Self-Evaluation 1. Demonstrate professional student responsibilities by following policies and procedures of the ADN Program and the clinical facility practice guidelines: a) Function within the nurse’s legal scope of practice and in accordance with policies and procedures. * 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Comply with professional appearance requirements according to ADN program policies. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 2. Assume responsibility and accountability for the quality of nursing care provided to patients and their families under the supervision of clinical instructor and assigned primary nurse. a) Assume accountability for individual nursing practice. * 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Evaluate learning needs of self and intervene to assure quality of care. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable c) Practice nursing in a caring, nonjudgmental, nondiscriminatory manner. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 3. Assess the physical and mental health status of patients with diverse health needs and preferences using a structured data collection tool with primary and secondary sources of information. a) Perform assessments on patients in assigned areas 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Involve the patient, the family, and health care providers in data collection when appropriate. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable Self-Evaluation c) Validate, report, and document complete assessment data for the patient. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 4. Analyze assessment data to prioritize problems that can be addressed by the nurse: a) Use clinical reasoning to identify the pediatric patient’s needs based on analysis of health data. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Prioritizes nursing diagnoses according to Maslow’s Hierarchy of needs. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable c) Provide safe and effective nursing care for the patient during their hospital stay. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 5. Develop a plan of care that identifies patient goals/outcomes and nursing interventions using information from evidence-based practice in collaboration with pediatric patients, their families, and the health care team: a) Establish SMART short- and long-term goals and outcomes. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Develop a congruent plan of care in collaboration with patient, family, and other interdisciplinary health care team members. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable c) Utilize evidenced based guidelines as a basis of nursing interventions to support the patient 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable Self-Evaluation 6. Implement the plan of care to provide safe compassionate, ethical, and family-centered nursing care for patients and their families. a) Implement individualized care plans to promote health and manage acute and chronic health needs. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Communicate accurately and document the patient’s response to interventions and medications in a timely manner. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 7. Evaluate attainment of patient goals and related nursing interventions and modify the plan of care in response to changing patient needs: a) Evaluate the effectiveness of nursing interventions based on expected patient outcomes. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 8. Use standards of nursing practice to provide and evaluate patient care by seeking supervision when practice behaviors and judgments fall outside individual knowledge and expertise: a) Obtain instruction, supervision or training as needed, when implementing nursing procedures or practices. * 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Safely administer medication and treatment. * 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable c) Demonstrate responsibility for continued competence in nursing practice and develop insight through reflection and self-analysis. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 9. Collaborate and communicate in a timely manner with patients, their families, and the health care team to plan, deliver, and evaluate patient-centered care. Self-Evaluation a) Uses principles of communication to implement therapeutic interactions with all patients and their familes. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 10. Serve as a health care advocate in assessing and promoting safety and quality for all patients with common health needs and their families: a) Implement measures to promote quality and a safe environment for patients, self and others. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Formulate goals and outcomes using evidenced based data to reduce patient risk. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable 11. Communicate and manage information using technology to support decision making to improve patient care: a) Identify, collect, process and manage data in the delivery of patient care. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable b) Protect patient confidentiality when using technology. * 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable c) Document electronic information accurately, completely, and in a timely manner. 2- Meets expectations 1- Needs Improvement, Inconsistent Performance 0- Unsatisfactory, Failing Performance N/A- Not Applicable Comments:
