Student Name:

Kyrie Wilmer

Southwestern Oregon Community College Nursing Program

Nursing 221
Foundations of Nursing: Chronic Care II

Clinical Evaluation Tool

The purpose of the weekly clinical performance evaluation tool is to provide feedback about achievement of the course
outcomes and competencies and to assist the student to meet the standards of care for nurses in Oregon as outlined in the
Nurse Practice Act.
Explanation of Rating Scale:
(S) Satisfactory = Clinical performance is safe and student adequately demonstrates application of the nursing
process/clinical judgment, required skills, and expected synthesis of learning appropriate to level in the program. Verified by
direct instructor observation.
(NI) Needs Improvement = Indicates that additional learning and attention to detail is required for a particular item or that
the overall performance for the week is at a minimum level. The instructor will write an explanation of the rating on the
comments page.
(U) Unsatisfactory = Clinical performance is unsafe and inadequately demonstrates application of the nursing
process/clinical judgment model, required skills, and expected synthesis of learning appropriate to level in the program. The
instructor will write an explanation of the rating on the comments page.
(NA) Not applicable = Particular item does not apply to the clinical performance.
(NO) Not observed = Instructor did not observe or has no knowledge of the students performance of the activity.
Students with a grade of NI or U will be required to meet with their advisor and clinical instructor and discuss a plan for
change in their behavior before their next clinical experience.
Safety and legal/ethical concepts are considered critical to the profession and will be graded as NI or U if any violation occurs.
If a student is assigned a U or NI for two weeks, the faculty will review the students clinical performance and consider the
options of either placing the student on probation or dismissing from the program.
In cases of potential failure, notification of the student by the instructor that she/he has been assigned a grade of U or NI for
one week constitutes proper warning of the grade status.
If a student is placed on probation and then receives a grade of U, the faculty will review the students performance and
determine whether or not the student will be dismissed from the program.

Nursing 221 Clinical Evaluation Tool

Student Name:

.
Compete
ncy
(C)
Course
Outcome
s
(CO)

C9
CO 1, 2,
3

CO5, 6

C8
C6, 7, 8

Clinical Week
1

Dates
Attendance: P=Present, A=Absent, T=Tardy

1/15
P

1/22
P

1/29
P

2/5
P

2/13
P

2/26
P

3/3

3/12

Facility/Unit

ICU

MCU

APU

PSU

TRAUM
A

2/19
A
abse
nt

ED

OR

NA

NA

NA

Applies concepts and theory to clinical practice in

client care and written assignments:
1. Conducts evidence-based health assessment
2. Collects and monitors a variety of data
3. Analyzes and interprets the data/assessment
findings in increasing complex chronic
conditions.
4. Recognizes pathophysiological changes and
symptoms
5. Regularly monitors clients level of comfort and
ability to manage symptoms and symptom
distress
6. Prioritizes health problems.
7. Develops and uses evidence-based
individualized interventions
8. Develops a plan of care that considers the
individual, family, age of client, functional
issues associated with co-morbidities,
developmental stage, psycho-socio-cultural
issues, capacity for and engagement in selfhealth care, and/or learning needs.
9. Evaluates and reflects on plan of care for
clients with chronic conditions.
Develops discharge plans in collaboration with
client, family, and other members of the health
care community.
Uses therapeutic communication with patients and
agency staff.
Recognize cultural issues and interact with clients

Makeup

C5
CO5
C10
CO2
C6,
CO4
C4

in culturally sensitive ways.

Collaborates with other members of the health
care team to provide comfort and symptom
management.
Uses research and evidence to support clinical
decision making.

Utilizes resources as needed.

Able to identify/define leadership skills for nurse's

role

NA

S
3

Compete
ncy
(C)
Course
Outcome
s
(CO)

C9, CO
1

C9,
CO1
C3
C4
C3
C4
C1,2
C1
C8
C3
C2
C4

Makeup

Exhibits critical thinking skills when prioritizing

and delegating patient care.
Demonstrate responsibility and accountability for
professional behavior:
1. Performs safely in clinical.
2. Prepared for clinical (Appropriate attire,
appropriate tools such as stethoscope, skills
list, evaluation tool, assessment tools).
3. Takes initiative in making decisions and
assuming responsibility for decisions.
4. Looks for opportunities for continued learning
and self-development.
5. Identifies behaviors and attitudes influencing
professional behavior.
6. Demonstrates growth in coping with stressful
situations in a calm and dependable manner.
7. Maintains patient confidentiality.
8. Documentation of client care is accurate and
relevant and consistent with agency policy
9. Completes and submits assignments on time.
10. Organizes and manages time effectively.
11. Attends and participates at post-conference.

NA

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

S
S
S

Instructor Initials
Student Initials

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SW
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Week

Instructor include comments that are positive, areas that need improvement or are
unsatisfactory. Reference the course outcomes listed in the syllabus and/or the OCNE
Competencies from the Nursing Student Handbook (Date/Sign all entries)

Kyrie, your excitement for nursing is contagious. I love that you love everything you are doing
in the clinical setting. This week in ICU you were able to witness critical care nursing and spend
time with critically ill patients. I do feel that you engaged in intentional learning and sought out
new experiences (competency 3). While it is great that you are excited to learn and you have
such a happy personality, remember to remain professional.
Jenny Tausch RN MSN PCCN 1/22/2015
Kyrie, this week you demonstrated competency 9, by making decisions to hold some of the
patient's medications. This displayed good nursing judgment. I may have forgotten to mention
it, but when you hold a medication, you are supposed to let the physician know. Your care plan
was pertinent for this complex patient, and I love that you were educating him, even though he
was not interested. Keep up the good work and continue looking for ways to improve your
nursing and critical thinking skills.
Jenny Tausch RN MSN PCCN 1/24/15
Kyrie, you seemed so comfortable in APU. This unit can be intimidating for some, but you
appeared very comfortable. I saw you visiting with your patient in the day room and
collaborating with the nursing staff on her care. This demonstrates competency 5. I noticed
that you added your interventions to your reflection, but didnt add the responses. Next time,
please add the responses and your evaluation.
Jenny Tausch RN MSN PCCN 2/5/15
Kyrie, this week you were able to adapt to changes as your patient was transferred to ICU. Your

Student
Initials

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enthusiasm for nursing never ceases to amaze me; it feels like you really enjoy nursing
(competency 2). Be sure to add subjective data to your nursing assessments. Overall, you had a
great clinical rotation and I feel that you are trying to enhance your skill level and knowledge
base.
Jenny Tausch RN MSN PCCN 2/15/15
2-13-15 Participated in Trauma Day. Functioned within scope of practice, communicated with
team well, recognized own difficulty communicating hand-off but overall did well. Worked well
with the inter-disciplinary team. It was fun to watch you work and see how well you have
progress. It is evident that you are working hard on communication

S. Walker, RN, MSN

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6

Absent
Kyrie, I did not get to spend much time with you during your rotation through the ED. I am glad
that you enjoyed it there, even though it was not as exciting as it can be Your reflection is
complete and well thought out and I feel that you were able to get a good idea of how the
emergency room nurses work together. Your patient sounds as if she had a lot going on, and I
am thankful that you took the time to hold her hand and try to help her calm down. Your main
concern was to keep her safe (competency 1).
Jenny Tausch RN MSN PCCN 3/3/15

9
12/12/12: sw, revised 12/6/14sw

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