NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
Name:
Term:
Final Course Grade:
DETERMINATION OF CLINICAL PERFORMANCE
A formative evaluation occurs throughout the clinical rotation. The evaluation of clinical performance is the shared responsibility of the
student and the clinical instructor. However, the instructor has the primary responsibility of determining whether the student’s performance
objectives meet the required course competencies. The student will review and initial this form with the clinical instructor weekly. The
clinical evaluation tool is returned to the lead course instructor following the last day of the clinical experience.
The summative evaluation occurs at the end of the course. Student performance will be evaluated in relation to the ability to demonstrate a procedure/behavior
with increasing efficiency and independence.
Passing Criteria
Upon completion of this course, the student must consistently function at a Satisfactory level for all course competencies. The final formative evaluation may not
contain any Needs Improvement or Unsatisfactory ratings.
Key to Evaluation Tool
S=Satisfactory
I=Needs Improvement
U=Unsatisfactory
NA=Not Applicable
Efficient and coordinated, usually independent or needs occasional supportive cues, meeting course competencies, and provides
safe care.
Needs directive and/or supportive cues. Requires additional supervision to perform appropriately and safely. Requires prompting
to seek out learning opportunities and complete learning activities. Performance is inconsistent.
Unable to demonstrate behavior, procedures, and or interventions related to core values and not meeting the unit objectives, lacks
confidence, coordination and efficiency, needs frequent verbal and physical cues, unprepared and unsafe.
Not applicable as determined by instructor, or not observed by instructor
Student Conference
The clinical instructor will complete a Student Conference Form for unsatisfactory clinical performance including the student’s inability to perform skills and
procedures as taught in the practice laboratory, tardiness and absences, and all instances of unprofessional behaviors.
Guidelines and policies for students receiving a warning or who have been placed on clinical probation can be found in the Student Handbook and / or the
Clinical Instructor Handbook.
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NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
Name:
S = Satisfactory
Term:
I = Need Improvement
Course Objective
Final Course Grade:
U = Unsatisfactory
NA = Not Applicable
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CRITICAL THINKING
Prioritize appropriate nursing care for clients across the lifespan.
Develop a plan of care based on assessment data to meet the needs of clients across the
wellness/illness continuum.
Utilize the nursing process to develop a plan of care for child-bearing, pediatric, adult and
geriatric clients.
Utilize assessment data to develop a plan of care for clients and families with acute and
chronic health alterations.
Modify plan of care based upon an evaluation of patient outcomes and according to client
needs.
Based on developmental needs, design a health education/promotion teaching plan utilizing
multiple resources that identifies learning needs across the lifespan.
Implement a discharge plan with integrated client teaching.
Report significant client data to appropriate members of the health care team.
Course Objective
SAFE PRACTICE
Demonstrate preparation for clinical experience including an understanding of the effects of
the alteration in health, effects of therapy, and implications for nursing care.
Apply principles of safe medication administration
Demonstrate safe and competent care for clients receiving intravenous therapy.
Perform nursing interventions and clinical skills safely for child-bearing, pediatric, adult and
geriatric clients.
Course Objective
INFORMATION MANAGEMENT & TECHNOLOGY
Integrate appropriate data from electronic and web-based information sources to plan and
deliver safe nursing care.
Integrate patient care technology safely and confidently to document and report client findings.
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NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
Name:
S = Satisfactory
Term:
I = Need Improvement
Course Objective
Final Course Grade:
U = Unsatisfactory
NA = Not Applicable
Date
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HOLISM
Implement a holistic plan of care for clients across the lifespan.
Integrate physical, biological, psychological, sociological, cultural, and spiritual needs into the
plan of care for clients and families across the lifespan.
Course Objective
CARING
Formulate strategies that promote a therapeutic environment for clients and families
Incorporate caring behaviors in nursing care of clients and families.
Demonstrate therapeutic communications skills in the nurse-client relationship across the
lifespan.
Course Objective
ROLE DEVELOPMENT
Adhere to the standards of nursing practice.
Integrate EBP into a plan of care for a stable client.
Practice within regulatory, legal and ethical frameworks of professional nursing.
Demonstrate knowledge, skills, and behaviors of the Registered Nurse.
Communicate significant client findings and events to members of the health care team.
Delegate appropriately according to health care team member role and client needs.
Adhere to the standards of the MaricopaNursing Program
Student Signature:
Initial:
Date:
Instructor Signature:
Initial:
Date:
Instructor Signature:
Initial:
Date:
Instructor Signature:
Initial:
Date:
Peds Absence_________ Tardy__________
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OB Absence_________ Tardy__________
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MS Absence_________ Tardy__________
NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
Name:
PEDS ROTATION
Term:
Final Course Grade:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
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Date:
NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
Name:
OB ROTATION
Term:
Final Course Grade:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
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NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
Name:
MED/SURG ROTATION
Term:
Final Course Grade:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
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NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
Name:
Term:
Final Course Grade:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
Instructor notation: Area of exceptional performance and area needing improvement.
Objective:
Date:
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NUR251
Nursing Theory and Science III
Formative/Summative Clinical Evaluation Tool
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