STUDENT WEEKLY SELF-EVALUATION FORM University of Hawai‘i School of Nursing NURS 255/256 - Care of the Adult Patient STUDENT'S NAME:___________________ DATE:______ INSTRUCTOR:_____ AGENCY:_______ UNIT:____ PATIENT'S ROOM NO.______ INITIALS:________ PART I CLINICAL OBJECTIVES (To be completed prior to clinical) EVALUATION (To be completed after clinical and turned in to instructor)   STUDENT COMMENTS: (Exceptional experiences, growth, performance, specific areas of needed improvement, etc.) PART II: CLINICAL PERFORMANCE SELF-EVALUATION (To be completed after clinical lab experience) CLINICAL OBJECTIVES DOCUMENTATION 1. Utilize knowledge of adult health problems to provide safe care based on scientific rationale. Yes____ No____ N.A.____ 2. Understand and apply knowledge in relation to diagnostic tests and therapeutic measures used in the care of the adult patient. Yes____ No____ N.A.____ 3. Identify psychological, social, cultural, and spiritual factors which impact on the hospitalized adult patient & relate these changes to the patient's health care needs. Yes____ No____ N.A.____ CLINICAL OBJECTIVES DOCUMENTATION 4. Utilize current research findings which have implications for the care of the adult patient. Yes____ No____ N.A.____ 5. Provide standardized care to a group of adult patients in a structured setting. Yes____ No____ N.A.____ 6. Utilize the nursing process to administer care to the adult patient with commonly occurring medical and/or surgical problems. Yes____ No____ N.A.____ CLINICAL OBJECTIVES DOCUMENTATION 7. Provide nursing health information to the patient and his/her family using standardized teaching care plans. Yes____ No____ N.A.____ 8. Utilize therapeutic communication skills, guidance and support in interacting with the adult patient and recording pertinent information. Yes____ No____ N.A.____ 9. Assume responsibility for personal and professional growth in the medical-surgical setting. Yes____ No____ N.A.____ PART III: INSTRUCTOR'S COMMENTS Return to 200-level Adult Nursing
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