaluation form.
• The faculty evaluation is final.

Faculty and student will mark “P” for Pass or “F” for Failure under each criterion. An unsatisfactory
behavior will be described and documented on an attached Clinical Communication Form. A copy of this
form will be attached to the student’s copy as well. Faculty and student will confer at the time each
unsatisfactory behavior is noted.

Faculty and student will also complete the narrative portion of the form regarding strengths and areas to
be improved. Evaluations will be compared in the clinical evaluation conference. Both the student and
faculty copy will be filed in the student’s record at the end of the course.

Student must meet the clinical hours assigned to that course in order to satisfactorily complete the clinical
component.

Students are permitted to fail only one clinical nursing course and repeat the course. A third failure in a
nursing course will result in dismissal from the program

Revised 6/17/03
 Drexel University
College of Nursing & Health Profession
Undergraduate Nursing
Nursing 303- Women’s Health Nursing
Clinical Evaluation Form

OBJECTIVE I S COMMENTS I S COMMENTS

MID- MID- FINAL FINAL
TERM TERM
1. Utilizes the growing compendium of
current knowledge and information
sources from nursing and other
disciplines to learn, to teach, to heal the
sick and conserve health
a. Demonstrates satisfactory preparation
for clinical practicum
b. After obtaining patient assignment, is
able to review pertinent data and
initiate a preliminary plan of care.
c. Identifies common health problems
important to women’s health
d. Discusses the incidence and relevance
of women’s health issues as they occur
across the life span
e. Describes common treatment
modalities and therapeutic
interventions for health alterations of
the childbearing family
f. Utilizes current knowledge, resources,
and the nursing process to provide
comprehensive nursing care
2. Contributes to the profession by
sharing knowledge and skills with
patients, peers and other health
professionals through effective verbal
and written communication
a. Collaborates effectively with other
health care professionals within the
clinical setting and assists in the
 coordination of care with diverse health
care professionals
b. Analyzes the interrelationships of
human responses within the
childbearing family
c. Demonstrates therapeutic
communication and professional
demeanor with patients, families, and
other health care providers
d. Provides comprehensive patient
education to women and their families
e. Obtains report from the RN and
reports all pertinent data to the RN and
clinical instructor in a timely manner
f. Accepts constructive feed back
from instructor & peers and
incorporated into practice
3. Utilizes multiple technologies, such
as the computer and PDA to access
and manage information to guide
professional practice
a.Accesses computer data bases for
patient/community care when
necessary
b.Actively seeks new learning
experiences
c.Accesses medication information
appropriately using the PDA
4. Participates in culturally sensitive
health promotion activities that
contribute to the health and wellness of
the client and/or individual and of the
community
a. Demonstrates sensitivity and
cultural awareness when caring for
diverse populations of women and their
families
 b. Provides culturally sensitive,
effective health promotion information
to women and their families
c. Evaluates the impact of a family’s
culture, spirituality, and health beliefs
on family functioning and nursing care
d. Examines nursing’s responsibility
for promoting, maintaining, and
restoring health of the childbearing
family
5. Participates in ongoing educational
activities related to personal growth,
professional practice and community
service
a. Begins to integrate information
obtained from community and/or
professional groups into clinical
practice
b. Identifies her/his own strengths and
areas for potential growth
c. Demonstrates an awareness of
national organizations that focus on
improving care to women across the
lifespan
6. Applies knowledge and skills
appropriate to the selected area of
career clinical practice
a.Integrates current nursing &
women’s health research into clinical
practice
b.Demonstrates basic nursing care and
health assessment skills when
providing direct patient care.
c.Demonstrates health assessment
skills by performing comprehensive
assessments on women and their
newborns
 Identifies normal physiologic
 changes that occur during
pregnancy, postpartum, and
during the neonate’s transitional
period
 Differentiates between normal
and pathological changes found
on physical assessment of the
woman and/or newborn
d. Describes and provides appropriate
nursing interventions, after a thorough
assessment has been completed
e. Evaluates the effects of nursing
interventions based on evidence and
achievement of patient care outcomes
f. Documents an accurate
assessment for each patient
g. Administers medications
identifying the 5 Rights of
Medication Administration and is
able to demonstrate a thorough
understanding of medications used in
the clinical settings.
h. Administers medications under
direct supervision of instructor or RN
preceptor.
7. Develops personal potential for
leadership in a changing health care
environment
a. Demonstrates problem-solving
skills while maintaining a safe patient
environment
b. Acts as a novice change agent in
the healthcare setting by describing
changes that can be made to possibly
improve patient outcomes
8. Integrates ethical concepts, nurses
code of ethics, principles and
professional standards into practice
within professional and academic
settings
a. Maintains safe nursing practice in
all clinical areas
b. Arrives on time for clinical
experiences and for conferences
c. Practices within a legal and ethical
framework
d. Adheres to hospital and unit based
standards of care
e. Adheres to standards of conduct
described in the Student Handbook
f. Identifies ethical and legal issues
related to women’s health care and
begins to formulate and verbally
express own ethical/moral opinions
g. Discusses legal and ethical
dilemmas originating from health care
problems that confront the childbearing
family
9. Utilizes critical thinking skills to
improve the health outcomes of
patients, families and communities
across the continuum of care
a. Uses clinical inference skills to
prioritize patient care needs
b. Uses problem solving skills to
guide decision making in the clinical
area
c. Utilizes standards of care and
research findings to evaluate the
effectiveness of nursing interventions
for the childbearing family
d. Articulates rationales and outcomes
for nursing interventions, patient
education, and health promotion
endeavors
 Drexel University
College of Nursing & Health Professions
MIDTERM EVALUATION

STUDENT SELF EVALUATION:

STRENGTHS:

AREAS FOR IMPROVEMENT:

COMMENTS:

FACULTY EVALUATION:

STRENGTHS:

AREAS FOR IMPROVEMENT:

COMMENTS:

Faculty Signature ____________________________________________Date

Student Signature ____________________________________________Date

 Drexel University
College of Nursing & Health Professions
FINAL EVALUATION
STUDENT SELF EVALUATION:

STRENGTHS:

AREAS FOR IMPROVEMENT:

COMMENTS:

FACULTY EVALUATION:

STRENGTHS:

AREAS FOR IMPROVEMENT:

COMMENTS:

Faculty Signature ____________________________________________Date

Student Signature ____________________________________________Date

Revised 9_01_2004