Graduate Program / Student Evaluation Community Health Nursing Practicums

STUDENT EVALUATION
COMMUNITY HEALTH NURSING PRACTICUMS

26:705:525; 26:705:550; 26:705:535

Student's Name: ______

(Last) (First) (Middle)

Preceptor’s Name: ______

(Last) (First) (Middle)

RUID: ______

Course Title: ______

Student’s Clinical Specialty: ______

Course Semester and Year: ______

Clinical Agency: ______

EVALUATION FOR (Select One):

۝ Mid-Term ۝Final

PERSON COMPLETING FORM (Select One):

۝ Student: ______

(Signature)

۝Preceptor: ______

(Signature)

Date: ______

PERSON REVIEWING FORM (Select One):

۝ Student: ______

(Signature)

۝ Preceptor: ______

(Signature)

Date: ______

This form should be completed twice during the semester: once at midterm by the student with a review by the preceptor and again around the final week of the semester by the student and preceptor.

Mid-term: The main purpose of the mid-term evaluation is to identify the student's strengths and weaknesses so that experiences can be provided to help the student meet the course objectives. The student should complete the form and make arrangements with the preceptor to discuss the ratings and plan future experiences. The mid-term self-evaluation by the student will not be used in calculating the final course grade because it is a formative evaluation. However, it is a required activity. The student should return the completed form to the course faculty after the conference with the preceptor.

Final:The main purpose of the final evaluation is to determine the extent to which the

student achieved the course objectives (summative evaluation). Before the last week of the course, the student and preceptor should independently complete the form, discuss their respective evaluations, and sign both forms. The signatures only indicate that each has seen the evaluation — not that each agrees or disagrees with the ratings. The student's and preceptor's ratings will be used by the faculty member in determining the student's final course grade as specified in the course syllabus.

Performance indicators are located under each course objective. Please place a 

mark in the column to indicate the student's achievement of each course objective as evidenced by the following performance indicators. Please use the following scale. Space is provided for comments. Comments can be directed to performance on one or more performance indicators. Refer to the letters to save space.

4 = Excellent: Consistently functions above the expected level. Demonstrates outstanding ability to apply theoretical knowledge to the clinical setting and superior clinical performance.

3 = Satisfactory: Consistently functions at the expected level. Demonstrates expected ability to apply theoretical knowledge to the clinical setting and average clinical performance.

2 = Marginal: Inconsistently functions at the expected level. Frequently requires assistance in applying theoretical knowledge to the clinical setting and in clinical performance.

1 = Unsatisfactory: Consistently functions below the expected level. Unable to apply theoretical knowledge to clinical setting and to perform safely and/or effectively.

NA = Not Applicable

NO = No opportunity to observe

Advanced Practice Nurse (APN)
Competencies Expected at End of Program

Evaluation of competencies inThe COMMUNITY HEALTH NURSING PRACTICUMS (circle relevant semester)

OBJECTIVES:

  1. Diagnose (only) or diagnose and manage (circle all that apply) ** the design, implementation and evaluation of health promotion programs and services of populations, aggregates, and individuals / families in the community.

Performance Indicators:

The student:

  1. performs a complete assessment including an evaluation of the health patterns, resources, strengths, weaknesses, needs and priorities of populations, aggregates and individuals/families ;
  2. collects data using appropriate assessment techniques and relevant supporting diagnostic information;
  3. prioritizes data collection according to the immediate condition and needs of populations, aggregates or individuals/families;
  4. integrates data from relevant sources and utilizes data findings to make clinical judgments and decisions about appropriate interventions including programs and policies;
  5. analyzes the assessment data in determining diagnoses;
  6. identifies expected outcomes and indicators individualized to meet relevant needs;
  7. formulates a database which is synthesized, prioritized and documented in a retrievable form;
  1. develops an action plan that specifies diagnostic strategies and therapeutic interventions, and addresses the continuing needs of populations, aggregates, and individuals/families;
  2. implements the interventions identified in the action plan;
  3. evaluates client progress toward the attainment of expected outcomes using quality indicators and a multidisciplinary collaborative approach to care.

The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of clinical experience: Circle one

PERFORMANCE INDICATORS / SEMESTER / 4 / 3 / 2 / 1 / N/A / NO
INDICATORS FOR OBJECTIVE #1

COMMENTS:

______

______

______

______

Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the competency until the final semester. At end of final semester , actual achievement should be rated. Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need not reserve 3's & 4's only for 3rd or 4th semester students).

**705:525 circle community Assessment only; 705:735 Circle all 4 behaviors.

2. Use current research findings in the community assessment, design, implementation and evaluation (circle all that apply) ** of health promotion programs and services to promote health care for populations, aggregates, and individuals / families in the community.

Performance Indicators:

The student

  1. applies a theory-based conceptual framework to guide practice;
  2. evaluates and applies research findings pertinent to client care management and outcomes of care;
  3. uses interventions substantiated by relevant research data as appropriate for the client and the practice setting;
  4. incorporates research findings into clinical practice;
  1. participates in the research process to discover, examine, and test knowledge and theories;
  2. uses epidemiological, social, and environmental data to draw inferences about the health status of aggregates and populations.

The APN student has performed in the following manner during the (1st ) (2nd ) (3rd ) (4th) semester of clinical experience: Circle one

PERFORMANCE INDICATORS / SEMESTER / 4 / 3 / 2 / 1 / N/A / NO
INDICATORS FOR OBJECTIVE #2

COMMENTS:

______

______

______

______

Semester I, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the competency until thefinal semester. At end offing/ semester, actual achievement should be rated. Please note that students can be scored from 4 to l for the semester they are in (ie. you need not reserve 3's & 4's only for 3rd or 4rhsemester students).

**705:525 circle community Assessment only; 705:735 Circle all 4 behaviors.

3. Consult and collaborate with other health professionals in the community assessment, design, implementation and evaluation (circle all that apply) of health promotion programs and services for populations, aggregates, and individuals / families in the community.

Performance Indicators:

The student:

  1. consults and collaborates with key groups, agencies and individuals, and other members of the healthcare team to provide a coordinated multidisciplinary approach to care delivery;
  1. collaborates with other disciplines in teaching, consultation, and management of client health care;
  2. makes appropriate referrals to other systems and health care providers

The APN student has performed in the following manner during the (1st ) (2nd ) (3rd ) (4th) semester of clinical experience: Circle one

PERFORMANCE INDICATORS / SEMESTER / 4 / 3 / 2 / 1 / N/A / NO
INDICATORS FOR OBJECTIVE #3

COMMENTS:

______

______

______

______

Semester I, 2, 3, for ail specialties except FNP has 4. Students should be rated on progress toward the competency until the final semester. At end offing/ semester, actual achievement should be rated. Please note that students can be scored from 4 to l for the semester they are in (ie. you need not reserve 3's & 4's only for 3rd or 4rh4 semester students).

FOR COURSE INSTRUCTOR’S USE ONLY:

The grade point should be computed as follows:

1.

2.

3.

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