Student Name:

Amy Mendez

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 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 grade of U, the faculty will review the students performance and
determine whether or not the student will be dismissed from the program.

Nursing 221 Clinical Evaluation Tool

Student Name:

.
Compete
ncy
(C)
Course
Outcome
s
(CO)

C9
CO 1, 2,
3

Amy Mendez

Clinical Week
Makeup

Dates

1/15/1
5

1/22/1
5

1/29/1
5

2/5/1
5

2/13/1
5

2/19/1
5

2/26/1
5

3/5/1
5

3/12/1
5

Attendance: P=Present, A=Absent,

T=Tardy

n/a

Facility/Unit

MCU

PSU

Traum
a

ED

APU

OPI

Resour
ce

PSU

NI

Applies concepts and theory to clinical

practice in client care and written
assignments:
1. Conducts evidence-based health
assessment
2. Collects and monitors a variety of
data
3. Analyzes and interprets the
data/assessment findings in
increasing complex chronic
conditions.
4. Recognizes pathophysiological
changes and symptoms
5. Regularly monitors clients level of
comfort and ability to manage
symptoms and symptom distress
6. Prioritizes health problems.
7. Develops and uses evidence-based
individualized interventions
8. Develops a plan of care that considers
the individual, family, age of client,
functional issues associated with comorbidities, 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 clients with chronic conditions.

2/10/1
5
P

CO5, 6

C8
C6, 7, 8
C5
CO5
C10
CO2
C6,
CO4
C4

Develops discharge plans in collaboration

with client, family, and other members of
the health care community.
Uses therapeutic communication with
patients and agency staff.
Recognize cultural issues and interact
with clients in culturally sensitive ways.
Collaborates with other members of the
health care team to provide comfort and
symptom management.
Uses research and evidence to support
clinical decision making.
Utilizes resources as needed.
Able to identify/define leadership skills for
nurse's role

n/o

n/o

n/o

S
3

Compete
ncy
(C)
Course
Outcomes
(CO)

C9, CO
1

C9,
CO1
C3
C4
C3
C4
C1,2
C1

Makeups

Exhibits critical thinking skills when prioritizing

and delegating patient care.
Demonstrate 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.

S
S
S

S
S

C8

8. Documentation of client care is accurate and

relevant and consistent with agency policy
9. Completes and submits assignments on time.
10. Organizes and manages time effectively.
11. Attends and participates at post-conference.

C3
C2
C4

S
S
S

S
S
S

S
S
s

S
S
S

S
S
S

S
S
S

S
S
S

S
S
s

TYF

TYF

TYF

TYF

TYF

TYF

TYF

TYF

TYF

TYF/D
H

Student Initials AKM

AKM

AKM

AKM

AKM

AKM

AKM

AKM

AKM

AKM

Instructor Initials

Week

Instructor include comments that are positive, areas that need improvement or are
unsatisfactory. Reference the course outcomes listed in the syllabus and/or the OCNE
Competencies from the Nursing Student Handbook (Date/Sign all entries)

Student
Initials

1/15/15: I gave you an NI, as you do need to work on integrating your pathophysiology paper a
bit. You seem to understand the disease process well, but I am not seeing the entire patient
being brought into the mix. Remember, you need to integrate everything about the patient: Her
labs, her meds, her ADLs, her psychosocial, etc How do the meds affect labs? How might the
disease process affect secondary issues? This relates to competency #9, which deals with
devising a plan of care that accounts for the whole process within patient- centered care.
Otherwise, your professionalism and demeanor is spot on and you are a pleasure for nurses and
your peers to work alongside. Your medication safety was deemed very safe.
Tracy Fawns, RN, MSN

AKM

1/22/15: Much improvement on your pathophysiology paper. Please do make corrections on your
final care plan, changing the items that I have made comments for on your care plan prep in the
future. Very good professionalism and care for your patients.
Tracy Fawns, RN, MSN

AKM

1/29/15: Clinical canceled by instructor.

AKM

2/5/15: Student absent.

AKM

AKM

2/10/15: Makeup clinical with Dustin Hawk, RN.

2/13/15: Trauma simulation.
Tracy Fawns, RN, MSN.Ed

AKM

2/19/15: Time in the ED. I received excellent feedback from the RNs in the ED about your
enthusiasm and care of patients. Nicely done.
Tracy Fawns, RN, MSN.Ed

2/26/15: APU. Amy- You had quite an experience and some ethical issues come up in clinical this
week. You learned a great lesson regarding HIPAA, and you realized how close to home some
issues can be with regard to a small town and potential personal acquaintances as patients. You
seemed to handle this very well considering the amount of new experiences for you. You
successfully met all competencies and outcomes.
Tracy Fawns, RN, MSN

AKM

3/5/15: OPI. A fantastic experience for you in OPI and tumor board. I think this was a nice chance
for you to observe and participate in intravenous therapy in an intensive area. You successfully
met all competencies for this week.
Tracy Fawns, RN, MSN

AKM

3/12/15: Resource. I wasnt able to catch up with you all day, but I feel your experience was a
good one and very educational.

AKM

Tracy Fawns, RN, MSN

12/12/12: sw, revised 12/6/14sw