Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM

Pediatric Nursing
CLINICAL EVALUATION

NAME_____________Serban Ionita____________________ DATE_______________01/19/2022________________

CLINICAL SITE__Health Heroes 3868 Dartmouth Way Livermore CA 94550, simulations INSTRUCTOR(s)_______Michelle Faxel

The student is responsible and accountable for:

a. Meeting performance expectations at a competent level on a consistent basis by the end of the term.
b. Monitoring progress in course using Clinical Evaluation Guide.
c. Using dates and examples to document level of performance.
d. Making appointment with faculty for midterm and final evaluation conferences.
e. Notifying faculty of difficulty in achieving course outcomes and seeking assistance

The faculty is responsible and accountable for:

a. Monitoring students’ progress and providing immediate feedback to students in clinical.
b. Obtaining information on students’ progress and performance from nurses, other health care members, and patients with whom the student
has contact, as appropriate.
c. Being available and approachable to meet with students outside of clinical in the faculty office for questions related to clinical.
d. Making time available and promptly responding to student requests for midterm and final evaluation conferences.
e. Issuing a written academic warning/counseling note to a student who is having difficulty meeting course outcomes, professional behaviors
and/or showing no improvement in one or more areas of the course outcomes after feedback is given.

Other Student Expectations:

 Read and familiarize yourself with course outcomes, professional behaviors stated on this document, student handbook (Code of Conduct),
ANA Code of Ethics and the S/US grading system.
 Before meeting with clinical faculty at midterm and final evaluation, print the Clinical Evaluation tool and provide examples of how you made
progress in clinical and met the course outcomes and professional behaviors. Submit to faculty as directed before your clinical evaluation
day.
 Before meeting with faculty for final evaluation; print the Clinical Evaluation form and attach evidence for continuing to make progress and
meeting the course outcomes since midterm evaluation has been given to you; also attach written faculty feedback given to you at midterm
and/or anytime during the term.

Clinical evaluation will be done on each objective using a scale of Satisfactory (S), Unsatisfactory (U), or Not Applicable (NA).

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Pediatric Nursing
CLINICAL EVALUATION

Written comments will illustrate the ratings.

Both the Clinical Faculty and the Student should rate the Student/Self using satisfactory or unsatisfactory.
S = Meets or exceed expectations for a student at this level
U = Below expectations for this level
NA = Not applicable

MIDTERM PROGRESS FINAL EVALUATION

Attendance: Inpt. Days _______ Community Days _________ Attendance: Inpt. Days _______ Community Days _________
Simulations ________ vSims _____ Other _________ Simulations ________ vSims _____ Other __________
Absences: ______0______ Absences: _______________

Criteria: Criteria:
 S = Demonstrates the expected behavior/performance  S = Demonstrates the expected behavior/performance
specified by the clinical specified by the clinical
 U = Demonstrates behaviors/performance that need to be  U = Demonstrates behaviors/performance that need to
improved to meet the clinical objectives by final be improved to meet the clinical objectives
evaluation  N/A = Has not had the clinical experience in order to
 N/A = Has not had the clinical experience in order to evaluate performance of the objective
evaluate performance of the objective

CLINICAL PROJECTS (list health education topics): S U CLINICAL PROJECTS (list health education topics: S U
 Midterm Tracking Form 
 
 
 
MIDTERM CLINICAL PROGRESS S U FINAL CLINICAL PERFORMANCE S U

OVERALL CLINICAL PERFORMANCE EVALUATION:  Pass  Fail  Incomplete

A student must receive a passing grade in clinical in order to pass the theory portion of the course. Students who consistently, or at the Final
Evaluation, have an “Unsatisfactory” rating will not pass the clinical or theory portions of the course.
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Pediatric Nursing
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
1. Examine the issues, including legal and ethical concerns, influencing professional Patient Centered S S
nursing in planning and implementing nursing care for infants, children and youth. Care

As demonstrated by: Clinical

o Formulate a nursing care approach that reflects respect for the dignity, A-2) Respect and S S
individuality and developmental level of infants, children and youth. encourage individual
o Identify congruence or lack of congruence among child’s, family’s, and expression of patient S S
professional care provider’s values in order to provide therapeutic care. values, preferences
o Understand and apply the concepts of family centered care. and expressed needs S S

Comments/Examples:
MIDTERM:
I participated in the preparation of a lesson plan for a group of 2-3 year old children. The lesson activities prepared were catered to the
audience and their developmental level. We looked at what lessons parents might want their children to learn and wanted to reinforce
them. For example, we saw that parents want to teach their children to have healthy eating habits so we prepared a lesson teaching them
about healthy fruit and vegetables.

FINAL:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Clinical Objective: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
2. Integrate critical thinking skills into clinical decision making outcomes for Patient Centered Care S S
infants, children and youth with wellness issues, and acute and chronic health
care problems.
As demonstrated by: Clinical S S
o Integrate assigned readings, research findings, child’s medical history, and S-5) Recognize personally held
treatment regimens and formulate corresponding nursing problems, attitudes about working with S S
assessments and interventions. patients from different ethnic,
o Develop pathophysiology flow sheets that analyze the disease process and cultural and social backgrounds S S
integrate laboratory results, ordered medications, symptoms and S-7) Initiate effective treatments to
treatment regimens, into a nursing plan of care. relieve pain and suffering in light of S S
o Problem solves nursing issues that occur during clinical experience or a patient values, preferences and
change in client status. expressed needs S S
o Individualize plan of care based on a child’s physiologic, psychosocial and S-10) Engage patients or designated
developmental needs. surrogates in active partnerships S S
o Organize and prioritize nursing plan of care that promote health, safety and
o Demonstrate a thorough understanding of medication action and dosage well-being, and self-care S S
calculations as it relates to a specific patient and administer medications management
accurately and safely (if applicable).
o Develop and deliver age and developmentally appropriate health lessons.

Comments/Examples:
MIDTERM:
Before preparing the lesson plans for the children, I studied the lecture and read supplemental material on children’s developmental levels according to
Erikson and Freud’s theories. We individualized the lesson plan to include activities that were suited to children of the specific ages of our demographic.
For example, when learning about road safety, for the ages of 2-3 the lesson they need to learn is to always be holding on to an adult’s hand. This is
different from a lesson taught to an 8-year old for example who would be learning to look both ways before crossing the street. In this way our lessons
were age-appropriate.

FINAL:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Clinical Objective: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
3. Apply knowledge of human development and therapeutic communication to wellness Teamwork and S S
and illness issues in infants, children and youth when planning and implementing nursing Collaboration
care.
As demonstrated by: Clinical S S
o Apply knowledge of growth and development when providing care to children. S-3) Act with integrity,
o Compare children’s physical, cognitive and social development to norms established for consistency and respect for S S
that age. differing views
o Analyze the effect of health problems or stressors on children’s development. A-4) Function competently S S
o Critique own and other’s use of therapeutic techniques in facilitating effective within own scope of practice
communication. as a member of the health S S
care team
A-7) Clarify roles and
accountabilities under
conditions of potential
overlap in team member
functioning
Comments/Examples:
MIDTERM:
In the Immunizations simulation, I had to apply knowledge of growth and development to understand where the child is on a vaccine schedule for his
age. For one of the scenarios, there was a child who came in from a foreign country and based on their limited medical record, I had to make a
recommendation for what vaccines the child has had, what titers should be run, and what vaccines should be given.

FINAL:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
4. Integrate knowledge of the effect of home, culture, socio-economic influences, and Patient Centered Care S S
other environments that affect optimal health promotion, development, and disease
prevention when planning and implementing effective and safe nursing care.
As demonstrated by: Clinical S S
o Analyze the effect of changes in a child’s home and social environment on the child’s S-3) Provide patient-centered
response to nursing care. care with sensitivity and S S
o Work within interdisciplinary teams (OT, PT, teacher, child life specialist, respiratory respect for the diversity of
therapist, social worker, physician) in providing nursing care to children. human experience
A-2) Respect and encourage
individual expression of
patient values, preferences
and expressed needs

Comment/Examples:
MIDTERM:

In my assessment of a newborn simulation, I worked as part of a team to provide a thorough assessment to the infant. I worked with other nurses to
make sure I got an accurate hand-off report and understood the condition of my infant patient, I looked at the physician’s orders for the patient, and I
made recommendations to the physician based on my assessment of the infant’s condition.

FINAL:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
5. Advocate for the child by facilitating positive parental coping behavior, enhancing Patient Centered Care S S
parenting skills and increasing family involvement in the care of the child.

As demonstrated by: Clinical S S

o Assess parental knowledge, coping behavior and stress level and encourage participation A-1) Value seeing health
in child’s care when applicable. care situations "through S S
o Demonstrate appropriate role modeling for care providers and health care workers. patients' eyes"
o Provide appropriate information to the child, family, and professional team members A-14) Appreciate shared S S
about the child’s status. decision-making with
o Be assertive in acting as the child’s and family’s advocate when applicable. empowered patients and S S
families, even when
conflicts occur.

Comments/Examples:
MIDTERM:
In our lesson planning, we emphasized the role of parents, especially as it relates to road safety. When teaching the children, our lesson plan addresses
the children’s need to hold on to the parent’s hand the entire time of crossing and focusing on the parent. Providing information to the family is also
important when dealing with vaccination about potential side effects, and providing education as to why vaccination is important as per our
Immunization SIM.

FINAL:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
6. Apply knowledge of health issues, including: health promotion and maintenance, Patient Centered Care S S
illness, and primary, secondary and tertiary concepts of prevention when providing Safety
nursing care to clients.

As demonstrated by: Clinical S S

o Analyze children’s changing clinical status and response to nursing and medical A-7) Appreciate the role of
interventions when applicable. the nurse in relief of all types S S
o Prioritize care on an on-going basis as the child’s clinical status changes when and sources of pain or
applicable. suffering S S
o Synthesize all relevant data to provide health education and/or comprehensive nursing Clinical
care. S-11) Recognize the S S
o Assess immunization/vaccine status when providing primary prevention and education boundaries of therapeutic
to children and families. relationships

Comments/Examples:
MIDTERM:
In the Health Assessment of an infant simulation, I analyzed the child’s changing clinical status by monitoring his O2 saturation and turning up the
oxygen flow per the standing order. I did this in increments of 1L/min until I reached the cap of 4 L/min. The goal of the saturation was 93% and I tried
to increase the oxygen flow to reach this number. This task was given priority as it deals with the essential respiratory system.

FINAL:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
7. Use the nursing process to promote a therapeutic and humanistic environment Patient Centered Care S S
that facilitates optimal health of children and families in a variety of cultures.
As demonstrated by: Clinical S S
o Use the five steps of the nursing process to individualize nursing care for children A-3) Value the concept of EBP
regarding health issues. as integral to determining best S S
o Provide health education and anticipatory guidance to maintain age appropriate clinical practice
optimal health. A-6) Acknowledge own S S
o Plan appropriate stimulation and developmental/play activities for children of all limitations in knowledge and
ages. clinical expertise before S S
o Provide care which is sensitive to cultural, ethical, and moral values. determining when to deviate
from evidence-based best
practices

Comments/Examples:
MIDTERM:
Our lesson plans were formulated for the children using the 5 steps of the ADPIE system. First, an assessment was done of the clinical site by going to
meet with the teachers and the children to assess the needs of the children based on their age and developmental level. Information was gathered from
the teachers as well to see what they wanted to emphasize as health lessons for the children. This helped in forming a diagnosis of what lessons would
be best to teach. We then formulated a plan with implementation and evaluation to follow.

FINAL:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Clinical Objectives: Upon completion of the course, the student will be able to: QSEN Competency MIDTERM FINAL
Self Fac Self Fac
8. Synthesize and translate current research evidence in providing professional Evidence Based Practice S S
nursing care to infants, children, and youth in a variety of settings.
As demonstrated by: Clinical S S
o Use knowledge of pathophysiology, nursing assessment, laboratory, diagnostic, A-3) Value the concept of EBP as
and monitoring data in providing comprehensive care to the children. integral to determining best clinical S S
o Apply knowledge of assigned readings, public health guidelines, professional practice
journals, and/or medical and pathophysiology texts when planning and A-6) Acknowledge own limitations in
implementing nursing care to children. knowledge and clinical expertise
before determining when to deviate
from evidence-based best practices
Comments/Examples:
MIDTERM:
In our Immunization simulation, we used the appropriate guidelines for vaccine storage and administration to ensure a correct count of vaccines on
hand, to judge whether or not the vaccines on hand were usable or “spoiled”, and to formulate a vaccine schedule that we would then share with the
parents and explain the importance of vaccinations to children. I read the CDC’s guidelines on catch up schedules for missed vaccinations and other
information regarding vaccine administration and safety.

FINAL:

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 Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

MIDTERM: STUDENT COMMENTS

Areas to be Strengthened:
Follow up on assessment values
Transition of tasks in assessment

Areas of Strength:
Willingness to Learn
Bedside Manner
Biochemistry Background
Positive Disposition

Faculty Signature ___ ____________________Date:__1/20/22_______

Student Signature _______________________________________________ Date:_________01/19/2022_____

FINAL: STUDENT COMMENTS

Areas to be Strengthened:

Areas of Strength:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Faculty Signature ________________________________________________Date:__________________________

Student Signature _______________________________________________ Date:__________________________

Midterm
MIDTERM:Faculty
FACULTYComments
COMMENTS
Areas to be Strengthened:
Continue to participate in clinical direct and indirect care activities to demonstrate competency.

Areas of Strength: Serban shows an understanding of how the different clinical activities in this course are contributing to her gaining competency in the
course objective. She used various examples and thus demonstrated meeting the objectives in many ways. Serban participates in post clinical conference
and her contributions are valuable.

Faculty Signature ___ _______________Date:___1/20/22_______

Student Signature _______________________________________________ Date:__________1/20/22_______

FINAL: FACULTY COMMENTS

Areas to be Strengthened:

Areas of Strength:

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Revised 10/5/2020 SAMUEL MERRITT UNIVERSITY NURSING PROGRAM
Pediatric Nursing
CLINICAL EVALUATION

Faculty Signature ________________________________________________Date:__________________________

Student Signature _______________________________________________ Date:__________________________

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