ALBANY STATE UNIVERSITY DEPARTMENT OF NURSING FAMILY NURSE PRACTITONER PROGRAM MIDTERM & FINAL CLINICAL PERFORMANCE EVALUATION-PRECEPTOR STUDENT: Plexaude/ Wels preceptor: Cael YS Vows sire: Kegecare DATE: A \i7|\S" Midterm Evaluation: Semester Yeai Final Evaluation: Semester SpasVear 2S Definition of Terms: igh Skill Level: Performs tasks with proficiency with minimal supervision Uses good judgment to interpret subjective and objective data Safely Functions in setting with only consultation available Satisfactory Skill Level: Performs tasks safely with moderate amount of assistance Interprets data with minimal supervision/assisance Below Expected Skill Level: Consistently requires substantial assistance’supervision to perform tasks adequately Unsafe to funetion in setting with only consultation available Not Observed (N/O}: Did not observe belnavior in clinical setting Tigh Sk] Saiisfactory | Below | NO Level ‘Skill Level | Expected Level ‘Course Specific Content ‘Applies knowledge of developmental variations, pathophysiology, genetics, family assessment a spirituality, ethics, cultural variations, and disease processes as related to health and risk assessment across the lifespan Identifies family, community, social, cultural, spiritual, and individual resources to support health v ‘maintenance and promotion. Interviewing and history taking skills i Establishes good rapport with client ata collection is accurate and complete Physical examination skills Performs complete physical exam as indicated by history safe and efficient! NN Lrilizes proper assessment technique ygnosis Skills nana da 9 Scie Tt OF TST hapracs orto pry izing sia {hiking and lgnoste reasoning sll v, Uses sound clinical judgment Ts able to make the correct diagnosisDemonsirates cost effective diagnostic testing Planning/Implementation Skills Collaborates with preceptor to formulate plan of care ‘Acknowledges patient concer in plan of care Identifies therapeutic treatments for appropriate Diagnosis Selects pharmacological agents in accordance with state nursing practice act N\A WN Seleeis pharmacologic interventions appropriately “Articulates the syathesis and application of current ‘multidisciplinary evidence based knowledge, using effective written and verbal communication. ‘Consults with health are providers at appropriate times Evaluaies client's progress through follow up Demonstrates ability to access and collaborate with ‘community groups io Identifies legal and ethical Issues in the APN role Leadership Satisfactory Unsatisfactory ‘Applies APN and leadership principles Practices within the scope of an APN Understands coding and reimbursement issues 7 iz Profession: Professional in manner and appearance F Works in collaboration with other healthcare team members ‘Accepts responsibility for behavior and performance Interacts ina professional manner ‘Maintains confidentiality Documents using correct SOAP format ‘Standards of Patient Care Safeguards patient integrity, acting asa patient care advocate ‘Adheres fo clinical policies and procedures Utilizes sound nursing judgment in providing patient Promotes standards of nursing care in a non- Jjudgmental, nondiscriminatory, sensitive and culturally competent manner NN INS | ANSI SN Zeny ‘Comments (optional narrative final summary): Signat Py) Signature of Fag seh Sighature of He