Clinical Evaluation_IUBAT (201501.xls

	A	B	C	D	E	F	G	H	I	K
1		CLINICAL EVALUATION
2								Year
3
4		Please enter the number of the score in the box. (If the student scores 85 in category 1.1, enter the number 85 in the appropriate column). If you have not had an opportunity to evaluate a category, leave the row blank and delete the "100" from the "Best Score" box for that row. (This form will automatically adjust and sum results.)
5
6		55 = poor, 65 = below the standard, 75 = meets the standard, 85 = above the standard, 100 = excellent
7										Best Score
8	1.0 Health and Healing	Wellness and Communication	55	65	75	85	100
9
10	1.1	Able to use therapeutic communication effectively (actively communicates with patients & families)								100
11	1.2	Maintains client confidentiality & demonstrates respect for patients & family members								100
12	1.3	Demonstrates appropriate level of assertiveness (not aggressiveness)								100
13	1.4	Able to communicate appropriately & effectively with staff & students								100
14		Category Total	0	0	0	0	0	0	Section Total
15	COMMENTS:
16
17	2.0	Teaching & Learning	55	65	75	85	100
18
19	2.1	Competently performs admission and discharge procedures (history; teaching)								100
20	2.2	Uses opportunities for patient & family teaching (explains procedures, medication routines, diet; invites questions; checks that the client has understood)								100
21	2.3	Actively looks for extra learning opportunities anytime assigned tasks are complete; includes comfort care, observing skills practices of staff nurses or doctors, additional patient assessments, medication study								100
22	2.4	Able to demonstrate understanding of the nursing process								100
23	2.5	Performs accurate & thorough research for nursing care of patients (checks patient records; hospital protocol manuals where available; drug guides)								100
24		Category Total							Section Total
25	COMMENTS:
26	3.0	Application of Nursing Knowledge	55	65	75	85	100
27
28	3.1	Able to perform complete patient assessments (head to toe)								100
29	3.2	Able to describe the normal and abnormal assessment/values for the skills in the course/level								100
30	3.3	Able to detect, report and document changes in patient condition								100
31	3.4	Performs vital signs monitoring accurately and on time								100
32	3.5	Able to maintain aseptic technique (appropriate hygiene for nurse and patient; management of equipment and medical waste)								100
33	3.6	Performs medication administration according to the 6 rights								100
34	3.7	Student is safe with all clinical skills								100
35	3.8	Demonstrates caring practices and comfort measures (including patient hygiene management of all body fluids)								100
36		Category Total	0	0	0	0	0	0	Section Total
37	COMMENTS:
38
39
40
41
42	4.0 Professional Responsibility		55	65	75	85	100
43
44	4.1	Advocates for the patient regarding safe care								100
45	4.2	Functions within the policies of the university & agency (including grooming, attendance and timeliness)								100
46	4.3	Is accountable for actions & mistakes								100
47	4.4	Respects patient privacy during procedures								100
48	4.5	Responds constructively to instructions, suggestions and criticism								100
49	4.6	Is prepared to answer any questions assigned by the clinical supervisor								100
50		Category Total	0	0	0	0	0	0	Section Total
51	COMMENTS:
52
53
54	5.0	Journal (RJ = Reflective Journal)	55	65	75	85	100
55
56	5.1	Maintains both ward journal and reflective journals								100
57	5.2	Submits journals in a timely manner								100
58	5.3	RJ respects confidentiality in journal entries								100
59	5.4	RJ summarises daily events BRIEFLY								100
60	5.5	RJ reflects on emotional response of self (why did I feel that way)								100
61	5.6	RJ reflects on the actions of self and others								100
62	5.7	RJ reflects on how events might influence future actions/practice								100
63		Category Total	0	0	0	0	0	0	Section Total
64	COMMENTS:
65
66		For category 6.0 the satisfaction levels of the categories will be the same but the total scores will be higher
67	6.0	Mastery of the semester skill for the course/level	550	650	750	850	1000
68
69	6.1	Student has mastered the practice of skills for the course/level						0	Section Total	1000
70	COMMENTS:
71
72			Sum of Section Totals					0		4000
73		The final % score =
74		(sum of section totals) x 100 / best possible total					%	0
75
76		Supervisor:
77		Date of Evaluation:
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100