Napa Valley College
Psychiatric Technician Program PTEC 150
Mid-term self evaluation
CLINICAL PERFORMANCE EVALUATION
STUDENT __________________________________
Please fill out using S for satisfactory and X for needs improvement.
weeks of clinicals. Please fill out the first 6 weeks.)
1 2
3
4
5
CLINICAL PERFORMANCE
OBJECTIVES
PROFESSIONAL ATTITUDE
A.
B.
Punctuality
Attendance-including notifying clinical
area of absences
C.
Appearance and personal hygiene
D.
Ability to set priorities in patient care
E.
Ability to develop and maintain effective
working relationships
F.
Initiative in utilizing learning
experiences
G.
Meets all professional standards
outlined in PTEC Handbook
MAINTAIN RESPECT FOR INTEGRITY
OF THE PATIENT
A.
B.
C.
D.
Confidentiality
Civil rights
Privacy
Respect for patient as person
SAFETY
A.
B.
C.
D.
E.
Attends orientation
Follows all facility standards
Follows Standard Precautions
Demonstrates medical and surgical
asepsis
Performs all skills in safe, accurate
manner
COMMUNICATION
A.
B.
C.
D.
E.
Communicates appropriately with staff,
patients, peers and instructors.
Ability to develop and maintain effective
working relationships with staff, patients,
peers and instructors.
Reports to staff at beginning of shift
and gives report at end of shift.
Reports and charts in a timely complete
manner.
Participation in clinical conference and
seminars.
WRITTEN ASSIGNMENTS
A.
B.
C.
All work turned in on time.
All work prepared as assigned
Charting in concise, clear, accurate and
(the numbers refer to the
6
7
8
9
10
11
12
13
D.
E.
complete.
Follows charting format of facility.
All work completed by end of rotation.
PHARMACOLOGY SKILLS
A.
B.
C.
D.
E.
Maintain 75% accuracy on exams
90% accuracy on generic name,
classification, action, dosage and side
effects of drugs administered.
Demonstrate knowledge of the rules of
medication administration.
100% accuracy in pouring,
administering, and charting.
80% of the available medication
experience
DEVELOPMENT OF THERAPEUTIC
NURSING SKILLS
A.
B.
C.
D.
E.
F.
G.
Accurate assessment of self and impact
of self on others.
Receptivity to feed-back.
Accurate assessment of patient.
Use of problem-solving to implement
plan of care.
Ability to develop and maintain
professional therapeutic relationships.
Systematic observation of deviant
behaviors
Demonstrates appropriate therapeutic
interventions.
KEY:
S = Satisfactory
X = Less than satisfactory
 = Not available
My strengths:
My weaknesses:
My goals for the next few weeks:
Please determine your level of professional behavior. Read
Professional Behaviors Rubric
carefully
Dangerous to Practice:
Unable to interact with staff students patients.
Disrespectful. Appearance and hygiene are unkempt, unprofessional. Does not
participate. Does not accept constructive criticism. Aggressive or abusive to others. (
If one or more of these are present at any time during clinical rotation the instructor may
remove the student the program or put on probation)
Needs Improvement:
Nervous, scattered thoughts. Difficulty completing tasks.
Respectful appearance and hygiene are appropriate. Attentive, participated with
encouragement. Receives and accepts constructive criticism professionally. ( Student
may be put on probation).
Acceptable for Experience: Interacts clearly and professionally, may be less than
calm. Self-motivated,. Respectful, appearance/hygiene are appropriate. Actively
participates, attentive, receives and accepts constructive criticism professionally.
Proficient/Field Ready: Interacts calmly, clearly and professionally.
Self-motivated, delegates within team, respectful, appropriate appearance and personal
hygiene. Actively participates, engaged and attentive. Receives & accepts
constructive criticism in a professional manner.
Please determine which of the Student learning outcomes you are satisfactorily
achieving.
Student Learning Outcome
S = satisfactory X = needs improvemet
1. Accurately perform and document basic nursing skills, including medication pass
without error, basic physical assessments and interventions while prioritizing patient
care.
2. Student will ethically advocate for patients with developmental disabilities and
children, in all settings, assuring patient’s rights, privacy, dignity and confidentiality.
3. Student will develop leadership and supervision skills and identify need for crisis
intervention using the least restrictive measures.
4. Able to effectively participate in a therapeutic environment and communicate in a
professional and respectful manner.