Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE
Student
Date
Location
Faculty
S = Satisfactory
N = Needs Improvement U = Unsatisfactory
N/A = Not applicable (*) Critical behavior
Students who meet any of the following criteria will be given a remediation plan and may be placed on probation.
Failure to progress in these areas may result in failure of the course.
-One unsatisfactory grade in a critical behavior
-Two needs improvements in a critical behavior
-Two unsatisfactory grades in a non-critical behavior
-Four needs improvements
Student Instructor
Outcome 1
SelfEval of
Apply the nursing process when creating a plan of care. (SLO 1, GE 3)
Eval
Student
S/N/U
S/N/U
Collects evidence related to assigned patient(s) from appropriate resources.
s
S
Demonstrates accurate patient assessment skills.
s
S
Establishes appropriate nursing diagnoses based on collected evidence and patient assessment.
s
S
Prioritizes patient care based on assessment.
s
S
Identifies measurable patient outcome based on nursing diagnosis.
s
S
Implements care interventions according to established plan and desired outcomes.
Uses therapeutic communication techniques during nurse/patient interactions to facilitate
the nursing process.
s
S
Identify appropriate interventions based on assessment.
s
S
Demonstrates knowledge of medications for assigned patients.
s
S
*Administers medication safely using six rights of medication administration.
s
S
*Implements appropriate infection control precautions.
s
S
Follows through with all patient care.
s
S
Evaluates patient response to care and revises plan as needed.
s
S
Student Instructor
Outcome 2
SelfEval of
Seek opportunities that promote personal and professional growth and a commitment to lifelong
Eval
Student
learning. (SLO 2, GE 5)
S/N/U
S/N/U
Participates actively in all aspects of the clinical experience.
s
S
Discusses patients plan of care with instructor.
s
S
Demonstrates professional behavior and appearance.
s
S
Engages in self-reflection and communicates learning needs to instructor.
s
S
Completes assignments as required and submits on time.
s
S
Organizes time efficiently.
s
S
Student Instructor
Outcome 3
SelfEval of
Plan holistic, culturally competent care for patients and families. (SLO 3, GE 6)
Eval
Student
S/N/U
S/N/U
Demonstrates caring behaviors with the ability to develop and maintain therapeutic relationships
with people from diverse backgrounds.
s
S
Considers patient values, cultural characteristics and religious differences when planning care.
s
S
Student Instructor
Outcome 4
SelfEval of
Contribute to healthcare teams to provide patient-centered care. (SLO 4, GE 1)
Eval
Student
S/N/U
S/N/U
Identifies patient/family health education needs.
s
S
Implements patient and family education.
s
S
Seeks input from patient, instructor, peers, and healthcare team in the delivery of patient care.
s
S
*Updates instructor and healthcare team regarding changes in the patients condition.
s
S
*Identifies safety concerns and notifies instructor and appropriate healthcare team members.
s
S
Demonstrates initiative in assisting peers and healthcare team members in the clinical setting.
s
S
Demonstrates communication skills using SBAR.
s
S
Acts as an advocate for patients and families.
s
S
Outcome 5
Provide nursing care based on scientific evidence. (SLO 4, GE 1)
Approved 12/4/14; Revised

3/21/2016

Student
Self-

Instructor
Eval of

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE
Identifies evidenced-based rationale that supports the patient plan of care.
Integrates knowledge from nursing and other disciplines to plan care.
Outcome 6
Plan nursing care based on legal and ethical principles and standards of practice. (SLO 6, GE
7)
Adheres to attendance policy.
*Demonstrates safe clinical practice.
Provides nursing care based on the policies and procedures of the facility.
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act.
*Adheres to HIPAA guidelines regarding patient confidentiality.
*Provides care according to the ANA Nursing Scope and Standards of Practice.
*Demonstrates accountability and responsibility for own actions and attitudes.
Outcome 7
Develop informatics skills using technology and electronic sources of health care information to
support clinical decisions, promote communication, and monitor care outcomes. (SLO 7, GE 4)
Gathers data from the electronic medical record to provide patient care.
Uses electronic medical record to document patient care accurately and in a timely manner.

Eval
S/N/U
s
s
Student
SelfEval
S/N/U
s
s
s
s

Student
S/N/U
S
S
Instructor
Eval of
Student
S/N/U
S
S
S
S

s
s
s
Student
SelfEval
S/N/U
s
s

S
S
S
Instructor
Eval of
Student
S/N/U
S
S

Student Reflection Looking back on the rotation:

How have you grown as a nurse? Please explain and use specific examples. My pediatric experience allowed me
to strengthen my computer charting skills as well as assessment skills. Doing my assessments on the younger children
I had to be quick as well as gain their trust before preforming simple tasks such as taking temperature. By the second
day I was more prepared as to what to say to make the children more comfortable in the hospital setting.
Do you have any continuing concerns about your performance? Please explain. My biggest concern is making
sure I have the knowledge to answer patient questions. I know that I am a novice nurse and this will come with time, but
I always feel as though I can be more prepared.
Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are
necessary to clarify student performance**)
Molly had the opportunity to work on both the ER and inpatient side of the Peds unit. While in the ER, she performed
multiple full and focused assessments, noting abnormalities and reporting them appropriately. She formulated well
thought out nursing diagnoses and appropriate nursing care. She thoroughly utilized the electronic records to obtain lab
and test results, and used that info to anticipate orders and care to be provided. Charting was kept current, even in the
fast paced ER. Molly had multiple opportunities to administer medications (PO, IV reconstitutions, IV maintenance
fluids and medlock flushes), all which she was thoroughly prepared to do.
Having more confidence in your knowledge will come with practice and your studies. However, Molly always
demonstrated confidence when caring for her patients, and would actively seek out answers to any question she did not
know.

Student Signature: Molly Brown

Instructor Signature:

Theresa Breitenbach, RNC, BSN

Approved 12/4/14; Revised

3/21/2016

04/24/15