Graduate Program
Student Evaluation / Advanced Practice in Pediatrics
STUDENT EVALUATION
ADVANCED PRACTICE IN PEDIATRIC NURSING PRACTICUMS
26:705:527; 26:705:537
Student’s Name: ___________________________________________________________________
(Last)
(First)
(Middle)
Preceptor’s Name: __________________________________________________________________
(Last)
(First)
(Middle)
RUID: _____________________________________________
Course Title: ________________________________________
Student’s Clinical Specialty: ____________________________
Course Semester and Year: _____________________________
Clinical Agency: ______________________________________
EVALUATION FOR (Select One):
О Mid-Term
О Final
PERSON COMPLETING FORM (Select One):
О Student: __________________________________________
(Signature)
О Preceptor: ________________________________________
(Signature)
Date: __________________________________
PERSON REVIEWING FORM (Select One):
О Student: : __________________________________________
(Signature)
О Preceptor: _________________________________________
(Signature)
Date: __________________________________
This form should be completed twice during the semester: once at midterm by the student with a
review by the preceptor and again around the final week of the semester by the student and preceptor.
Mid-term: The main purpose of the mid-term evaluation is to identify the student’s strengths and
weaknesses so that experiences can be provided to help the student meet the course objectives. The
student should complete the form and make arrangements with the preceptor to discuss the ratings and
plan future experiences. The mid-term self-evaluation by the student will not be used in calculating the
final course grade because it is a formative evaluation. However, it is a required activity. The student
should return the completed form to the course faculty after the conference with the preceptor.
Final: The main purpose of the final evaluation is to determine the extent to which the student achieved
the course objectives (summative evaluation). Before the last week of the course, the student and
preceptor should independently complete the form, discuss their respective evaluations, and sign both
forms. The signatures only indicate that each has seen the evaluation—not that each agrees or disagrees
with the ratings. The student’s and preceptor’s ratings will be used by the faculty member in
determining the student’s final course grade as specified in the course syllabus.
Performance indicators are located under each course objective. Please place a checkmark in the
column to indicate the student’s achievement of each course objective as evidenced by the following
performance indicators. Please use the following scale. Space is provided for comments. Comments can
be directed to performance on one or more performance indicators. Refer to the letters to save space.
4 = Excellent: Consistently functions above the expected level. Demonstrates outstanding ability to apply
theoretical knowledge to the clinical setting and superior clinical performance.
3 = Satisfactory: Consistently functions at the expected level. Demonstrates expected ability to apply
theoretical knowledge to the clinical setting and average clinical performance.
2 = Marginal: Inconsistently functions at the expected level. Frequently requires assistance in applying
theoretical knowledge to clinical setting and to perform safely and/or effectively.
1 = Unsatisfactory: Consistently functions below the expected level. Unable to apply theoretical
knowledge to clinical setting and to perform safely and/or effectively.
NA = Not Applicable
NO = No opportunity to observe
Advanced Practice Nurse (APN)
Competencies Expected at End of Program
Evaluation of competencies in ADVANCED PEDIATRIC NURSING PRACTICE PRACTICUMS (circle relevant
semester).
OBJECTIVES:
1. Diagnose and manage primary health care needs of children and adolescents.
Performance Indicators:
The student:
a. Obtains a complete health history including an evaluation of the client’s
developmental level, physical maturation, psychosocial status, coping abilities, and
ability to perform activities of daily living;
b. Collects data using appropriate assessment techniques and relevant supporting
diagnostic information;
c. Prioritizes data collection according to the client’s immediate condition and needs;
d. Integrates data from relevant sources and utilizes data findings to make clinical
judgments and decisions about appropriate recommendations and treatments;
e. Analyzes the assessment data in determining diagnoses;
f. Identifies expected outcomes individualized to meet client needs;
g. Formulates a database which is synthesized, prioritized and documented in a
retrievable form;
h. Develops a plan of care that specifies diagnostic strategies and therapeutic
interventions, and addresses the continuing needs of the client;
i. Implements the interventions identified in the plan of care;
j. Evaluates client progress toward the attainment of expected outcomes using quality
indicators and a multidisciplinary collaborative approach to care.
The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of
clinical experience:
Circle One
Performance Indicators
Indicators for Objective #1
Semester
4
3 2 1
N/A
NO
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the
competency until the final semester. At end of final semester, actual achievement should be rated.
Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need reserve
3’s and 4’s only for 3rd or 4th semester students).
2. Use current research findings to provide advanced nursing care to promote health and care
for children and adolescents.
Performance Indicators:
The student:
a. Applies a theory-based conceptual framework to guide practice;
b. Evaluates and applies research findings pertinent to client care management and
outcomes of care;
c. Uses interventions substantiated by relevant research data as appropriate for the
client and the practice setting;
d. Incorporates research findings into clinical practice;
e. Participates in the research process to discover, examine, and test knowledge and
theories;
f. Uses epidemiological, social, and environmental data to draw inferences about the
health status of individuals, families, and the community.
The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of
clinical experience:
Circle One
Performance Indicators
Indicators for Objective #2
Semester
4
3 2 1
N/A
NO
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the
competency until the final semester. At end of final semester, actual achievement should be rated.
Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need reserve
3’s and 4’s only for 3rd or 4th semester students).
3. Consult and collaborate with other health professionals in the planning, implementation,
and evaluation of advanced nursing care to children and adolescents.
Performance Indicators:
The student:
a. Consults and collaborates with client, significant others, and other members of the
healthcare team to provide a coordinated multidisciplinary approach to acute care
delivery;
b. Collaborates with other disciplines in teaching, consultation, and management of
client health care;
c. Makes appropriate referrals to other systems and health care providers.
The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of
clinical experience:
Circle One
Performance Indicators
Indicators for Objective #3
Semester
4
3 2 1
N/A
NO
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the
competency until the final semester. At end of final semester, actual achievement should be rated.
Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need reserve
3’s and 4’s only for 3rd or 4th semester students).
4. Incorporate and evaluate innovative strategies that include the use of information
technology, patient classification systems, and other technology in the delivery of advanced
nursing care to children and adolescents through advanced practice roles of educator,
consultant, and expert practitioner.
Performance Indicators:
The student:
Educator Role:
a. Determines client’s/family’s readiness to learn;
b. Identifies client’s/family’s learning needs;
c. Develops and/or utilizes existing technologies and information resources to
instruct clients/family members in the provision of care;
d. Selects teaching strategies and evaluation techniques with consideration of
objectives and client/family characteristics (age, learning style, sensory
deficit, language skills, pathophysiological alteration, developmental and
reading levels);
e. Measures client’s/family’s ability to achieve learning objectives and
modifies the plan as needed.
Consultant Role:
a. Utilizes information systems to transmit, store, retrieve, import and export
electronic data in consultation with other disciplines;
b. Engages in on-line synchronous or asynchronous telehealth, telemedicine,
teleconferencing and other technologies to disseminate/obtain information;
c. Analyzes electronic/digital information transmitted by consulting health
professionals.
Expert Practitioner:
a. Incorporates use of information systems in the provision of primary care to
men and women;
b. Utilizes telecommunication technologies and information systems to classify
client levels of acuity, manage clinical data, communicate clinical findings,
and modify physiological alterations;
c. Evaluates the effectiveness/accuracy of electronic data transmissions.
The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of
clinical experience:
Circle One
Performance Indicators
Indicators for Objective #4
Semester
4
3 2 1
N/A
NO
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the
competency until the final semester. At end of final semester, actual achievement should be rated.
Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need reserve
3’s and 4’s only for 3rd or 4th semester students).
5. Manage the care of children and adolescents within current acceptable practice
guidelines/standards of care.
Performance Indicators:
The student:
a. Participates in a quality management program which addresses collection and
analysis of quality data indicators, patient safety/satisfaction, symptom
management/control, appropriateness of levels and acuity of care, and analysis of
risk/benefits associated with quality and effectiveness;
b. Participates in quality of care improvement mechanisms in evaluation of clinical
practice;
c. Analyzes data generated through quality of care activities to indentify opportunists
to improve care;
d. Formulates recommendations to improve clinical practice based on data obtained
from quality of care activities;
e. Engages in collaborative appraisal of professional practice by peers, clients,
colleagues and others;
f. Collaborates in the development, evaluation and update of clinical
guidelines/standards/pathways consistent with current science;
g. Demonstrates awareness of legal and regulatory constraints or opportunities that
affect care delivery.
The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of
clinical experience:
Circle One
Performance Indicators
Indicators for Objective #5
Semester
4
3 2 1
N/A
NO
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the
competency until the final semester. At end of final semester, actual achievement should be rated.
Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need reserve
3’s and 4’s only for 3rd or 4th semester students).
6. Provide culturally competent care to diverse groups of children and adolescents.
Performance Indicators:
The student:
a. Performs a culturological assessment of the client;
b. Obtains data that reflects sensitivity to cultural diversity, ethnicity, gender and life
style choices from multiple sources, including the client, significant others, and
medical records;
c. Contributes to the establishment of a culturally receptive environment that
supports for the rights of all participants;
d. Contributes to the creation of an individual and systems response to resolution of
cultural dilemmas.
The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of
clinical experience:
Circle One
Performance Indicators
Indicators for Objective #6
Semester
4
3 2 1
N/A
NO
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the
competency until the final semester. At end of final semester, actual achievement should be rated.
Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need reserve
3’s and 4’s only for 3rd or 4th semester students).
7. Evaluate efficacy, effectiveness, cost and health policy in providing care to children and
adolescents in a variety of settings.
Performance Indicators:
The student:
a. Performs risk/benefit analysis of the treatment process;
b. Analyzes organizational system enhancement and barriers which have an impact on
client care;
c. Assists clients and families to access appropriate health care services;
d. Integrates current understandings of cost and benefits in caring for clients;
e. Assists multidisciplinary team members, clients, families in selecting therapies that
integrate perspectives of cost and quality benefits;
f. Serves as resource to various publics for the purpose of influencing health care
delivery and policy formation;
g. Advocates for the client in matters of health policy and services;
h. Provides age-appropriate and gender relevant health promotion and disease
prevention information.
The APN student has performed in the following manner during the (1st) (2nd) (3rd) (4th) semester of
clinical experience:
Circle One
Performance Indicators
Indicators for Objective #7
Semester
4
3 2 1
N/A
NO
COMMENTS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
Semester 1, 2, 3, for all specialties except FNP has 4. Students should be rated on progress toward the
competency until the final semester. At end of final semester, actual achievement should be rated.
Please note that students can be scored from 4 to 1 for the semester they are in (i.e. you need reserve
3’s and 4’s only for 3rd or 4th semester students).
FOR COURSE INSTRUCTOR’S USE ONLY:
The grade point should be computed as follows:
1.
2.
3.