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BON SECOURS MEMORIAL COLLEGE OF NURSING

BSN PROGRAM
2014-2015 School Year
NUR 4143 Clinical Immersion
PRACTICUM EVALUATION TOOL
The student will have multiple opportunities in clinical areas to meet practicum outcomes. The
student, preceptor, and faculty will meet at selected times during the practicum to assess progress
toward attaining practicum competency outcomes. Students must attain three (3) or greater on the
practicum evaluation tool in order to pass the practicum. It is expected that students will be active in
the assessment process of their progress. Students need to cite specific examples of how progress is
being made towards the successful achievement of practicum competency outcomes. Each student
will be provided feedback at least once during the semester (formative) and upon completion of the
practicum work (summative).

Student Name:

Preceptor:

Aubrey Moore

Semester:

Franciska Garland

Fall
2015

Year: 201
5

Trina Gardner, Arlene

Faculty: Holowaychuk

Facility: _MRMC Short Stay_____________________

PRACTICUM GRADE (P/F)
Formative (Midterm)

Summative (Final)

Pass
Fail
ATTENDANCE

Pass
Fail

The student must participate in 100% of the 225 practicum hours in order to pass
the course.
Direct Care
Acute

Direct Care
Community

Direct Care
Simulation

BSMCON NUR 4143 Clinical Immersion

Observation

Alterative
Experiences

Other

TOTAL

Definitions for the Rating Scale for Clinical Evaluation Tools

4

Self-Directed: demonstrates reasonable consistency in meeting the competency related to

the five program outcomes; provides safe evidence-based accountable care; demonstrates
ability to individualize nursing care and identify innovative and creative solutions;
documentation is mostly in-depth; routinely embraces the altruistic values of Bon Secours;
meets the expected outcome consistently

Directed: demonstrates a need for faculty intercession in meeting the competency related to
the five program outcomes; provides safe evidence-based accountable care; documentation is
a mix of superficial and in depth; embraces the altruistic values of Bon Secours with direction;
this is average performance where most students fall; meets the expected outcomes with
direction

Remedial: demonstrates inconsistent and unreliable behavior related to the five program
outcomes; documentation is superficial; care is safe but inconsistent; this is below functioning
for a student at this level; inconsistently meets expected outcomes even with detailed direction

Ineffective: demonstrates unreliable behavior, lack of safety, accuracy; documentation

superficial and inaccurate; lack of accurate knowledge; unable to meet expected outcome

**3 or 4 required in ALL areas for successful passing of the Practicum

BSMCON NUR 4143 Clinical Immersion

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FORMATIVE
EVALUATIONS
(midpoint)

PROGRAM OUTCOME
DATE

SUMMATIVE
EVALUATION
(final)

10/9/15

Communication and Collaboration: Engage in communication and collaboration with the

interprofessional health care team
Course Objectives
1. Student creates healing-trusting relationships with
3
patients, families, and interprofessional team members
2. Student actively engages in interprofessional
3
communication and collaboration
3. Student communicates and collaborates effectively
with all members of the interprofessional healthcare team
2
to effectively address system issues
4. Students Objective related to this outcome
3
Communication and Collaboration
Student Comments

Communication and Collaboration

Faculty/Preceptor Comments

MIDTERM DATE: 10/9/15

1. Creation of healing-trusting relationships were
demonstrated by providing therapeutic presence,
listening, and response to a patient in emotional distress,
engaging in honest, open, and encouraging
communication with anxious patients and family
members seeking information, and communicating areas
of personal strengths and weaknesses, willingness to
help team members, and any questions regarding proper
practice to my preceptor and floor nurses.

MIDTERM DATE:

2. Active engagement has been demonstrated by

willingness to and independent initiative in calling report
to and receive orders from physicians, the nurse
manager, CT, OT, dietary, and other units to or from which
patients were being transferred.
3. Multiple demonstrations by preceptor of SBAR reports
to night shift, physicians, CT/PT/OT, dietary, and other
units were required before independent performance was
attempted. Communications are inconsistently efficient,
and some require multiple efforts.
4. Midpoint objective relates to effective communication
and collaboration by including patients and families as a
vital part of the healthcare team, and has been met by
inquiring about patients preferences regarding their care
and encouraging patients and family to ask questions,
call for assistance and express their needs.
FINAL DATE:
1.
2.
3.
4.
BSMCON NUR 4143 Clinical Immersion

FINAL DATE:

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FORMATIVE
EVALUATIONS
(midpoint)

PROGRAM OUTCOME
DATE

SUMMATIVE
EVALUATION
(final)

10/9/15

Caring: Practice empathetic caring within the framework of the Catholic health ministry
Course Objectives
1. Student embraces the altruistic values of Bon Secours,
respects the Catholic health ministry, and practices with
3
loving kindness
2. Student demonstrates the ability to be the caring3
healing environment
3. Students Objective related to this outcome

2
Caring
Student Comments

Caring
Faculty/Preceptor Comments

MIDTERM DATE: 10/9/15

1. Empathy and loving kindness have been demonstrated
by treating all patients equally and with dignity and
respect, including withholding judgment, accepting a
patients definition of pain, providing therapeutic presence
and attentiveness when a distressed patient needed
someone to listen, verbally communicating with an
unresponsive patient, reassuring anxious family members,
taking action on patient and family requests to the best of
my ability, and demonstrating patience, kindness, and
positivity to a patient who was angry with their situation.

MIDTERM DATE:

2. The caring-healing environment has been consistently

established by practicing empathy and loving kindness as
demonstrated in the examples above.
3. Multiple families have been included in care planning
and discharge teaching, encouraged to ask questions and
had their questions answered to the best of my ability, and
have been treated as equals to and partners with both the
patients and staff to empower both the patient and family,
and foster a sense of community between patient, family
and staff.
FINAL DATE:
1.

FINAL DATE:

2.
3.

PROGRAM OUTCOME
BSMCON NUR 4143 Clinical Immersion

FORMATIVE
EVALUATIONS

SUMMATIVE
EVALUATION

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(midpoint)
DATE

(final)

10/9/15

Servant Leadership and Global Health: Integrate servant leadership into nursing practice
to promote global health
Course Objectives
1. Student integrates servant leadership into nursing
3
practice to promote global health
2. Student appreciates the attributes of global health
including social justice, and demonstrates a commitment
3
to the health of vulnerable populations and the elimination
of health disparities
3. Students Objective related to this outcome
3
Servant Leadership and Global Health
Servant Leadership and Global Health
Student Comments
Faculty/Preceptor Comments
MIDTERM DATE: 10/9/15
1. Servant leadership is consistently demonstrated by
considering wants and needs of both patients and
families, and being equally supportive of patients, family,
and peers to foster a sense of community and
empowerment for all.

MIDTERM DATE:

2. A patient with a psychiatric history was given respect

and dignity, encouraged to express and be empowered
by their thoughts about their situation and their
preferences regarding their own care, and cared for with
empathy in a non-judgmental environment.
3. Cultural assessment was completed on admission of a
patient with GI issues. Assessment included preferred
foods and eating environments before and after onset of
illness, financial/socioeconomic needs, spiritual and
emotional needs were addressed (pastoral consultation
offered and pastoral care was informed of patients
presence).
FINAL DATE:
1.

FINAL DATE:

2.

FORMATIVE
EVALUATIONS
(midpoint)

PROGRAM OUTCOME
DATE

SUMMATIVE
EVALUATION
(final)

10/9/15

Safe, Quality, Evidence-based Care: Provide safe, quality care incorporating evidence
based nursing practice
BSMCON NUR 4143 Clinical Immersion

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Course Objectives
1. Student delivers compassionate, patient-centered, safe,
evidence-based care that demonstrates clinical judgment
to promote high quality patient outcomes

3
3

2. Student creates, implements, and revises the plan of

care based on an ongoing evaluation of patient outcomes
3. Students Objective related to this outcome
Safe, Quality, Evidence-based Care
Student Comments
MIDTERM DATE: 10/9/15
1. Safe and compassionate care has been demonstrated
by administering medications with consideration for
patient comfort (crushing pills, using applesauce or water,
rotating injection sites, asking for patient preference
regarding sticks) and safety (five rights of administration,
administering as ordered).

3
Safe, Quality, Evidence-based Care
Faculty/Preceptor Comments
MIDTERM DATE:

2. Plans to incorporate ambulation, incentive spirometry,

increased time out of bed, and adjustment medication
orders as needed and allowed have consistently been
implemented, evaluated, and kept or adjusted depending
on individual tolerance and outcomes for each patient
and throughout each shift.
3. A patients increased pain, and tolerance for/need for
additional pain medication were reported to the on call
physician upon notice, evaluation, and patient
expression. Another patients change in lung sounds
from clear to adventitious were reported immediately.
FINAL DATE:
1.

FINAL DATE:

2.
3.

FORMATIVE
EVALUATIONS
(midpoint)

PROGRAM OUTCOME AND EXEMPLARS

DATE

SUMMATIVE
EVALUATION
(final)

10/9/15

Professionalism and Lifelong Learning: Demonstrate commitment to the nursing

profession and lifelong learning
Course Objectives and Exemplars
1. Student demonstrates the professional standards of
3
moral, ethical, and legal conduct
2. Student demonstrates professional attributes including
the abilities to prioritize and organize care, maintain
3
stamina, and display confidence
3. Student synthesizes previous learning to approximate
3
the knowledge, skills, and attitudes of a beginning nurse
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generalist
4. Student evaluate ones own practice, and assume the
responsibility for supporting the nursing profession and
continuing lifelong learning
5. Student manages care to maximize health,
independence, and quality of life for a group of individuals
that approximates a beginning practitioners workload
6. Students Objective related to this outcome

3
3
3

Professionalism and Lifelong Learning

Student Comments

Professionalism and Lifelong Learning

Faculty/Preceptor Comments

MIDTERM DATE: 10/9/15

1. HIPPA standards have consistently been met by signing
out of Connect Care each time a screen is left visible,
sharing patient information only with the patient present
and at the patients discretion, ensuring that the transfer or
release of documents are for the proper patient, and
properly discarding of all unneeded written forms of
information.

MIDTERM DATE:

2. Multiple patients have been cared for with regard for

acuity. Highest acuity are assessed and pain and
concerning changes in patient status are addressed first.
Multiple patients, transfers and discharges, call bells,
phone calls, and documentation are all balanced
effectively, or help from preceptor and peers is actively
sought in a timely manner. A desire to continue working
despite occasional fatigue or discomfort is consistently
expressed and delivered. Occasionally, a deer-in-theheadlights look is reported by my preceptor.
3. Every shift has offered opportunities to learn new and
practice known skills, including thorough assessments,
proper communication, establishing IVs, giving IV
medications, proper documentation, and forming and
implementing individualized care plans, with initial
guidance from preceptor, fostering growth and
independence as a new nurse.
4. Personal reflection and feedback from preceptor
regarding the days accomplishments, growing strengths,
and areas for improvement are the focus of the end of
every shift. All reflection/feedback is documented on the
clinical progress log.
5. Daily priorities and plans are recognized, developed,
addressed, implemented, evaluated and appropriately
adjusted for between two to four patients each shift,
6. Two strengths ability to effectively prioritize care and
take initiative, and two areas for improvement
developing confidence and maintaining a calm attitude and
outward appearance, have been identified with guidance
from preceptor.
FINAL DATE:
BSMCON NUR 4143 Clinical Immersion

FINAL DATE:

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1.
2.
3.
4.
5.
6.

Mid-point

BSMCON NUR 4143 Clinical Immersion

Final