Clinical Practicum Evaluation Report
Student Name: Student No.
Programme: Bachelor of Health Science (Hons): Applied Gerontology
Hospital/ Institute: Ward/ Specialty:
Supervisor
Types of assessment: Formative (F) Date: Summative (S) Date:
Score
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Standard Procedure
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Quality of Performance
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Assistance
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5
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Safe
-
Accurate
-
Effect - each time
-
Affect - each time
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Without supportive cues
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4
| -
Safe
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Accurate
-
Effect - each time
-
Affect - each time
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Occasional supportive cues
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3
| -
Safe
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Accurate
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Effect - most of the time
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Affect - most of the time
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Frequent verbal and occasional physical directive cues in addition to supportive ones
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2
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Safe but not alone; Performs at risk
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Accurate – not always
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Effect – occasionally
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Affect - occasionally
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Unskillful and inefficient
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Considerable expenditure of excessive energy
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With prolonged time period
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Continuous verbal and frequent physical cues
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1
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Unsafe
Unable to demonstrate behaviour
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Unable to demonstrate procedure/ behaviour
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Lacks confidence, coordination, and efficiency
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Continuous verbal and physical cues
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X
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Not applicable / Not Observed
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Bondy, K.N. (1983). Criterion-Referenced Definitions for Rating Scales in Clinical Evaluation. Journal of Nursing Education, 22 (9), 376-381.
Krichbaum, K., Rowan, M., Duckett, L., Ryden, M.B. & Savik, K. (1994). The clinical evaluation tool: a measure of the quality of clinical performance of baccalaureate nursing students. Journal of Nursing Education, 33 (9), 395-404.
Lofmark, A. & Thorell-Ekstrand, I. (2004). An assessment form for clinical nursing education: a Delphi study. Journal of Advanced Nursing, 48(3): 291-298.
Watson, R., Stimpson, A., Topping, A. & Porock, D. (2002). Clinical competence assessment in nursing: a systematic review of the literature. Journal of Advanced Nursing, 39(5): 421-431.
Woolley, G. R., Bryan, M. S. & Davis, J. W. (1998). A Comprehensive approach to clinical evaluation. Journal of Nursing Education, 37 (8), 361-366.
Note: Students must score 3 or above for all objectives in order to obtain a satisfactory grade.
Objectives | Score | Remarks | F | S |
1.
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Assessment
1.1 Collects data for assessment from a variety of sources.
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1.2 Identifies presence of health and/or social risk factors.
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1.3 Identifies potential problems by differentiating normal and abnormal behaviour of elderly and their families.
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1.4 Interprets data based on acquired knowledge.
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1.5 Identifies health and/or social problems.
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1.6 Establishes priorities of care.
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2.
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Planning
2.1 Develops goals with specific time frame based on the needs of elderly.
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2.2 Identifies interventions and services appropriate to the elderly problems.
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2.3 Incorporates elderly and family strengths and weakness in planning.
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2.4 Identifies learning needs of elderly.
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3.
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Intervention
3.1 Uses communication techniques appropriate to elderly situation.
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3.2 Provides safe and competent care.
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3.3. Responds appropriately and detects verbal and non-verbal cues of elderly and their family.
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3.4 Respects the rights and dignity of elderly and their significant others.
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3.5 Provides health teaching based on identified learning needs.
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3.6 Makes referrals for elderly based on their needs.
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4.
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Evaluation
4.1 Utilizes the problem-oriented method for recording relevant data.
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4.2 Evaluates outcomes of care.
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4.3 Develops alternative interventions.
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5.
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Professional Behaviours
5.1 Recognizes own strengths and limitations.
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5.2 Demonstrates ability to reflect own competency, feeling and understanding of work situations through keeping of learning diary or journal.
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5.3 Seeks guidance as appropriate.
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5.4 Demonstrates ability to criticize own performance for continuing development.
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5.5 Communicates with other care team members on overall plan for elderly.
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5.6 Participates in group conference and shares pertinent learning experience.
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5.7 Reports on time.
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F = Formative Assessment
S = Summative Assessment
Narrative Comments
(Summative evaluation)
Supervisor
Student
Overall Performance: Satisfactory / Unsatisfactory
Student Signature Date
Supervisor Signature _______________________ Date
NHS-CP003-V1
Updated on 25 April 2014
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