You are on page 1of 5

Jackson Community College Associate Degree Nursing

NUR 277 Mental Health Nursing

Level III Clinical Performance Evaluation
Name: Hayley Jacobs
Semester: F 16 Clinical: S U
KEY S = satisfactory Tardy:
NI = needs improvement Absences: 1
U = unsatisfactory Make-up: 10/29
NO = not observed NAMI Conf.

Behavior Week1 Week2 Week3 Week4 Week5

Orient/A SIM/PD IFS/AA GU/absen AU/IFS
U t
Treats client with dignity and S S S S S

respect, provides privacy

during therapeutic interactions

Provides culturally appropriate S S S S S

care with diverse client


Maintains a safe and S S S S S

therapeutic environment
consistent with pt's
individualized plan of care,
professional standards &
MMHC as amended

Adapts care for clients S S S S S

functional abilities/ encourages

self-care based upon plan of

Provides effective client/family S NO S S S

teaching r/t self-care needs

Demonstrates medication S NO NO NO NO

teaching to clients &

designated others in
accordance with nursing
standards & MMHC as
Performs nursing skills safely S S S S S

& appropriately
Uses self-care model as basis S S S S S

for planning/ providing care

Displays critical S S S S S

thinking/clinical reasoning to
protect/promote client health.
Completes clinical S: 1, 2, 5, S: 1, 2, 7, S: 1, 2, 8, S: 1, 2, 3, S: 1, 2,
8, 9, 10 8, 9 9 4, 8 5, 6, 8
1) Submits Goals
2) Submits Journal
3) IA
4) Support Group
5) WPC
6) Milieu Group
7) Simulation
8) Post-conf.
9) Logs/quizzes
10) Behavioral Health
Modules: Treatment of Behavioral
Health Patients and Petitions and Clinical

Demonstrates mental health S S S S S

assessments of utilizing
appropriate assessment
Provides nursing care to S S S S S

support client's functioning

based upon NANDA & ANA

Accurately is able to discuss S NO NO NO NO

related dosages, therapeutic

effects, side effects & toxic
effects of psychotropic

Maintains client S S S S S


Obtains report prior to S S S S S

caring for client/ discusses

client care plan with assigned

Identifies care role with S S S S S

RN/team members

Reports off to RN whenever S S S S S

he/she leaves the unit

Communicates effectively S S S S S

with interdisciplinary team

Demonstrates correct SBAR S S S S S


Verbal/written S S S S S

communication is
appropriate, complete, and

Immediate verbal report of S S S S S

any significant client

information to designated
staff & clinical instructor.
Professional appearance, S S S S S

timeliness, preparation.

Displays professional, caring S S S S S


Displays positive attitude & S S S S S


Identifies & builds on S S S S S

strengths/ improves

Seeks out and participates in S S S S S

learning opportunities

Weekly Review
Student Initials JMT JMT JMT JMT JMT
Instructor Initials

Student Comments:

Instructor Summary Comments:

WK 1: Hayley was able to work with a client and her family as they made the
treatment decision for ECT. WPC identified interventions that were client specific.
She was able to complete medication teaching on Lexapro.
WK2: Active participant in simulation with the ability to accurately apply
theoretical concepts to patient scenario. Observed ECT treatment. Observed in
Partial Day Program.
WK3: Observed at Allegiance Addiction. At Interfaith Shelter had no difficulty
interacting with staff and residents.
WK 4: Absent due to a funeral, plans to go to NAMI conference on 10/29 to make
this up. Observed ECT treatments and then participated in groups on Geriatric
unit. Milieu group proposal submitted. Support group paper completed. IA
completed-able to identify communication techniques without difficulty as well as
relate behavioral responses to patients specific DSM-V diagnosis.
Wk 5: On geriatric unit, Hayley participated in group therapy and interacted well
with clients. Led pumpkin decorating Milieu group at IFS. The group was an
overall success, the residents and staff at the shelter appreciated the opportunity to
participate. Proposed goals were met.

Hayley is a talented student nurse in the MH setting. She applied theory to

clinical practice, demonstrated clinical reasoning and critical thinking.

Jennifer Tharp, RN___ 10-7-2016

Clinical Instructor Date
Hayley Jacobs 10-7-2016
Student Date