Providence Care Quality Clinical Placements Evaluation Tool

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* 1. What is the name of your educational institution?

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* 2. What is the code for the clinical course you have just instructed?

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* 3. At what level of education are you instructing?

Certificate

Diploma

Undergraduate Degree

Masters Degree

PhD

Doctorate

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* 4. In which year of a program are you instructing? (if a combination, list highest year)

First year

Second year

Third year

Fourth year

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* 5. Where was your most recent clinical placement?

Providence Manor

ACOP/Endymion

Hildegarde

Other

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* 6. Using the scale below, please respond to the following statements about your placement experience:

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
The students were fully orientated to the clinical area	The students were fully orientated to the clinical area Strongly disagree	The students were fully orientated to the clinical area Disagree	The students were fully orientated to the clinical area Neither agree nor disagree	The students were fully orientated to the clinical area Agree	The students were fully orientated to the clinical area Strongly agree
The staff were willing to work with students	The staff were willing to work with students Strongly disagree	The staff were willing to work with students Disagree	The staff were willing to work with students Neither agree nor disagree	The staff were willing to work with students Agree	The staff were willing to work with students Strongly agree
The staff were positive role models	The staff were positive role models Strongly disagree	The staff were positive role models Disagree	The staff were positive role models Neither agree nor disagree	The staff were positive role models Agree	The staff were positive role models Strongly agree
The staff were ethical and professional	The staff were ethical and professional Strongly disagree	The staff were ethical and professional Disagree	The staff were ethical and professional Neither agree nor disagree	The staff were ethical and professional Agree	The staff were ethical and professional Strongly agree
The staff demonstrated respect and empathy towards residents	The staff demonstrated respect and empathy towards residents Strongly disagree	The staff demonstrated respect and empathy towards residents Disagree	The staff demonstrated respect and empathy towards residents Neither agree nor disagree	The staff demonstrated respect and empathy towards residents Agree	The staff demonstrated respect and empathy towards residents Strongly agree
Patient safety was fundamental to the work of the Resident Home Area	Patient safety was fundamental to the work of the Resident Home Area Strongly disagree	Patient safety was fundamental to the work of the Resident Home Area Disagree	Patient safety was fundamental to the work of the Resident Home Area Neither agree nor disagree	Patient safety was fundamental to the work of the Resident Home Area Agree	Patient safety was fundamental to the work of the Resident Home Area Strongly agree
I felt valued during this placement	I felt valued during this placement Strongly disagree	I felt valued during this placement Disagree	I felt valued during this placement Neither agree nor disagree	I felt valued during this placement Agree	I felt valued during this placement Strongly agree
I felt safe in the clinical environment (e.g. physically, emotionally, culturally)	I felt safe in the clinical environment (e.g. physically, emotionally, culturally) Strongly disagree	I felt safe in the clinical environment (e.g. physically, emotionally, culturally) Disagree	I felt safe in the clinical environment (e.g. physically, emotionally, culturally) Neither agree nor disagree	I felt safe in the clinical environment (e.g. physically, emotionally, culturally) Agree	I felt safe in the clinical environment (e.g. physically, emotionally, culturally) Strongly agree
I assisted the student in identifying their learning objectives/needs	I assisted the student in identifying their learning objectives/needs Strongly disagree	I assisted the student in identifying their learning objectives/needs Disagree	I assisted the student in identifying their learning objectives/needs Neither agree nor disagree	I assisted the student in identifying their learning objectives/needs Agree	I assisted the student in identifying their learning objectives/needs Strongly agree
I was able to access assistance when needed	I was able to access assistance when needed Strongly disagree	I was able to access assistance when needed Disagree	I was able to access assistance when needed Neither agree nor disagree	I was able to access assistance when needed Agree	I was able to access assistance when needed Strongly agree
I provided constructive feedback to the student	I provided constructive feedback to the student Strongly disagree	I provided constructive feedback to the student Disagree	I provided constructive feedback to the student Neither agree nor disagree	I provided constructive feedback to the student Agree	I provided constructive feedback to the student Strongly agree
I actively looked for learning opportunities for the student	I actively looked for learning opportunities for the student Strongly disagree	I actively looked for learning opportunities for the student Disagree	I actively looked for learning opportunities for the student Neither agree nor disagree	I actively looked for learning opportunities for the student Agree	I actively looked for learning opportunities for the student Strongly agree
I had an understanding of the student's learning needs	I had an understanding of the student's learning needs Strongly disagree	I had an understanding of the student's learning needs Disagree	I had an understanding of the student's learning needs Neither agree nor disagree	I had an understanding of the student's learning needs Agree	I had an understanding of the student's learning needs Strongly agree
After this experience, the students have accomplished their learning objectives	After this experience, the students have accomplished their learning objectives Strongly disagree	After this experience, the students have accomplished their learning objectives Disagree	After this experience, the students have accomplished their learning objectives Neither agree nor disagree	After this experience, the students have accomplished their learning objectives Agree	After this experience, the students have accomplished their learning objectives Strongly agree
Working with the student supported my own professional development	Working with the student supported my own professional development Strongly disagree	Working with the student supported my own professional development Disagree	Working with the student supported my own professional development Neither agree nor disagree	Working with the student supported my own professional development Agree	Working with the student supported my own professional development Strongly agree
When asked, I felt confident assessing the student's skills	When asked, I felt confident assessing the student's skills Strongly disagree	When asked, I felt confident assessing the student's skills Disagree	When asked, I felt confident assessing the student's skills Neither agree nor disagree	When asked, I felt confident assessing the student's skills Agree	When asked, I felt confident assessing the student's skills Strongly agree
I feel positive about working with students	I feel positive about working with students Strongly disagree	I feel positive about working with students Disagree	I feel positive about working with students Neither agree nor disagree	I feel positive about working with students Agree	I feel positive about working with students Strongly agree
I have gained the skills and knowledge to further my practice	I have gained the skills and knowledge to further my practice Strongly disagree	I have gained the skills and knowledge to further my practice Disagree	I have gained the skills and knowledge to further my practice Neither agree nor disagree	I have gained the skills and knowledge to further my practice Agree	I have gained the skills and knowledge to further my practice Strongly agree
I am confident in my role supporting students	I am confident in my role supporting students Strongly disagree	I am confident in my role supporting students Disagree	I am confident in my role supporting students Neither agree nor disagree	I am confident in my role supporting students Agree	I am confident in my role supporting students Strongly agree

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* 7. On a scale of 1-10, with 1 being very dissatisfied and 10 being extremely satisfied, how satisfied were you with this placement experience?

Clear

i We adjusted the number you entered based on the slider’s scale.

Providence Care Quality Clinical Placements Evaluation Tool - Instructors

Question Title

* 1. What is the name of your educational institution?

Question Title

* 2. What is the code for the clinical course you have just instructed?

Question Title

* 3. At what level of education are you instructing?

Question Title

* 4. In which year of a program are you instructing? (if a combination, list highest year)

Question Title

* 5. Where was your most recent clinical placement?

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* 6. Using the scale below, please respond to the following statements about your placement experience:

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* 7. On a scale of 1-10, with 1 being very dissatisfied and 10 being extremely satisfied, how satisfied were you with this placement experience?

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* 8. Please provide any additional comments about your placement experience.