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when comments are added. JLD
UNC CHAPEL HILL SCHOOL OF NURSING
UNDERGRADUATE CLINICAL EVALUATION TOOL

Student : Faculty:
Course: Semester: Year: Clinical Site:

Introduction: This clinical evaluation tool consists of nine essential competencies with specific performance criteria. The nine competencies were
drawn from: terminal outcome objectives for the BSN program at UNC Chapel Hill School of Nursing, The Essentials of Baccalaureate Education
for Professional Nursing Practice (AACN, 2008), and Quality and Safety Education in Nursing (Cronenwett et al., 2007). The performance criteria
for each competency include cognitive, affective, and psychomotor domains of learning and provide a complete evaluation of an individual
student’s clinical performance. The use of this clinical evaluation tool makes it possible to see the student’s development over time as he/she
progresses through the specific course, as well as through the nursing curriculum. It also provides standard measures for student, course, and
program evaluation.

This clinical evaluation tool is to be used in each clinical course. A formal evaluation is completed and shared with the student at the
conclusion of the rotation. In some courses, faculty will also use this tool for mid-rotation evaluation. The tool can also be used at other
times during the rotation and can serve as the basis for a learning contract.

Instructions: Faculty will rate students on each of nine competencies using the designated rating scale, considering the quality of the
performance (Almost Never Exhibits to Almost Always Exhibits) and the amount of guidance required (Almost Always Requires to Almost
Never Requires). Referring to the scale below, as students improve in accuracy, safety, and efficiency, it is expected that they will require less
guidance. To determine the rating for each competency, faculty will consider student performance on the specific performance criteria and will
arrive at a rating for each competency using the 0-4 scale. Faculty may also include comments related to each competency. At the end of this
clinical evaluation tool, faculty should write summary comments and document recommendations for further development/improvement. The
faculty who wrote the evaluation will review it with the student and document the date of the meeting. The student should be provided with a copy
of the evaluation. Students may be asked to complete a self-evaluation at midterm and final. Clinical faculty should discuss the tool with students
at the beginning of each clinical rotation and describe how and when it will be used.
NOTE: In these competencies, client is defined as the recipient of professional nursing services and may be an individual, family, or group.

References Used for Tool Development

American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author.
Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D., & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55,122-131.
Holaday, S., & Buckley, K. (2008). A standardized clinical evaluation tool-kit: Improving nursing education and practice. In M. H. Oermann & K. T. Heinrich (Eds.), Annual Review of Nursing Education,
Vol. 6. New York: Springer Publishing.
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The Rating Scale

Self-Directed (4)
Almost Never Requires (<10% of the time) Almost Always Exhibits (>90% of the time)
 direction  monitoring  a focus on the client or system  efficiency and organization
 guidance  support  accuracy, safety, and skillfulness  an eagerness to learn
 assertiveness and initiative
Supervised (3)
Occasionally Requires (25% of the time) Very Often Exhibits (75% of the time)
 direction  monitoring  a focus on the client or system  efficiency and organization
 guidance  support  accuracy, safety, and skillfulness  an eagerness to learn
 assertiveness and initiative
Assisted (2)
Often Requires (50% of the time) Often Exhibits (50% of the time)
 direction  monitoring  a focus on the client or system  efficiency and organization
 guidance  support  accuracy, safety, and skillfulness  an eagerness to learn
 assertiveness and initiative
Novice (1)
Very Often Requires (75% of the time) Occasionally Exhibits (25% of the time)
 direction  monitoring  a focus on the client or system  efficiency and organization
 guidance  support  accuracy, safety, and skillfulness  an eagerness to learn
 assertiveness and initiative
Dependent (0)
Almost Always Requires (>90% of the time) Almost Never Exhibits (<10% of the time)
 direction  monitoring  a focus on the client or system  efficiency and organization
 guidance  support  accuracy, safety, and skillfulness  an eagerness to learn
 assertiveness and initiative

Expected Levels of Performance: For the Final Evaluation students must achieve the minimal expected level of performance for each
competency in order to pass the course and progress in the program.

Level Minimum Expected Performance Minimum Score Upon Completion of:

I Novice — Assisted 1.5
II Assisted 2.0 First semester of clinical practice
III Assisted — Supervised 2.5 All interim semesters of clinical practice
IV Supervised — Self-directed 3.0 Final semester of clinical practice
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Competencies, Performance Criteria, and Comments

1. Demonstrates professional behaviors
a. Follows university, school, and agency policies i. Incorporates constructive feedback for performance improvement
b. Practices within the legal and ethical frameworks of nursing j. Maintains professional appearance
c. Assumes accountability for own actions and practices k. Maintains professional attitude
d. Treats all individuals with dignity/respect l. Maintains professional behavior
e. Demonstrates cultural sensitivity m. Arrives on time for clinical
f. Protects client rights (privacy, autonomy, confidentiality) n. Notifies faculty in a timely manner if he/she will be absent or late
g. Demonstrates initiative in seeking learning opportunities and resources o. Prepares for clinical practice
h. Analyzes personal strengths and limitations in providing care p. Identifies situations in which assistance is needed OR appropriately seeks assistance
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:

2. Collects and analyzes comprehensive client data

a. Determines relevant information needed d. Interprets laboratory/diagnostic test results
b. Identifies appropriate sources for data collection e. Incorporates data from client, family/support persons and health care team
c. Uses correct techniques for assessment members
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:

3. Plans appropriate client care

a. Develops plan of care based on analysis of assessment data d. Considers needs/preferences of the client in planning care
b. Accurately determines priorities for care e. Establishes realistic goals/expected outcomes
c. Communicates priorities and rationale for decisions to instructor f. Identifies appropriate resources to inform care planning
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:
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4. Provides safe client-centered care

Safe Behavior Criteria: The student is required to practice professional nursing safely in specific client-centered situations with clinical
supervision. Safe behavior is defined as behavior which does not place the client or self and other professional staff at risk of physical and/or
psychosocial harm. The student is subject to receiving a Failure in the course and to being dismissed from the program if safe behavior is not
consistently demonstrated.
a. Plans and implements evidence-based interventions that are congruent with g. Takes appropriate steps to improve nursing skills and use of technologies
assessment data h. Creates a safe environment for client care
b. Considers client needs and preferences in providing care i. Demonstrates flexibility in adapting to changing client care situations
c. Performs nursing skills and therapeutic procedures safely and competently j. Reports abnormal data and changes in client condition to instructor or
d. Follows principles of infection control appropriate health team member
e. Follows procedures for medication administration k. Honors and promotes the rights of clients and others by acting on their
f. Recognizes own limitations related to nursing skills or technologies and behalf and in their best interest
takes appropriate steps for improvement
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:

5. Engages in systematic and ongoing evaluation of the plan of care

a. Evaluates nursing interventions based on goals/expected outcomes c. Revises plan of care based on evaluation and consultation
b. Analyzes client data for accuracy and completeness d. Involves client, significant others, and health team members in evaluation
process as relevant
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:

6. Applies knowledge relevant to client care

a. Demonstrates initiative to obtain needed knowledge e. Integrates concepts of health promotion and disease prevention
b. Evaluates sources of data for appropriateness, usefulness, and accuracy into client care
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c. Integrates theory from nursing, natural and social sciences to enhance client f. Identifies issues/problems in nursing practice that need to be improved
care g. Evaluates nursing practices based on current research evidence
d. Relates pathophysiology and epidemiology of disease(s) to clients’
assessment findings, medications, laboratory and diagnostic test results,
medical and nursing interventions
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:

7. Communicates effectively
a. Produces clear, relevant, organized, and thorough writing d. Listens attentively and respectfully to others
b. Exhibits timely, legally accurate, and appropriate documentation e. Is actively involved in team building, fostering collegiality, and encouraging
c. Communicates therapeutically with clients utilizing verbal and nonverbal cooperation
skills f. Contributes insight and helpful information to the health care team/group
conferences
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:

8. Uses teaching-learning process when providing individualized client/family/group education

a. Assesses learning needs of clients, families, and groups e. Specifies reasonable and appropriate outcome measures
b. Assesses readiness for and barriers to learning f. Utilizes appropriate principles of teaching/learning when implementing a
c. Considers appropriate client characteristics in teaching (e.g., teaching plan
culture, age, developmental level, and educational level) g. Evaluates learner outcomes, provides feedback, and revises teaching plan
d. Develops an appropriate teaching plan for learner needs as needed
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:
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9. Exhibits caring to facilitate physical, mental, and spiritual health

a. Demonstrates sensitivity to cultural, moral, spiritual, and ethical beliefs of c. Protects the client’s safety and privacy, and preserves human dignity while
clients, families, peers, health care team members, and others providing care
b. Recognizes barriers to care such as socioeconomic factors, environmental d. Encourages family and/or significant others’ participation in care as
factors, and support systems appropriate
e. Assists clients with coping and adaptation strategies
Faculty Comments MIDTERM Student Comments
Rating: Rating:

Faculty Comments FINAL Student Comments

Rating: Rating:

Midterm Evaluation

Faculty Comments: Faculty recommendations for further development/improvement:

Final Evaluation

Faculty Comments: Faculty recommendations for further development/improvement:

By typing their names below, the student and the faculty acknowledge that a meeting was held on < date > to discuss this evaluation and that a copy of this evaluation
was provided to the student.

Student Signature: Date:

Faculty Signature: Date:

Revised 8/12