University of Massachusetts Boston - QSEN



University of Massachusetts Boston

College of Nursing & Health Sciences

CLINICAL EVALUATION TOOL

COURSE: Freshmen- Introduction to Nursing Fall 20____or Spr 20___ or Sum 20____

Student Name: _________________________________ Skills/ Competencies Passed, Date: ____________

Clinical Site and Unit: _____________________________ Midterm Evaluation Date: __________________

Clinical Faculty: _____________________________ Final Evaluation Date: _____________________

Absent/Tardy Dates: _____________________________ Specify Clinical Makeup Assignment completed:_____________

Key: Instructions: Please evaluate the student’s performance, circling the letter rating (see “Key”) and providing comments

S = Satisfactory D= Developing NI = Needs Improvement U= Unsatisfactory

RATING SCALE

|Satisfactory |

|Almost Never Requires (90% of the time) |

|Direction |A focus on the client or system |

|Guidance |Accuracy, safety & skillfulness |

|Monitoring |Assertiveness and initiative |

|Support |Efficiency and organization |

| |An eagerness to learn |

|Developing |

|Occasionally requires (25% of the time) |Very often exhibits (75% of the time) |

|Direction |A focus on the client or system |

|Guidance |Accuracy, safety & skillfulness |

|Monitoring |Assertiveness and initiative |

|Support |Efficiency and organization |

| |An eagerness to learn |

|Needs Improvement |

|Often requires (50% of the time) |Often Exhibits (50% of the time) |

|Direction |A focus on the client or system |

|Guidance |Accuracy, safety & skillfulness |

|Monitoring |Assertiveness and initiative |

|Support |Efficiency and organization |

| |An eagerness to learn |

|Unsatisfactory |

|Very often requires (75% of the time) |Occasionally Exhibits (25% of the time) |

|Direction |A focus on the client or system |

|Guidance |Accuracy, safety & skillfulness |

|Monitoring |Assertiveness and initiative |

|Support |Efficiency and organization |

| |An eagerness to learn |

* Criteria marked with ** indicate knowledge, skills, or attitudes expected to be satisfactorily demonstrated at all times.

I. Patient Centered Care – Recognizes the patient as source of control and partner in providing compassionate and coordinated care based on respect for patient preferences, values, and needs.

| Competency |MIDTERM - STUDENT |MIDTERM - FACULTY |FINAL STUDENT |FINAL |

| | | | |FACULTY |

|A.** Elicits patient values, preferences, and expressed needs as part of |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|clinical interview, implementation of plan of care, and evaluation of care. | | | | |

| | | | | |

|B. Demonstrates respect and sensitivity for diverse, older adult patients and | | | | |

|pt. preferences, values, and needs in providing compassionate care, |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|recognizing own values and beliefs. | | | | |

| | | | | |

|C. Integrates understanding of additional, multiple dimensions of patient | | | | |

|care: coordination of care, communication, education, involvement of | | | | |

|family/significant others, physical and emotional comfort, transition and |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|continuity of care. | | | | |

| | | | | |

|D. Explores legal-ethical implications of patient care for older adults. | | | | |

| | | | | |

|E. Recognizes limits and boundaries of therapeutic patient-centered, nursing | | | | |

|care and scope of practice. |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| | | | | |

| | | | | |

| | | | | |

| |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

Please comment on your/student’s strengths as well as next steps for development.

II. Teamwork and Collaboration – Functions effectively within nursing and interdisciplinary teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

| Competency |MIDTERM - STUDENT |MIDTERM - FACULTY |FINAL STUDENT |FINAL |

| | | | |FACULTY |

|A. Describes own strengths, limitations, and values in |S / D /NI/ U |S / D /NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|functioning as a member of a team. | | | | |

|B. Initiates requests for help when appropriate to situation. | | | | |

|C. Communicates findings in a timely, accurate and effective |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|manner to clinical instructor and with nursing and | | | | |

|interdisciplinary team members to meet the needs of older adult | | | | |

|patients and families. This includes verbal and written |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|communication. | | | | |

|D. Follows communication and documentation practices that | | | | |

|minimize risk associated with handoffs among providers and | | | | |

|across transitions in care, utilizing SBAR or agency specific | | | | |

|guidelines. | | | | |

|E. Values perspectives and expertise of all team members. |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

Please comment on your/student’s strengths as well as next steps for development.

III. Evidence-Based Practice – Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

| Competency |MIDTERM - STUDENT |MIDTERM - FACULTY |FINAL STUDENT |FINAL |

| | | | |FACULTY |

|A. Bases pt. assessment, individualized care plan, and nursing |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|actions on patient values, clinical knowledge, and evidence. | | | | |

|B. Demonstrates knowledge of basic scientific principles and | | | | |

|nursing concepts when applying nursing interventions and |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|standards of care to older adult patients. | | | | |

|C. Examines evidence related to clinical practice topics and | | | | |

|guidelines, focusing on best practices in elder care, health | | | | |

|promotion, pain, comfort, transition/ continuity of care, and | | | | |

|health disparities. | | | | |

| |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

Please comment on your/student’s strengths as well as next steps for development.

IV. Quality Improvement – Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

|Competency |MIDTERM - STUDENT |MIDTERM - FACULTY |FINAL STUDENT |FINAL |

| | | | |FACULTY |

|A. Recognizes role of nurses and other health professionals as parts of |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|systems of care and care processes that affect outcomes for older adult | | | | |

|patients and families. | | | | |

|B. Values need for continuous quality improvement as an essential part of |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|daily work of all health professionals. | | | | |

| | | | | |

Please comment on your/student’s strengths as well as next steps for development.

V. Safety – Minimizes risks of harm to patients and providers through both system effectiveness and individual performance.

| Competency |MIDTERM - STUDENT |MIDTERM - FACULTY |FINAL STUDENT |FINAL |

| | | | |FACULTY |

|Sufficiently prepares for and completes clinical assignments to | | | | |

|implement safe and effective care, including identifying key |S / D /NI/ U |S / D /NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|nursing assessment data, analyzing data, developing priority | | | | |

|nsg. diagnoses, plans of care, interventions, evaluation | | | | |

|criteria. | | | | |

|Demonstrates appropriate priorities and time management skills | | | | |

|to provide safe and effective care. | | | | |

|Demonstrates beginning proficiency in performing patient | | | | |

|interviews and assessments, focusing on priority patient |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|concerns and physical, psychosocial, cultural, developmental, | | | | |

|environmental, and learning needs. | | | | |

|D. Incorporates scientific principles and theoretical knowledge |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|in the performance of care, skills, and education with older | | | | |

|adult patients. | | | | |

|E. Demonstrates knowledge of medication administration for | | | | |

|clients using standardized practice guidelines. | | | | |

|F.** Identifies and adheres to patient safety practices | | | | |

|instituted at clinical agency (such as, name band checks, |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|timely reporting of changes in patient condition, accurate and | | | | |

|comprehensive communication, verbal reports, and written | | | | |

|documentation, appropriate abbreviations, use of | | | | |

|safety-enhancing technologies and practices, maintaining safe |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|pt. environment, and others deemed important). | | | | |

|G. Values own role in preventing errors and reducing risk of | | | | |

|harm to self and others. |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| | | | | |

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| | | | | |

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| |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| | | | | |

Please comment on your/student’s strengths as well as next steps for development.

VI. Informatics – Use information and technology to communicate, manage knowledge, mitigate error,

and support decision-making.

| Competency |MIDTERM - STUDENT |MIDTERM - FACULTY |FINAL STUDENT |FINAL |

| | | | |FACULTY |

|A. Uses the electronic health record system to access relevant |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|patient information, including accessing and interpreting | | | | |

|patient history, diagnostic and laboratory findings. | | | | |

|B. Utilizes technology fully and accurately document patient | | | | |

|assessment, plan of care, referrals, care provided. | | | | |

|C. Protects confidentiality of protected health information. |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| | | | | |

| | | | | |

| |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

Please comment on your/student’s strengths as well as next steps for development.

PROFESSIONAL BEHAVIORS

The College of Nursing and Health Sciences has based its definition upon the American Nurses Association Standards of Practice. Students are expected to meet these standards of conduct throughout the program. The student:

| | Competency |MIDTERM - STUDENT |MIDTERM - FACULTY |FINAL STUDENT |FINAL |

| | | | | |FACULTY |

|1. |**Accepts responsibility for one’s own actions and |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |attitudes. | | | | |

|2. |**Demonstrates the ability to develop and maintain |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |therapeutic relationships and appropriate personal | | | | |

| |boundaries. | | | | |

|3. |**Demonstrates a respectful, sensitive, and non-judgmental |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |manner when communicating with others. Others are defined | | | | |

| |as: peers, faculty, clients, staff, families, community, and| | | | |

| |staff. | | | | |

|4. |**Demonstrates personal and professional ethics, honesty, |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |and integrity. | | | | |

|5. |**Completes assignments as required and scheduled. |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

|6. |**Provides prior notification to appropriate faculty when |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |he/she is unable to meet commitments or requirements. | | | | |

|7. |**Participates in clinical activities as scheduled, arriving|S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |on time and prepared for the daily assignment throughout the| | | | |

| |length of the nursing program. | | | | |

|8. |**Demonstrates professional appearance and prof’l |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |presentation in clinical settings CNHS activities. | | | | |

|9. |**Demonstrates the ability to use good judgment in all |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |decision making and provide sound rationale for actions. | | | | |

|10. |**Respects others during clinical activities (i.e., no |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |talking while others are talking, cell phones are silenced, | | | | |

| |and no inappropriate use of computers) | | | | |

|11. |**Demonstrates respect and politeness to all individuals |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |regardless of culture, ethnicity, religion, work experience,| | | | |

| |gender, age and sexual orientation. | | | | |

|12. |**Communicates with others with respect, sensitivity, and |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |politeness in all forms (verbal, nonverbal, written, and | | | | |

| |electronic; includes listening and caring behaviors). | | | | |

|13. |**Maintains confidentiality of all client information in |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

| |conversation, electronic and written means. | | | | |

|14. |Actively participates as a patient advocate. |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |S/ D/ NI/ U |

ADDITIONAL COMMENTS Comment on your/student’s overall strengths as well as next steps for professional development.

Midterm Next steps for focus and growth Final Next steps for focus and growth

Faculty Signature: _________________________ Faculty Signature: _________________________

Student Signature: _________________________ Student Signature: _________________________

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