Clinical Placement Evaluation Form

12/10/2010 Revision No 4

CLINICAL PLACEMENT EVALUATION FORM

BSc in General/Psychiatry Nursing Programmes

Dublin-Mid Leinster in partnership with Athlone Institute of Technology

This questionnaire is part of a continuous evaluation of clinical placements for student nurses. The aim is to develop and maintain practice placements where students can receive a high quality experience. Please complete the following questionnaire reflecting your placement experience and use the space provided for additional comments if so desired. Thank you for taking time out to complete this questionnaire.

Clinical Placement site:______

Ward/Dept:______

Date:______

Duration of Allocation:______

Year of training:______GeneralPsychiatry

Please tick each statement with the response closest to your experience of the placement.

Please reply to all statements.

Agree / Disagree / N/A / Comments
1. / I received a comprehensive orientation to the hospital/care facility(If applicable)
2. / Staff in the clinical area were aware I was commencing placement
3. / I received a comprehensive orientation to the clinical placement area by the CNM/Staff nurse
4. / Apreceptor/co-preceptor was identified for me on this placement.
5. / I was allocated a registered nurse to work with during each shift.
6. / I was welcomed as part of the multidisciplinary team.
7. / Learning outcomes for this placement were available to me on site
8. / Learning outcomes for this placement were discussed with me at my preliminary interview.
9. / My preceptor/co-preceptor was familiar with the expected learning outcomes in relation to this clinical placement.
10. / I was able to achieve the learning outcomes during the placement.
11. / There were learning resources including journals, books, articles and research material available to me.
Agree / Disagree / N/A / Comments
12. / IT resources were available.
13. / I had access to HSE policies, guidelines, protocols and procedures.
14. / I was facilitated to avail of my Protected Learning Time.
15. / My assessment was carried out by my preceptor/co-preceptor.
16. / The clinical placement was appropriate to my level of experience.
17. / During my clinical placement I was supervised to an appropriate level
18. / I was not allocated duties that were beyond my scope of practice.
19. / Staff facilitated my learning needs and encouraged a questioning approach.
20. / I received feedback (verbal & written) on my performance throughout my clinical placement which was constructive, helpful and given at an appropriate time.
21. / I was able to participate in the ward report/care planning.
22. / My duty roster was available far enough in advance.
23. / The Clinical Placement Co-ordinator (CPC)/Clinical Placement Facilitator was available for support and guidance.
24. / I am familiar with and know how to contact the Student Allocation Liaison Officer for the HSE

Information provided through evaluation feedback is used to continuously monitor and improve clinical placements