College of Nursing
Family Nurse Practitioner
Preceptor Feedback of Student
Clinical Competencies
Student:
Date completed:
Due Week of:
Semester: Fall
Spring
Summer
PERFORMANCE SKILLS SUPPORTING CLINICAL COMPETENCIES
Superior
1.
Demonstrates skillful interviewing with patients/families
2.
Elicits an age-appropriate comprehensive health history including
modifications of the following for specific populations: Identifying
information Chief Complaint History of present illness Past Health
history Family history occupational history Health habits Clinical
preventive services Functional status Psycho social history Review of
systems.
3.
Elicits and records pertinent dimensions of the patient’s
symptomatology such as the following: Setting Onset Timing
Quality/Intensity Location Precipitating factors Alleviating/aggravating
factors Associated symptoms
4.
Differentiates the components of a complete health history versus a
problem focused history of the present illness. (Based on Current
Procedural Terminology [CPT] Codes for evaluation and management.
5.
Identifies the appropriate information to be included in each section of
progress notes.
6.
Performs a complete physical examination.
7.
Demonstrates the appropriate use of the techniques of inspection,
palpation, percussion, and auscultation throughout the physical exam.
Differentiates normal from abnormal findings in all age groups.
8.
Utilizes appropriate equipment accurately and efficiently in performing
physical assessment.
9.
Records the subjective and objective data in a concise, accurate and
logical manner using appropriate terminology and format.
10. Please add other comments relating to the student’s achievements or
progress in the area of health assessment.
11. Identifies specific health promotion/maintenance needs of patients,
families, and populations.
12. Integrates national guidelines for prevention and screening into
practice.
13. Appreciates the growing diversity of the population and understands
health status and health care needs in the context of different cultural
values.
14. Please add other comments on the student’s progress and skill in the
area of health promotion.
Very Good
Adequate
Weak
Inadequate
Not
Observed
College of Nursing
Family Nurse Practitioner
Preceptor Feedback of Student
Clinical Competencies
Superior
15. Maintains confidentiality.
16. Recognizes, detects, and attends to expressed and unexpressed
content/feeling/concerns.
17. Monitors and reflects own emotional response to patient interaction.
18. Add other comments relating to the student/patient relationship.
19. Elicits information about the patient’s interpretation of health conditions
as a part of the routine health assessment.
20. Elicits information about the patient’s perceived barriers, supports, and
modifiers to learning when preparing the patient/s education.
21. Elicits information about cultural influences that may affect the patient’s
ability to learn.
22. Additional comments relating to the teaching-coaching function of the
nurse practitioner student.
23. Utilizes scientific foundations and theoretical frameworks to describe
and implement the nurse practitioner role.
24. Recognizes own level of skill, limitations, and place in role
development.
25. Additional comments relating to the student’s professional role
development.
26. Shows enthusiasm to learn. Demonstrated by preparation for clinical,
timeliness, working “until the work is done”, willingness to accept new
challenges, and accepting instruction and suggestions from
preceptor/s.
27. Comments on enthusiasm to learn.
28. Thank you for completing this evaluation. Add any other comments or
suggestions.
Very Good
Adequate
Weak
Inadequate
Not
Observed