How Am I Doing?

Evaluation and Feedback

Objectives
Describe the four steps in the evaluation process

Demonstrate how to provide effective and constructive

feedback

Examine samples of evaluation tools

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 Evaluation and Feedback

Reflecting
“It has been years since my first precepting experience. That new
employee I precepted back then occasionally functions as charge nurse on
our unit. A few weeks ago, she helped me with a critically ill patient of
mine. That is the beauty of precepting. What you give, you get back,
whether it is directly through working with a new co-worker or indirectly
by helping a new nurse enter the profession with confidence. Precepting is
the wheel that makes nursing turn and continue on down the road.”
(Lisa R. Davila, RN)

Evaluation
How do I evaluate?
What do I evaluate?
What do I document?
Evaluation tools
Why do I evaluate?

Evaluate Competence
Use the Critical Thinking Indicators
www.alfaroteachsmart/new2008cti.pdf

Evaluating Knowledge and Critical Thinking

Ask questions/give scenarios
Why do you think the physician ordered that?
What do you think is going on with the patient?
What lab values/test would you want to look at/have ordered?

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 Questions to Evaluate Knowledge
and Critical Thinking Skills
You may expect your preceptees to be able to answer the following
questions. Use your own judgment to determine which questions to ask
based on the knowledge you have of your preceptee. Some questions are
appropriate for new graduates, and some are appropriate for experienced
nurses.

When Administering Medications:

What is the medication needed? Side effects?
How will it affect THIS patient?
Are there labs or vital signs you want to check before/after you
give the med?
If IV med, have you given an IV med before?
What is the technique for giving IV meds?
What is the recommended rate of administration?
What might happen if you give it too fast or slow?
Have preceptees write out drug calculations when necessary.

Consider asking these or similar questions during the preceptee’s time

with you. Let them impress you!
What do you know about this patient physiologically that explains
this behavior and drives your interventions?
What can you do that will help this patient get through this
situation?
How can you help as a patient advocate?
What’s the next step in getting the patient home?
What changes would you make to solve . . . ?
What would happen if . . . ?
Can you predict the outcome if . . . ?
What might you anticipate as a complication of this procedure?
Can you propose an alternative plan/treatment/med/method . . . ?
Would it be better if . . . ?
How could you determine . . . ?
How would you prioritize . . . ?
Based on what you know, how would you explain . . . ?
What data did you use to make the conclusion . . . ?
How would you compare this patient’s situation with a previous
patient or the textbook picture?

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 Explain why. How do you know that? What are other possible
reasons for . . . ?
What would you do if . . . ?
What would you do if your patient’s blood sugar was 50?
Why would you hold the insulin?
What is the physiology behind this decision?
We make decisions based on assumptions. Are our assumptions
correct?
On what data are you basing this assumption?
What assessment techniques were used to make this
assumption?
“My patient has had a urine output of 200 mLs during the past
12 hours.”
What conditions, disease states or medications could be
causing this symptom?
What assessments would you complete on this patient?
What are other possibilities or alternatives?
How might the patient view this situation?
What are other ways of approaching this situation?
If this occurs, what would you expect to happen next?
Why?
What would be the effect of your intervention for this patient?
Your patient is SOA (short of air). What further assessment and
interventions should take place?

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Evaluating Attitude
Observe
Listen
to your preceptee
to your co-workers
Recognize contribution to team
examples of accountability
examples of lack of accountability

Evaluating Skills
Observe
identify patterns
Compare performance
policy/procedure
standards of care

Evaluation Process (Alspach, 2000)

Measurement
What are you measuring?
Comparison
compare performance to a standard
Appraisal
objective assessment of performance
Decision
Where do we go from here?

Proactive Evaluation
Ongoing
Open two-way conversation
Continuous feedback is key!

Evaluation Tools
Hospitalwide
Unit-specific

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Date: ________________

Name of Orientee _______________________ Preceptor _________________________ Unit________

Clinical Knowledge and Performance

Score 1 – 6
1 = Requires monitoring, unable to safely function alone 4 = Requires minimal assistance
2 = Requires complete assistance 5 = No assistance required but still dependent on preceptor
3 = Requires monitoring of activities & some assistance 6 = Works independently
Any score below a “4” requires documentation (may use the back of the form).
Complete weekly and return to educator or manager 1 2 3 4 5 6 Comments
COMMUNICATION
Communicates in a clear and timely manner
Remains approachable
Welcomes and accepts constructive criticism
Communicates effectively with pt and family
Communicates with members of multidisciplinary team

CRITICAL THINKING SKILLS

Critically reviews pts. condition and identify needs
Implements the plan of care
Demonstrates ability to make appropriate changes in plan of care
Anticipates needs and follows up with pt./family to ensure needs met
Demonstrates ability to respond to emergency situation
Solves problems as they occur
Seeks appropriate resources

DELEGATION/LEADERSHIP
Identifies appropriate task for delegation
Delegates tasks appropriately and supervises care
Makes expectations clear
Provides appropriate support

ORGANIZATIONAL SKILLS
Demonstrates ability to organize care for team of patients
Prioritizes and organizes work effectively
Demonstrates flexibility with changes

TEAMWORK
Treats others with fairness and respect
Works well with other team members
Demonstrates understanding of role as team member
Displays self direction and initiative

COMMENTS
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 Clinical Knowledge and Performance
Score 1 – 6
1 = Requires monitoring, unable to safely function alone 4 = Requires minimal assistance
2 = Requires complete assistance 5 = No assistance required but still dependent on preceptor
3 = Requires monitoring of activities & some assistance 6 = Works independently
Any score below a “4” requires documentation (may use the back of the form).
Complete weekly and return to educator or manager 1 2 3 4 5 6 Comments
PERFORMS CORE NURSING SKILLS
Assessment, Physical
Documentation (computer and paper)
Dressing changes – Wound or Incision
Foley catheter insertion and care
Isolation patient
IV line and pump maintenance
IV medication administration
Medication administration
Order management
Oxygen application / monitoring
Patient Safety / Restraints
Pre op care
Post op care

ADDITIONAL
Blood and blood component therapy
Central line care (PICC and Non-tunneled)
IV start
NG insertion /care
Suctioning
Tube Feeding

COMMENTS
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Developed by Diana Tilton, BSN, RN

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 Clinical Knowledge and Performance

Score 1 – 6
1 = Requires monitoring, unable to safely function alone 4 = Requires minimal assistance
2 = Requires complete assistance 5 = No assistance required but still
3 = Requires monitoring of activities and some assistance dependent on preceptor
6 = Works independently

Any score lower than a “4” requires documentation (may use the back of the form).

Complete weekly and return to

1 2 3 4 5 6 Comments – Week 2
educator or manager.

COMMUNICATION

Communicates in a clear and Needs advice as to when to call

x
timely manner physician.

Curt with NA when the NA asked her a

Remains approachable x
question about a patient.

Improving but became defensive when I

Welcomes and accepts
x corrected her technique when starting IV
constructive criticism
and inserting a foley.

Communicates effectively with Personable and professional when

x
patient and family interacting with patient and family.

Communicates with members of Unsure of self when communicating with

x
multidisciplinary team physician and social worker.

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 Clinical Knowledge and Performance

Score 1 – 6
1 = Requires monitoring, unable to safely function alone 4 = Requires minimal assistance
2 = Requires complete assistance 5 = No assistance required but still
3 = Requires monitoring of activities and some assistance dependent on preceptor
6 = Works independently

Any score lower than a “4” requires documentation (may use the back of the form).

Complete weekly and return to

1 2 3 4 5 6 Comments – Week 4
educator or manager

COMMUNICATION

Is making progress figuring out when to

Communicates in a clear and
x call the physician. Reports information to
timely manner
preceptor and others appropriately.
More comfortable with others on unit.
Remains approachable X
Working as team member
Improving. Working more collaboratively
Welcomes and accepts X
and understand limitations. Correcting
constructive criticism own actions without always needing
direction.
Communicates effectively with Personable and professional when
x
patient and family interacting with patient and family.
Becoming more comfortable with social
Communicates with members of
x worker and dietician. Is feeling more
multidisciplinary team
comfortable delegating skills to others.

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 Possible Comments for Evaluation Form
Provide evidence/example of real situation for both the orientee and manager.
1. Is unsure of self when …
Needing to communicate with physician or other professional.
Example: Was hesitant to talk with Dr. Jones when her patient was not
getting good pain relief with current order. When she did call
him, she was articulate and a good advocate for her patient.
2. Works well with team.
Helps other team members with beds/baths/meds/during crisis.
Example: When Mary’s patient was deteriorating, the orientee gave meds
to Mary’s other patients and answered her call lights.
3. Needs to improve communication skills with nurse aids.
Appears uncomfortable when delegating.
Example: Her patient was running a temp and needed to have her temp
checked after administering Tylenol and was reluctant to tell
the NA to do it. Felt like she had to take it herself.
Example: Was short with NA when the NA asked her if the patient could
walk to the bathroom.
4. Needs to be more attentive to detail.
Example: Missed a new medication order on chart. Forgot to chart vital signs.
5. Needs to develop better organization/prioritization skills.
Does not complete patient care in a timely manner.
Example: Unable to leave on time on three occasions because she didn’t have her
charting complete when caring for two moderately complex patients.
6. Personable and professional when interacting with others.
7. Good attention to detail when documenting.
8. Demonstrates good sterile technique when performing procedures.
9. Articulate when talking with physicians and other professionals.
10. Able to anticipate patients’ needs in most circumstances.
11. Provides holistic care to complex patient.
12. Delegates tasks appropriately to NA.
13. Offers to help other team members.
14. Is organized and gets tasks done in timely manner.
15. Asks appropriate questions.
16. Confident when asking for help.
17. Understands pathophysiology in depth for commonly seen disease processes.
18. Needs to use resources more readily when she doesn’t understand pathophysiology.
19.
20.
Use 19 and 20 to write your own comments to use on evaluations.
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 Performance Appraisal

Degree of
Supervision Organization Application Understanding

Difficulty caring for Disorganized in Exposes patient Cannot state

patient assignment attempts to perform and/or others to purpose, rationale,
with instruction and care unnecessary risks precautions R/T
supervision while providing care care of assigned
patients

Performs care safely Difficulty adapting Performs care Can state and is
with direct when unexpected in a correct and aware of some
supervision factors interfere deliberate manner, purposes, rationale
with established but takes too long to and precautions R/T
sequence accomplish it care of assigned
patients

Requires no Approaches care in Performs care Can state and is

supervision to safely a systematic, correctly according aware of purpose,
perform organized way to policy/protocol; rationale and
care after given time required only precautions R/T
instruction/ slightly longer than care of assigned
demonstration experienced person patients

Successfully Adapts to Performs care Can evaluate the

performs care unexpected correctly according effectiveness of the
without formal occurrences without to established care and
instruction/ losing control of policy/protocol in interventions
demonstration situation timely manner with
accuracy and safety

Acts as role model Proposes alternate Performs care Incorporates the

for others methods/techniques correctly in a whole picture in
performing care to improve care/ spontaneous way evaluating care/
performance without hesitation outcome on patient
well-being

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Effective Feedback
Positive: give often but honestly.
Negative: avoid giving negative feedback. The approach is critical.
Constructive: give as necessary and honestly.
Be patient and understanding while providing constructive
feedback.
It will motivate the preceptee to do better next time.
The preceptee wants you to be proud of him/her.

Elements of Feedback
Describe what was observed: who, what, when, where and how.
Be as specific as possible; avoid judging and generalizing.
Relate what effect the observed behavior had (or could have had)
on the patient/co-worker/physician, etc.
Suggest alternatives to behavior.

Attributes of Effective Feedback (Alspach, 2000)

Specific rather than general
Factual rather than opinionated
Descriptive rather than judgmental
Clearly understood by the receiver
Timed when it will be most useful
Sensitive to the learner’s feelings
Constructive rather than destructive
Directed at the learner’s behavior rather than at the learner

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Scenario 1
You are precepting a new grad, and it is his third day of orientation.
He has no previous hospital working experience.

You suggest that today would be a great day to work on starting IVs.
Your preceptee replies, “I did that in school, and I’m comfortable with it.
I don’t need any practice.”

How would you respond?

What are your concerns, if any?

Scenario 2
Your preceptee is on her second day of orientation, and she seems to be
doing well. The problem is that she reminds you of your ex-sister-in-law
whom you really couldn’t stand. She is really direct and outspoken though
not inappropriate. You notice that sometimes you are short with her.

How would you handle a personality conflict without impairing the

orientation process or creating a confrontational relationship?

Scenario 3
Your preceptee is progressing well in his orientation and is working
autonomously. However, when you do your follow up, you find he is
cutting corners on the standards for the unit and not completing his work.

How do you address this problem?

Scenario 4
You have been precepting a new employee for several weeks and find her
distracted and careless with patient care issues. She seems overwhelmed at
times and always behind. She is frequently complaining about her
workload, but when you offer to help her, she insists that she is OK and
doesn’t need help.

How would you manage this situation?

What are your primary concerns and why?

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Preceptee Self-Reflection and Evaluation
Personal learning objectives
Reflection on performance
Observations
Learning experiences
Risk-taking experiences
Accomplishments
Barriers and obstacles to overcome

Self-Reflection
Not stressed in any way
Somewhat stressed though not interfering with work performance
Stressed: anxious at work
Very stressed: having difficulty coping at work
Extremely stressed: having trouble sleeping at night and/or coming
to work

Explanation/Comments/Reflection on day (week):

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The Essence of Compassion

“Resolve to be tender with the young, compassionate with the aged,
sympathetic with the striving and tolerant with the weak and wrong …
because sometime in your life, you will have been all of these.”
(unknown)

This presentation was developed by Claudia Horton, PhD, MSN, RN

File: G NPA Manual Tab 6 Evaluation

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