Carroll Communi$ College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140 - Nursing ConcePts 2
Student Clinical Performance Evaluation - SUMMATIVE

Student M 5/ralI ltt

5///:
Date l-ocation Ua F
ement I U = Unsatisfactory I ftn = Not applicable I {"} Criti
willbegivenaremediationplanandmaybeplacedonprobat[on.
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 unsatisfactorv qrades in a non-critical behavior -Four needs improve!:lpnts
lnslruclor
:I Eval'of,,
GE;3)r, -'Sfudent
:;::: : rl ':i:: ,. S/N/U, ,,',

Collects evidence related to assigned patient(s) from appropriate Esqqqqes- s S

Demonstrrtea accurate oatient assessment skills J
ffinuisinq diagnoses based on collected evidenc@ 5
Prioritizes patient care based on assessment. \)$ )
ldentifies measurable patient outcome based on nursing diagnosis. -: S
lmolements care interventions according to established plan and desired outcqqqes.
User$ therapeutic cqmmunication techniques during nurse/patient interaclions to facilitate
the nursinq Drocess.
5 5
ldentifu anoronriate interventions based on assessment. -s S
Demonstrates knowledqe of medications for assigned patients- S
l4dministers medication safely using slx rights of medicatiqq eqrylnislra'llqn, .\ 5
*l m nlements annrooriate infection control orecautions- S
.J C
Fol[ows through with all patient care.
eviiuates oatient response to care and revises plan as needed- -\
StudEnt.:
., ,;SelF',.
i
EVAI
rs/Nluj,
Particioates activelv in all aspeets of the clinical experience" \
Discusses patient's plan of care with instructor. .1
Demonstrates Professional behavior and appeara4qe, -5
Enoaqes in self-reftection and cornmunicates learning needs to instructor. -5'
Comoletes assiqnments as required and submits on time. J
Orqanizes time efficiently. J J
l:nstructor
bvat oI
: Student',
, slN/u ,'

Dernonstrates canng behaviors with the ability to develop and rnaintain thempeutic relationships g
with oeonle fi-om diverse backsrounds-
5
ConsiOers patient values. eultural characteristics and religious differences when planning cale. J 5'
StUdent. lnstructor:
Outcome 4 hval ot
Cont*fute to neaiincar:efeams rrr- provide patient-centered care, (SL0 a; GE 1)r, ,"SG11;,,
EVal. , Student
S/N/U. . SIN/U.
ldentifies oatienUfamilv health education needs .\ 5
S
Seeka intilt from oatient, instructor, peers, and healthcare team in the delivery of patient care. *S 5
-UDdates instructor and healthcare team reqarding changes in the patient's condition. -S s
tOentmes safetv concerns and natifies instructor and appropriate healthcare team members. .J 5
Demonstratesfifttive in assisting peers and healthcare team members in the clinicalsetting. J f
Demonstrates communication skills using SBAR. \)<\ t
Acts as an advocate for patients and families. \

Approved 121411 4: Revised 51912016