Practice Immersion Clinical Evaluation Tool – Agency/Site
| Agency/Site Criteria |
Student Evaluation |
Faculty Evaluation | Comments | |||||
| Does Not Meet | Meets | Excels* | Does Not Meet | Meets | Excels* | |||
| 1. Agency/site was able to provide the opportunities for the student to meet practice immersion clinical objectives. | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ | ||
| 2. Agency/site was able to establish a comfortable, yet stimulating, practice environment. | ☐ | ☐ | ☐ | ☐ | ☐ | ☐ | ||
Criteria:
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Does Not Meet: Elements are missing.
Meets: Agency/site meets this criterion.
Excels: Agency/site meets this criterion and further a teaching point opportunity or expanded information, guidance, or other element to further enhance student learning.
Agency/site – strengths:
| Student Evaluation | Faculty Evaluation |
Agency/site – areas of improvement needed:
| Student Evaluation | Faculty Evaluation |
Agency/site – Suggestions to incorporate more responsiveness to student learning needs:
| Student Evaluation | Faculty Evaluation |
Practice Immersion Clinical Evaluation Tool – Mentor
| Clinical Criteria |
Student Feedback of Mentor Experience |
Comments | ||
| Does Not Meet | Meets | Excels* | ||
| 3. Exemplify professionalism in diverse health care settings. | ☐ | ☐ | ☐ | |
| 4. Utilize the nursing process to provide safe and effective care for patients across the health-illness continuum: promoting, maintaining, and restoring health; preventing disease; and facilitating a peaceful death as opportunity presents. | ☐ | ☐ | ☐ | |
| 5. Implement patient care decisions based on evidence-based practice. | ☐ | ☐ | ☐ | |
| 6. Utilize patient care technology and information management systems. | ☐ | ☐ | ☐ | |
| 7. Communicate therapeutically with patients. | ☐ | ☐ | ☐ | |
| 8. Professionally communicate and collaborate with the interdisciplinary health care teams to provide safe and effective care. | ☐ | ☐ | ☐ | |
| 9. Understand the human experience across the health-illness continuum. | ☐ | ☐ | ☐ | |
| 10. Provide culturally sensitive care. | ☐ | ☐ | ☐ | |
| 11. Preserve the integrity and human dignity in the care of all patients. | ☐ | ☐ | ☐ | |
Criteria:
Does Not Meet: Elements are missing; mentor did not achieve.
Meets: Mentor meets this criterion.
Excels: Mentor meets this criterion and further incorporates a teaching point scenario or expanded information, guidance, or other element to further enhance student learning.
Practice Immersion Clinical Evaluation Tool – Student
| Clinical Criteria | Mentor
Sign Off |
Faculty Sign Off |
Comments | ||
| Does Not Meet | Meets | Excels* | |||
| 12. Exemplify professionalism in diverse health care settings. | ☐ | ☐ | ☐ | ☐ | |
| 13. Utilize the nursing process to provide safe and effective care for patients across the health-illness continuum: promoting, maintaining, and restoring health; preventing disease; and facilitating a peaceful death as opportunity presents. | ☐ | ☐ | ☐ | ☐ | |
| 14. Implement patient care decisions based on evidence-based practice. | ☐ | ☐ | ☐ | ☐ | |
| 15. Utilize patient care technology and information management systems. | ☐ | ☐ | ☐ | ☐ | |
| 16. Communicate therapeutically with patients. | ☐ | ☐ | ☐ | ☐ | |
| 17. Professionally communicate and collaborate with the interdisciplinary health care teams to provide safe and effective care. | ☐ | ☐ | ☐ | ☐ | |
| 18. Understand the human experience across the health-illness continuum. | ☐ | ☐ | ☐ | ☐ | |
| 19. Provide culturally sensitive care. | ☐ | ☐ | ☐ | ☐ | |
| 20. Preserve the integrity and human dignity in the care of all patients. | ☐ | ☒ | ☐ | ☐ | |
Criteria:
Does Not Meet: Elements are missing; student is required to remediate this element to pass the course
Meets: Student meets this criterion.
Excels: Student meets this criterion and further incorporates a teaching point scenario