Clinical Evaluation

Clinical grades are based on your performance in the clinical setting, including your work in community with individuals, families, and the community as a whole. The specific letter grade is based on the School’s grading criteria and scale. An A is earned through outstanding and appropriately independent work. Clinical excellence and leadership are characteristics of students making an A.

Significant effort has been put into writing and updating the Clinical Procedures that are given to each student. Reading these procedures initially and referring back to them to guide clinical activities and answer questions is necessary to work independently in this clinical. The same is true for the Community Resources Guide. It is necessary to use both of these documents throughout the semester. The following are particularly important in the clinical evaluation:

Community Care Activities

All students participate in community care activities, i.e., activities to improve the health of the community as a whole (vs. care for individuals). These activities are based on the nursing process and incorporate all phases of the process. Health promotion, disease/ risk screening, health education, and community assessment are examples of community care activities. Currently, community care is focused on the Zaragoza Project and screening & promotion activities.

Individual Patients

Except as noted, all these occur at the time of patient contact:

• At least three times during the rotation, each student performs a focused physical assessment with the instructor present. The focus of the assessment is based on the history and any other relevant factors obtained by the student. The instructor need not be present for the history. The assessment and subsequent steps in the nursing process may occur in the clinic or on home visits (HVs). Clearly, students need to review physical assessment and test the necessary equipment before beginning. There are assessment guides specific to this clinical (found in logs), and these should be used as appropriate.
• Based on the history and assessment, the student (1) generates at least a preliminary diagnosis/es and (2) identifies further assessment and/or analysis needed to better understand the patient’s condition.
• Plans to address diagnoses/problems follow the student’s analysis and the examination and diagnosis/es by the clinic physician or nurse practitioner. The student is present during the medical exam. Expanded plans may follow after the clinical day.
• The student implements nursing and medical plans (1) at the time of contact and (2) later as indicated (e.g., follow-up, teaching, referral).
• When documentation is submitted (or earlier), the student identifies actions or phases of the nursing process needing expansion or improvement and notes plans for expansion or improvement.
  Note that each student is responsible for ensuring that the above occurs in a timely manner. A sign-up sheet is used to determine the days when individual students perform evaluation assessments and subsequent steps of nursing process. At the instructor’s discretion, individual students may be required to perform additional assessments and subsequent steps of nursing process; or to perform fewer than three.

Clinical Log

Your log is an important part of the evaluation process. The specific purposes of the log are to (1) help you plan, organize, and document your work in community health; (2) help me understand the degree of insight you have into community health nursing; and (3) help me evaluate your work in community health.

Clinical logs should be completed daily beginning in the first week of clinical and turned in each Monday by 0830 unless other arrangements are made. I will return them to you no later than Thursday. I appreciate it when you come to my office to pick up your log early. Please do not remove material that I have placed in your log. Logs should include the following information in the same order given on this memo. All pages should be placed in the order of most recent on top. Use the dividers found in each log to organize this material as follows.

1. A discussion of experiences and clients seen on the reporting day (infants and parents, school children, homeless families, etc.; please note that we are considering families, parents, and others as important to discuss along with the primary patient).
2. "SOAPs” of patient problems and interventions. Use the Agape/Baylor Progress Notes form for SOAPing. A copy of this form will go to the client’s chart. A copy of a complete SOAP (CC, Hx, ROS, PA, Dx, plan, etc.) is included in your log.
3. This one is very important: Note what you would do differently if you had the opportunity. I am interested in decisions, actions, statements, and any other patient/community-oriented actions.
4. Discuss utilization of the various nursing roles, such as collaborator, teacher, manager, consumer of research and information, etc.
5. Discuss utilization or incorporation of concepts from CHN lecture (from a long ago, far away time, back in last semester) according to the following:
   Week 1: Health care delivery system, standards, CHN theory
   Week 2: Culture and health
   Week 3: Biostatistics/epidemiology
   Week 4: Community assessment
   Week 5: Community analysis/diagnosis
   Week 6: Community planning, intervention
   Week 7: Community implementation

Throughout, respond to comments (with contrasting color ink) I make on your work. This is critical, as I want to ensure that we have an ongoing written dialogue on your experiences and work.

As you demonstrate understanding of roles, needs, community health concepts, and other CHN issues, I will ask you to discontinue writing up the area of mastery. I may also ask you to change direction with your log. I want to avoid you writing and me reading repetitive material.

I am especially interested in hearing any ideas to improve clinical.