Nursing 4205 06 07 Approved 1 28 08 COTC Instructor and Student clinical evaluation March 11 2008 by I66V751d

VIEWS: 9 PAGES: 12

									                                                            COTC Instructor and Student (Self) Clinical Evaluation Tool

                 Student______________________________                                                                    Course Instructor Cindy Washington, MSN, RN
                 Course         4205-4206-4207
                 Quarter/Year__________________________                                                                   Final Clinical Grade______________________

                 Key for evaluation:
                                               O      Student performance exceeds expectations
                                               S      Satisfactory/Passing (safe, accurate, independent in previous learned skills,
                                                      competency increasing over time, needs occasional supportive cues/direction)
                                               I      Needs Improvement. At risk performance. Requires frequent verbal/direction cues.
                                                      Corrective Action Plan (CAP) to be developed. The student maybe redirected to
                                                      return to lab (for practice/remediation) if applicable. May progress to an U for the
                                                      clinical if no improvement.
                                               U      Unsafe performance. Consistently requires verbal/direction cues.
                                              NO      Not observed
                                              NA      Not applicable

                 *A made by the instructor beside the students’ evaluation, indicates that comments have been added to the comment section of the evaluation.
                 *Evidence of student’s success in each area of listed program outcomes may be placed in the student’s portfolio as
                  evidence of achievement. Examples of evidence may include (but not limited to): client assessments/care plans, critical
                  thinking assignments, mapping, and any other assignments required for the clinical experience.

                                                         Student clinical client assignment for the clinical experience
Wk 1        Age/Gender:          Diagnosis:

Wk 2        Age/Gender:          Diagnosis:

Wk 3        Age/Gender:          Diagnosis:

Wk 4        Age/Gender:          Diagnosis:

Wk 5        Age/Gender:          Diagnosis:

Wk 6        Age/Gender:          Diagnosis:

Wk 7        Age/Gender:          Diagnosis:

Wk 8        Age/Gender:          Diagnosis:

Wk 9        Age/Gender:          Diagnosis:

Wk 10       Age/Gender:          Diagnosis:



       Page 1
       1/28/08
Safe, effective care environment: Management of Care
     Promote achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting in order to protect clients, family/significant others
       and other health care personnel.
              o         Provide and direct nursing care that enhances the care delivery setting to protect clients, family/significant others and healthcare personnel:
                       Practice within legal and ethical standards of the profession.
                                 Provide for client privacy and treat each client with courtesy, respect and dignity.
                                 Demonstrate awareness of client rights, advocacy, advance directives and confidentiality issues.
                       Prioritize, implement, communicate and document client care in a safe, timely and appropriate manner.
                                 Document and communicate client care, assessments and plan of care.
                                 Organize client care activities to promote continuity of care.
                       Display collaborative practice and participate in coordination of client care.
                                 Efficiently prioritize and manage care assignments of multiple clients.
                                 Delegate and supervise basic care performed by other health team members.
                       Develop and display leadership skills.
Week                                                    1            2             3          4            5              6             7            8             9            10
Date
Instructor: student evaluation (O, S, I , or U)
                                Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




        Page 2
        1/28/08
Safe, effective care environment: Safety and Infection Control
    Promote achievement of client outcomes by providing and directing nursing care that enhances the care delivery setting in order to protect
      clients, family/significant others and other health care personnel.
                o Protect clients, family/significant others and health care personnel from health and environmental hazards.
                     Ensure the safety of clients, others, self, and health care personnel from health and environmental hazards.
                              Effectively use handwashing/universal precautions and asepsis.
                              Demonstrate safe use of equipment and devices.
Week                                                1           2           3          4            5            6           7            8              9   10
Date
Instructor: student evaluation (O, S , I , or U)
                      Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




       Page 3
       1/28/08
Health Promotion & Maintenance
    Provide and direct nursing care of the client and family/significant other that incorporates knowledge of expected growth and development
       principles; prevention and/or early detection of health problems; and strategies to achieve optimal health.
            Perform complete client physical and mental assessment in accordance with client developmental stage.
                    Identify expected changes in body image.
            Identify and provide nursing care that incorporates knowledge of disease prevention, early detection of health problems,
               and strategies to promote and maintain client/family health.
            Engage in effective age-appropriate teaching/learning.
Week                                                1           2           3           4           5            6           7            8              9   10
Date
Instructor: student evaluation (O, S , I , or U)
                      Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




       Page 4
       1/28/08
Psychosocial Integrity
        Provide and direct nursing care that promotes and supports the emotional, mental, and social well-being of the client and family/significant
           others experiencing stressful events, as well as clients with acute or chronic mental illness.
               Implement and maintain intentional caring, therapeutic relationships with clients.
                       Direct nursing care that supports the well-being of clients experiencing stress and mental illness.
               Manage nursing care that is culturally and religion sensitive and promotes and maintains optimal client/family
                      health.
                  Manage client sensory/perceptual and communication alterations.

Week                                               1          2         3          4          5           6          7          8            9      10
Date
Instructor: student evaluation (O, S , I , or U)
                 Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).

Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10



       Page 5
       1/28/08
Physiological Integrity: Basic Care and Comfort
    Promote physical health and wellness by providing care and comfort, reducing risk potential and managing health alterations.
         o Provide comfort to clients and assist in the performance of their activities of daily living.
                  Competently direct and evaluate care to maintain client basic needs and communication ability.
Week                                                1           2           3          4            5            6           7            8              9   10
Date
Instructor: student evaluation (O, S , I , or U)
                      Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




       Page 6
       1/28/08
Physiological Integrity: Pharmacological Therapies
    Promote physical health and wellness by providing care and comfort, reducing risk potential and managing health alterations.
         o Provide care related to the administration of medications and parenteral therapies.
                  Correctly calculate and administer medications in a safe, timely and appropriate manner.
                          Safely adapt pharmacological therapies to client developmental age.
                  Display knowledge of pharmacological action and relevance to client health status.
                  Competently manage potential side/adverse effects of pharmacological therapies.
                  Describe the commonly used blood components used for transfusion.
                  Explain the nursing evaluation and management of the collaborative problems of clients receiving blood
                     component therapy.
Week                                                1           2           3          4            5            6           7            8              9   10
Date
Instructor: student evaluation (O, S , I , or U)
                      Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




       Page 7
       1/28/08
Physiological Integrity: Reduction of Risk Potential
    Promote physical health and wellness by providing care and comfort, reducing risk potential and managing health alterations.
      o Reduce the potential for clients to develop complications or health problems related to treatments, procedures or existing conditions.
              Competently monitor and evaluate client health status by performing on-going system-specific assessments including
                 on-going evaluation of vital sign patterns and laboratory values.
              Monitor, evaluate and manage potential for alteration for clients undergoing diagnostic testing, therapeutic and
                 surgical procedures.
              Competently anticipate and manage potential alterations in client body systems.
Week                                                1           2           3          4            5            6           7            8              9   10
Date
Instructor: student evaluation (O, S , I , or U)
                      Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




       Page 8
       1/28/08
Physiological Adaptation
    Promote physical health and wellness by providing care and comfort, reducing risk potential and managing health alterations.
      o Manage and provide care for clients with acute, chronic or life-threatening physical health conditions.
              Use clinical judgment and the nursing process to provide and coordinate care for groups of adult clients with common
                health needs.
              Fluidly incorporate current knowledge from other disciplines into nursing practice.
               Recognize, monitor and plan/intervene in response to adverse/unexpected response to therapy.
Week                                                1           2           3           4           5            6           7            8              9   10
Date
Instructor: student evaluation (O, S , I , or U)
                      Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




       Page 9
       1/28/08
Professionalism
   Model professional nursing behavior, Practice within the profession's ethical and legal framework in providing nursing care for clients
    throughout the life span, Value the individual members of the nursing profession for their unique contributions to the discipline of nursing, and
    Preparation for passing the NCLEX-RN successfully.
   o Practice within established ethical guidelines
   o Apply the principles of accountability to their practice
   o Initiate own learning
   o Evaluate own strengths and areas needing improvement
   o Take action to enhance learning
   o Articulate the importance of professional growth through lifelong learning activities.
           Demonstrate professional nursing behaviors.
Week                                                    1           2          3           4           5            6           7            8              9   10
Date
Instructor: student evaluation (O, S , I , or U)
                         Student self evaluation: Describe behaviors supporting achievement of objective or plan to achieve objective (in the box below).
Wk 1


Wk 2


Wk 3


Wk 4


Wk 5


Wk 6


Wk 7


Wk 8


Wk 9


Wk 10




        Page 10
        1/28/08
Anecdotal notes to be completed by clinical instructor (attach additional notes as needed):




 Observations (Name/Date):




      Page 11
      1/28/08
Midterm evaluation:




Date: _________     Student Signature: ___________________________ Clinical Instructor Signature: __________________________________
                         Print Name: ___________________________                     Print Name: __________________________________

Final evaluation:




Date: _________     Student Signature: ___________________________ Clinical Instructor Signature: __________________________________
                         Print Name: ___________________________                     Print Name: __________________________________
                                                                                                     Final Clinical Grade (S/U): _______



     Page 12
     1/28/08

								
To top