Name of Teacher _____ School by HC120808023439

VIEWS: 8 PAGES: 9

									                                                                         Evidence of Teaching
     Teacher’s Name                                                                                                      Evaluator’s Name

     Observation Date/Period                                                                                             Post Conference Date/Time

     Domain 1: Planning and Preparation
  Component                  Unsatisfactory                             Basic                               Proficient                                 Distinguished
1a. Knowledge of     The school nurse does not          The school nurse demonstrates         The school nurse demonstrates             The school nurse applies the knowledge of
and collection of    demonstrate fundamental            minimal knowledge of health history   consistent understanding of health        thoroughly collecting the data for a health
data for a health    knowledge of health history        components.                           history components.                       history while making intervention decisions.
history              components.
Evidence: Not Applicable to this lesson.
1b. Knowledge of     The school nurse does not          The school nurse has a basic          The school nurse demonstrates an          The school nurse applies the knowledge of
anatomy and          demonstrate a fundamental          knowledge of anatomy and              understanding between the anatomy of      pathophysiology while making nursing
pathophysiology of   knowledge of anatomy and           pathophysiology.                      bodily systems and pathophysiology.       assessments.
body systems         pathophysiology.
Evidence: Not Applicable to this lesson.
1c. Knowledge of     The school nurse does not follow   The school nurse has a basic          The school nurse uses the knowledge of    The school nurse demonstrates appropriate
emergencies in the   general emergency guidelines       understanding of general emergency    basic first aid measures and general      assessment skills of an emergency situation in
school setting and   and first aid measures for         guidelines and first aid measures.    emergency guidelines while responding     the school setting by administering,
appropriate          emergency care in the school                                             to an emergency situation in the school   instructing, and /or delegating to others first
responses to         setting.                                                                 setting.                                  aid emergency care.
emergencies
Evidence: Not Applicable to this lesson.




                        Administrator Initials                                                                                          Formal Observation Summary, page 1
                                                                                                                          Charlotte Danielson, Enhancing Professional Practice
                        Teacher Initials                                                                                                      A Framework for Teaching, 2007
  Component                  Unsatisfactory                              Basic                                   Proficient                                 Distinguished
1d. Knowledge of     The school nurse does not          The school nurse has a limited             The school nurse demonstrates a broad      The school nurse demonstrates a thorough
acute, episodic,     demonstrate a fundamental          knowledge and past experience in the       knowledge of acute, episodic and chronic   understanding of acute, episodic and chronic
and chronic health   knowledge of acute, episodic and   assessment of acute, episodic, and         health conditions.                         health conditions while making nursing
conditions           chronic health conditions.         chronic health conditions as relative to                                              assessments and appropriate interventions in
                                                        the school health setting.                                                            a school health setting.
Evidence: Not Applicable to this lesson.
1e. Knowledge of     The school nurse does not          The school nurse demonstrates              The school nurse                           The school nurse demonstrates a thorough
communicable         demonstrate knowledge of           minimal knowledge of communicable          demonstrates knowledge of                  knowledge of communicable diseases and
diseases             communicable disease.              diseases.                                  communicable diseases.                     makes appropriate referrals as needed.
Evidence: Not Applicable to this lesson.




                        Administrator Initials                                                                                               Formal Observation Summary, page 2
                                                                                                                               Charlotte Danielson, Enhancing Professional Practice
                        Teacher Initials                                                                                                           A Framework for Teaching, 2007
                                                                              Evidence of Teaching

      Domain 2: The Classroom Environment
   Component                  Unsatisfactory                             Basic                                  Proficient                                 Distinguished
2a. Immunization     The school nurse does not           The school nurse demonstrates a basic   The school nurse works diligently to       The school nurse communicates
requirements         demonstrate a knowledge of the      knowledge of the required               meet the school mandated                   immunization requirements to parents and
                     required immunization schedule.     immunization schedule.                  requirements. In addition, the school      collaborates with outside community
                                                                                                 nurse coordinates the exclusion of         agencies, other school districts and
                                                                                                 unprotected students according to          physician’s offices.
                                                                                                 district policy.
Evidence: Not Applicable to this lesson.
2b. Certificate of   The school nurse does not           The school nurse demonstrates a basic   The school nurse has a thorough            The school nurse maintains and coordinates
child health         demonstrate a knowledge of the      knowledge of the child health           understanding of the child health          the certificate of child health examination
examination          child health examination            examination components.                 examination certificate and interprets     information with former health records in an
                     components.                                                                 health status.                             organized and professional manner for each
                                                                                                                                            student.
Evidence: Not Applicable to this lesson.
2c. Risk reduction   The school nurse does not         The school nurse possesses a basic        The school nurse identifies and provides   The school nurse communicates to students,
and infection        possess knowledge of or           understanding of risk reduction and       information to students, parents, and      parents and staff and collaborates with
control              ignores opportunities for risk    infection control.                        staff members to correct deficient         appropriate agencies. The school nurse has
                     reduction and infection                                                     patterns of health care.                   an understanding of primary, secondary and
                     control.                                                                                                               tertiary prevention.

Evidence: Not Applicable to this lesson.




                        Administrator Initials                                                                                              Formal Observation Summary, page 3
                                                                                                                              Charlotte Danielson, Enhancing Professional Practice
                        Teacher Initials                                                                                                          A Framework for Teaching, 2007
  Component                Unsatisfactory                          Basic                                  Proficient                                   Distinguished
2d. Health and      The school nurse does not     The school nurse possesses a basic       The school nurse identifies and provides    The school nurse consistently provides
safety education    possess knowledge of health   understanding of health and safety       information to students, parents and        information to enhance health and safety in
                    and safety measures in the    measures.                                staff members of health and safety          the school setting. The school nurse
                    school setting.                                                        measures.                                   encourages students to develop patterns of
                                                                                                                                       healthful living and to accept responsibility
                                                                                                                                       for his/her own health and well being.

Evidence: Not Applicable to this lesson.
2e. Counseling      The school nurse has no       The school nurse has a basic knowledge   The school nurse identifies opportunities   The school nurse understands a variety of
techniques          understanding of counseling   of counseling techniques.                to advise, educate and teach health         counseling techniques. The school nurse
                    techniques.                                                            issues.                                     develops rapport and relationships with
                                                                                                                                       student, parent or staff to advise or educate
                                                                                                                                       on specific health issues with an awareness of
                                                                                                                                       the importance of confidentiality.
Evidence: Not Applicable to this lesson.
2f. Knowledge of    The school nurse does not     The school nurse has a basic             The school nurse has a thorough             The school nurse is effective in identifying
community health    have an awareness of          understanding of community health        knowledge of services and is able to        services that are appropriate for the
needs and           community health needs.       needs and resources.                     match appropriate services to the needs     individual student’s needs and serves as a
resources                                                                                  of individuals.                             resource for others in the school
                                                                                                                                       environment.
Evidence: Not Applicable to this lesson.




                       Administrator Initials                                                                                         Formal Observation Summary, page 4
                                                                                                                        Charlotte Danielson, Enhancing Professional Practice
                       Teacher Initials                                                                                                     A Framework for Teaching, 2007
                                                                              Evidence of Teaching
      Domain 3: Instruction
   Component                Unsatisfactory                            Basic                                     Proficient                                  Distinguished
3a. Ability to       The school nurse is unable to   The school nurse possesses a general       The school nurse consistently recognizes     The school nurse possesses thorough
identify needs of    recognize the needs of the      knowledge of the health issues             the needs of the adolescent and              knowledge of appropriate
adolescents          adolescent regarding            surrounding adolescent pregnancy and       implements appropriate intervention.         community/outside agencies and provides
regarding            pregnancy and sexuality.        sexuality.                                                                              referrals.
pregnancy and
sexuality
Evidence: Not Applicable to this lesson.
3b. Knowledge of     The school nurse has no         The school nurse has limited knowledge     The school nurse consistently                The school nurse consistently collaborates
psychosocial needs   knowledge of the psychosocial   of psychosocial needs of the adolescent.   demonstrates an understanding of the         with PPS colleagues and appropriate outside
impacting            needs of the adolescent.                                                   psychosocial needs of the adolescent.        community agencies as needed.
adolescent health
Evidence: Not Applicable to this lesson.
3c. Knowledge of     The school nurse lacks          The school nurse has a limited             The school nurse demonstrates the            The school nurse demonstrates a broad
medical              awareness or is resistant to    awareness of medical technology used in    ability to utilize medical technology in a   knowledge of current medical technology and
technology in the    medical technology.             the school setting.                        school setting.                              pursues educational opportunities to enhance
school setting                                                                                                                               delivery of services in the school setting.
Evidence: Not Applicable to this lesson.




                        Administrator Initials                                                                                               Formal Observation Summary, page 5
                                                                                                                               Charlotte Danielson, Enhancing Professional Practice
                        Teacher Initials                                                                                                           A Framework for Teaching, 2007
   Component                Unsatisfactory                               Basic                                     Proficient                                   Distinguished
3d. Knowledge of     The school nurse does not          The school nurse understands all            The school nurse consistently recognizes    The school nurse collaborates with PPS
abuse and neglect    recognize and / or does not        categories of child abuse are required by   and reports all categories of abuse to      colleagues and appropriate support services.
                     report abuse and neglect.          law to be reported to the proper            appropriate authorities.                    Performs physical assessment, documents
                                                        authorities.                                                                            findings, provides first aid for any injuries
                                                                                                                                                requiring emergency management, reports
                                                                                                                                                suspicion of abuse/neglect to authorities in
                                                                                                                                                accordance to child protection laws and
                                                                                                                                                school district policies.
Evidence: Not Applicable to this lesson.
3e Individualized    The school nurse does not          The school nurse has a basic                The school nurse participates in            The school nurse consults and collaborates
educational plan     understand the process of          understanding of the process of creating    developing a goal that is educationally     with other school personnel, the parents and
                     creating an Individual             an Individual Education Plan for an         relevant to an individual medical need.     the student, in gathering other health related
                     Education Plan for an identified   identified student with a medical need.                                                 information pertinent in developing and IEP
                     student with a medical need.                                                                                               goal.
Evidence: Not Applicable to this lesson.
3f. Multi-           The school nurse does not          The school nurse provides a basic written   The school nurse provides an accurately     The school nurse provides an accurately
disciplinary         provide an accurate written        report.                                     written report and attends the MDC to       written report, can communicate pertinent
conference           report and does not                                                            present findings.                           health information, and contributes in
                     communicate effectively with                                                                                               determining special education eligibility.
                     those involved in the MDC.
Evidence: Not Applicable to this lesson.
3g. Individualized   The school nurse does not          The school nurse possesses a basic          The school nurse develops an IHP for a      The school nurse constructs the IHP that
Health Plan (IHP)    possess an understanding of an     understanding of a basic Individualized     student with a medical need that            contains the following identifiable parts:
                     Individualized Health Plan.        Health Plan.                                interferes with the educational process.    history, assessment data, nursing diagnosis,
                                                                                                                                                goal of care, nursing actions or interventions,
                                                                                                                                                and expected outcomes to reflect the needs
                                                                                                                                                of a student in an educational setting.
Evidence: Not Applicable to this lesson.
3h. Special          The school nurse does not          The school nurse has a basic knowledge      The school nurse has a thorough             The school nurse collaborates with other
education laws/      possess a knowledge of special     of special education laws and section       understanding of special education laws     school personnel, the parents and student
American with        education laws and section 504     504 (ADA).                                  and section 504 (ADA).                      and other appropriate outside community
Disabilities (504)   of the rehabilitation act (ADA).                                                                                           agencies to provide necessary
                                                                                                                                                accommodations in the educational setting.
Evidence: Not Applicable to this lesson.
3i. Nursing          The school nurse does not          The school nurse has a basic                The school nurse utilizes the nurse         The school nurse possesses a thorough
Practice Act         possess an understanding of        understanding of how the state Nurse        practice act as a guideline for nursing     understanding of the Nurse Practice Act, what
                     how the state Nurse Practice       Practice Act regulates school nursing.      care in the educational setting.            nursing care can be delegated, qualifications
                     Act regulates school nursing.                                                                                              of persons providing nursing care, and how
                                                                                                                                                failure to comply may result in litigation or
                                                                                                                                                loss of one’s nursing license.
Evidence: Not Applicable to this lesson.

                        Administrator Initials                                                                                                  Formal Observation Summary, page 6
                                                                                                                                  Charlotte Danielson, Enhancing Professional Practice
                        Teacher Initials                                                                                                              A Framework for Teaching, 2007
                                                                                 Evidence of Teaching
     Domain 4: Professional Responsibilities
  Component                  Unsatisfactory                              Basic                                    Proficient                                  Distinguished
4a. Medication        The school nurse does not         The school nurse has a basic               The school nurse implements the district    The school nurse collaborates with parents,
policy                possess an understanding of       understanding of the district medication   medication policy as defined.               physicians, and students regarding safe
                      the district medication policy    policy regulating the authorization and                                                distribution of medication. The school nurse
                      regulating the authorization of   administration of medication in the                                                    maintains proper authorization, and
                      medication in the school          school setting.                                                                        documentation of records. The school nurse
                      setting.                                                                                                                 provides appropriate storage of medications.
Evidence: Not Applicable to this lesson.
4b. Management        The school nurse does not         The school nurse has a basic               The school nurse maintains accurate and     The school nurse efficiently interprets health
of health records     possess an understanding of       understanding of the need for              complete health records on each student     record information. The school Nurse seeks
                      compliance with state, federal    compliance of school health records.       while maintaining confidentiality.          out clarification of incomplete records while
                      laws, regulations and                                                                                                    striving for the goal of compliance of all
                      guidelines governing school                                                                                              records according to state law.
                      health records.
Evidence: Not Applicable to this lesson.
4c. Supervision and   The school nurse does not         The school nurse has a limited             The school nurse clearly defines tasks to   School nurse delegates tasks, provides
delegation of care    understand roles and              awareness of nursing responsibilities      be delegated to para- professionals and     supervision, inservice training and evaluation
                      responsibilities that may be      that may be delegated to                   volunteers within guidelines of their job   of performance of paraprofessionals and
                      delegated to paraprofessionals    paraprofessionals and volunteers.          description.                                volunteers.
                      and volunteers.
Evidence: Not Applicable to this lesson.
4d. Growing and       The school nurse does not         The school nurse pursues course work,      The school nurse is active in developing    The school nurse continually expands
developing            pursue opportunities to           seminars and workshops to enhance          expertise in relevant areas and shares      knowledge and skills, sharing with colleagues
professionally -      expand his/her knowledge          knowledge and develop skills               that knowledge and expertise with           and incorporating knowledge into practice
Formal                base or acquire new skills.                                                  colleagues.                                 and programs. The school nurse maintains
                                                                                                                                               professional affiliations.
Evidence: Not Applicable to this lesson.
4e. Growing and       The school nurse does not         The school nurse engages in reading and    The school nurse actively shares from       The school nurse incorporates knowledge and
developing            utilize opportunities to read     discussions related to professional        personal reading and initiates              insights into daily practice utilizing
professionally -      about and discuss current         issues.                                    discussions with colleagues about issues    professional journals, resources, and other
Informal              professional literature and                                                  related to education and nursing.           technologies.
                      issues.
Evidence: Not Applicable to this lesson.
4f. Awareness of      The school nurse is unaware of    The school nurse has general knowledge     The school nurse has comprehensive          The school nurse is a resource for others in
available resources   available resources and does      of resources and can refer appropriately   knowledge of available resources and        sharing knowledge and making referrals to
and community         not provide appropriate           as needed.                                 makes appropriate referrals as needed.      community resources and agencies.
agencies              referrals.
Evidence: Not Applicable to this lesson.
4g. Cooperative       The school nurse does not         The school nurse makes appropriate         The school nurse actively collaborates      The school nurse initiates effective
working               make appropriate referrals and    referrals and responds to requests from    with community agencies.                    relationships with community agencies.
agreement with        does not respond to requests      community agencies.
                         Administrator Initials                                                                                                Formal Observation Summary, page 7
                                                                                                                                 Charlotte Danielson, Enhancing Professional Practice
                         Teacher Initials                                                                                                            A Framework for Teaching, 2007
community             from community agencies
agencies              regarding the student’s needs.
Evidence: Not Applicable to this lesson.
4h. Ethics and        The school nurse does not        The school nurse has a basic knowledge   The school nurse demonstrates proper       The school nurse is a resource for others in
professional          have an understanding of the     of proper professional conduct and       professional and ethical conduct.          issues of professional conduct and ethics.
conduct               issues involving ethics and      ethics.
                      professional conduct.
Evidence: Not Applicable to this lesson.
4i. Standards of      The school nurse is not aware    The school nurse has a basic             The school nurse has a thorough            The school nurse consistently uses the
Professional School   of the Standards of              understanding of the Standards of        knowledge of the Standards of              Standards of Professional School Nursing
Nursing Practice      Professional School Nursing      Professional School Nursing Practice.    Professional School Nursing Practice.      Practice as a guideline for competent
                      Practice.                                                                                                            practice.

Evidence: Not Applicable to this lesson.




                         Administrator Initials                                                                                            Formal Observation Summary, page 8
                                                                                                                             Charlotte Danielson, Enhancing Professional Practice
                         Teacher Initials                                                                                                        A Framework for Teaching, 2007
Recommendations:



                              This document serves as the permanent record citing evidence of one specific classroom observation.



 Teacher’s Signature                                                                            Administrator’s Signature


 Date                                                                                           Date




                Administrator Initials                                                                        Formal Observation Summary, page 9
                                                                                                Charlotte Danielson, Enhancing Professional Practice
                Teacher Initials                                                                                    A Framework for Teaching, 2007

								
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