Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 233 Nursing Concepts 3
Student Clinical Performance Evaluation SUMMATIVE
Student:

Laura Greul

S = Satisfactory

Date:

N = Needs Improvement

Fall 2015

Location:

U = Unsatisfactory

St Agnes

Faculty:

NA = Not applicable

Donna Rohrbaugh, RN
(*) 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
Analyze the effectiveness of the plan of care using the nursing process (SLO 1, GE 3)
Eval
Student
S/N/U
S/N/U
Collects evidence related to clinical practice from appropriate resources.
S
S
*Demonstrates accurate patient assessment skills.
S
S
Establishes appropriate nursing diagnoses based on patient assessment.
S
S
*Prioritizes patient care based on assessment.
S
S
Identifies measurable patient outcome based on nursing diagnosis.
S
S
*Implements care according to established plan and desired outcomes.
S
S
Uses therapeutic communication techniques during nurse/patient interactions to facilitate
S
S
the nursing process.
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
Incorporate learning opportunities that promote personal and professional growth and a
Eval
Student
commitment to lifelong 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/preceptor.
S
S
Completes assignments as required and submits on time.
S
S
Organizes time efficiently.
S
S
Student Instructor
Outcome 3
SelfEval of
Implement nursing care that considers the uniqueness of various cultures, backgrounds, and
Eval
Student
belief systems (SLO 3, GE 6)
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 and 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
Approved 12/4/14. Revised 12/9/2014

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233 Nursing Concepts 3
Student Clinical Performance Evaluation SUMMATIVE

Outcome 5
Provide nursing care based on scientific evidence. (SLO 5, GE 2)
Identifies evidenced-based rationale that supports the patient plan of care.
Integrates knowledge from nursing and other disciplines to plan care.
Outcome 6
Implement nursing care based on legal and ethical principles that reflect current 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
Incorporate 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.

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

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

S
Student Learning Goals (List desired learning goals, and your plans to meet them, for the next clinical
experience. Goals should be based on identified performance issues and the desire for new knowledge and
experiences.)

I believe that I over think some topics and that hinders my performance sometimes. I would also like to be
able to look at previous visits and make comparisons and connections that way, with labs, imaging and other
dx tests
Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are
necessary to clarify student performance**)
You are an excellent nurse. You are well organized and able to manage a group of patients. You have faced
disaster and survived. You will have no trouble transitioning into the roll of primary nurse. Next semester you
will have a chance to practice and build on the things you have learned. Your documentation is thorough.
Your reports are organized. You can care for my family any time.

Student Signature:

Date:

Preceptor/Instructor Signature:

Date:

Approved 12/4/14. Revised 12/9/2014