Revised 2/22/12

Reviewed 03/30/20 , 07/15/21 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM

N129 MENTAL HEALTH
CLINICAL EVALUATION
NAME:_ Sue Dong________________________________ DATE: 2/7/2023

CLINICAL SITE: Fremont Hospital ____________________________ INSTRUCTOR:___Jennie Fernandez___________________________________

The student is responsible and accountable for:

a. Meeting performance expectations at a competent level on a consistent basis by the end of the term.
b. Monitoring progress in course using Clinical Evaluation Guide.
c. Using dates and examples to document level of performance.
d. Making appointment with faculty for midterm and final evaluation conferences.
e. Notifying faculty of difficulty in achieving course outcomes and seeking assistance

The faculty is responsible and accountable for:

a. Monitoring students’ progress and providing immediate feedback to students in clinical.
b. Obtaining information on students’ progress and performance from nurses, other health care members, and patients with whom the student
has contact, as appropriate.
c. Being available and approachable to meet with students outside of clinical in the faculty office for questions related to clinical.
d. Making time available and promptly responding to student requests for midterm and final evaluation conferences.
e. Issuing a written academic warning/counseling note to a student who is having difficulty meeting course outcomes, professional behaviors
and/or showing no improvement in one or more areas of the course outcomes after feedback is given.

Other Student Expectations:

 Read and familiarize yourself with course outcomes, professional behaviors stated on this document, student handbook (Code of Conduct),
ANA Code of Ethics and the S/US grading system.
 Before meeting with clinical faculty at midterm and final evaluation, print the Clinical Evaluation tool and provide examples of how you made
progress in clinical and met the course outcomes and professional behaviors. Submit to faculty as directed before your clinical evaluation
day.
 Before meeting with faculty for final evaluation; print the Clinical Evaluation form and attach evidence for continuing to make progress and
meeting the course outcomes since midterm evaluation has been given to you; also attach written faculty feedback given to you at midterm
and/or anytime during the term.
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N129 MENTAL HEALTH
CLINICAL EVALUATION
Clinical evaluation will be done on each objective using a scale of Satisfactory (S), Unsatisfactory (U), or Not Applicable (NA).
Written comments to illustrate the rating are encouraged.

Both the Clinical Faculty and the Student should rate the Student/Self using satisfactory or unsatisfactory.
S = Meets or exceed expectations for a student at this level
U = Below expectations for this level

MIDTERM PROGRESS FINAL EVALUATION

Attendance: Hours Absent___0____ Hours Make-Up___0______ Attendance: Hours Absent______ Hours Make-Up______

Criteria:
 S = Demonstrates the expected behavior/performance
specified by the clinical
 U = Demonstrates behaviors/performance that needs to be
improved to meet the clinical objectives by final
evaluation
 N/A = Has not had the clinical experience in order to
demonstrate performance of the objective
Criteria:
 S = Demonstrates the expected behavior/performance
specified by the clinical
 U = Demonstrates behaviors/performance that needs to
be improved to meet the clinical objectives
 N/A = Has not had the clinical experience in order to
demonstrate performance of the objective

CLINICAL PROJECTS: S U N/A CLINICAL PROJECTS: S U

vSimulation, self-help group, hearing voices, MAB, Post vSimulation, self-help group, Post Conference Nursing
Conference Nursing Assessment & Self Reflection Form, SBAR, Assessment & Self Reflection Form, SBAR, Simulation(s)
Simulation(s)
MIDTERM CLINICAL PROGRESS S U N/A FINAL CLINICAL PERFORMANCE S U

OVERALL CLINICAL PERFORMANCE EVALUATION: Pass Fail Incomplete

A student must receive a passing grade in clinical in order to pass the theory portion of the course. Students who consistently, or at the Final
Evaluation, have an “Unsatisfactory” rating will not pass the clinical or theory portions of the course.
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N129 MENTAL HEALTH
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Faculty Self Faculty
1. Apply nursing concepts and theories to the nursing process including Patient Centered Care S S x
relevant information from the physical and behavioral sciences, informational
technology and the humanities.
As demonstrated by: Clinical S S
o Preparation for clinical by written and/or verbal knowledge of required A-2.)Respect and
nursing care, medications and treatments. encourage individual
o Successful completion of Case Study Presentation and facilitating of expression of patient
discussion. values, preferences
o Provides theoretical/research based rationale for nursing actions. and expressed needs
o Ability to use critical thinking in planning care. A-5.)Recognize
o Ability to locate high quality websites for information about psychiatric personally held
mental health care and apply the knowledge to patient care. attitudes about
o Knowledge of the common categories of psychiatric medications, their working with patients
purpose and common side effects. from different ethnic,
o Verbalization and or written knowledge of the more common cultural and social
neurological side effects, their treatment and implications for the client. backgrounds

MIDTERM COMMENTS:
I met the objectives by applying nursing concepts and theories to the nursing process including relevant information from the physical and
behavioral sciences, informational technology and the humanities.
An example is : I took care a transgender female client who experiences schizophrenia. I tried to establish a trust and comforting relationship with
the client. Tried to provide a quiet calm environment to her. I encouraged client to communicate her concern. I utilized technique to enhance
communication with her by active listening, direct eye contact. I used therapeutic techniques, even if sometimes I can’t understand her words, I
tried to get the feeling behind them.
FINAL COMMENTS:
I met the objectives by
Revised 2/22/12
Reviewed 03/30/20 , 07/15/21 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
N129 MENTAL HEALTH
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Faculty Self Faculty
2. Use components of the nursing process in performing evidenced based Teamwork and s S x
psychiatric / mental health nursing care using developmentally and culturally Collaboration
appropriate approaches that reflect patient and family preferences
As demonstrated by: Clinical s S
o Performing a comprehensive assessment of client needs A-4.)Respect the
o Applies physical assessment information to the plan of care. centrality of the
o Conducts a mental status exam and applies mental status assessment patient/family as core
data to the plan of care members of any health
o Identifies psychiatric history and emotional, behavioral, social and care team
substance abuse issues in the individual or family members.
o Identifies current suicidal or homicidal ideation and level of risk.
o Assesses for symptoms found in common psychiatric disorders
o Examining and questioning own assumptions concerning the client’s
needs
o Prioritizing patient needs using Maslow’s Hierarchy
o Formulating nursing diagnosis statements based on documented
assessments.
o Elicit client perspectives on functioning, physical condition and
psychiatric condition and work with client in development of a plan of
care
o Developing measurable short term goals
o Working with the interdisciplinary team to elicit potential resources for
the client
o Prioritizing interventions individualized to client requirements
o Performing safe, independent and/or collaborative nursing
interventions.
o Applies fundamental nursing skills to care of patients with alterations in
physiological function related to psychiatric mental health dysfunction.
o Evaluates and modifies nursing interventions based on continuous
assessment of client needs
o Monitors patient behavior and mood for changes requiring
interventions.
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N129 MENTAL HEALTH
CLINICAL EVALUATION
o When available working with families and /or care givers to understand
the patient’s illness and treatment.
o Utilizes evidence-based instruments to assess risk for or level of co-
morbidity of physical conditions and common psychiatric syndromes
(e.g., Mini-mental status exam (Folstein), full mental status exam,
depression scales (Beck), anxiety scales (Beck), suicide assessment scales,
substance abuse scales (CAGE)).
o Identifies and uses standardized psychiatric evaluation instruments to
monitor client outcomes.
MIDTERM COMMENTS:
I met the objectives by using components of the nursing process in performing evidenced based psychiatric / mental health nursing care using
developmentally and culturally appropriate approaches that reflect patient and family preferences
An example is: I took care a client who attempted to commit suicide due to the grieving of his father. I provided frequent rounding with my clinical
partner. We spent sufficient time communicated with the client for the short term goal-remain safe and no harm self. I encouraged client to
communicate and express his feeling. I provided feedback and validation of feeling. I explored client’s past coping strategies. I also help client
identified his support system. Client showed positive coping skill. He also stated sense of control of life and hopeful future.

FINAL COMMENTS:
I met the objectives by
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Reviewed 03/30/20 , 07/15/21 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
N129 MENTAL HEALTH
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Faculty Self Faculty
3. Communicate and collaborate effectively with all members of the Teamwork and s S x
interdisciplinary healthcare team Collaboration
As demonstrated by: Clinical s S
o Initiating communications with appropriate health care team members S-9.)Communicate
o Communicates verbally in a clear, concise and respectful manner. with team members,
o Initiating communications with appropriate health care team members adapting own style of
o Communicates verbally in a clear, concise and respectful manner. communicating to
o Attending and participating in multidisciplinary care meetings to review needs of the team and
and evaluate treatment plans, when they are available. situation
o Assess the group dynamics of the interdisciplinary team. A-1.)Acknowledge
o Use strategies for communicating in transitions among levels of care own potential to
(“hand-offs”) (such as SBAR) contribute to effective
team functioning
A-2.)Appreciate
importance of intra-
and inter-professional
collaboration
A-3.)Value the
perspectives and
expertise of all health
team members
MIDTERM COMMENTS:
I met the objectives by Communicating and collaborate effectively with all members of the interdisciplinary healthcare team

An example is we worked as a pair when going to clients’ rooms. We have a good communication with the involved health care team including the
charge nurses/ staff nurses, Mental health Therapists, and support services. We followed the charged nurse for admitting clients. We debrief with the
team members.
Revised 2/22/12
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N129 MENTAL HEALTH
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Faculty Self Faculty
4. Create a safe care environment that respects human rights Safety s S x
As demonstrated by: Clinical s S
o Expressing knowledge of clients’ rights, including voluntary and involuntary S-2.)Demonstrate
treatment. effective use of
o Helping clients to understand their rights as mental health patients strategies to reduce
o When appropriate acting as an advocate to protect client ‘s rights risk of harm to self or
o Immediately reporting incidents of suspected or actual aggression to self or others
others
o Immediately seeking clinical supervision when unclear and /or concerned
about client behavior.
o Reporting abnormal behavior/findings or changes in client’s condition to
the appropriate person in a time
o Expressing awareness of the environmental and milieu factors that effect
patient’s behavior.
o Assessing and verbally describe the dynamics of the milieu on your
assigned unit
o Assumes responsibility and accountability for one’s own behavior within a
therapeutic nurse-patient relationship (self-awareness).
o Maintaining personal boundaries through appropriate use of assertiveness.
o Working with clients in clinical areas that are continually supervised by
staff.
o Seeking out ongoing information from staff related to status of clients.
o Assisting the client to articulate concerns they might have concerning the
stigma of their illness.
MIDTERM COMMENTS:
I met the objectives by creating a safe care environment that respects human rights.
An example is a client was admitted in the hospital because of suicidal ideation. We tried to provide quiet environment, tried to reduce noise from
her roommate, we provided interval visual observations, promoted environmental safety and comfort by offering her pillows, clean socks, blanket.
free from potential harm by frequent rounding. Patient remain safe while in the hospital, with the aid of nursing intervention and support.
Revised 2/22/12
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N129 MENTAL HEALTH
CLINICAL EVALUATION
Revised 2/22/12
Reviewed 03/30/20 , 07/15/21 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
N129 MENTAL HEALTH
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Faculty Self Faculty
5. Demonstrate therapeutic communication and teaching skills Patient Centered Care S s x
As demonstrated by: Clinical
o Ability to form interpersonal, therapeutic relationships with assigned S-11.)Recognize the
clients. boundaries of
o Participating in a variety of clinical groups as offered by the treatment therapeutic
team. relationships.
o Providing patient information or health teaching based on patient S-13.)Assess own
readiness to learn and allow patient choice as possible level of
o Evaluating the effectiveness of your health teaching. communication skill
o Applying therapeutic communication techniques in care practices with in encounters with
persons experiencing common psychiatric symptoms such as patients and families
hallucinations, delusions and decreased production of speech.
o Using verbal and non-verbal skills to assist the client to problem solve, and
express emotions
o Helping clients organize and express their needs to staff.
o Helping clients organize and express their needs to family and/or
caregivers
o When family or care givers are available, working with families and /or
care givers to understand the patient’s illness and treatment.
o Using clinical supervision to augment therapeutic ability.
o Lead or co-lead a group activity
MIDTERM COMMENTS:
I met the objectives by
An example is that a client was admitted for depression. He was sleeping for the whole day. After assess client’s ability to communicate, I tried to
build a relationship with client by using therapeutic communication skills. I encouraged client to express emotions. I encouraged his participation in
music therapy. Client went to the music therapy. He asked me to tell Scott the music therapist that even though he could sit there till the end to say
good bye but he enjoyed the activity/
FINAL COMMENTS:
I met the objectives by
Revised 2/22/12
Reviewed 03/30/20 , 07/15/21 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
N129 MENTAL HEALTH
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Faculty Self Faculty
6. Thoroughly and accurately document the nursing process Informatics s S x
As demonstrated by: Clinical s S
o Expressing knowledge of purpose of written documentation S-4.)Document and
o Describing the written documentation used in the setting. plan patient care in an
o Providing written communication in the client chart and other written electronic health
assignments that are legible and appropriate in terminology and form for record
the setting. A-3.)Protect
confidentiality of
protected health
information in
electronic health
records

MIDTERM COMMENTS:
I met the objectives by documenting and planning patient care in an electronic health record. Protecting confidentiality of protected health information
in electronic health records.
An example is: I don’t have access to EHR. After taking patients’ vitals, I gave the information to the charge nurse who helped me to input the data. But
I followed HIPPA and protected patients’ confidentiality. I don’t discuss the patient’s case with visitors, I don’t share patient’s information with visitors. I
don’t leave hard copies of forms or records where unauthorized visitors may access them. I shredded patients’ information immediately after clinical
ends.

FINAL COMMENTS:
I met the objectives by
Revised 2/22/12
Reviewed 03/30/20 , 07/15/21 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
N129 MENTAL HEALTH
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Faculty Self Faculty
7. Patient Centered Care s S x
As demonstrated by: Clinical s S
o Clarifying personal values concerning working with persons experiencing A-10.)Value active
psychiatric disorders. partnership with
o Maintaining client confidentiality at all times patients or designated
o Maintaining honesty in academic and nursing activities surrogates in planning,
o Functioning within the policies of the clinical agency and Samuel Merritt implementation, and
University evaluation of care
o Notifying faculty and clinical setting in a timely manner when absent. A-14.)Appreciate
o Consistently punctual shared decision-
o Appropriate grooming and dress. making with
o Reporting to appropriate person at the beginning and end of empowered patients
assignments. and families, even
o Professional conduct in all communication and practice interactions with when conflicts occur
clinical instructor, healthcare staff, and clients.
o Managing own time when interacting with clients and completing daily
assignments
o If possible, attend an ethics review committee meeting in the clinical
setting.
MIDTERM COMMENTS:
I met the objectives by demonstrating ethical behaviors, professional values and standards of nursing practice in the delivery of mental health
nursing.
A client was admitted because working under influence of alcohol. I tried to build a patient center care relationship with her. I enhanced the sense
of trust. I assessed patient’s anxiety level which was high at that time. I tried to reduce her anxiety and agitation. I assessed her effectiveness of
coping skills. 5h

FINAL COMMENTS:
I met the objectives by
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N129 MENTAL HEALTH
CLINICAL EVALUATION

MIDTERM: FACULTY COMMENTS

Areas to be Strengthened:
Try to practice doing more 1:1 interviews with patients. You don’t have to try to talk, but practicing active listening also helps these patients!
Try to get more comfortable with different medications, their drug to drug interactions and side effects.

Areas of Strength:
Sue is a very sweet and caring individual who is eager to learn. She brings a very positive energy during clinical. She engages in meaning
conversations with patients and motivates herself to learn and get most of the clinical experience. She is a very good team player and understands
the role of being a good nurse.

Faculty Signature _______ _________________________________________Date: 2/14/2023

Student Signature __________________Sue Dong_____________________________ Date: 02/07/23

FINAL: FACULTY COMMENTS

Areas to be Strengthened:

Areas of Strength:
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N129 MENTAL HEALTH
CLINICAL EVALUATION

Faculty Signature _________________________________________________ Date:

Student Signature_________________________________________________ Date: