COMPETENCIES/PERFORMANCE CRITERIA Weekly Evaluation Tool 2012-2013… · competencies/performance criteria i. apply the nursing process to individuals and groups across the lifespan

LOS ANGELES HARBOR COLLEGE WEEKLY CLINICAL EVALUATION for NURSING 343

32

Student: Clinical Instructor:

Agency:

Date:

Evaluation Criteria Satisfactory: Clinical performance demonstrates

continued growth towards course competencies.

Behaviors are consistent, safe, and performed at

expected learner level described in the student

competency behavior descriptors for satisfactory

performance.

Needs Improvement: Behaviors manifested have

potential for causing harm. Student requires

excessive prompting and direction to perform safely

and at expected learner level.

Unsatisfactory: Behaviors performed are unsafe.

Omits student behaviors required to achieve course

competencies. Student behaviors lack knowledge

base and skill competencies expected (see

unsatisfactory behavior descriptors).

(*)-Represents Critical Competency Behaviors: Competency Behaviors must be met in order to pass the clinical component of this course. “Unsatisfactory” daily ratings will be given for the following behaviors: An “Unsatisfactory” rating in any critical

behavior (delineated by an “*”). Three or more “Needs Improvement”

ratings in any area on one day of clinic or 1 “Unsatisfactory” rating in a non critical behavior and 1 “Needs Improvement” in 1 clinic day

The Student must demonstrate a “Satisfactory” level of performance for 75% of the clinical rotation in order to pass. Two “Unsatisfactory” clinical weeks will result in a clinic failure. The student must pass theory and clinic in order to pass the course.

COMPETENCIES/PERFORMANCE CRITERIA I. APPLY THE NURSING PROCESS TO INDIVIDUALS AND GROUPS ACROSS THE LIFESPAN AND IN VARIOUS DEVELOPMENTAL STAGES.

1. Assess and categorize ineffective behaviors that affect adaptation in the four modes: physiologic, self-concept, role function, and interdependence as demonstrated in detailed nursing history and assessments.*

2. Practice Mental Status Assessment to competence.* 3. Analyze assessment data to formulate actual and potential nursing diagnoses and formulate/propose expected

outcomes.* 4. Propose rationale for prioritizing nursing diagnosis in the psychiatric setting. 5. Design and implement an individualized plan of care based on priority nursing diagnoses and pertinent needs

of the patient.* 6. Evaluate progress toward attainment of outcomes.* WEEK/DATE 1 2 3 4 5 6

Evaluator Std. Inst. Std. Inst. Std. Inst. Std. Inst. Std. Inst.

SAT.

O R I E N T

N.I.

UNSAT.

N/A


33

II. DISPLAY PROFESSIONAL BEHAVIOR STANDARDS WITHIN NURSING PRACTICE.

1. Complies with agency and school policies, state laws and regulations (including the Behavioral Health Care National patient Safety Goals) and practices within the legal and ethical frameworks of nursing.*

2. Treat all individuals with dignity and respect, and maintains patient confidentiality.* 3. Comes prepared to care for assigned patients.* 4. Completes all required clinical forms correctly.* 5. Demonstrates appropriate behaviors (attendance, appearance, honesty, attitude, punctual).* 6. Integrates constructive criticism to improve performance, being accountable for own actions, behaviors,

outcomes of actions, and making appropriate changes. 7. Appraise personal strengths and weaknesses in the psychiatric setting to identify areas for personal and

professional growth. 8. Establishes and maintains nurse-patient boundaries including appropriate use of self-disclosure. WEEK/DATE

1 2 3 4 5 6

Evaluator Std. Inst. Std. Inst. Std. Inst. Std. Inst. Std. Inst. SAT.

O R I E N T

N.I.

UNSAT.

N/A

III. INTEGRATE THERAPEUTIC COMMUNICATION SKILLS VERBALLY, NON-VERBALLY, AND IN WRITING.

1. Consistently develops therapeutic communication techniques that assist the patient, family, and significant others to cope with and resolve problems and self-evaluates these therapeutic interactions in the process recordings.*

2. Interacts effectively with patient, staff, and instructor and actively participates in clinical conferences.* 3. Process verbally and in writing personal responses and patterns of coping in relation to the nurse-patient

relationship, nursing interventions and exposure to the psychiatric environment. 4. Provides accurate information to patients and families.* 5. Displays use of appropriate and respectful words and tone in verbal communications.* 6. Relates overt patient behavior (outward behavior) to covert stimuli (internal sources) and recognizes

manipulative behavior. 7. Recognize and examine the phenomenon of transference and countertransference in the therapeutic

relationship. 8. Adapts communication strategies based on patient’s age, developmental level, disability, and/or culture. WEEK/DATE

1 2 3 4 5 6


SAT.

O R I E N T

N.I.

UNSAT.

N/A


34

IV. DEMONSTRATE CLINICAL DECISION MAKING THAT IS ACCURATE AND SAFE AND THAT MOVES CLIENT AND FAMILY TOWARDS POSITIVE OUTCOMES ACROSS THE LIFESPAN AND VARIOUS DEVELOPMENTAL STAGES

1. Assembles adequate information for decision making.* 2. Integrates nursing concepts and recognizes stimuli of ineffective behaviors. 3. Develops plan of care and makes decisions on the basis of general evidenced based guidelines or principles.* 4. Collects data from appropriate resources (electronically or through other means) as well as critical reasoning

to assist in solving patient problems. WEEK/DATE

1 2 3 4 5 6


SAT.

O R I E N T

N.I.

UNSAT.

N/A

V. CREATE CARING INTERVENTIONS THAT ASSIST CLIENTS IN MEETING THEIR BIO-PSYCHO-SOCIAL NEEDS ACROSS THE LIFESPAN AND IN VARIOUS DEVELOPMENTAL STAGES.

1. Comes to clinical prepared per course protocol and physically and mentally prepared to provide safe care.* 2. Recognize and question personal biases and stereotypes related to the mentally ill. 3. Demonstrates patient advocacy, protecting patient from injury, infection, and harm.* 4. Maintains a safe, care environment. 5. Seeks assistance and mentorship when needed. 6. Performs nursing procedures according to college or agency policy and procedure guidelines.* 7. Relates knowledge of the mechanism of action, indication, dosage range, therapeutic effect, related laboratory

values, side effects and nursing implications of all medications prescribed to the patient. 8. Integrate patient’s developmental stage, values, customs, culture, and /or habits in plan of care. WEEK/DATE

1 2 3 4 5 6


SAT.

O R I E N T

N.I.

UNSAT.

N/A


35

VI. APPRAISE AND DISPLAY TEACHING AND LEARNING PROCESSES TO PROMOTE HEALTH AND REDUCE RISKS FOR THE CLIENT AND FAMILY ACROSS THE LIFESPAN AND IN VARIOUS DEVELOPMENTAL STAGES 1. Takes initiative to obtain pertinent information and prepares patient for interventions. 2. Plan and provide for learning needs of the patient, family, and group incorporating community resources as

needed in developing teaching plan.* 3. Uses evidenced based teaching and learning principles to accommodate various learning styles. 4. Evaluate whether learning has occurred and identify evaluation method used.* 5. Provides patient with information they need to make informed decisions.

WEEK/DATE

1 2 3 4 5 6


SAT.

O R I E N T

N.I.

UNSAT.

N/A

VII. PRACTICE PROVIDING CARE AS PART OF AN INTERDICIPLINARY TEAM TO DELIVER CLIENT-CENTERED CARE TO THE CLIENT AND FAMILY ACROSS THE LIFESPAN AND IN VARIOUS DEVELOPMENTAL STAGES.

1. Uses appropriate channels of communication.* 2. Reports ineffective behaviors, accurate, pertinent information, and patient concerns in a timely manner to

staff, and instructor.* 3. Conveys respect, support and appreciation when working with patients and staff members.* 4. Use of SBAR in communication with interdisciplinary team members. WEEK/DATE

1 2 3 4 5 6


SAT.

O R I E N T

N.I.

UNSAT.

N/A


36

VIII. ASSIST CLIENTS ACROSS THE LIFESPAN IN A VARIETY OF HEALTH CARE SETTINGS IN THE COMMUNITY TOWARD POSITVE OUTCOMES UNDER THE CARE OF EXPERTS.

1. Completes care in a cost effective, organized, timely manner. 2. Adapts plan of care in response to patient needs.* 3. Evaluates patient response to nursing and medical interventions, including medication response, therapeutic

treatments and interventions, patient teaching, lab and diagnostic reports.* 4. Uses measurable outcomes on care plans to evaluate care. WEEK/DATE

1 2 3 4 5 6


SAT.

O R I E N T

N.I.

UNSAT.

N/A


37

STUDENT REFLECTIONS: Review performance criteria from the previous tables. Write about feelings, opinions and concerns regarding patient care activities that went well and not so well, transfer of theoretical knowledge and nursing interventions that promoted effective adaptation of your client. Write comments related to resolution of performance, lessons learned, procedures performed.

Reflection Comments: USE BACK OF PAGE AS NEEDED Week 1 Week 2 Week 3 Week 4 Week 5 Week 6


38

Instructor’ Weekly Feedback regarding student clinical performance: State positive performance and suggestions for improvement. Circle weekly performance level rating.

Student Initial

Week 1 ____ punctual ____ dressed appropriately ____ wore name tag ____ brought all materials _____ completed Prep/pathophysiology _____ participated in clinical conference

Weekly Rating: Sat. NI Unsat

Week 2


Week 3


Week 4


Week 5


Week 6 (Summary)


Total Points______ Theory Grade______ Clinic Grade____ _ Date:_________________

Student Signature Clinic Instructor Signature___________________ __


39

NURSING 343: STUDENT COMPETENCY BEHAVIOR DESCRIPTORS FOR CLINICAL PERFORMANCE RATINGS Competency

Satisfactory (Moving toward independent level. Performing as Expected for this level).

Needs Improvement (Concerns regarding performance level).

Unsatisfactory (Dependent level, significant concerns for safety).

I. APPLY THE NURSING PROCESS TO INDIVIDUALS AND GROUPS ACROSS THE LIFESPAN AND IN VARIOUS DEVELOPMENTAL STAGES.

Utilizing appropriate guidelines, resources, & assessment techniques, demonstrates steps of the nursing process. Identifies adaptive & ineffective behaviors in all four modes. Includes subj. & obj. data. Identifies etiology for ineffective behaviors, includes pathophysiology, growth & developmental stage, culture, self concept, adaption levels, & economic factors, as they relate to the patient. H&A forms contain 95% of pertinent data. E.g. lab, diagnostic tests. < 2 areas needing minor corrections or additions. Identifies 3 prime Nursing diagnoses (ND). Identifies > 3 pertinent manipulatable stimuli for each ND. Care Plans (CP) reflect priority NDs. Goal stated are appropriate for patient. Has > 3 outcomes measurable & with realistic critical times. Identifies 95% of therapeutic nursing interventions (NI) related to stated outcomes. Gives rationale for each NI. Evaluates progress towards outcomes & revises NI PRN. Receives > 22.5 out of 30 points awarded on each CP.

Does not consistently use appropriate guidelines or resources available or in a timely manner. Does not assess all components of affected body system. Assesses /identifies less than (4) adaptive and ineffective behaviors in the four modes. History and Assessment contains less than 95% of pertinent information or missing data on 2 areas. Missing (1) key subjective or objective ineffective behavior on care plan. Missing (2 or more) related minor ineffective behaviors. (1) Nursing Diagnosis not a priority for your patient. Identifies only 2 manipulatable stimuli on care plan. 75% of outcomes not measurable or not realistic to patient, nursing diagnosis, goal, or stimuli. Missing (2) key nursing interventions or (2) incomplete or unrelated rationales. Does not revise care plan when outcomes are not achieved. Score < 22.5 overall on care plan. Performance does not meet expected level behaviors.

Does not utilize appropriate guidelines or resources. Does not consult with instructor or staff when needed. Does not utilize appropriate assessment techniques. H&A does not address significant patient data or four modes. Does not relate growth and development, cultural or economic, adaptation level, self-concept factors or etiology when indicated. Inaccurate data obtained. Failure to identify all significant related subj. & obj. data for pt. behaviors. Etiology of behaviors inaccurate/incomplete. Care plan not individualized. Does not assign priority NDs. Outcomes are not measurable or lack of realistic critical time. NI’s do not have related rationales. Neglects to perform necessary NI to promote positive outcomes for patients. Missing 3 or more key interventions on plan of care. Does not evaluate outcomes or revise nursing interventions as indicated. Care plan not individualized to pt. as to data on H & A. Score < 20 on care plan.


40

Competency




II. DISPLAY PROFESSIONAL BEHAVIORS WITHIN NURSING PRACTICE.

Notifies instructor & unit of any absence or tardiness before start of duty. Prompt arrival to clinical, prepared to care for pt. with accurate completion of prep forms, med. cards, CP & prepared to perform expected duties & procedures following program & agency policies & procedures (including the current Behavioral Health Care National patient Safety Goals). < 2 minor prompts during procedure. Asks for assistance when unsure. Responds in a positive manner to corrections/suggestions by instructor or staff. Takes responsibility for behaviors & outcomes of actions. Assigns self to a variety of pts. To enhance learning & hone skills. Notifies instructor & staff in a timely manner of difficulty completing assignment or of change in pt. condition. Works within the scope of a nursing student. Evaluates clinical performance honestly & writes corrective actions in weekly evaluation. Maintains ethical & legal principles. Uniform & grooming comply with program policy. Submits assignments on time.

Prompt arrival, can answer instructor's questions regarding significant patient information, meds & plan of care with minimal prompts. Needs >2 minor prompts to correctly perform procedures. Patient care not performed in a timely manner. Needs prompt to complete necessary care. Does not report information in a timely manner or information given has minor omissions. Does not ask appropriate person for information when in doubt. Assigns self to patients with minimal learning experiences. Comments on evaluation do not reflect on how to improve performance. Submits assignments < 1 day late. Professional behaviors not performed at expected learner level. Use of 1 patient identifier when providing care. Use of unapproved abbreviations on paperwork.

Does not notify instructor &/or unit of absence or tardiness. Cannot answer significant questions asked by instructor regarding Dr. orders/labs/meds/stimuli/interventions, etc. Needs major prompt or instructor intervening to safely perform procedure. Gives medication or performs procedure without the instructor’s knowledge. Does not notify instructor/staff of meds, procedure or nursing care not performed. Does not comply with instructor’s request/instructions. Does not correct behaviors after being discussed by instructor. Does not notify instructor of errors. Does not notify instructor of detrimental change in patient condition. Is disrespectful/ argumentative with patient, staff, or instructor. Leave unit without reporting to primary nurse or instructor. Assignments submitted > 1 day late, or < 2 weekly assignments submitted late. Not assessing or reporting suicidal ideation. No use of handwashing or universal precautions when necessary. Consistent use of unapproved abbreviations. No use of patient identifier when providing care.


41

Competency




III. INTEGRATE THERAPEUTIC COMMUNICA- TION SKILLS VERBALLY, NON-VERBALLY, AND IN WRITING.

Adapts principles of effective communication (verbal/non verbal & written) with, patients, families, instructor and interdisciplinary team members. Asks appropriate questions with minimal guidance from instructor. Aware of blocks. Reports all serious ineffective behaviors to instructor/appropriate team member in a timely manner. Identifies ineffective verbal and non-verbal psychosocial behaviors. Adapts communication strategies as needed. Imparts correct information verbally and in writing, or electronically. Documents objective facts in accordance to agency policies and procedures, using approved abbreviations. Checks with instructor when unsure of correct documentation. Utilizes interpreter (via in-person or phone) as needed to impart information to patient and or family.

Inconsistent using effective communication with staff, patients, and instructor. Not aware of patient or family communication problems after input. Assessment of patient communication- needs is inconsistent, incomplete, or not timely. Inconsistently recognizes blocks in communication. Documentation with < 3 minor errors. Needs reminders to complete all necessary documentation. Documentation not completed by end of shift or by due date.

Major blocks in communication with patient/family/staff/inst Does not ask appropriate questions to collect necessary data to correctly assess/address patient psychosocial or physical needs. Verbally or non-verbally reports inaccurate or false information. Does not document medications given. Gives inaccurate information to patient/family/staff or instructor. Failure to follow legal or agency documentation guidelines. Grammar not correct, judgment comments. Inappropriate statements/comments. Concerned with own feelings not patients’.


42

Competency




IV. DEMONSTRATE CLINICAL DECISION MAKING THAT IS ACCURATE AND SAFE AND THAT MOVES THE PATIENT AND FAMILY TOWARDS POSITIVE OUTCOMES.

History/Assessment and care plans supported by evidence based nursing theory and practice from reliable sources. Utilizes agency care maps, critical pathways, core measures, and bundles as guides to pt. care. With cues from experts identifies recurring themes and establish priorities. Beginning recognition of ineffective physiological responses, diagnostic tests and lab values. Recognizes overt psychosocial responses and needs, and provides appropriate interventions & support. Student can articulate etiology for pt. behaviors and therapeutic nursing interventions. Weekly comments in self-evaluation demonstrate reflection of clinical behaviors & plan for improvement

Minor omissions on History/Assessment and care plans. Cannot verbalize rational for major therapeutic nursing interventions. < 2 interventions do not relate to nursing diagnosis or desired outcomes. Does not utilize/verbalize understanding of agency guides or individualize plan of care without major assistance from experts. Recognizes overt change in patient condition only after addressed by instructor/staff. 1 out of 3 outcomes are not measurable. Self evaluation comments do not reflect plan for improvement or demonstrate critical thinking related to clinical experience.

Does not prioritize care given. Does not ask questions when unsure of patient status or appropriate interventions. Does not follow agency guides in caring for patient. Does not know results of diagnostic reports/ completed lab work. Major omission on care plan, or care plans do not address priority nursing diagnosis. Cannot verbalize stimuli for patient behaviors with major cues. Has not researched pathophysiology of patient behaviors before care given? Does not recognize/report significant change in patient condition. Does not correctly evaluate self for second week during the rotation. Does not reflect on how to correct or improve upon major weakness.


43

Competency




V. CREATE CARING INTERVENTIONS THAT ASSIST PATIENTS IN MEETING THEIR BIO-PSYCHO-SOCIAL NEEDS.

Comes to clinical prepared to provide individualized, safe nursing care. Recognizes when help is needed in managing and/or providing pt. care. Seeks information required before start of procedure. <2 minor cues from instructor during previously learned procedures. Follows standard precautions for infection control. Recognizes and corrects breaks in sterile technique. Performs environmental safety check within the first 20 minute of care & maintains pt. safety. Follows agency policy in assessing and documenting restraints. Performs therapeutic interventions correctly and in a timely manner. Monitors and documents.

Comes to clinical with partial completion of plan of care. Needs instructor’s input to complete. Makes error of omission/commission prevented by instructor. Cannot state pertinent action/side effects of meds. Needs assist with clean and/or sterile technique, or 6 rights administering meds. Needs reminding of standard precautions or hospital policies concerning patient safety, i.e., fall prevention, restraints. Environmental checks > 1 hour. Wears gloves outside of room x 1. Does not ask for information before start of procedure. >2 minor cues from inst. during previously learned procedures. >3 minor cues for new course procedures.

Does not come to clinical prepared. Medications not researched. Does not know action, side effects, nursing responsibilities for med or treatments. Inaccurate assessment of patient. Failure to assess /report and/or measure overt objective/ Subjective behaviors. Therapeutic nursing interventions not performed. Does not seek help or advise from instructor when delays, excess time/or error results. Failure to document or inaccurate documentation. Dependent performing procedures and/or therapeutic interventions. Unable to follow instructions. Does not maintain standard precautions. Does not follow program or agency policies. Situation/environment not safe for patient.


44

Competency




VI. APPRAISE AND DISPLAY TEACHING AND LEARNING PROCESSES TO PROMOTE HEALTH AND REDUCE RISKS FOR THE PATIENT AND FAMILY.

With minor cues from instructor, correctly assesses pt. and family readiness to learn, and cognitive functioning level. Utilizes appropriate media, handouts, and teaching documentation forms. Participates in discharge planning and/or instruction with minimal assistance from staff/instructor.

Inaccurate identification of pt. learning needs. Needs help with developing plan to meet learning needs. Teaching plan missing >2 minor points. Not aware of pt or family communication problems after input. Teaching plan does not address priority problem.

Negligence in assessing & identifying teaching-learning needs, barriers to teaching & learning. Teaching plan incomplete or not done. Gives inaccurate information. Does not implement teaching plan.

VII. PRACTICE PROVIDING CARE AS PART OF AN INTERDICIPLIN-ARY TEAM TO DELIVER PATIENT-CENTERED CARE TO THE PATIENT AND FAMILIES.

Participates in pre and post clinical conferences including discussions of case studies. Verbally reports assessment findings to instructor and primary nurse. Uses existing resources for health promotion of pts; i.e., dietary, social services, diabetic educator, etc. Works with ancillary staff and follows up on care provided. Introduces self to Nurse /CNA caring for patient, reports using SBAR concerns for pt. and when leaving unit. Respectful & supportive at all times to other health care workers. Takes responsibility for care of patient

Needs > 5 cues from instructor to include essential data in presenting pt case. Does not initiate use of existing resources for pt. without additional cues from instructor. Does not communicate to the nurse or other health care providers in a timely manner. Instructor/nurse has to ask questions to obtain necessary information. Passive, primary nurse retains primary care giver role.

Does not actively participate in pre and post conference without direct question from instructor. Does not introduce self to nurse caring for patient. Does not coordinate care with aide. Does not use SBAR and leaves out major data regarding pt. when requesting services or giving report. Is disrespectful or does not convey support or appreciation to other’s contributions to patient care. Leaves with care incomplete. Does not notify instructor/staff of need for referral.


45

Competency




VIII. ASSISTS IDENTIFIED ADULT POPULATION IN A PSYCHIATRIC ACUTE CARE SETTING TOWARD POSITIVE OUTCOMES UNDER THE GUIDANCE OF EXPERTS.

Completes patient care and documentation within the constraints of the scheduled clinical time. Communicates unexpected situations necessitating additional time, support to complete patient care in a timely manner. With cues from instructor, worksheet complete and organized. Meds and procedures completed within 30 minutes of scheduled times. Reassesses pt. progress towards outcomes including pertinent subjective and objective data; i.e., PE, learning, labs, and diagnostic reports after performing interventions & administration of meds. Revises plan of care in response to progress towards outcome criteria. Considers cost in implementation of care, without compromising outcome.

Completion of patient care and documentation necessitates that the student be late for post conference or work past end of shift <15 mins. Needs > 1 reminder in order to stay on schedule or reassess patient. Does not complete up to 2 minor nursing interventions. Does not complete care at level criteria.

Completion of patient care and documentation necessitates that the student be late for post conference or work past end of shift >15 mins. Does not communicate problems meeting patient needs to instructor in a timely manner. Does not recognize patient changes in pt. condition or re-evaluate. Does not refer to pertinent labs, behaviors in evaluating patient. Does not revise plan of care when indicated. Does not perform major nursing intervention required to progress pt.

At this level, which comprises courses in the third semester and two courses in the fourth semester of the nursing program, students are expected to continue to apply and adapt medical surgical concepts to patient across the life span in a variety of community based health care settings, modify plan of care and make decisions for patients at a variety of developmental stages on the basis of general guidelines or principles derived from previous experiences, organize and prioritize nursing interventions with supervision, and use appropriate resources to assist in solving patient problems. The student can adapt to different age groups basic skills, and develops new skills applying guidelines that are based on cues from experts. They attempt to correlate and build on medical surgical theory and practice.