Nursing Student Feedback by Preceptors - Texarkana College Forms

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Enter the Full Name of Student*

Texarkana College Clinical Instructor Name*

Enter Clinical Site Location / Department*

Survey Questions

	Satisfactory	Unsatisfactory	Not Observed
Assessment: Data gathering and analysis
Planning: Prior to care, discusses with preceptor interventions necessary to achieve expected outcomes.
Implementation: Implements the plan of care to meet the patient’s psychosocial and physiological needs.
Interpersonal Relations: Written, verbal, and non-verbal communication.
Evaluation: Evaluates self and patient, revises plan appropriately.
Professional Growth and Ethics: Shows professional growth and practices ethical behavior.
Safety: Practices techniques that promote physiological and psychological safety.

Skills observed / Other Comments*

Preceptor Full Name with Credentials*

Preceptor Email address*