CLINICAL EVALUATION

setting utilizing the Clinical Evaluation Criteria. The clinical grade is P/F.

Course Grade: The course grade is a composite of Theory, Theory Application, and Clinical. A passing grade in each of these components is necessary to pass the course. The semester syllabi have specific information on each component and the grading scale.

CLINICAL EVALUATION

Each student’s performance in the clinical setting will be evaluated throughout the semester using a list of behavioral objectives specific to a given semester. These objectives are based on the program outcomes.

Many of the listed objectives, such as punctuality, readiness for clinical experiences and confidentiality, are behaviors expected of all nursing students throughout the program during each clinical experience. Other objectives pertain to the performance of skills taught during specific semesters of the program, or to skills that are introduced one semester and further developed in subsequent semesters. These skills, which are listed in each semester’s syllabus, can be evaluated during that semester or any subsequent semester. Thus, in PNUR 1040, students can be evaluated on any skill from PNUR1020, as well as any skill taught prior to that point in time in PNUR 1040.

Students are expected to show increasing clinical proficiency throughout the program.

As the faculty member observes each student’s behavior, the faculty member will make

anecdotal notes on an evaluation form and select a scale label that best represents the behavior in terms of the standards met, quality of performance displayed, and assistance required. The clinical evaluation is graded on a pass/fail basis. The scale labels for independent behavior (I), supervised behavior (S), and assisted behavior (A) are all satisfactory; students displaying only these behaviors will pass this clinical evaluation. The scale labels for marginal behavior (M) and dependent behavior (D) are unsatisfactory behaviors. See the following explanation of these behaviors.

Criteria for Ongoing Clinical Evaluation

Independent: The student demonstrates both efficiency of movement and deftness. Is able to utilize subtle perceptual cues to modify the behavior in order to achieve the desired effect.

Demonstrates exceptional coordination and integration. Sequence of movements and communication are fluid, even, and intertwined. Economical use of movements, equipment, and conversation. Behavior demonstrated within an expedient time period. Appears confident, relaxed, and generally expends an appropriate amount of energy to accomplish the behavior.

Behavior focuses on the patient/client rather than on self or the skill that is being performed.

Supervised: The student is efficient and coordinated, but expends more personal energy or that of the patient/client to accomplish the behavior than does the independent performer. The student appears confident and focuses on the patient/client, but becomes distracted and focuses more on the skill as the skill becomes more complex. The behavior is accomplished during a reasonable time period, however, the student becomes flustered when confronted by unforeseen variables such as a STAT (immediate) order.

Assisted: The student demonstrates skillfulness in portions of the behavior; remaining portions characterized by uncoordinated and/or inefficiency of movement. The student periodically

appears anxious, worried, or flustered, but makes an effort to project confidence. Behavior outcomes take longer to accomplish than the Supervised performer, and sometimes are late.

Increased attention is focused on the student behavior, rather than on the patient/client.

Marginal: The student’s performance is unskilled, inefficient, and wasteful of energy

expenditure. Little thought appears to be given to the sequence of activities to be performed. A high level of anxiety is apparent. Completion of the behavior is considerably delayed to the extent that other activities are disrupted or omitted. Performance is *unsafe and requires continuous verbal and frequent physical cues from the instructor.

Dependent: The student may attempt the behavior but is unsuccessful. Unreasonable energy may be expended in attempting the behavior, or the student may appear unable to move.

Communication is inappropriate. The student’s behavior is *unsafe. Continuous verbal and physical cues are required.

*Unsafe behavior is any behavior that does not meet the accepted standard of nursing care and/or is judged to be very likely to cause harm if allowed to proceed, or in fact causes harm.

Harm may be physical, emotional, or psychosocial in nature and involve self or others in the environment.

Scale Label Professional Standard Quality of Performance Assistance Required

-Skillful in parts of behavior -Inefficient and un-

coordinated

-Expands excess energy -Within a delayed time period

-Frequent verbal and

occasional physical directive cues in addition

non-verbal

Faculty members supplying verbal feedback and/or writing anecdotal notes on an evaluation form provide evaluation and instruction to students in the clinical arena. Students are accountable for their own safety and the safety of the clients placed in their care. Written evaluative marginal and or dependent notifications identifying undesirable behaviors are given to students when they do not apply standard, common, and necessary nursing behaviors. This is not to imply that students are not allowed an opportunity to learn, but that once a student has been given instruction, practice, and is expected to know particular behaviors subsequent failure to apply knowledge at the expected level will result in written notification. These written evaluative and instructional notifications will describe the marginal and or dependent behaviors that were evaluated by the instructor during the student’s clinical performances. Students are held accountable for retaining information from previous semesters. The following list is not meant to cover every possible infraction, but is intended to cover the most common types of behaviors for which marginal or dependents can be awarded and to clarify for students the standard of care to which they are held.

PNUR 1010, 1020 1. Safety Issues:

 failure to check a client's identification band before giving a medication or

 initiating a treatment

 failure to appropriately identify IM or Sub Q injection site landmarks

 failure to use basic precautions when giving a medication (7 rights)

 failure to use a transfer belt when moving a client from bed to chair or ambulating

 failure to get help needed to transfer, ambulate, or move a client to avoid injury

 failure to re-position a client with frequency necessitated to prevent complications of immobility

 failure to observe/monitor the client for changes in status

 failure to look up procedures before attempting them

 failure to monitor IV infusion in predictable situations

 failure to perform basic medication calculations

 failure to seek appropriate assistance with new tasks

 failure to see limits of own skill level or scope of practice

 failure to foresee obvious and predictable danger to client, self, others

 leaving client unattended with bed in high position

 leaving assigned area without permission

 failure to use appropriate control measures with narcotic medications 2. Asepsis Issues:

 failure to use basic Standard Precautions (Infection Control)

 failure to wash hands after contamination

 failure to heed basic contact, respiratory or droplet precautions

 failure to keep a syringe and/or needle area sterile while giving an IM or Sub Q medication

 failure to understand and use concepts of "sterile, clean, dirty" in predictable situations 3. Privacy Issues:

 failure to provide privacy for a client

 failure to pull a curtain for invasive procedures

 failure to provide minimal draping of a client

 failure to meet confidentiality standards by speaking about a client and/or agency issues to someone who has no right to the information

 reading the chart of a client for whom the student is not caring for

 failure to observe client's obvious boundary issues 4. Technique Issues:

 failure to take and record simple blood pressure, pulse, temperature, respiration, weight, I&O

 failure to perform basic hygiene bathing techniques

 failure to use standard procedures for medication administration 5. Communication Issues:

 failure to use respectful communication with client, peers, staff members

 failure to communicate changes in client status to the appropriate staff

 failure to use basic principles concerning charting--timely, accurate, pertinent

 failure to do minimal documentation of cares--such as medication administration

 failure to initiate minimal teaching

 failure to notify the staff that the student is leaving the assigned area

6. Time Management Issues:

 failure to arrive on time for clinical experience

 failure to call when late or not attending clinical experience

 failure to attempt or complete assigned tasks in predictable situations

 failure to complete assigned tasks on time in predictable situations

 failure to plan ahead in predictable situations

 failure to prepare for clinical by looking up predictable medications, client condition and nursing activities

7.Honesty and Integrity Issues: Clinical Misconduct Academic Misconduct (List not intended to be exhaustive)

 Seeking to mislead staff members and/ or faculty members about extent or quality of care given.

 Submitting false documentation in order to attain entrance and/or maintain enrollment in the nursing program.

 Seeking to mislead staff/faculty about level of skill.

 Seeking to mislead staff about specific assignment.

 Seeking to chart false or inaccurate data.

 Consciously failing to follow explicit directions from the instructor or supervising staff member, that produces or could produce foreseeable harm to persons in the clinical agency.

 Knowingly failing to follow agency policy or procedures, which produces or could produce foreseeable harm to persons in the clinical agency.

 Violation of client confidentiality.

Nonacademic Misconduct (List is not intended to be exhaustive) Inappropriate or unethical behavior including but not limited to:

 Threatening, intimidating and/or bribing any persons in the clinical agency

 Use of inappropriate touch or unwelcome touch with persons in the clinical agency.

 Use of harassing language with persons in the clinical agency.

 Stealing objects from persons in the clinical area.

 Use of demeaning language (stereotypical, prejudicial) Infractions in the clinical agency policies including but not limited to:

 Misappropriation of medications

 Violation of the controlled substance policy

 Unauthorized use of computers and/or computer passwords.

o Accessing restricted databases, files, or tampering with computer equipment, sending threatening e-mails

 Reporting to the clinical site under the influence of alcohol or a o controlled substance (See Section III Substance abuse policy)

Nursing faculty are mandated reporters of professional misconduct and will act in accordance with the current reporting procedures.

Any instructor involved in the incident(s) may also file a complaint against

the student. For example a student who threatens an instructor, or attempts to carry out such a threat.

PNUR 1040

All previously identified behaviors listed above (students are expected to be more consistent and to apply concepts with more proficiency and in less obvious situations than those expected in previous semesters) The following list is not meant to cover every possible infraction, but is intended to cover the most common types of behaviors for which marginals or dependents can be awarded and to clarify for students the standard of care to which they are held.

Technique Issues:

 Failure to recognize obvious warning signs of impaired tissue perfusion

 Failure to recognize obvious and predictable problems with an IV infusion

 Failure to safely perform basic bladder catheterization

 Failure to perform basic sterile dressing change

 Failure to use basic safety precautions with the administration of heat and cold therapies

 Failure to recognize basic and predictable problems for the general surgical patient

 Failure to use basic safety precautions with newborns

 Failure to use basic safety precautions with the pregnant/ postpartum mother UNSATISFACTORY CLINICAL PROGRESS

Definition:

Students who receive two marginal notifications and/or one dependent notification demonstrate a lack of clinical proficiency at a level expected at a specific time in the nursing program. Unsatisfactory clinical progress may be demonstrated by the student’s inability to transfer knowledge and/or respond to situations requiring problem solving, analysis, and/or application skills at a level expected at a specific time in the nursing program. Unsatisfactory clinical progress may also be demonstrated by students who display behaviors of clinical misconduct.

Procedure:

The faculty seeks every opportunity to give students adequate experiences to demonstrate safe and competent clinical behaviors in a safe and caring, teaching and learning environment.

Whenever possible, the faculty member first gives the student verbal feedback expressing their concerns about the unsatisfactory clinical behavior(s) before the issuance of the marginal and or dependent notification. The faculty, however, reserves the right to issue a marginal or

dependent notification, (or in extreme situations ask the student to leave the clinical setting), without first giving the student an official verbal warning. Any situation, in the clinical

instructor’s expert opinion, that poses imminent danger to the student’s safety or the safety of a client or the general public or seriously impairs the instructor’s ability to meet the safety needs of fellow students and their clients may prompt such action. Students demonstrating

unsatisfactory clinical progress will be required to participate in the Evaluation of Progression Review Process to clarify, verify, develop and evaluate possible solutions. The student’s

instructor will use the worksheet included in this booklet to clarify the Evaluation of Progression Review process, review Nursing Program and College policies and instruct the student on how to prepare for the Evaluation of Progression Review.

See Evaluation of Progression Review Process and Evaluation of Progression Review Worksheet (AppendixE) and the section on the Grievance/Complaint policy in the Riverland Community College Student Handbook.