ASSOCIATE DEGREE
NURSING PROGRAM
CLINICAL WEEKLY
EVALUATION
IN COMMUNITY & NON-ACUTE CARE SETTING
Student: ______________________________ Date(s):
______________________
Complete evaluation with specific examples of how
you met the course requirements. Ask the
preceptor to evaluate your performance during your time at the facility. If a preceptor gives a “0” in any area please
provide written comments as to why a “0” was given. You must have a weekly
evaluation for home health rotation, cardiac rehab, dialysis, and hospital
rehab or wound care clinic and 3 for non-acute care area.
POINTS
POINTS
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STUDENT COMMENTS |
(0,1) |
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PRECEPTOR COMMENTS |
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1. Performs nursing care competently. |
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A.
Follows applicable policies/procedures. |
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B. Maintains client safety and meets client’s basic needs. |
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C. Demonstrates professional interpersonal skills when collaborating with clients/family/staff/peers. |
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D. Reports appropriate information to health care team and documents appropriately. |
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E.
Utilizes critical thinking skills supported by
scientific rationale. |
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F. Meets client’s teaching needs with appropriate and accurate information. |
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G.
Demonstrates client advocacy. |
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POINTS POINTS
STUDENT COMMENTS (0,1) (0,1) PRECEPTOR COMMENTS
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2. Maintains professionalism. |
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A. Performs in a professionally honest/ethical/legal manner and displays caring attitude. |
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B.
Maintains appropriate clinical behavior (participated
in the experience, requested assistance with unfamiliar tasks and skills,
demonstrated a willingness to learn and implemented nursing skills, accepted
all assignments, dressed appropriately, arrived promptly, stayed required
length of time and
follows directions. |
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C. Completes and documents appropriate number of hours in community setting. Completes requirements for clinical (clinical, objectives, interviews, journal, weekly evaluations). D. Late work will result in up to five (5) points being deducted from weekly evaluation. Hours in setting: __________ |
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TOTALS |
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Student Signature: __________________________ Preceptor Signature: ___________________________
Date: _____________________________________ Date: _______________________________________
Bonus Points: ________________________________
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