FACULTY HANDBOOK PART II FORMS

FACULTY HANDBOOK PART II FORMS Revised: 6/04;7/08; 2/10, 5/10 Revised May10

Table of Contents Pre-Affiliation Meeting 3 Post-Affiliation Meeting 4 Faculty Evaluation of Clinical Agency (FECA) 5 Student Emergency Contact Information 6 Clinical Assignment 7 Course Evaluation 8 Faculty Theory Evaluation 9 Faculty Clinical Evaluation 10 Facility Evaluation of Faculty 11 Record of Counseling 12/13 Action Plan for Success 15 Medical Exam Clearance form for Pregnant Student 16 Rating Scale for Clinical Evaluation Tool 17 Sample clinical Evaluation Tool 19 Revised May10 2

OHLONE COLLEGE NURSING PRE-AFFILIATION MEETING REPORT Date Held: Semester: Year Course: Facility: Name Title Faculty 1. Facility Attendee(s) 1. 2. Yes No Comment Confirmation of dates, time location and student assignment Written copies of course and clinical objectives discussed Staff expectations of instructor Staff expectations of students Arrangements discussed regarding: Parking (permits?) Meals Student absence/illness calls Student Orientation: Introductions Conference room dates/times Instructor contact Instructor Orientation: Policies and Procedures Revised May10 3

Additional Comments: Revised May10 4

OHLONE COLLEGE NURSING POST-AFFILIATION MEETING REPORT Date Held: Semester: Year: Course: Facility: Name Title Faculty 1. Facility Attendee(s) 1. 2. Yes No Comment Staff evaluation of student performance Student evaluation of facility Adequate instructor availability Problems encountered during rotation by instructor/students Problems encountered during rotation by staff Plans for future affiliations Additional Comments: Revised May10 5

Faculty Evaluation of Clinical Agency FECA Faculty: Date: Course: Facility Please circle the number that best reflects your evaluation 1. Highly Agree 2. Agree 3. Somewhat agree 4. Somewhat disagree 5. Disagree 1. This clinical agency consistently provides adequate learning opportunities to meet course clinical objectives 1 2 3 4 5 2. Staff at this agency support students in their learning process 1 2 3 4 5 3. Students have ample opportunity to apply critical thinking skills in this setting 1 2 3 4 5 4. Students are exposed to professionals from many disciplines who are an integral part of the health care team. 1 2 3 4 5 5. Students are encouraged to participate as part of the interdisciplinary team in this setting. 1 2 3 4 5 6. Staff at this agency role model high standards of nursing practice. 1 2 3 4 5 7. Staff in this agency treat students in a collegial manner. 1 2 3 4 5 8. Students have ample opportunity to practice communication skills in this setting. 9. This agency provides students with opportunities to learn who to render care to culturally diverse clients across the life span. 1 2 3 4 5 1 2 3 4 5 10. The nursing care rendered in this setting is current and up to date. 1 2 3 4 5 11.The morale of the staff in this agency is generally positive. 1 2 3 4 5 Revised May10 6

SCHOOL: COURSE: PROGRAM: GENERIC MOBILITY BEGINNING (1 ST SEMESTER) INTERMEDIATE (2 ND /3 RD SEMESTER) ADVANCED (4 TH SEMESTER) SCHEDULED DAYS: TIMES: STUDENT NAME ADDRESS PHONE EMERGENCY # EMERGENCY PHONE 1. 2 3 4 5 6 7 8 9 10 11 ALPHABETICAL ORDER, LAST NAME FIRST INSTRUCTOR'S NAME: OFFICE NUMBER: HOME PHONE: OTHER NUMBER: EMAIL; 6 Revised May10

OHLONE COLLEGE STUDENT CLINICAL ASSIGNMENT DATE: TIME: INSTRUCTOR: Instructor Contact Number: HOSPITAL UNIT Student Name Patient Assignment Skills able to perform Revised May10

: Ohlone College Course Evaluation Course Number Semester In an effort to continue to provide high quality education in the Ohlone College nursing program, please complete this survey. Your answers will remain confidential and will be used to review and critique the quality of theory and clinical content taught. Your cooperation is appreciated. Please check the response that best reflects your perception. OVERALL COURSE EVALUATION Highly Agree Agree Somewhat Agree 1. The objectives of this course are clear. 2. The amount of work required for this course was appropriate for the credit received. 3. The required textbooks for this course were helpful in relation to the objectives. 4. The class assignments were relevant. 5. The required readings and media were appropriate 6. The exams reflected course objectives. 7. The course was well organized. 8. The instructional approach stimulated critical thinking. 9. The class time allowed for interactive learning 10. The use of human simulation improved my ability to integrate theory into practice. 11. The course helped me to improve in clinical performance. 12. At course completion, the objectives were met. Circle the grade you expect in this course A B C D Somewhat Disagree Highly Disagree Circle the closest to your cumulative GPA 4.0-3.6 3.5-3.1 3.0-2.6 2.5-2.1 1. What do you think have been the strong points of this course? 2. What do you consider the weak points of this course? 3. How could the course be improved by additions, deletions or revision to better meet your needs? Revised May10 9

Revised May10 OHLONE COLLEGE NURSING DEPARTMENT THEORY EVALUATION OHLONE COLLEGE NURSING THEORY EVALUATION Faculty: Course: Date: Your instructors are continually trying to improve their teaching techniques and your learning experience. Please rate each of the following professional characteristics by checking the corresponding scale and comment with constructive criticism. Highly Agree Agree Somewhat agree Somewhat disagree A. Organization in classroom setting Comments 1 2 3 4 5 B. Clarification of classroom objectives Comments: 1 2 3 4 5 C. Application of theory to practice Comments: 1 2 3 4 5 D. Teaching Techniques Comments: 1 2 3 4 5 E. Communication Skills Comments: 1 2 3 4 5 F. Ability to Arouse Interest in Subject Comments: 1 2 3 4 5 G. Interaction with students Comments: 1 2 3 4 5 H.Strengths: I.Suggestions for Improvement: J.Other: Revised: 3.5.07; May10: student handbook, Part III, Faculty Handbook, Part II 9 Highly disagree

OHLONE COLLEGE NURSING CLINICAL THEORY EVALUATION Faculty: Course: Date: Your instructors are continually trying to improve their teaching techniques and your learning experience. Please rate each of the following professional characteristics by checking the corresponding scale and comment with constructive criticism. Highly Agree Agree Somewhat agree Somewhat disagree C. Organization in clinical setting Comments 1 2 3 4 5 D. Clarification of clinical objectives Comments: 1 2 3 4 5 C. Application of theory to practice Comments: 1 2 3 4 5 G. Teaching Techniques Comments: 1 2 3 4 5 H. Communication Skills Comments: 1 2 3 4 5 I. Ability to Arouse Interest in Subject Comments: 1 2 3 4 5 G. Interaction with students Comments: 1 2 3 4 5 Highly disagree H. Strengths: I. Suggestions for Improvement: J. Other: Revised: 3.5.07: student handbook, Part III, Faculty Handbook, Part II 10 Revised May10

OHLONE COLLEGE FACILITY STAFF EVALUATION OF NURSING INSTRUCTOR HOSPITAL: YOUR NAME: (OPTIONAL) UNIT: DATE: POSITION: F.T. P.T. NAME OF CLINICAL INSTRUCTOR: STUDENTS: 1st Year 2nd Year LENGTH OF STUDENT ROTATION: (Weeks) As part of our effort to evaluate and improve the Ohlone College Nursing Program, we are seeking the perspective of the community agencies who work with our students and faculty. As a key person in your agency, you are in a position to help in our assessment. Please complete this evaluation form and return to the faculty person who presented it to you. Thank you for your assistance. Please rate how effectively the instructor carried out the following activities. ACTIVITIES OF INSTRUCTOR Provided information about staff and instructor responsibilities re: student supervision Gave timely information about student rotation schedules for your hospital Met hospital's needs for instructor availability and timely communication Set standards for student performance that meet your professional expectations Provided clear information re: daily patient assignment Provided information re: student skill expectations and clinical objectives Provided students a theoretical background for clinical application STRONGLY AGREE AGREE DISAGREE STRONGLY DISAGREE NOT APPLIC- ABLE STRENGTHS/AREAS FOR IMPROVEMENT: 11 Revised May10

OHLONE COLLEGE HEALTH SCIENCES DIVISION NURSING PROGRAM RECORD OF COUNSELING CONFERENCE STUDENT: COURSE: DATE: Situation/Subject: Goals/Plan: Student Comments: Student: Faculty: (Evaluation on back) Revised May10 13

Evaluation (follow up): DATE: Student: Faculty: Revised May10 14

Dear Nursing Faculty, Attached you will find an action plan form to be completed by the nursing faculty member for students failing your course. Use the form as appropriate. Let s review a few situations to see how this form may apply. Student #1: Action: Student #2: Action: Strong student having lots of personal stress and working long hours. Fails course. Tells you did not study. Your assessment concurs with student who previously has had strong record. You might recommend seeing an Ohlone counselor for stress reduction or cutting back on work hours. You may not use this form at all in this case. Student just barely getting by in beginning courses. Slow reader, doesn t seem to grasp what s being said in class. Failing exams. Fails course. You recommend content review, selected videos and computer programs and portfolio completion. You re concerned with the student s slow learning and apparent lack of understanding and you think comprehension may be an issue. You may require that the student be tested and indicate on the form who the student should make an appointment with. The faculty member calls the reading lab and states her assessment of the student s problem. She requests that the student be tested and then informs the student to make an appointment. These diagnostic services are provided by the writing and math labs as well after they hear from the faculty member. Once the student has been assessed by the reading lab, for example a recommendation is made and it is important for the nursing faculty to support the recommendation of the reading lab or why bother with testing. This ultimately could mean that the student will be delayed if she needs to take recommended course work based on testing results. The Admissions and Promotions Committee recommends that faculty: 1. Strongly encourage students to follow through on testing recommendations even if it means a delay in their program completion. 2. Notify students that if they do not follow through on required testing and testing recommendations it may impact on their return to the program as spaces are limited and students completing action plan requirements will be given higher priority. Revised May10 15

Dear Nursing Student: ACTION PLAN FOR SUCCESS After considerable thought, the following action plan has been devised for you by a nursing faculty member. Keep in mind that the recommendations checked and described below are intended to help you master course concepts and be successful but only you can do it! RECOMMENDATIONS: Review the following course content-related deficits, i.e.: Review the following videotapes and/or computer programs for the N course: Purchase N Portfolio and complete all exercises. Complete all support courses for the major prior to nursing courses. See Ohlone counselor regarding stress reduction. Enroll in stress reduction course: PD 101 College Survival Techniques PD 111 Strategies for College Success Other REQUIREMENTS: DEADLINE DATE INITIAL OF SUPERVISOR Make an appointment with in the Reading Lab for diagnostic testing. Make an appointment with in the Writing Lab for diagnostic testing. Make an appointment with in the Math Lab for diagnostic testing. Student Signature Date Faculty Signature Date Revised May10 16

OHLONE COLLEGE ALLIED HEALTH PROGRAMS REPORT OF MEDICAL EXAMINATION DURING PREGNANCY This form must be completed and returned to the Health Science Office (NC2301) prior to the start of the clinical experiences. NAME: ***************************************************************************** EXAMINATION COMMENTS AND FINDINGS: The above named is able to safely perform the physical activities required for the nursing program through Date Attending physician s signature Date Student s signature. I give permission to release information to affiliating clinical facility. I release Ohlone College from liability due to illness or injury which may occur during clinical experience. Rating Scale for Clinical Evaluation Tool SATISFACTORY Safe clinical performance; demonstrates expected skills, synthesis of learning and application of nursing principles at expected level. Revised May10 17

1. Functions safely with guidance. 2. Demonstrates ability to make expected observations. 3. Demonstrates ability to relate and apply knowledge, clinical performance at expected level. 4. Assumes responsibility for assignments. 5. Makes appropriate nursing judgments with guidance. 6. Initiates appropriate nursing interventions with guidance. 7. Usually seeks learning experiences. 8. Usually demonstrates expected professional conduct. NEEDS IMPROVEMENT Inconsistent clinical performance; inconsistently demonstrates expected skills, synthesis of learning and application of nursing principles at the expected level. 1. Functions safely only with continual guidance. 2. Inconsistently demonstrates ability to make obvious observations related to patient care. 3. Inconsistently relates knowledge to clinical situation at expected level. 4. Inconsistent in assuming responsibility for assignment. 5. Fails to seek guidance in making nursing judgments; makes occasional, unsafe nursing judgments. 6. Inconsistent in initiating nursing intervention even with guidance. 7. Seeks learning experiences only when prompted. 8. Demonstrates expected professional conduct under continued guidance. UNSATISFACTORY Clinical performance inadequate, indicates lack of skill, unsafe nursing practice, inadequate depth of knowledge, or application of nursing principles. Functions below expectations of student at this level. 1. Does not function safely even with guidance. 2. Does not demonstrate ability to make expected, obvious observations related to patient care. 3. Does not demonstrate ability to relate knowledge to clinical situation at expected level. 4. Has difficulty accepting responsibility. 5. Does not make safe nursing judgments. 6. Does not initiate nursing intervention without maximum guidance. 7. Seldom seeks learning experiences. 8. Demonstrates unprofessional clinical conduct. Revised May10 18

To receive a passing grade in Clinical Lab, the student must attain at least a satisfactory rating on the critical requirements and a mean of satisfactory on all clinical objectives. CRITICAL ELEMENTS A critical element (C. E.) is defined by the Ohlone college nursing faculty as a specific, observable and measurable behavior that all students are expected to perform. A critical element pertains to safety issues or course requirements. When a critical element related to safety is violated or omitted, patients are actually or potentially endangered and care being delivered less than satisfactory. When a critical element related to course requirements is not completed at a satisfactory level, the student has not progressed to the expected level of competency. If a student receives less than a satisfactory rating on any identified critical element, at completion of the course, the student will not progress to the next level. Critical elements are leveled throughout the program, using criteria of complexity and application of nursing process and critical thinking. Clinical objectives for nursing courses are cumulative. Specific clinical objectives are expected to be met satisfactorily in early clinical courses. Therefore, even though clinical objectives for preceding courses are not always repeated on evaluation tools they are implied. Revised May10 19

NURSING 303 Nursing Care of Women and Children CLINICAL EVALUATION TOOL (SAMPLE) Name: S = Satisfactory NI = Needs Improvement *Faculty Comment on Back Hospital #1: U = Unsatisfactory Instructor #1: NO = Not Observed or No Opportunity **Critical Requirement Hospital #2: Instructor #2: Semester: Fall Spring Year: Absences: Peds: OB: I. PROVIDER OF CARE/MANAGER OF CARE A. Nursing Process PEDS OB 1. Assessment **a. Collects pertinent data prior to care of maternity & pediatric patients. **b. Verbalizes understanding of medical diagnosis and usual nursing care needs. **c. Completes data collection sheet prior to caring for a pediatric patient. xxx **d. Assesses and records vital signs of maternity, pediatric patients. **e. Completes one physical assessment form, and one gestational age assessment of newborn. xxx **f. Performs three basic physical assessments on postpartum patients: (Turns in Assessment Sheet) xxx 1) Vaginal delivery patient includes: vital signs, lungs, breasts, fundus, abdominal muscles, perineum, lochia, xxx rectum, lower extremities, DTR/clonus status, and psychosocial status. 2) Cesarean delivery patient includes: all of the above and bowel sounds, and circulatory status for post-op xxx complications. **g. Performs accurate head-to-toe physical assessment of pediatric patient. xxx **h. Completes assessment tool on two labor and delivery patients. xxx **i. Performs and documents in-depth developmental assessment on EACH pediatric patient assigned to care for. xxx **j. Compares results of patient s diagnostic tests with normal values, and identifies nursing actions for abnormal values. Revised May10 2. Nursing Diagnosis PEDS OB **a. Prepares satisfactory standardized nursing care plan on laboring patient, postpartum patient and newborn. xxx

Revised May10 21