REHABILIATION ASSISTANTS PROGRAM ... - CNA Online Learning

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PERSONAL FO TIO

Student Name: Student Number:

Placement Site: Placement Dates:

Type of Rotation:

REHABILIATION ASSISTANTS PROGRAM (OTA and PTA)

TA2751 CLINICAL PLACEMENT II FOR PTA Evaluation Form

Frank Knox B.Sc. PT, FCAMT

Rehabilitation Assistants Program, College of the North Atlantic

P.O. Box 1693, St. John’s, Newfoundland, CANADA A1C 5P7

Phone: 1.709.758.7212 Fax: 1.709.758.7634

Email: [email protected]

INSTRUCTIONS

Students should retain a copy of the completed form and bring to all subsequent placements & practical skills sessions..

Return this form to the instructor(s) above via mail, email or fax.

COMMENTS

TO BE COMPLETED BY THE PLACEMENT SITE

Contact Name:

Supervising Therapist Name: Supervising Therapist Role: OT ___ PT ___

Supervising Assistant Name: Supervising Assistant Role: OTA ___ PTA ___ RA ___

Final Grade: Pass _________ Fail _________

# Hours Missed:

Reason(s) for Absences/Missed Hours:

Were missed hours worked in? (Y/N):

mailto:[email protected]

2

4 Exceeds

Expectations

Exceeds expectations as an entry level PTA. Student requires minimal supervision to perform this competency/skill following instruction within this specific practice setting. Thus the student is able to work independently and requires infrequent assistance and guidance to perform his/her assigned tasks.

3 Meets

Expectations

Consistently meets expectations of an entry level PTA. Student carries out competency/skill following instruction and with moderate supervision by the PT and/or PTA. The student requires occasional assistance and guidance to perform his/her assigned tasks.

2 Working Towards

Inconsistent in meeting expectations of an entry level PTA. Student requires assistance and guidance to perform competency/skill. Note if due to lack of ability or lack of experience/practice.

1 Unsatisfactory

Difficulty meeting expectations of an entry level PTA. Requires direct supervision to perform competency/skill safely.

N/A Not

Applicable

This competency/skill does not relate to this level of student or to this placement.

OBS Observed

Only

Student experience with this competency/skill was entirely observational. No opportunity for hands on experience.

CLINICAL PLACEMENT COMPETENCY EVALUATION FORM

Rating Scale Definitions

NOTE: Students in this clinical placement must achieve a minimum of 3 on all relevant competencies by their

final evaluation. Failure to do so may result in them having to repeat all or part of one or all of their clinical placements.

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RATING SCALE DEFINITIONS

4 3 2 1 OBS N/A

Exceeds Expectations

Meets Expectations

Working Towards

Unsatisfactory Observed

Only Not

Applicable

1. DEMONSTRATES PROFESSIONAL BEHAVIOR DURING INTERACTIONS WITH OTHERS.

This includes:

a. Adherence to scope of practice

b. Adherence to code of ethics and rules of conduct

c. Adherence to the physiotherapy act

d. Adherence to workplace confidentiality policies

e. Adherence to workplace sexual harassment policies

f. Demonstration of professional decorum

g. Establishes and maintains an effective working relationship with staff and clients and their family

h. Demonstration of sound judgement

i. Participation in continuing education activities

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

4


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

2. DEMONSTRATES EFFECTIVE COMMUNICATION SKILLS.

This includes:

a. Demonstration of effective listening skills

b. Ability to follow directions

c. Ability to participate in teams

d. Ability to provide appropriate verbal directions and explanations

e. Ability to adapt communication style to their audience

f. Demonstration of effective written skills

g. Demonstration of effective interpersonal skills

h. Demonstration of effective presentation skills

i. Ability to participate in staff and committee meetings

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

5


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

3. DEMONSTRATES ORGANIZATIONAL SKILLS.

This includes:

a. Demonstration of effective listening skills

b. Ability to organize their environment

c. Demonstration of effective problem solving skills

d. Uses time effectively

e. Ability to work within the organizational structure of the practice setting

f. Coordination of their schedule with the other team members

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

6


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

4. DEMONSTRATES SAFE PRACTICE BOTH PERSONALLY AND WITH PATIENTS.

This includes:

a. Demonstration of proper body mechanics

b. Recognition of contraindications and precautions and responds appropriately

c. Demonstration of awareness of patient safety factors

d. Demonstration of awareness of personal safety factors

e. Maintenance of a safe working environment

f. Responds appropriately in emergency situations to ensure safety of self and patients

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

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4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

5. PROVIDES ASSISTANCE WITH PATIENT PRE- AND POST-TREATMENT.

This includes:

a. Assistance of physiotherapist with patient assessment

b. Obtaining consent/agreement from patient

c. Ensuring patient privacy and dignity

d. Transferring patient onto treatment surface

e. Assistance with undressing/dressing patient

f. Assistance with application and removal of orthotic and prosthetic devices

g. Assistance with application and removal of bandages/dressings

h. Positioning of patient for comfort and treatment

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

8


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

6. POSITIONS PATIENTS TO OPTIMIZE TREATMENT, FUNCTION, AND COMFORT.

This includes:

a. Demonstration of knowledge of normal body alignment

b. Recognition of deviations from the normal

c. Application of principles of positioning

d. Modification of treatment positions to ensure patient comfort

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

9


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

7. MEASURES, FITS, AND TRAINS PATIENTS IN THE USE OF GAIT AIDS.

This includes:

a. Demonstration of knowledge of the various types of weight bearing and gait patterns

b. Adjustment of gait aid to the height and size of the patient

c. Instruction and demonstration of the proper use of the gait aid to the patient

d. Instruction and demonstration of how to maneuver around barriers and obstacles, i.e. stairs, curbs, etc.

e. Instruction and demonstration of proper ways to fall and rise from falling while using the gait aid

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

10


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

8. DEMONSTRATES EFFECTIVE UTILIZATION OF WHEELED CHAIRS.

This includes:

a. Demonstration of knowledge of components of wheeled chairs

b. Ability to transfer patient into and out of the chair ensuring patient safety

c. Ability to position patient properly in the chair

d. Instruction to patient on using chairs properly and safely

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

11


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

9. PERFORMS AND COACHES THERAPEUTIC EXERCISES.

This includes:

a. Instruction of patient in exercise program

b. Demonstration of hands-on skills in exercise programs

c. Supervision of patients during exercise programs

d. Motivation and encouragement of patients to perform exercise program

e. Demonstration of the understanding of the purpose of the exercise program

f. Proper progression of exercise program under the direction of the physiotherapist

g. Correction of faulty performance or technique

h. Conducting group therapeutic exercise classes

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

12


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

10. APPLIES AND ADMINISTERS PHYSICAL MODALITIES, I.E. SUPERFICIAL HEAT AND COLD, TOPATIENTS APPROPRIATELY.

This includes:

a. Demonstration of an understanding of the indications of the treatment

b. Demonstration of an understanding of the contraindications and precautions associated with thetreatment

c. Positioning patient in a comfortable position while exposing and inspecting the area to be treated

d. Preparation of the equipment and modality

e. Explanation to the patient concerning the treatment and what is to be expected in terms of sensation andresponse

f. Timing and monitoring of treatment and patient to ensure patient safety and comfort

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

13


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

11. APPLIES AND ADMINISTERS SELECT ELECTRICAL MODALITIES, I.E. TENS AND MUSCLESTIMULATION, TO PATIENTS APPROPRIATELY.

This includes:

a. Demonstration of an understanding of the indications for treatment

b. Demonstration of an understanding of the contraindications and precautions associated with treatment

c. Positioning of patient in a comfortable position while exposing and inspecting the area to be treated

d. Preparation of modality, electrodes, leads, gel, etc. for treatment

e. Inspection of modality to ensure that it is functioning properly

f. Ensures treatment parameters are those which have been prescribed by the physiotherapist

g. Application of modality to the patient with the electrodes in the position as indicated by thephysiotherapist

h. Explanation to the patient of the purpose of the modality and what is to be expected in terms ofsensation and response

i. Timing and monitoring of the treatment and patient to ensure patient safety and comfort

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

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4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

12. APPLIES ELECTRICAL MODALITIES AND MECHANICAL TRACTION APPARATUS TO PATIENTSAPPROPRIATELY.

This includes:

a. Portering of the modality and/or patient to the treatment area

b. Positioning of the patient in a comfortable position while inspecting and exposing the area to be treated

c. Application of the modality to the patient as indicated by the physiotherapist

d. Informing the physiotherapist that the patient has been set up so that the treatment can be initiated

e. Timing and monitoring of the treatment and patient to ensure patient safety and comfort

f. Removal of the treatment modality from the patient once the treatment has been completed

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

15


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

13. ASSISTS AND SUPERVISES PATIENTS WITH MOBILITY ACTIVITIES.

This includes:

a. Provision of manual support and cues during activities

b. Assistance and coaching of patients with bed mobility activities

c. Assistance and coaching of patients with transfers

d. Assistance and coaching of patients with ambulation activities

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

16


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

14. MONITORS PATIENT STATUS DURING PHYSIOTHERAPY TREATMENT.

This includes:

a. Measurement and recording of vital signs

b. Recognition of the cardinal signs of distress

c. Observation and reporting of patient’s response to treatment

d. Performance of objective measures as specified by the physiotherapist

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

17


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

15. COMPLETES APPROPRIATE DOCUMENTATION.

This includes:

a. Proper use and understanding of the SOAP format of note writing

b. Documentation of observations

c. Documentation of specified objective measures

d. Documentation of the treatment provided

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

18


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

16. PREPARES EQUIPMENT AND TREATMENT AREA PRIOR TO TREATMENT.

This includes:

a. Obtaining and placement of equipment

b. Proper set up of equipment (including modalities)

c. Ensuring treatment area is free of any potential risks and hazards

d. Preparation and changing of linens

e. Returning equipment and supplies after use

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

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4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

17. MAINTAINS A SAFE WORKING ENVIRONMENT.

This includes:

a. Following proper infection control protocols

b. Following proper emergency and evacuation protocols

c. Checking and maintaining equipment

d. Following WHMIS protocol

e. Ensuring treatment area is free from potential risks and hazards

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

20


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

18. MONITORS AND MAINTAIN INVENTORY.

This includes:

a. Checking inventory levels

b. Monitoring equipment loans and rentals

c. Maintaining supplies as necessary

d. Ensuring equipment and supplies are functioning properly and are maintained in safe working order

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

21


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

19. PERFORMS PORTERING DUTIES.

This includes:

a. Portering patients to and from treatment area

b. Portering equipment to and from treatment area

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

22


4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

20. PERFORMS CLERICAL DUTIES.

This includes:

a. Scheduling of patients and resources

b. Performing office related duties

c. Utilizing computers effectively

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

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4 3 2 1 OBS N/A


Meets Expectations

Working Towards


Only Not

Applicable

21. RECORDS WORKLOAD STATISTICS.

This includes:

a. Demonstrates a knowledge of workload statistics and their purpose

b. Records patient care statistics

c. Records non-patient care statistics

d. Generates reports based upon the statistics they have received

FINAL

COMMENTS: RATING:

________

MIDTERM

COMMENTS: RATING:

________

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OVERALL IMPRESSION

MIDTERM EVALUATION

STRENGTHS:

NEEDS IMPROVEMENTS:

FINAL EVALUATION

STRENGTHS:

NEEDS IMPROVEMENTS:

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EVALUATION SIGNATURES

MIDTERM EVALUATION

_____________________________

Student Signature

_____________________________

Date

_____________________________

Supervisor Signature

_____________________________

Evaluator Position/Title

_____________________________

Date of Evaluation

FINAL EVALUATION

_____________________________

Student Signature

_____________________________

Date

_____________________________

Supervisor Signature

_____________________________

Evaluator Position/Title

_____________________________

Date of Evaluation

REHABILIATION ASSISTANTS PROGRAM ... - CNA Online Learning

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