Portfolio ms2 Final Clinical Evaluation

Final Clinical Evaluation
NUR 4216L.013 MPM Spring 2015 4/14/2015

Evaluation date: 4/27/2015
Evaluator: Pollack, Patricia (ppollack@health.usf.edu)
Evaluatee: Weyant, Christina (weyantc@health.usf.edu)
5-Outstanding: Exceeds Standards

Exhibits above average performance of nursing care for this level student. The student is
proactive, self-directed, and consistently engaged in learning; needs minimal guidance; is
knowledgeable; and appropriately incorporates knowledge with skills. Student is proactive and
self-directed in approach to learning.
4-Satisfactory: Meets Standards
Exhibits average performance of nursing care for this level student. Functions with minimum
guidance. Demonstrates adequate knowledge and requires minimum assistance in applying
knowledge to skills. Recognizes learning opportunities but may require assistance in utilizing
them.
3-Minimal
Exhibits minimal performance of nursing care for this level student. Functions safely with
moderate guidance. Demonstrates minimal knowledge and requires moderate assistance in
applying knowledge to skills. Requires some direction in recognizing and utilizing learning
opportunities. Often focuses on the task or own behavior, not on the patient.
2-Unsatisfactory
Requires intense guidance for the performance of activities at a safe level. Clinical performance
reflects difficulty in the provision of nursing care. Demonstrates gaps in necessary knowledge
and requires frequent or almost constant assistance in applying knowledge to skills. Requires
frequent and detailed instructions regarding learning opportunities. Focuses primarily on the task
or own behavior, not on the patient.
1-Unsafe to Practice
Is unsafe to practice without constant, intense guidance. Frequently lacks necessary knowledge
and skills and unable to integrate these into practice. Requires constant detailed instructions
regarding learning opportunities and is often unable to utilize them. Attempts activity or
behavior, yet is unable to complete. Focuses entirely on the task or own behavior, not the patient.
Standard I--Communication
The student communicates pertinent information regarding the patient's
condition/concern to health team members.
(Comment
Answer: 5
Outstanding: Exceeds Standards
Required)
Comment: Christina's first clinical was in CCU, and she was hesitant to assess or
communicate information regarding the patient. With encouragement and determination, she
sought out new opportunities to learn which strengthened her knowledge base and thus
enhanced her communication skills.
The student communicates effectively in written form (Nursing Process Worksheet is
organized and complete)
(Comment
Answer: 5
Required)
Comment: Christina pays attention to details. Her NPWs, PAT, and written nurse reports were
well organized with relevant information pertaining to the specifics. She utilized effective
communication skills to obtain the information through interviews with the patient, nurse, and
data from the medical record.
The student communicates effectively in verbal form.
Answer: 4
Satisfactory: Meets Standards
Comment: Christina communicates very effectively.
The student initiates, maintains, and terminates the nurse-patient relationship using
principles of therapeutic communication.
Answer: 4
Comment:
The student functions as an advocate for the patient/family and communicates family
needs to other members of the health care team.
Answer: 4
Comment:
The student examines the dynamic interactions between the patient, family, community,
and society.
Answer: 4
Comment:
The student initiates discussion to identify and resolve interpersonal problems that impact
care.
Answer: 4
Comment:
The student uses interpersonal skills to enhance patient/family coping abilities.
Answer: 4
Comment:
The student discusses the ethical issues and approaches the ethical dilemmas that confront
the patient/family and appropriately discusses experience with faculty/preceptor.
Answer: 4
Comment:
The student delegates appropriately to patient care technician, family, or other team
members.
Answer: 4
Comment:
Standard I-Knowledge
The student applies knowledge of humanities, physical and social sciences, and nursing
when providing patient care.
Answer: 4
Comment:
Standard I-Knowledge
The student applies knowledge of social, cultural, and genetic factors to the care of diverse
populations.
Answer: 4
Comment:
Standard I-Attitude
The student does not in anyway demonstrate disrespect or inappropriate behavior to the
patient, staff, or faculty
Answer: 4
Comment:
Standard I-Attitude
The student is actively engaged in and seeks out opportunities for learning.
Answer: 5 (Comment Outstanding: Exceeds Standards
Required)
Comment: Christina actively sought out opportunities to learn in clinicals and in the nursing
lab. In the lab simulation, she stepped out of the group to assume a leadership role, began
assessing the patient, implementing treatment and working cooperatively with her peers.
Standard II-Safety
The student does not make judgmental, discriminatory, or prejudicial statements to the
patient, staff, or faculty.
Answer: 4
Comment: Christina was professional toward the patient, staff, and faculty. She worked well
with her preceptors receiving positive feedback from her weekly evaluations.
Standard II-Safety
The student applies principals of universal precautions, practices specific isolation
techniques, and teaches the reasons for universal precautions.
Answer: 4
Comment:
Standard II-Safety
The student assesses patients for fall risk and applies principles of safe patient handling.
Answer: 4
Comment:
Standard II-Safety
The student maintains the patient's physical safety by protecting the patient from harm.
Answer: 4
Comment:
Standard II-Safety
The student maintains medical and surgical asepsis when doing procedures requiring
sterile technique.
Answer: 4
Comment:
Standard II-Safety
The student properly identifies techniques and teaches the reasons for universal
precautions.
Answer: 4
Comment:
Standard II-Safety
The student validates the accuracy and appropriateness of orders for nursing/medical care
prior to initiating care.
Answer: 4
Comment:
Standard II-Safety
The student implements orders accurately and efficiently.
Answer: 4
Comment:
Standard II-Safety
The student is able to identify potential signs and symptoms of an emergent medical
condition and promptly reports changes in the patient's health status to preceptor and/or
clinical faculty member.
Answer: 4
Comment:
Standard II-Safety
The student adapts skill performance using principles of theory when necessary.
Answer: 4
Comment:
Standard III-Nursing Process:Assessment
The student identifies data from the history and physical assessment to formulate
appropriate nursing diagnoses.
Answer: 4
Comment:
Standard III-Nursing Process:Assessment
The student identifies the patient's health education needs.
Answer: 4
Comment:
Standard III-Nursing Process:Diagnosis
The student synthesizes history and assessment data as well as diagnostic results into the
development of nursing diagnoses.
Answer: 4
Comment:
Standard III-Nursing Process:Plan
The student integrates psychosocial needs into care plan, identifies appropriate resources
for the plan of care, and incorporates health education into the care plan.
Answer: 4
Comment:

The student identifies measurable, expected patient outcomes that are realistic and
individualized to the patient.
Answer: 4
Comment: NPWs were consistently appropriate along with verbal and written report that
focused on pertinent patient problems.
The student identifies the discharge planning process and needs of the patient upon
admission and throughout the hospitalization.
Answer: 4
Comment:
The student demonstrates judgement in decision-making and priority setting.
Answer: 4
Comment:
The student uses appropriate collaborative resources to personalize the nursing care the
patient receives.
Answer: 4
Comment:
Standard III-Nursing Process:Intervention/Implementation
The student demonstrates understanding of the principles underlying nursing actions
appropriate for the student at this point in the curriculum.
Answer: 4
Comment:
The student performs skills according to agency policy and procedure and clinical lab
guidelines.
Answer: 4
Comment:
The student implements the written action plan/protocol considering the priorities for each
assigned patient.
(Comment
Answer: 5
Required)
Comment: Strong documentation skills as evidenced in NPWs, PAT, and highlighted in the
case study.

The student implements a teaching plan based on scientific knowledge and utilizes
resources appropriately.
Answer: 4
Comment:
The student incorporates evidence based research into nursing practice.
Answer: 4
Comment:
The student practices individualized and culturally competent care.
Answer: 4
Comment:
The student initiates appropriate referrals as needed.
Answer: 4
Comment:
Standard III-Nursing Process:Evaluation
The student evaluates the patient's response/outcome to the intervention.
Answer: 4
Comment: Well documented NPWs and PAT outlining patient interventions.
Standard III-Nursing Process:Evaluation
The student utilizes subjective and objective data to revise nursing actions (as appropriate
for the student at that level of the curriculum).
Answer: 4
Comment:
Standard III-Nursing Process:Organization
The student provides organized, coordinated, and prioritized nursing care for the patients
with a range of health problems.
Answer: 4
Comment:
The student organizes time and resources effectively and efficiently.
Answer: 4
Comment:

The student gathers and organizes equipment necessary for patient care/procedures.
Answer: 4
Comment:
The student identifies and seeks appropriate resources during patient care provision.
Answer: 4
Comment:
The student completes the daily clinical assignment in a timely manner.
Answer: 4
Comment:
Standard III-Nursing Process:Documentation
The student appropriately develops long and short term patient oriented nursing care
goals based on patient assessment and scientific principles of nursing practice.
(Comment
Answer: 5
Required)
Comment: Christina developed strong and measurable long and short-term goals for her
patients. Her NPWs served as a student example among her peers.
The student documents problems and nursing care goals in the patient record (with cosignature).
Answer: 4
Comment:
The student identifies and documents nursing actions/orders initiated in implementing the
plan of care.
Answer: 4
Comment:
The student correctly enters data into the patient record in a timely manner per agency
protocol.
Answer: 4
Comment:
The student assures privacy of the patient record at all times.

Answer: 4
Comment:
Standard III-Nursing Process:Critical Thinking
The student utilizes critical thinking skills to prioritize patient needs based on the patient
assessment.
Answer: 4
Comment:
Comments:
Total: 214 Christina was consistently self-directed and professional during her clinical rotation.
She developed warm and therapeutic relationships with her patients. She showed passion in her
determination to provide high-quality patient care by asking questions, utilizing resources, and
taking the opportunity to learn. I observed her assume a leadership role under a stress-related
environment in the simulation lab. She is learning and growing fast

Portfolio ms2 Final Clinical Evaluation

Diunggah oleh

Informasi Dokumen

Deskripsi Asli:

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Portfolio ms2 Final Clinical Evaluation

Diunggah oleh

Hak Cipta:

Format Tersedia

Final Clinical Evaluation

NUR 4216L.013 MPM Spring 2015 4/14/2015

5-Outstanding: Exceeds Standards

Satisfactory: Meets Standards

Standard III-Nursing Process:Plan

Standard III-Nursing Process:Intervention/Implementation

Standard III-Nursing Process:Organization

The student assures privacy of the patient record at all times.

Anda mungkin juga menyukai