Student Clinical Evaluation

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Evaluation of Core Competencies

Communication/Interaction with Patients and Preceptors*

Communication/Interaction with Patients and Preceptors
	M	PM	UM*	N/A
Demonstrates appropriate communication skills including listening, consideration of cultural differences. Explains examination to patient and family; Includes patient and family in planning	Communication/Interaction with Patients and Preceptors: Demonstrates appropriate communication skills including listening, consideration of cultural differences. Explains examination to patient and family; Includes patient and family in planning (M)	Demonstrates appropriate communication skills including listening, consideration of cultural differences. Explains examination to patient and family; Includes patient and family in planning (PM)	Demonstrates appropriate communication skills including listening, consideration of cultural differences. Explains examination to patient and family; Includes patient and family in planning (UM*)	Demonstrates appropriate communication skills including listening, consideration of cultural differences. Explains examination to patient and family; Includes patient and family in planning (N/A)
Uses an accepted order of report/communication to preceptors and interprofessional colleagues	Uses an accepted order of report/communication to preceptors and interprofessional colleagues (M)	Uses an accepted order of report/communication to preceptors and interprofessional colleagues (PM)	Uses an accepted order of report/communication to preceptors and interprofessional colleagues (UM*)	Uses an accepted order of report/communication to preceptors and interprofessional colleagues (N/A)

Instructions

These criteria are based on nationally accepted core competencies for advanced nursing practice. Please evaluate the student's performance in all of the areas below using the learning goals provided in the documentation you received at the beginning of the semester. If you do not have the learning goals, they can be found here: College of Nursing Website - Preceptor Information. The student you are evaluating will know which set of goals matches their rotation with you.

Evaluation Scale Key

M = Met: Performs at expected/appropriate student level for specific semester.
PM = Partially met: Performs some aspects at expected level, but not entirely.
UM* = Unmet: Does not perform at expected level for specific semester. Requires narrative explanation in comment section.
N/A = Not Applicable

Data Collection: History and Chart Review*

Data Collection: History and Chart Review
	M	PM	UM*	N/A
Obtains a complete patient history	Data Collection: History and Chart Review: Obtains a complete patient history (M)	Obtains a complete patient history (PM)	Obtains a complete patient history (UM*)	Obtains a complete patient history (N/A)
Conducts a thorough chart review, including laboratory and other diagnostic data	Conducts a thorough chart review, including laboratory and other diagnostic data (M)	Conducts a thorough chart review, including laboratory and other diagnostic data (PM)	Conducts a thorough chart review, including laboratory and other diagnostic data (UM*)	Conducts a thorough chart review, including laboratory and other diagnostic data (N/A)

Conducts Appropriate Examination*

Conducts Appropriate Examination
	M	PM	UM*	N/A
Appropriate physical and/or psychosocial assessment skills	Conducts Appropriate Examination: Appropriate physical and/or psychosocial assessment skills (M)	Appropriate physical and/or psychosocial assessment skills (PM)	Appropriate physical and/or psychosocial assessment skills (UM*)	Appropriate physical and/or psychosocial assessment skills (N/A)
Identifies data and findings as normal or abnormal	Identifies data and findings as normal or abnormal (M)	Identifies data and findings as normal or abnormal (PM)	Identifies data and findings as normal or abnormal (UM*)	Identifies data and findings as normal or abnormal (N/A)

Assessment/Diagnosis:*

Assessment/Diagnosis:
	M	PM	UM*	N/A
Identifies range of possible diagnoses (differential diagnosis)	Assessment/Diagnosis:: Identifies range of possible diagnoses (differential diagnosis) (M)	Identifies range of possible diagnoses (differential diagnosis) (PM)	Identifies range of possible diagnoses (differential diagnosis) (UM*)	Identifies range of possible diagnoses (differential diagnosis) (N/A)
Narrows differential diagnosis appropriately	Narrows differential diagnosis appropriately (M)	Narrows differential diagnosis appropriately (PM)	Narrows differential diagnosis appropriately (UM*)	Narrows differential diagnosis appropriately (N/A)

Management: Develops a Plan of Care*

Management: Develops a Plan of Care
	M	PM	UM*	N/A
Plan is evidence based, appropriate to patient’s culture, follows established standards of practice, includes appropriate follow up, and integrates knowledge base	Management: Develops a Plan of Care: Plan is evidence based, appropriate to patient’s culture, follows established standards of practice, includes appropriate follow up, and integrates knowledge base (M)	Plan is evidence based, appropriate to patient’s culture, follows established standards of practice, includes appropriate follow up, and integrates knowledge base (PM)	Plan is evidence based, appropriate to patient’s culture, follows established standards of practice, includes appropriate follow up, and integrates knowledge base (UM*)	Plan is evidence based, appropriate to patient’s culture, follows established standards of practice, includes appropriate follow up, and integrates knowledge base (N/A)
Includes pharmacologic and non-pharmacologic therapies, patient education, health promotion, laboratory and diagnostic tests and referrals as needed	Includes pharmacologic and non-pharmacologic therapies, patient education, health promotion, laboratory and diagnostic tests and referrals as needed (M)	Includes pharmacologic and non-pharmacologic therapies, patient education, health promotion, laboratory and diagnostic tests and referrals as needed (PM)	Includes pharmacologic and non-pharmacologic therapies, patient education, health promotion, laboratory and diagnostic tests and referrals as needed (UM*)	Includes pharmacologic and non-pharmacologic therapies, patient education, health promotion, laboratory and diagnostic tests and referrals as needed (N/A)

Implementation: Assumes Responsibility for Implementation of Plan*

Implementation: Assumes Responsibility for Implementation of Plan
	M	PM	UM*	N/A
Orders appropriate therapies for individual patient, counsels about health and disease prevention behaviors, provides resources and referrals, and includes patient and family in planning	Implementation: Assumes Responsibility for Implementation of Plan: Orders appropriate therapies for individual patient, counsels about health and disease prevention behaviors, provides resources and referrals, and includes patient and family in planning (M)	Orders appropriate therapies for individual patient, counsels about health and disease prevention behaviors, provides resources and referrals, and includes patient and family in planning (PM)	Orders appropriate therapies for individual patient, counsels about health and disease prevention behaviors, provides resources and referrals, and includes patient and family in planning (UM*)	Orders appropriate therapies for individual patient, counsels about health and disease prevention behaviors, provides resources and referrals, and includes patient and family in planning (N/A)

Documentation: Utilizes Medical Record Appropriately*

Documentation: Utilizes Medical Record Appropriately
	M	PM	UM*	N/A
Writes organized, legible notes using SOAP format/site appropriate format	Documentation: Utilizes Medical Record Appropriately: Writes organized, legible notes using SOAP format/site appropriate format (M)	Writes organized, legible notes using SOAP format/site appropriate format (PM)	Writes organized, legible notes using SOAP format/site appropriate format (UM*)	Writes organized, legible notes using SOAP format/site appropriate format (N/A)
Completes medical record documentation in appropriate time frame	Completes medical record documentation in appropriate time frame (M)	Completes medical record documentation in appropriate time frame (PM)	Completes medical record documentation in appropriate time frame (UM*)	Completes medical record documentation in appropriate time frame (N/A)

Professional Behaviors:*

Professional Behaviors:
	M	PM	UM*	N/A
Receptive to feedback from clinical faculty / preceptor; Identifies strategies to improve performance	Professional Behaviors:: Receptive to feedback from clinical faculty / preceptor; Identifies strategies to improve performance (M)	Receptive to feedback from clinical faculty / preceptor; Identifies strategies to improve performance (PM)	Receptive to feedback from clinical faculty / preceptor; Identifies strategies to improve performance (UM*)	Receptive to feedback from clinical faculty / preceptor; Identifies strategies to improve performance (N/A)
Maintains confidentiality and ethical behaviors	Maintains confidentiality and ethical behaviors (M)	Maintains confidentiality and ethical behaviors (PM)	Maintains confidentiality and ethical behaviors (UM*)	Maintains confidentiality and ethical behaviors (N/A)
Displays prompt and courteous behaviors	Displays prompt and courteous behaviors (M)	Displays prompt and courteous behaviors (PM)	Displays prompt and courteous behaviors (UM*)	Displays prompt and courteous behaviors (N/A)

Student Strengths:*

Areas for Improvement or Concern:*