Health Care Aide Formal Clinical Evaluation Tool for Course 5

Learner Name Learner ID

Clinical Site Clinical Instructor
Clinical Course # Clinical Course Name
Clinical Placement Dates Absence Dates

Clinical Evaluation Tool Introduction

 This clinical evaluation tool is used for both Course 5 Clinical Placement I and Course 8 Clinical Placement II. Indicate which course
number and name the evaluation tool applies to in the appropriate box in the table above.
 Read the tool thoroughly prior to using. Some items may not be applicable to learners in course 5, so read carefully.
 This form indicates what expectations learners will be evaluated on throughout the clinical placement. In addition to this formal clinical
evaluation tool, learners must also receive ongoing formative assessment and feedback throughout the clinical placement. It is
suggested that you keep anecdotal notes throughout the clinical placement to track success for each learner. An anecdotal notes
template is provided in the clinical instructor guide.
 If the learner is not meeting expectations or is struggling, please call the appropriate contact for the program.
Amber Bobyk
amber.bobyk@abmcollege.com
403-719-4300, ext 119
 The instructor is the authority on the learner passing the clinical placement.
 When the clinical placement is completed, the instructor and the learner must sign this evaluation form. The learner’s signature does
not indicate agreement with the information on the form; the signature indicates that the learner has reviewed and understood the
information on the form.
 The instructor should return the signed form to the program contact.
Amber Bobyk
amber.bobyk@abmcollege.com
403-719-4300, ext 119

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Clinical Evaluation Tool Part 1
For each item in the table, indicate the date completed.

Item Date Completed

Site orientation
Clinical expectations explained
Site policies and procedures explained
Met attendance expectations
Reflection assignment complete
CARE Approach assignment complete

Clinical Evaluation Tool Part 2

Learners will be evaluated based on the performance ratings outlined below.

Legen Rating Explanation

d
E Exceeds expectations Able to meet all learning outcomes consistently, skillfully, and with early progression to independence
S Satisfactory performance Able to meet all clinical learning outcomes with limited guidance
ID In development Applies principles for safe practice, but requires further development of skill
 only possible for mid-term evaluation
U Unsatisfactory performance Unable to inconsistently meet clinical objectives
 Unsatisfactory performance in any learning outcome at mid-term results in a performance
improvement plan.
 Unsatisfactory performance in any learning outcome at final evaluation results in a failing
course grade.
NA Not applicable Assessed criteria not applicable to the learner/situation/clinical setting

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For the mid-term and final evaluations, do the following.
 For each learning outcome, write the appropriate legend rating symbol (E, S, ID, U, or NA).
 At the bottom of each category of learning, write specific comments on learner performance to support your rating using examples
where possible.

Knowledge and Person-Centred Care

Learning Outcomes Mid-Term Final
Applies knowledge of growth and development, structure and function of the human body, and chronic illness in
providing person-centred care
Demonstrates a holistic view of diverse clients by incorporating spiritual, psychosocial, physiological, and cultural
aspects in providing person-centred care
Prepares for client care by completing research requirements
Participates in the care planning process within the health care aide (HCA) role by:
 Following and implementing the care plan
 Providing client-specific information that can be incorporated in the development and revision of the care
plan
Plans, organizes, and prioritizes client care to ensure completion of daily assignments and tasks within the role of
the health care aide (HCA)
Performs actions to meet client-care needs in a professional, safe, and timely manner
Collaborates with clients to provide person-centred care
Demonstrates evidence-informed practices when providing person-centred care in assisting clients with activities of
daily living:
 Grooming and personal hygiene
 Bathing
 Bed making
 Elimination
 Mobility
 Nutrition and mealtimes
Demonstrates evidence-informed practices for positioning, transferring, and using mechanical lifts when providing
person-centred care

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 Assisting with Complex Skills
Demonstrates evidence-informed practices while assisting clients with range of motion
Demonstrates evidence-informed practices when performing medication assistance
Demonstrates evidence-informed practices when providing wound care
Demonstrates evidence-informed practices when providing care related to:
 Nasogastric tubes
 Gastrostomy tubes
 Tube feeds
Demonstrates evidence-informed practice when providing care related to urinary catheters and drainage systems
Demonstrates evidence-informed practice when providing ostomy care
Demonstrates accurate measurement of clients’:
 Height and weight
 Vital signs
 Pain
Demonstrates evidence-informed practice when performing specimen collection
Demonstrates evidence-informed practice when assisting with respiratory care and oral suctioning
Assisting with Clients with Various Health Conditions
Demonstrates evidence-informed practice when providing individualized person-centred care to clients diagnosed
with dementia
Assists in providing a safe environment for clients living with dementia
Demonstrates a palliative care/end-of-life approach when providing care for clients where possible by:
 Providing comfort measures
 Demonstrating ability to offer compassion
 Observing and communicating changes in clients’ symptoms including pain
Demonstrates evidence-informed practices by acknowledging the role of the family in providing holistic care to
clients across the lifespan
Demonstrates evidence-informed practices when assisting with infant care
Demonstrates evidence-informed practices when assisting with pediatric care

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 Learning Outcomes Mid-Term Final
Demonstrates evidence-informed practice when assisting clients with:
 Physical disabilities
 Developmental delays
 Mental health disorders
 End-of-life care
Demonstrates post-mortem care according to agency policy and evidence-informed practices
Instructor Comments

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Professionalism and Role of the Health Care Aid (HCA)
Learning Outcomes Mid-Term Final
Incorporates and follows legislation, health care aide competencies, and employer/agency policies and procedures
into client care
Demonstrates initiative by seeking new learning experiences to improve skills
Seeks feedback to ensure growth as a health care aide
Takes responsibility for own actions, behaviours, and decisions
Works cooperatively as part of the client-care team
Maintains positive working relationships
Maintains confidentiality
Practices professionalism by following agency/program policy in these areas:
 Dress code
 Attendance and punctuality
Performs actions and tasks following:
 Roles and responsibilities outlined in the HCA competency profile and applicable legislation
 Agency policy
Demonstrates the following in providing person-centred care within the role of the health care aide:
 Time management
 Prioritization
 Decision making
 Problem solving

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Professionalism and Role of the Health Care Aid (HCA)
Instructor Comments

Communication and Documentation

Learning Outcomes Mid-Term Final
Follows verbal and/or written direction
Uses professional and effective communication skills when conducting telephone conversations
Reports relevant information to appropriate persons using professional and assertive communication
Documents pertinent data sequentially, legibly, accurately, completely, and in a timely manner per agency policy
Uses correct medical terminology and legal abbreviations
Contributes to group discussions and team conferences in a positive manner
Uses therapeutic communication skills while working with clients at all stages of the life cycle to promote the
helping relationship
Uses appropriate evidence-informed practices to effectively communicate with clients diagnosed with dementia
Uses various aids and strategies that promote effective communication with clients who have communication
barriers such as:

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  Speech/language disorders
 Eye/vision problems
Incorporates communication that is culturally appropriate
Accepts and incorporates constructive feedback
Takes action to resolve conflicts using appropriate communication skills
Demonstrates digital literacy and familiarity with information technology by being able to:
 Access and send emails when required
 Use electronic documentation records as per agency policy when required
 Access agency policies, standards, and practices electronically using a web platform when required
Instructor Comments

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Safety
Learning Outcomes Mid-Term Final
Recognizes, reports, and adheres to program/agency policies in situations where the safety and well-being of client,
self, coworkers, and others are compromised
Verifies and clarifies instructions made by collaborative-care team members
Employs the principles of environmental safety
Demonstrates infection prevention and control principles including:
 Hand hygiene
 Personal protective equipment (PPE)
 Care of supplies and equipment
Follows principles of body mechanics to ensure safety of self
Follows agency policies when operating health equipment safely
Follows evidence-informed practices in safe use and application of restraints
Follows safe food practices during preparation of client meals/nourishment
Demonstrates knowledge in identifying and preventing food hazards
Instructor Comments

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Clinical Evaluation Tool Part 3
Complete the following table at the mid-term and final evaluation and sign where required.

Item Mid-Term Date Item Final Date

Instructor Comments Instructor Comments
Overall Strengths and Areas Requiring Improvement Overall Strengths and Areas Requiring Improvement

Learner Comments (If Any) Learner Comments (If Any)

Instructor Name Instructor Name

Instructor Signature Instructor Signature
Learner Name Learner Name
Learner Signature Learner Signature

Final Course Evaluation: Check the appropriate box.

❑ Successful (meets all HCA core competency
domains at a novice level)
❑ Unsuccessful

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