UNIVERSITY

OF

SOUTH FLORIDA COLLEGE

OF

NURSING

NUR4636L Community / Public Health Nursing Clinical Evaluation Tool

This form will be completed at mid-term and the end of the semester of the students community clinical experience. Please enter a rating of 1 (poor), 2
(fair), 3 (satisfactory), 4 (very good) or 5 (excellent) for each clinical skill learned. Write a brief comment as appropriate. Additional space is provided at the
end of this form. Students must attain a rating of 3 or greater to pass the community clinical.
Student Name: Gianna Constantine
Faculty Name: Denise Maguire
Agency Mid-Term: Chitre Clinic, Panama

Agency Final: Chitre Clinic, Panama

Preceptor Name Mid-Term:

Preceptor Name Final:

Please rate the student as follows:

5 = Excellent

4 = Very Good

3 = Satisfactory

2 = Fair
1 = Poor
N/A = Not Applicable (Justify any ratings as appropriate)

Standard I- Professionalism and Accountability : Communication

Mid-Term Rating Date

__/__/__
Stude
nt

Precept
or

Facu
lty

Demonstrates therapeutic interviewing skills with individuals, families, or groups.

Final Rating Date

_6_/29__/16__
Stude
nt
5

Precept
or

Facul
ty
5

Takes initiative to acquire new knowledge and skill in providing care to individuals,
families or groups in the community.

Uses knowledge of community assets and needs to act as change agency with
individuals, families, or
groups in the community.

Arrives promptly each clinical day.

Reports on and off to preceptor, agency contact, and / or faculty each day.

Presents and maintains professional appearance and demeanor.

Interacts appropriately with multi-disciplinary / interdisciplinary professional and

paraprofessional health and health-related personnel.

Communicates regularly with preceptor and / or faculty to seek advice and guidance
and to plan and coordinate clinical time and activities.

Exhibits cultural sensitivity in interpersonal relationships with clients, families, groups,

and agency staff.

Standard I- Professionalism and Accountability: Knowledge

Standard I-Professionalism and Accountability: Attitude

Please rate the student as follows:

5 = Excellent

4 = Very Good

3 = Satisfactory

2 = Fair
1 = Poor
N/A = Not Applicable (Justify any ratings as appropriate)

Mid-Term Rating

Final Rating

Student Name:
Standard II- Safety must achieve 3 or higher in each component of this
standard
The student maintains the community populations physical safety by protecting the
agencys clients from harm.
The student does not make judgmental, discriminatory, or prejudicial statements to the
community agencys population, staff or faculty.
The student validates the accuracy and appropriateness of orders, plan of care, and/or
agencys policies prior to initiating nursing care.
The student implements nursing skills with proficiency and safety
The student adapts skill performance using principles of theory when necessary.
Standard III- Nursing Process: Community Assessment Skills
Assists / performs client, family, or population-based assessments in collaboration with
agency staff.

Stude
nt

Precep
tor

Facult
y

Stude
nt

Precep
tor

Facult
y

5
5

5
5

Appraises the effects of socio-economic, cultural, environmental, and political factors

that influence health
Standard III-Nursing Process: Community Diagnosing

Analyzes data from agency, staff, client, or population-based sources to identify a need
for a Service Learning Project.

5
5

5
5

5
5
5

5
5
5

Discusses client care outcomes with community agencys population, faculty or/and
staff

Appraises client, family, or group responses to health teaching / health promotion.

Standard III- Nursing Process: Community Planning

Assists / develops health plans for clients, families, and groups in the agency or
community.
Assists / develops a comprehensive written plan for implementing a health education,
health promotion, health service, or other project to benefit individuals, families, or
groups associated with the agency.
Incorporate disease prevention, risk reduction, health promotion, and health restoration
in plans of care for clients, families, or groups in the community.
In collaboration with community agency plan a Service Learning Project
Standard III- Nursing Process: Community Interventions
Assists / performs therapeutic interventions for diverse groups across the life span.
Assists / provides teaching to enable self and / or family care and health promoting
behaviors.
Assists / refers individuals, families and groups to other health and welfare sources.
Assists / performs health education or health promotion to families or groups.
Implements Service Learning Project.
Standard III- Nursing Process: Community Evaluation

Evaluates impact of service learning project on individuals, families, groups, or

agency.

Students Name:
Comments
Mid-term Student:
Comments
Mid-term Preceptor:

NA

Comments
Mid-term Instructor:

NA

Comments
Final Student:
Comments
Final Preceptor:

Comments
Final Instructor:

Student Signature /
Date:

NA
Gianna is an outstanding student with excellent clinical and leadership skills that have been demonstrated both in simulation and in
our clinical area. She actively participated in the simulation experiences, and came prepared. I had the opportunity to observe
Gianna prepare and administer dozens of flu shots during the H1N1 outbreak, which she did calmly and efficiently. She
communicated basic information in Spanish to children and adults, and conversed with the nursing staff to learn directions and gain
additional knowledge. Even though she knows just a moderate amount of Spanish, she was able to clearly communicate with
patients and staff, who all seemed to feel very comfortable with her and her ability to provide care. Gianna provided patient care in
the outdoor vaccine operation and the pediatric vaccine clinic, the vaccine clinic, assessed outcomes of nebulizers in pediatric and
adult patients, and worked with the pediatrician. She also participated in every station at the Health Fair, and was always very
flexible in the assignments and program changes. She fully participated in the SLP, and demonstrated critical thinking during the
final presentation. Gianna provided leadership for our group by role modeling professional behavior.
Gianna Constantine / June 29, 2016

Faculty Signature /
Date:

Denise Maguire, PhD, RN / June 29, 2016*

Preceptor Signature/Date ____NA_______________________________________________________________________________________________________

*I verify that this form was reviewed with the student, who had an opportunity to write a self evaluation and discuss with the faculty.