NUR1116 Clinical Competency Evaluation - Lawrence S ...

Evaluation Form – Fall 2011
NUR/NPD 1116 Advanced Nursing Practice in Caring for Clients and
Families I - Paediatric
LEARNER (print name)
DATE:
PRECEPTOR (print name)
Indicate : Primary Preceptor or NP Advisor (drop down menu)
Indicate: NP Preceptor or NP Advisor or NP – Paeds or NP – PHCNP or APN or MD (drop down)
I have evaluated the above competency based on: (drop down menu)
Direct Observation and Assessment OR Indirect Assessment
Rating Criteria:
Outstanding – performs consistently and continuously exceeds expectations for the competency;
demonstrates an intuitive grasp of the competency
Exceeds Expectations – performance often exceeds expectations; demonstrates an advanced
understanding and performance of the competency
Meets Expectations - consistently meets and occasionally exceeds the expectations of the competency;
demonstrates competency in a wide variety of settings
Below Expectations – occasionally below level required for competency; actively learning and developing to
demonstrate proficiency, further experience and/or development required
Unsatisfactory - consistently below level required for the competency; performance requires immediate
improvement
Not Observed – skills not observed during clinical hours spent with this preceptor
1. Professional Role, Responsibility and Accountability
a. Clinical
Criteria: Outstanding Exceeds
Expectations
Meets
Expectations
Below
Expectations
Unsatisfactory
Not
Observed
Practices within provincial & federal
legislative, professional and ethical
standards.
Adheres to provincial & federal
policies and standards related to
privacy, documentation and
information management (verbal,
written and electronic).
Understands the NP scope of
practice and differentiates it from
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that of an RN.
Assessments, diagnoses and
therapeutic plans reflect knowledge
of client diversity, socioeconomic
status and social support networks
within the household and
communities in which the client
lives.
Incorporates knowledge of
developmental and life stages,
pathophysiology, psychopathology,
demographics and family processes
into assessments, diagnoses and
therapeutic plans.
Incorporates knowledge of
epidemiology, environmental risk
factors and communicable diseases
into assessments, diagnoses and
therapeutic plans.
Incorporates knowledge of chronic
disease and other co-morbid
conditions into the urgent &
emergent health needs of clients.
Considers costs and impact on
resources of testing choices and
therapeutic interventions.
Discloses adverse events to clients
and reports as per legislative and
organizational policies.
Provides safe client care by
addressing immediate risks and
anticipating adverse events.
Provides education that is evidencebased
and relevant to clients’ needs.
Documents clinical data,
assessment findings, diagnoses,
plans of care, therapeutic
interventions, and outcomes in a
timely, concise and accurate
manner.
b. Research
Criteria: Outstanding Exceeds
Expectations
Meets
Expectations
Below
Expectations
Unsatisfactory
Not
Observed
Incorporates research and best
practice guidelines into therapeutic
plans for clients.
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Disseminates knowledge through
informal discussions, presentations
and/or publications.
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c. Leadership
Criteria: Outstanding Exceeds
Expectations
Meets
Expectations
Below
Expectations
Unsatisfactory
Not
Observed
Provides leadership in the
management of clinical care.
Acts as a resource person,
educator, mentor and role model.
Articulates and promotes the role of
the nurse practitioner to clients,
families and members of the health
care team.
Advocates for an environment that
promotes safe client care,
collaborative practice and
professional growth.
Plans, initiates, coordinates and
conducts educational programs
based on client needs, priorities, and
organizational resources.
d. Collaboration, Consultation and Referral
Criteria: Outstanding Exceeds
Expectations
Meets
Expectations
Below
Expectations
Unsatisfactory
Not
Observed
Initiates timely and appropriate
consultation, referrals, and
collaboration with other health care
providers.
Refers and accepts referrals from
other health care providers,
community agencies and allied nonhealth
care professionals.
Demonstrates knowledge and skill in
communication, negotiation, and
conflict resolution.
Advocates for individuals, families,
groups and communities in relation
to treatment, the health-care system,
and policy decisions that affect
health and quality of life.
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2. Health Assessment and Diagnosis
Criteria: Outstanding Exceeds
Expectations
Meets
Expectations
Below
Expectations
Unsatisfactory
Not
Observed
Carries out focused and complete
advanced health assessments
based on the client’s age and
developmental stage.
Physical examinations are
organized, accurate, complete; able
to consistently identify abnormal
from normal findings.
Health history includes physical,
psychosocial, emotional, ethnic,
cultural and spiritual dimensions of
health.
Synthesizes findings of assessment,
physical exam and diagnostic tests
to identify differential diagnoses,
diseases, disorders and conditions.
Uses appropriate clinical reasoning
strategies when connecting
knowledge to diagnoses and
therapeutic plans.
Anticipates and identifies emergent,
urgent and life-threatening
situations.
Orders diagnostic tests, interprets
results and assumes responsibility
for follow-up.
Communicates with clients about
assessment findings and diagnostic
tests, including outcomes and
prognosis.
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3. Therapeutic Management
Criteria: Outstanding Exceeds
Expectations
Meets
Expectations
Below
Expectations
Unsatisfactory
Not
Observed
Applies knowledge of pharmacology
in selecting, prescribing, monitoring
of drugs and performs these
competencies as appropriate for the
NP scope of practice and provincial
and federal legislations.
Prescribes pharmacotherapy based
on the client’s health history,
condition and stage of life.
Coordinates and facilitates care with
other health-care providers,
agencies and community resources.
Promotes clients’ self-efficacy in
navigating the health care system
and identifying necessary resources.
Considers client perspectives,
feasibility and best outcomes when
initiating therapeutic plans.
Counsels clients on medication
therapy, benefits, potential side
effects, interactions, importance of
compliance and recommended
follow-up.
Uses an evidence-informed
approach in the consideration of
complementary and alternative
therapies.
Initiates interventions for the
purposes of stabilizing clients in
emergent, urgent and lifethreatening
situations.
Evaluates client’s response and
preference for interventions and
adjusts therapeutic plan as needed.
Supports, educates, coaches and
counsels clients regarding
diagnoses, prognoses and selfmanagement
(including risk factor
modification, lifestyle changes etc).
Safely performs invasive/noninvasive
procedures for the clinical
management of clients.
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4. Health Promotion and Prevention of Illness and Injury
Criteria: Outstanding Exceeds
Expectations
Meets
Expectations
Below
Expectations
Unsatisfactory
Not
Observed
Provides anticipatory guidance
related to common health and safety
risks and relevant to the client’s age
and developmental stage.
Additional Comments:
DATE
LEARNER SIGNATURE:
PRECEPTOR SIGNATURE(s)
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