NRS 340 Pediatric Nursing (minimum 60 hours)
Clinical Hours
Date
Time
Hours
Simulation hours
Instructor Initials
Date
Time
Total
Hours
Instructor
Initials
Total
Total Hours (Clinical + Simulation) =________________
Instructor Name (Printed)
Signature
Do not write below this line.
Items Reviewed:
_____ Clinical/Simulation Hours
_____ Reflective Logs (3)
Initials
Signature
Initials
_____ Clinical Evaluation Tool
_____ Wonderlic
_________________________________________________
Clinical Facilitator Signature
Updated 03.28.14
Instructor Name (Printed)
__________________________
Date
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
2 of 11
NRS 340 Pediatric Nursing
Clinical Evaluation Form – To Be Completed by Clinical Instructor
Complete one column per clinical day
S = Satisfactory, acceptable performance (does not require comments) P = Progressing towards satisfactory (instructor comments optional)
U = Unsatisfactory, failing performance (must contact course coordinator immediately, requires comments from instructor)
NYO = Not yet observed
***Student must obtain “Pass” for each objective by the end of the clinical rotation to progress in the nursing program***
Date
Final
Instructor Initials (Please sign last page)
Objectives
P/F
Demonstrate professional, ethical behavior at all times by
collaborating with other members of the health care team in
providing care (CO 6).
Develop learning goals for assigned patients (CO 1, 2,).
Adequately research and review basic skills required for the
pediatric patient and address a finite list of 3-4 pediatric diagnoses
provided prior to arriving for daily assignment (CO 1, 2, 4).
Develop a basic care plan using the nursing process for the
pediatric patient for the diagnoses provided (CO 1, 2, 4, 6).
Receive report to organize provision of care for the shift (CO 6).
Report off to co-assigned nurses when leaving the unit for breaks
or at the end of shift (CO 4, 6).
Chart on assigned patients to include flow sheets, MARs, interactive
notes and computerized charting (where required) (CO 3, 4).
Practice head to toe assessments (as available) on the pediatric
client (CO 2, 9).
Demonstrate effective and appropriate communication skills with
pediatric clients and their families (CO 10).
Complete a development tally appropriate assessment of a pediatric
client and their family in the inpatient and/or outpatient setting (CO
1, 2, 7, 9).
Perform a problem-focused examination using approved technique
(CO 1, 7).
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
3 of 11
Instructor Comments:
(Student to initial all comments)
Utilize appropriate pediatric calculation and techniques for
medication administration (CO 8).
Determine developmental level through interview and observation
with the client and family (CO 2, 9).
Appropriately apply course content in the care of children and their
illness/disease process (CO 1, 2, 4, 5, 8, 9).
Competently perform pediatric nursing interventions that evidence
client advocacy and compassion (CO 8).
Implement developmentally appropriate communication
techniques for the pediatric client at different age levels (CO 8, 10).
Provide developmentally appropriate patient teaching (CO 10).
Work with families for the provision of care for the pediatric client
(CO 5, 10).
Discuss community needs in providing care for the pediatric client
(CO 5, 8, 10).
Provide competent care of one patient (CO 1, 2, 5, 8).
Demonstrate understanding and application of the principles of
Relationship-Based-Care in working with the Pediatric patient and
family (CO 1, 2, 4, 8, 10).
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
4 of 11
Final Evaluation
Pass
Fail
Additional comments from student/clinical instructor:
Student Signature _____________________________ Date _________
Updated 03.28.14
Clinical Instructor Signature ________________________Date ________
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
5 of 11
NRS 340 Pediatric Nursing
Reflective Log for Acute Care Setting
To be completed by student on the first day of rotation
Date________________
1. Describe the developmental stage of the child.
2. Describe how the developmental level of the child influenced the care provided.
3. Describe the relationship between the child and primary care provider. Describe how this relationship hindered or promoted the child’s heath.
Instructor Initials _____________
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
6 of 11
NRS 340 Pediatric Nursing
Reflective Log for Acute Care Setting
To be completed by student at middle of rotation
Date________________
1. Describe how pain was assessed and interventions used to treat the client.
2. What teaching needs were identified for the client? Describe any education provided to the client/family.
3. Describe any unique or complex care provided for the client.
Instructor Initials ________
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
7 of 11
NRS 340 Pediatric Nursing
Reflective Log for Acute Care Setting
To be completed by student at the end of rotation
Date________________
1. Describe the process you used in your assessment today and how it was modified based on the client’s age.
2. Describe nursing interventions you provided today for your patient.
3. What is the discharge teaching required for successful transition to home for your client/family?
Instructor Initials________
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
8 of 11
NRS 340 Pediatric Nursing
Reflective Log Vision/Hearing Screenings
To be completed by student at each screening (Make copies as needed)
Date: ________________ School:_________________________________________
1. Why are hearing and vision screenings performed in the school system?
2. Which grades are regularly tested?
3. List three exceptions to this practice?
4. Why do we test for high frequency hearing loss in 6th and 8th graders?
5. What four additional tests are required for first graders’ vision screenings?
6. List four reasons adjustments in the screening process might be needed for special needs children?
7. What happens with a failed exam?
8. What resources are available to the child who fails an exam?
9. When a child fails an exam, what changes are made to facilitate learning?
Updated 03.28.14
Instructor Initials _________
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
9 of 11
NRS 340 Pediatric Nursing
Reflective Log for School Nursing
To be completed by student on the first day of rotation
Date________________
1. What different interview techniques did you utilize with different aged children?
2. Give an example of how you triaged a child for illness or injury.
3. What similarities, if any, did you see with the children’s complaints?
Instructor Initials __________
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
10 of 11
NRS 340 Pediatric Nursing
Reflective Log for School Nursing
To be completed by student at middle of rotation
Date________________
1. What are some common teaching methods used for the “every day” complaints, i.e. “My stomach hurts.”, “My head hurts.”, “My throat
hurts.”
2. List some stress reduction techniques that may help your students who may be experiencing anxiety.
Instructor Initials __________
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________
11 of 11
NRS 340 Pediatric Nursing
Reflective Log for School Nursing
To be completed by student at the end of rotation
Date________________
1. Describe some challenges with special needs children in your school.
a. What accommodations does the school make to meet the needs of these children?
2. How does the school nurse promote general health and wellness for the children in his/her school?
a. How can the school nurse help parents promote healthy snack and birthday party food choices?
Instructor Initials __________
Updated 03.28.14
Student Name (Printed) ________________________________________
Clinical Quarter ______________________Year____________________