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

Master's Degree

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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 experience instructing students?

Providence Care Community Program

Providence Transitional Care Centre

Providence Care Hospital

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* 6. In which area was your most recent clinical placement?

Heritage 0 - Forensics

Heritage 1 - Rehabilitation

Heritage 2 - Complex Medical/Palliative Care

Lakeview 0 - Adult Mental Health

Lakeview 1 - Rehabilitation

Lakeview 2 - Complex Medical

Parkside 0 - Adult Mental Health

Parkside 1 - Seniors Rehabilitation

Parkside 2 - Seniors Mental Health

PTCC - Level 2

PTCC - Level 3

Clinics (please specify in Comments below)

Community (please specify in Comments below)

Comments:

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

	Strongly disagree	Disagree	Neither agree or disagree	Agree	Strongly agree
The in-class orientation answered my questions.	The in-class orientation answered my questions. Strongly disagree	The in-class orientation answered my questions. Disagree	The in-class orientation answered my questions. Neither agree or disagree	The in-class orientation answered my questions. Agree	The in-class orientation answered my questions. Strongly agree
I know what to do if a student or myself are injured or ill while on placement.	I know what to do if a student or myself are injured or ill while on placement. Strongly disagree	I know what to do if a student or myself are injured or ill while on placement. Disagree	I know what to do if a student or myself are injured or ill while on placement. Neither agree or disagree	I know what to do if a student or myself are injured or ill while on placement. Agree	I know what to do if a student or myself are injured or ill while on placement. Strongly agree
I was fully orientated to the clinical area.	I was fully orientated to the clinical area. Strongly disagree	I was fully orientated to the clinical area. Disagree	I was fully orientated to the clinical area. Neither agree or disagree	I was fully orientated to the clinical area. Agree	I was fully orientated to the clinical area. Strongly agree
The student's learning needs were supported.	The student's learning needs were supported. Strongly disagree	The student's learning needs were supported. Disagree	The student's learning needs were supported. Neither agree or disagree	The student's learning needs were supported. Agree	The student's learning needs were supported. Strongly agree
I felt comfortable asking staff questions when I wasn't sure about something.	I felt comfortable asking staff questions when I wasn't sure about something. Strongly disagree	I felt comfortable asking staff questions when I wasn't sure about something. Disagree	I felt comfortable asking staff questions when I wasn't sure about something. Neither agree or disagree	I felt comfortable asking staff questions when I wasn't sure about something. Agree	I felt comfortable asking staff questions when I wasn't sure about something. Strongly agree
Staff were collaborative with students.	Staff were collaborative with students. Strongly disagree	Staff were collaborative with students. Disagree	Staff were collaborative with students. Neither agree or disagree	Staff were collaborative with students. Agree	Staff were collaborative with students. Strongly agree
Patient safety was fundamental to the work of the unit(s).	Patient safety was fundamental to the work of the unit(s). Strongly disagree	Patient safety was fundamental to the work of the unit(s). Disagree	Patient safety was fundamental to the work of the unit(s). Neither agree or disagree	Patient safety was fundamental to the work of the unit(s). Agree	Patient safety was fundamental to the work of the unit(s). Strongly agree
I felt valued as a Clinical Instructor.	I felt valued as a Clinical Instructor. Strongly disagree	I felt valued as a Clinical Instructor. Disagree	I felt valued as a Clinical Instructor. Neither agree or disagree	I felt valued as a Clinical Instructor. Agree	I felt valued as a Clinical Instructor. 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 or 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
This placement was a good learning environment.	This placement was a good learning environment. Strongly disagree	This placement was a good learning environment. Disagree	This placement was a good learning environment. Neither agree or disagree	This placement was a good learning environment. Agree	This placement was a good learning environment. Strongly agree

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* 8. Staff demonstrated:

	Never	Rarely	Sometimes	Frequently	Always
Respect towards patients/clients	Respect towards patients/clients Never	Respect towards patients/clients Rarely	Respect towards patients/clients Sometimes	Respect towards patients/clients Frequently	Respect towards patients/clients Always
Respect towards students and me	Respect towards students and me Never	Respect towards students and me Rarely	Respect towards students and me Sometimes	Respect towards students and me Frequently	Respect towards students and me Always
Empathy towards patients/clients	Empathy towards patients/clients Never	Empathy towards patients/clients Rarely	Empathy towards patients/clients Sometimes	Empathy towards patients/clients Frequently	Empathy towards patients/clients Always
Empathy towards students and me	Empathy towards students and me Never	Empathy towards students and me Rarely	Empathy towards students and me Sometimes	Empathy towards students and me Frequently	Empathy towards students and me Always

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* 9. Our goal is to promote a positive learning environment in the future. If you indicated "Never" or "Rarely" to any of the statements in Question 8 above, please provide details to help us improve this placement opportunity.

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* 10. 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

Introduction

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)

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* 5. Where was your most recent experience instructing students?

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* 6. In which area was your most recent clinical placement?

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

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* 8. Staff demonstrated:

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* 9. Our goal is to promote a positive learning environment in the future. If you indicated "Never" or "Rarely" to any of the statements in Question 8 above, please provide details to help us improve this placement opportunity.

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* 10. 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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* 11. Please provide any additional comments about this placement experience.