Clinical Learning Record, Geriatric Clinical Placement

Programme code:
53455 53455 SY 53081
/ /
(BSN) (BSN) (MN)

Student Name:________________________________________ Student No:_________________________

Date of absence from the clinical placement: ( ) days Date(s) of absence: _____________________
Clinical placement period: from ________________ to ______________________

Clinical Venues Clinical practice period Name of Clinical Signature of Clinical

(Hospital, Unit/Ward) dd/mm/yy --- dd/mm/yy Supervisor Supervisor
1
2
3
By the end of this clinical placement, the student is expected to have opportunities to observe and
explain, or describe, or discuss, or participate or be reinforced the following areas (*obtaining at least 8
“”from Areas of Learning):

Areas of Learning *Please ‘’ by the clinical Signature of the clinical

supervisor if the student had supervisor (Date)
opportunities to observe and
explain, or describe, or
discuss, or participate or be
reinforced
Assessment
1. Cognitive assessment (e.g. AMT,
MoCA-5mins, MMSE)
2. Fall risk assessment (e.g. Morse Scale)
3. Mobility assessment (e.g. EMS, muscle
strength, MFAC)
4. Pain assessment (e.g. PAIN-AD, NRS,
VAS, Abbey Pain Scale)
5. Nutritional assessment (e.g. MUST, C-
MUST, MUAC, BMI)
6. Functional assessment (e.g. MBI)
7. Sensory assessment (e.g. VA, whisper
test, HHIE-S)
8. Pressure injury risk assessment (e.g.
Braden Scale, Norton Scale)
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 9. Medication assessment (e.g. MAI,
Polypharmacy )
10. Frailty assessment (e.g. FFI, Clinical
Frailty Scale)
11. Sleep and rest assessment (e.g. PSQI)
12. Psychological health assessment (e.g.
GDS)
13. Others: (Specify)
Implementation
1. Communication (e.g. avoidance of elder
speak)
2. Continence care (e.g. prompt voiding)
3. Physical exercise training (e.g. ROM,
endurance)
4. Nutrition supplements and promote oral
intake (e.g. Ensure)
5. Fall prevention program
6. Pressure injury prevention program
7. Restraint reduction program
8. Sensory compensation devices (e.g.
hearing aids)
9. Ambulation support (e.g. use of different
kinds of walking aids)
10. ADL adaptation training (e.g. self-help
exercise, ADL training)
11. Non-pharmacological interventions (e.g.
pain/BPSD)
12. Cognitive training (e.g. reality
orientation)
13. Discharge Planning
14. Home assessment + modification (e.g.
Community Occupational Therapy)
15. Measures to prevent iatrogensis
Evaluation
1. Discussion of the evaluation method
Please write down the care evaluated, e.g. ACP,
nursing care related to EOL care

Student’s professional behaviour Satisfactory Unsatisfactory

Demonstrate professional behaviour (e.g. caring
attitude, responsibility, punctuality, honesty,
respect, initiation in learning, and so on)

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Narrative Feedback (On strengths/ weaknesses/ areas for improvement)
Clinical Supervisor

Student

Overall Grade: Satisfactory / Unsatisfactory

Student Name: ______________________ Student Signature: ________________ Date:________________

Name of Signature of
Clinical Supervisor:___________________ Clinical Supervisor: _______________ Date:________________

Remarks:
(1) Overall grade should be assessed and signed by the last clinical supervisor for this placement
(2) An overall satisfactory grade is given when a minimum of 8 items  from Areas of Learning, including
satisfactory in student’s professional behavior, receive satisfactory remarks
(3) For unsatisfactory cases, students should alert the clinical co-ordinator immediately via
sn.clinical.coordinator@polyu.edu.hk

Supplementary notes
1. A clinical supervisor is a person appointed by the School of Nursing, The Hong Kong Polytechnic
University, who supervises and assesses PolyU nursing students in clinical settings. He or she can be an
‘Honorary Clinical Instructor’ from the clinical side or a designated member of PolyU staff.
2. Students should actively seek advice and feedback from their clinical supervisor.
3. This Clinical Learning Record is used to document the learning activities. Each learning item can be
scored “Introduced” for initial learning and “Reinforced” for repeated learning. Feedback is essential to
students for improvement in clinical learning.
4. The Clinical Learning Record must be completed during the last week of the clinical placement. The
student must return this record to General Office within 3 working days after completion of the clinical
placement.

Please keep a duplicate of the record and submit the true copy to the School

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