1. 1
Clinical Performance Review Evaluation Tool
NURSING Second Semester
Student Clinical Agency(ies)
Purpose of Clinical Performance Review
The purpose of the Clinical Performance Review is to evaluate student’s progress towards meeting each clinical objective. The student is
expected to demonstrate competencies in each course by meeting the clinical objective specified in the course outline and syllabus. Students
are expected to progress in performance as they advance through each course and the program.
The following criteria, based on the nursing process, will form the guidelines for the student’s performance in all client-care situations:
1. Utilize learned scientific and behavioral principles to identify needs of adult patients experiencing common health stressors with
progressive ability.
2. Utilize the nursing process in meeting the priority needs of the patient with progressive ability. Emphasis is to be placed on priority
nursing diagnoses, including physiological needs, ego integrity and teaching/learning.
3. Perform all learned nursing skills (including medication administration) safely and therapeutically under supervision of an instructor
with progressive ability.
4. Function as an accountable member of the health care team.
Dates
Absences/Tardies
(A) (T)
Medication Error
(Type)
Faculty Initials
Student Initials
NURSING

2. 2
Second Semester
Explanation of Rating Scale
(S) Satisfactory = Clinical performance is safe and student adequately demonstrates application of the nursing process,
required skills, and expected synthesis of learning appropriate to level in the program.
(U) Unsatisfactory = Clinical performance is unsafe and inadequately demonstrates application of the nursing process,
required skills, and expected synthesis of learning appropriate to level in the program.
Clinical instructors will provide weekly written feedback for clinical objective(s).
Accomplishment of the clinical objectives will be evaluated at midterm and final conferences. When the student successfully meets the
clinical objectives of the course, a satisfactory (S) grade will be given. When a student is unsatisfactory at meeting the clinical objectives, a
conference will be scheduled with the faculty. The student and faculty will develop a clinical contract that outlines activities to assist the
student to correct the identified deficiencies.

3. 3
Clinical Objectives
NURSING Second Semester
Clinical Objectives for NURSING Second Semester are derived from the following course-specific objectives:
1. Utilize Maslow’s hierarchy of needs to assess clients with emphasis on health promotion throughout
the life span.
2. Involve the client in participating in his or her own health care.
3. Apply the components of the nursing process as related to the care of clients at
various stages of the life span.
4. Perform essential nursing skills according to critical requirements.
5. Utilize therapeutic communication techniques.
6. Exhibit caring behaviors.
7. Identify legal and ethical parameters of nursing practice.
8. Identify situations beyond one’s knowledge and experience and seek appropriate assistance;
9. Provide safe nursing care to clients.
10. Recognize socio-cultural differences in assigned clients.
11. Accept responsibility for personal and professional behaviors.
12. Exhibit preparation for planned learning experience using required resources.

4. 5
Clinical Objectives
Assessment
1. Gathers relevant subjective/ objective data pertaining to selected client from all available sources across the
lifespan.
2. Assesses all bio-psycho-social needs.
Instructor Midterm Evaluation: S U
Instructor Comments:
Instructor Final Evaluation Comments and Ratings: S U

5. 7
Clinical Objectives
Planning
1. Sets realistic goals in collaboration with clients. These goals are derived from prioritized nursing diagnoses, inclusive
of client learning needs. These goals are client-centered and have target-specific expected outcomes and specific time
frames for achievement.
2. Identifies specific nursing actions to meet goals.
3. Includes appropriate rationale for planned nursing care.
4. Individualizes plan of care.
5. Uses available resources to plan holistic care.
6. Establishes priorities for client care according to Maslow's Hierarchy.
Instructor Midterm Evaluation: S U
Instructor Comments:
Instructor Final Evaluation Comments and Ratings: S U
Clinical Objectives
Implementation
1. Interventions are formulated to achieve specific outcomes (goals), are individualized, theoretically sound, and
providing safe, competent client care.
2. Demonstrates organization in the performance of nursing actions.
3. Includes client responses to care provided.
4. Serves as client advocate.
5. Adapts environment for the welfare and safety of clients.
6. Uses verbal and nonverbal communication skills appropriately.
7. Documents accurately and appropriately.
8. Demonstrates psychomotor skills by performing currently learned skills and previously learned skills in a competent
manner.
Instructor Midterm Evaluation: S U
Instructor Comments:

6. 8
Instructor Final Evaluation Comments and Ratings: S U
Clinical Objectives
Evaluation
1. Collaborates with client and other health care professional to evaluate the expected outcomes in relation to goals
established.
2. Implements appropriate modifications/ revisions of specific nursing actions, with scientific rationales.
Instructor Midterm Evaluation: S U
Instructor Final Evaluation Comments and Ratings: S U

7. Clinical Objectives
Professional Development
1. Verbalizes his or her own thoughts, feelings, strengths, and limitations.
2. Demonstrates the use of basic critical thinking concepts and the development of independent judgment in clinical
decision-making.
3. Assumes responsibility for own learning (showing initiative by seeking out learning experiences in the clinical setting,
participating appropriately in clinical activities and in clinical conferences).
4. Works effectively with other professional, peers, and instructor within the clinical setting, and seeks and provides
feedback.
5. Reflects respect for self and others through professional attire, deportment, identification of self and role, and through
the notification of tardiness/ absences prior to clinical experience.
6. Reflects cultural sensitivity to others in the clinical setting.
7. Provides nursing care within the legal/ ethical guidelines and within the scope of registered nursing practice.
Instructor Midterm Evaluation: S U
Instructor Comments:
Instructor Final Evaluation Comments and Ratings: S U

8. Weekly Anecdotal Notes
Clinical Objectives Faculty Comments Faculty Comments Faculty Comments Faculty Comments
Assessment Date Date Date Date
1. Gathers relevant subjective/objective data
from selected client from all available
sources across the lifespan.
2. Assesses all bio-psycho-social needs.
Planning
1. Sets realistic goals in collaboration with
clients. These goals are derived from
prioritized nursing diagnoses, inclusive of
client learning needs. These goals are client-
centered and have target-specific expected
outcomes and specific time frames for
achievement.
2.Identifies specific nursing actions to meet
goals.
3.Includes appropriate rationale for planned
nursing care.
4.Individualizes plan of care.
5.Uses available resources to plan holistic
care.
6.Establishes priorities for client care
according to Maslow’s Hierarchy.
Implementation
1.Interventions are formulated to achieve
specific outcomes (goals), individualized,
theoretically sound, and providing safe,
competent care.
2. Demonstrates organization in the
performance of nursing actions.
3. Includes clients’ responses to care
provided.
4. Serves as client advocate.
5.Adapts environment for the welfare and
safety of clients.
6.Uses verbal and nonverbal communication
skills appropriately.
7. Documents accurately and appropriately.
8. Demonstrates psychomotor skills by
performing currently learned skills and
previously learned skills in a competent
manner.
Weekly Anecdotal Notes

9. Clinical Objectives Faculty Comments Faculty Comments Faculty Comments Faculty Comments
Evaluation
1. Collaborates with client and other
healthcare professionals to
evaluate the expected
outcomes in relation to
goals established.
2. Implements appropriate
modifications/ revisions of specific
nursing actions, with scientific
rationales.
Professional Development Date Date Date Date
1. Verbalizes his or her own thoughts,
feelings, strengths, and limitations.
2. Demonstrates the use of basic critical
thinking concepts and developing
independent judgment in clinical
decision-making.
3. Assumes responsibility for own
learning (showing initiative by seeking
out learning experiences in the clinical
setting, participating appropriately in
clinical activities and clinical
conferences).
4. Works effectively with other
professional, peers, and instructor within
the clinical setting, seeking and
providing feedback.
5. Reflects respect for self and others
through dress, deportment, identification
of self and role, and through the
notification of tardiness/ absences
prior to clinical experience.
6.Reflects cultural sensitivity to others in
the clinical setting.
7.Provides nursing care within
legal/ethical guidelines and the scope of
registered nursing practice
Weekly Anecdotal Notes

10. Medications Given Skills
Week 1 Week 1
Week 2 Week 2
Week 3 Week 3
Week 4 Week 4
Week 5 Week 5
Week 6 Week 6
Week 7 Week 7
Student Signature: Date
Student Signature: Date
Student Signature: Date
Student Signature: Date
Student Signature: Date
Student Signature: Date
Student Signature: Date