Internship Training and Evaluation Plan: Health Services Intern
Student: ________________________________________
Phone/Email:
Instructor: Lyn Gray, RN Jeanie Wilson, RN _________
Phone/Email: 503 353 5920 Fax 503 353 5918
E-mail: grayl@nclack.k12.or.us OR wilsonje@nclack.k12.or.us
Scoring Guide
For each performance indicator, use this guide to rate the performance observed.
3
Exceeds Standard
2
Meets Standard
1
Does Not Meet Standard
N0
Not Observed
Skill Objectives-Indicators-Evaluations
Skill Objectives:
From Oregon Skill Sets
A Apply technical skills
appropriate to health
services
Performance Indicators:
A1
A2
A3
B Use various methods of
giving and obtaining
information to demonstrate
effective oral, nonverbal
and written communication
skills.
B4
B5
B6
B7
Uses proper body mechanics for
positioning, transferring and transporting
of patients.
Follows procedures for blood borne
pathogens.
Ex: Handwashing/sanitizer,
gloves/gowns/masks
Demonstrates competency in basic
patient care skills.
Ex: Feeding, bathing, bedmaking,
measuring vital signs
Uses effective and courteous verbal and
nonverbal communications skills.
Ex: Give clear and concise information to
patients at the appropriate level of
understanding. Addresses patient/client
concerns in a positive manner.
Demonstrates effective and appropriate
social interaction skills. Uses effective
telephone skills.
Uses appropriate medical terminology.
Ex: Oral, written and electronic
communications
Demonstrates effective working
relationships with supervisor,
co-workers,& patients.
Demonstrates the ability to interact
competently with diverse patients & staff.
Evaluation:
Use 1 - 3 rating
Clinical Internships:
1
2 3
4
5
6
Skill Objectives:
Performance Indicators:
Evaluation:
Clinical Internships:
1
C Follow occupational safety
principles to prevent
existing and potential
hazards.
C8
D Communicate health/
medical information
accurately and within
legal/regulatory guidelines
and the strictest standards
of confidentiality.
D9
2
3
4
5
6
2
3
4
5
6
Follows mandated standards for
workplace safety (OSHA, CDC, CLIA).
Recognizes and removes potential
hazards to patient/client.
Applies safety techniques when
positioning, transporting and
transferring patients/clients.
Ex: Side rails up, assist with ambulation,
wheelchair, walker, crutches.
Maintains confidentiality and clients’ rights
according to the Patients’ Bill of Rights.
Manages recorded information and
documents within protocols that ensure
confidentiality and privacy.
Ex: Organization’s code of conduct,
HIPAA, and Patients’ Bill of Rights
Sub Total: (Points for College Credit):
WORK PLACE BEHAVIORS
E Demonstrate appropriate
behaviors and professional
responsibilities.
Time Management
Interpersonal Relations:
Attendance:
Appearance:
Problem Solving:
E10
(High school credit only)
1
Completes jobs on time.
Looks for work to do.
Prioritizes appropriately.
Cooperates with supervisors.
Works well with others.
Accepts suggestions.
Has a positive attitude.
Seeks to understand.
Is on time to work and remains until hours
are completed.
Alerts supervisor if absent or late for work
hours on work-related tasks.
Dresses appropriately for the workplace.
Exhibits cleanliness and good hygiene.
Follows rules and all directions.
Works independently.
Accurate and careful.
Adapts to work conditions.
Follows through.
Looks for ways to improve.
Behavior Points
Supervisor and Student Signatures
Please sign and add comments.
Internship Site #1 Training Supervisor :
Date:
Comments?
Internship Site #2 Training Supervisor:
Date:
Comments?
Internship Site #3 Training Supervisor:
Date:
Comments?
Internship Site #4 Training Supervisor:
Date:
Comments?
Internship Site #5 Training Supervisor:
Date:
Comments?
Internship Site #6 Training Supervisor:
Date:
Comments?
Student Name _______________________________________________
Student Signature:
Date: