School of nursing and midwifery



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SCHOOL OF NURSING AND MIDWIFERY
Family Nursing Practice 325 (Paediatric Placement)
Semester 2, 2009
CLINICAL EVALUATION FORM
STUDENT NAME:_________________________________ ID:__________________________
AGENCY:______________________________________________________________________
CLINICAL TEACHER:__________________________________________________________

IT IS THE RESPONSIBILITY OF THE STUDENT TO SIGN AND RETURN THIS FORM TO THEIR UNIT CONTROLLER AT THE END OF THEIR CLINICAL EXPERIENCE. FAILURE TO DO SO WILL RESULT IN FAILURE OF THIS UNIT.
PLEASE TAKE A COPY OF THIS FORM TO PLACE IN YOUR LEARNING PORTFOLIO BEFORE SUBMITTING THIS FORM TO THE UNIT CONTROLLER. YOU WILL NOT BE ABLE TO ACCESS THIS FORM ONCE SUBMITTED.
EVALUATION CRITERIA

Both the interim and summative evaluation of the student’s performance is based on the ANMC competencies. This assessment form is based upon the ANMC National competency Standards. Over the course of the practicum, the student must be graded for each competency using the following grades;



Grades




C = Competent

(to students level of education and practice)



Student functions efficiently, without cues and clearly relates theory to practice.

S = Supervision

Student requires direction and prompting and generally relates theory to practice.

D = Requires Development

Student requires assistance, is unable to link theory to practice.

Note: If the competency standard is unavailable or not applicable, write U/A or N/A next to the relevant competency standard.
Responsibility for the safe keeping of the Clinical Evaluation Form

The student is at all times responsible for the safe keeping of the Clinical Evaluation Form as well as making sure the clinical teacher has easy access to it throughout the student’s clinical experience.

Domains:

Professional Practice

This relates to the professional, legal and ethical responsibilities which require demonstration of a satisfactory knowledge base, accountability for practice, functioning in accordance with legislation affecting nursing and health care, and the protection of individual and group rights.


Critical Thinking and Analysis

This relates to self-appraisal, professional development and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/groups is an important professional benchmark.


Provision and Coordination of Care

This domain relates to the coordination, organization and provision of nursing care that includes the assessment of individuals/groups, planning, implementation and evaluation of care.


Collaborative and Therapeutic Practice

This relates to establishing, sustaining and concluding professional relationships with individuals/groups. This also contains those competencies that relate to the nurse understanding their contribution to the interdisciplinary health care team.

ANMC. (2005). The ANMC National Competency Standards for the Registered Nurse

Glossary of Terms:
ANMC: Australian Nursing and Midwifery Council
Competence: The combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a profession/occupational area.
Competent: The person has competence across all the domains of competencies applicable to the nurse, at a standard that is judged to be appropriate for the level of nurse being assessed.
Competency Unit: Represents a major function/functional area in the total competencies of a Registered Nurse in a nursing context representing a stand-alone function which can be performed by the individual.
Exemplars: Concrete, key examples chosen to be typical of competence. They are not the standard but are indicative of the standard.

Competency Based Clinical Assessment


This assessment is progressive and is based upon self appraisal by the student, feedback from clinicians and formal assessment by the Clinical Teacher and Unit Controller.
The competency standard form is designed to provide you with the opportunity to monitor and evaluate your own clinical performance by documenting examples of exemplars of clinical practice each day. This will assist you in reflecting on your practice, identifying both strengths and areas in need of improvement, setting personal objectives and identifying strategies to aid achievement of objectives.

Domain: Professional Practice.

_______________________________________________________________________________________



Competency Unit 1: Practises in accordance with legislation affecting nursing practice and health care.

________________________________________________________________________________


Performance criteria for clinical competence


Element 1.1: Complies with relevant legislation and common law.

Element 1.2: Fulfils the duty of care.

Element 1.3: Recognises and responds appropriately to unsafe or unprofessional practice.
Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. (To be completed by student)

Clinical Teacher/Buddy Nurse signature and date:______________________________________________

_______________________________________________________________________________________

Competency Unit 2: Practises within a professional and ethical nursing framework.

________________________________________________________________________________


Performance criteria for clinical competence


Element 2.1: Practices in accordance with the nursing profession’s codes of ethics and conduct.

Element 2.2: Integrates organizational policies and guidelines with professional standards.

Element 2.3: Practises in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals/groups.

Element 2.4: Advocates for individuals/groups and their rights for nursing and health care within organizational and management structures.

Element 2.5: Understands and practises within own scope of practice.

Element 2.6: Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care.

Element 2.7: Recognises the differences in accountability and responsibility between Registered Nurses, Enrolled Nurses and unlicensed care workers.
Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)

Clinical Teacher/Buddy Nurse signature and date:______________________________________________



Domain: Critical Thinking and Analysis


_______________________________________________________________________________________

Competency Unit 3: Practises within an evidence-based framework.

________________________________________________________________________________


Performance criteria for clinical competence


Element 3.1: Identifies the relevance of research to improving individual/group health outcomes.

Element 3.2: Uses best available evidence, nursing expertise and respect for the values and beliefs of individuals/groups in the provision of nursing care.

Element 3.3: Demonstrates analytical skills in accessing and evaluating health information and research evidence.

Element 3.4: Supports and contributes to nursing and health care research.\

Element 3.5: Participates in quality improvement activities.
Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)


Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________

_______________________________________________________________________________________

Competency Unit 4: Participates in ongoing professional development of self and others.

________________________________________________________________________________


Performance criteria for clinical competence


Element 4.1: Uses best available evidence, standards and guidelines to evaluate nursing performance.

Element 4.2: Participates in professional development to enhance nursing practice.

Element 4.3: Contributes to the professional development of others.

Element 4.4: Uses appropriate strategies to manage own responses to the professional work environment.


Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)


Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________



Domain: Provision and Coordination of Care

_______________________________________________________________________________________



Competency Unit 5: Conducts a comprehensive and systematic nursing assessment.

________________________________________________________________________________


Performance criteria for clinical competence


Element 5.1: Uses a relevant evidence-based assessment framework to collect data about the physical socio-cultural and mental health of the individual/group.

Element 5.2: Uses a range of assessment techniques to collect relevant and accurate data.

Element 5.3: Analyses and interprets assessment data accurately.
Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)

Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________


_______________________________________________________________________________________

Competency Unit 6: Plans nursing care in consultation with individuals/groups. Significant others and the interdisciplinary health care team.

________________________________________________________________________________


Performance criteria for clinical competence


Element 6.1: Determines agreed priorities for resolving health needs of individuals/groups.

Element 6.2: Identifies expected and agreed individual/group health outcomes including a time frame for achievement.

Element 6.3: Documents a plan of care to achieve expected outcomes.

Element 6.4: Plans for continuity of care to achieve expected outcomes.


Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)

Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________

_______________________________________________________________________________________

Competency Unit 7: Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes.

________________________________________________________________________________


Performance criteria for clinical competence


Element 7.1: Effectively manages the nursing care of individuals/groups.

Element 7.2: Provides nursing care according to the documented care or treatment plan.

Element 7.3: Prioritises workload based on the individual’s/group’s needs, acuity and optimal time for intervention.\

Element 7.4: Responds effectively to unexpected or rapidly changing situations.

Element 7.5: Delegates aspects of care to others according to their competence and scope of practice.

Element 7.6: Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately.

Element 7.7: Educates individuals/groups to promote independence and control over their health.

Element 7.8: Uses health care resources effectively and efficiently to promote optimal nursing and health care.


Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)

Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________

_______________________________________________________________________________________

Competency Unit 8: Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant others and interdisciplinary health care team.

________________________________________________________________________________


Performance criteria for clinical competence


Element 8.1: Determines progress of individuals/groups toward planned outcomes.

Element 8.2: Revises the plan of care and determines further outcomes in accordance with evaluation data.


Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)


Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________



Domain: Collaborative and Therapeutic Practice

_______________________________________________________________________________________



Competency Unit 9: Establishes, maintains and appropriately concludes therapeutic relationships.

________________________________________________________________________________


Performance criteria for clinical competence


Element 9.1: Establishes therapeutic relationships that are goal directed and recognizes professional boundaries.

Element 9.2: Communicates effectively with individuals/groups to facilitate provision of care.

Element 9.3: Uses appropriate strategies to promote an individuals’ group’s self-esteem, dignity, integrity and comfort.

Element 9.4: Assists and supports individuals/groups to make informed health care decisions.

Element 9.5: Facilitates a physical, psychosocial, cultural and spiritual environment that promotes individual/group safety and security.
Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)

Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________


_______________________________________________________________________________________

Competency Unit 10: Collaborates with the interdisciplinary health care team to provide comprehensive nursing care.

________________________________________________________________________________


Performance criteria for clinical competence


Element 10.1: Recognises that the membership and roles of health care teams and service providers will vary depending on an individual’sgroup’s needs and health care setting.

Element 10.2: Communicates nursing assessments and decisions to the interdisciplinary health care team and other relevant service providers.

Element 10.3: Facilitates coordination of care to achieve agreed health outcomes.

Element 10.4: Collaborates with the health care team to inform policy and guidelines development.


Evidence of accomplishment:

Elements/performance indicators

Description of scenario and date. . (To be completed by student)


Clinical Teacher/ Buddy Nurse signature and date:_____________________________________________


Competency Standards Record.


Date

Description of scenario/exemplar


Competencies/elements/ performance criteria demonstrated.








































































































































































































































































































































































































































Competency Standards Record (cont.).


Date

Description of scenario/exemplar


Competencies/elements/ performance criteria demonstrated.









































































































































































































































































































































































































































FAMILY NURSING PRACTICE 325

Paediatric placement



SUMMATIVE CLINICAL EVALUATION

Student Name: ____

Summative Comments:


PROFESSIONAL PRACTICE

CRITICAL THINKING AND ANALYSIS

PROVISION AND COORDINATION OF CARE

COLLABORATIVE AND THERAPEUTIC PRACTICE


Clinical Agency





Areas/Wards Involved





Dates





Number of clinical days missed





Clinical Teacher








RECOMMENDED FINAL GRADE: (Please tick)

PASS




FAIL





FURTHER COMMENT:








STUDENT COMMENT:






CLINICAL TEACHER’S

SIGNATURE: DATE:

STUDENT’S

SIGNATURE: DATE:
UNIT COORDINATOR’S RECOMMENDED FINAL GRADE
SIGNATURE: __________________________________DATE ____________


FNP 325 Clin Eval Paeds 1/2009

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