Practice Immersion Clinical Evaluation Tool

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*
Agency/site was able to provide the opportunities for the student to meet practice immersion clinical objectives.	☐	☐	☐	☐	☐	☐
Agency/site was able to establish a comfortable, yet stimulating, practice environment.	☐	☐	☐	☐	☐	☐

Criteria:

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*
Exemplify professionalism in diverse health care settings.	☐	☐	☐
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.	☐	☐	☐
Implement patient care decisions based on evidence-based practice.	☐	☐	☐
Utilize patient care technology and information management systems.	☐	☐	☐
Communicate therapeutically with patients.	☐	☐	☐
Professionally communicate and collaborate with the interdisciplinary health care teams to provide safe and effective care.	☐	☐	☐
Understand the human experience across the health-illness continuum.	☐	☐	☐
Provide culturally sensitive care.	☐	☐	☐
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*
Exemplify professionalism in diverse health care settings.	☐	☐	☐	☐
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.	☐	☐	☐	☐
Implement patient care decisions based on evidence-based practice.	☐	☐	☐	☐
Utilize patient care technology and information management systems.	☐	☐	☐	☐
Communicate therapeutically with patients.	☐	☐	☐	☐
Professionally communicate and collaborate with the interdisciplinary health care teams to provide safe and effective care.	☐	☐	☐	☐
Understand the human experience across the health-illness continuum.	☐	☐	☐	☐
Provide culturally sensitive care.	☐	☐	☐	☐
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.

 

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