Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Student Shalanei Streaker Date 12/1-12/2 Location FMH Faculty Breitenbach

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 Self- Eval 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
Utilized EMR, RNs and family to obtain thorough history
Demonstrates accurate patient assessment skills.
Completed a thorough head-to-toe assessment on 16do (including newborn reflexes) and S S
multiple focused assessments (ER patients)
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.
Properly IDd developmental level of her patients and then interacted with them accordingly. S S
Identify appropriate interventions based on assessment.
PRN suctioning, saline drops in nares for infant with upper airway congestion S S
Demonstrates knowledge of medications for assigned patients.
Researched all ordered medications thoroughly S S
*Administers medication safely using six rights of medication administration.
Reconstituded IV antibiotics, administered IV meds, IV maintenance 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
Self- Eval 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.
Performed procedures (NP suctioning, NP culture) and observed procedures completed by MD 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.
Self-evaluation was not completed N N
Organizes time efficiently. S S
Student Instructor
Outcome 3 Self- Eval 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 Self- Eval 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
Approved 12/4/14; Revised 4/14/2017
 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Implements patient and family education.

Explained to mom need to suction prior to feedings, ways to help thin nasal secretions at home 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.
Kept myself and primary RN aware of patients conditions and any abnormal findings 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

Student Instructor
Outcome 5 Self- Eval of
Provide nursing care based on scientific evidence. (SLO 4, GE 1) Eval Student
S/N/U S/N/U
Identifies evidenced-based rationale that supports the patient plan of care. S S
Integrates knowledge from nursing and other disciplines to plan care. S S
Student Instructor
Outcome 6
Self- Eval of
Plan nursing care based on legal and ethical principles and standards of practice. (SLO 6, GE
Eval Student
7)
S/N/U S/N/U
Adheres to attendance policy. S S
*Demonstrates safe clinical practice. S S
Provides nursing care based on the policies and procedures of the facility. S S
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act. S S
*Adheres to HIPAA guidelines regarding patient confidentiality. S S
*Provides care according to the ANA Nursing Scope and Standards of Practice. S S
*Demonstrates accountability and responsibility for own actions and attitudes. s S
Student Instructor
Outcome 7
Self- Eval of
Develop informatics skills using technology and electronic sources of health care information to
Eval Student
support clinical decisions, promote communication, and monitor care outcomes. (SLO 7, GE 4)
S/N/U S/N/U
Gathers data from the electronic medical record to provide patient care.
Interpreting lab and test results for the impact on patients plans of care S S
Uses electronic medical record to document patient care accurately and in a timely manner.
Independently charting in EMR s S

Student Learning Goals (List desired learning goals, and your plans to meet them, for the next weeks clinical
experience. Goals should be based on identified performance issues and the desire for new knowledge and
experiences.)
I really had a wonderful time working with peds. I want to go into neonatal nursing and my first day of clinical I was
able to work with a 16 day old baby. I very much loved that experience and when I was doing my clinical I know I made
the right career choice. I also really enjoyed the peds-ER experience also. I like the fast pace and keeping busy and
having a lot of patients, learning of different things, etc. I also enjoyed listening to the instructors stories and trying to
figure out what was causing the patient to be sick. I very much enjoyed my pediatric rotation and wish it was longer. I
most definitely didnt want to leave the hospital when it was time to go!
While I did my clinical I was able to practice the following skills: nasopharyngeal suctioning, vital signs, weighing
diapers, giving IV syringe medication (which involved reconstituting the medication) weighing a baby, and comforting
patients.
I was able to watch and learn how a doctor glues a cut together, how to try to remove an eraser from a small childs
ear, and able to listen to the doctor and patients interact.

Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are
necessary to clarify student performance**)
Approved 12/4/14; Revised 4/14/2017
 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Shalanei enjoyed being with children and it showed with her enthusiasm in caring for them. She was very confident
when entering patients rooms, helping them to trust in her skills. Because there was a vast array in ages of the
children, she would always correctly identify their developmental level and adjusting her approach/communication style
appropriately.
During group discussions (case scenarios), she demonstrated strong critical thinking skills to identify the possible
diagnoses, plan appropriate care, and re-evaluate for responses.

Student Signature: Shalanei Streaker Date: 12/5/2015

Instructor Signature: Theresa Breitenbach, RNC, BSN Date: 12/4/15

Approved 12/4/14; Revised 4/14/2017