Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 133 – Nursing Concepts 1
SUMMATIVE Student Clinical Performance Evaluation
Student Kelly Olson Date 11/3/17 CSE # Faculty Professor Nelson
S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = 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

Instructor
Student Eval of
Outcome 1 Self-Eval Student
Use the components of the nursing process when creating a plan of care (CSLO1) S/N/U S/N/U

1. *Prioritizes patient care based on assessment with coaching s S

2. Demonstrates accurate patient assessment skills with coaching s S
3. Gathers data from the patient’s medical record to provide patient care s S
4. Uses patient assessment data to develop individualized plan of care with coaching s S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient S
assessment with coaching s

6. Establishes measurable patient outcomes based on nursing diagnosis with coaching s S

7. Establishes appropriate nursing interventions based on assessment with coaching s S
8. Evaluates patient response to care and revises plan as needed with coaching s S
Instructor
Student Eval of
Outcome 2 Self-Eval Student
Develop an awareness of opportunities that promote professional growth (CSLO2) S/N/U S/N/U

9. Demonstrates professional behavior and appearance s S

10. Seeks input from patient, instructor, and healthcare team in the delivery of patient- S
centered care s

11. *Demonstrates accountability and accepts responsibility for own actions and attitudes s S
12. *Adheres to attendance policy s S
13. Participates actively in all clinical experiences s S
14. Engages in self-reflection and communicates learning needs to instructor s S
15. Completes assignments as required and submits on time s S
Instructor
Student Eval of
Outcome 3 Self-Eval Student
Provide patient-centered care with coaching (CSLO3) S/N/U S/N/U

Approved 12/4/14. Revised 12/10/2014; 01/2015

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 133 – Nursing Concepts 1
SUMMATIVE Student Clinical Performance Evaluation
16. *Implements appropriate infection control precautions s S
17. Provides culturally sensitive care with coaching s S
18. Documents patient care accurately with coaching s S
19. Uses beginning therapeutic communication skills s S
20. Follows through with all patient care with coaching s S
21. Verbalizes knowledge of medications for assigned patients s S
22. Demonstrates caring behaviors s S
23. Uses SBAR to communicate patient status to instructor with coaching s S
24. Identifies issues needing advocacy for assigned patients s S
25. *Demonstrates physical and mental competence s S
26. *Identifies safety concerns and notifies instructor and appropriate healthcare team S
members s

27. Identifies ways to spend clinical time more efficiently s S

28. Identifies patient and family health education needs s S
29. *Updates instructor and healthcare team regarding changes in the patient’s condition s S
30. *Provides nursing care based on the policies and procedures of the facility s S
31. *Provides nursing care in accordance with the Maryland Nurse Practice Act s S
32. *Adheres to HIPAA guidelines s S
33. *Provides care according to ANA Scope and Standards of Nursing Practice s S
Instructor
Student Eval of
Outcome 4 Self-Eval Student
Explore the scientific evidence that supports the patient’s plan of care (CSLO4) S/N/U S/N/U

34. Identifies evidence-based rationale that supports the patient’s plan of care s S

Approved 12/4/14. Revised 12/10/2014; 01/2015

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 133 – Nursing Concepts 1
SUMMATIVE Student Clinical Performance Evaluation
Student Reflection (Thoroughly answer all questions)
How has this clinical rotation helped to define your role as a nurse? Please explain.

This rotation helped me to see how nurses work in the hospital setting. I learned how much work the nurses
have and how much their patients rely on them. It made me excited to continue nursing school and learn more.
I absolutely loved observing how the nurses interact with the patients. i learn best by watching other people so i
was able to gain a lot of knowledge by just following my nurse around and see how she performed her
everyday job.

Nurses do have a lot “on their plate” You always need to make sure you prioritize your day the best you can
and take time for yourself as well to recoup from your day.

Which objective did you accomplish during this rotation? How did you do it?

This week I did my first finger stick test. I was given the chance to do it in the previous weeks but was hesitant
to do it. Of course after completing it i felt silly for being so scared of it before. I was able to gain so much
confidence this rotation just by doing little tasks like this.

I am so proud of the new skills you were able to accomplish this rotation! Never hesitate to seek out every new
opportunity possible during your next rotation.

What are your goals for your next clinical rotation?

Next rotation I hope to continue to learn more and keep stepping out of my comfort zone. I hope that I will be
able to become more confident when talking to the patients so that i can provide them with the best care
possible. My main goal is to just be the best student nurse that i can be so that i can help patients heal.

Faculty Comments/ Student Learning Goals (Goals must be established even if performance is satisfactory.
If an item was identified as N or U, narrative comments are necessary to clarify student performance along with
goals to improve performance).

Kelly it has been my pleasure working alongside of you at St. Agnes. You have grown in many ways, and will
continue with each new experiences. I am very proud of YOU! You will make a fantastic, caring &
compassionate nurse. 

Student Signature: Kelly Olson Date: 11/3/17

Instructor Signature: Date: 11/04/17

Approved 12/4/14. Revised 12/10/2014; 01/2015