Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical (Practicum) Performance Evaluation SUMMATIVE
Faculty
Taylor
N/A = Not
S = Satisfactory
N = Needs Improvement U = Unsatisfactory
(*) Critical behavior
applicable
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
Evaluate the effectiveness of a plan of care using the nursing process to achieve patient
Eval
Student
outcomes.
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 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.
Uses therapeutic communication techniques during nurse/patient interactions to facilitate the
S
S
nursing process.
*Identifies 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
Assimilate into the profession of nursing with a commitment to lifelong learning and personal and
Eval
Student
professional growth.
S/N/U
S/N/U
Participates actively in all aspects of the clinical experience.
S
S
Discusses patients plan of care with instructor. (preceptor)
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
Provide culturally competent, holistic care using respectful and caring behaviors.
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
Collaborate with healthcare teams to provide patient-centered re.
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 (preceptor) and healthcare team regarding changes in the patients
condition.
S
S
*Identifies safety concerns and notifies instructor (preceptor) and appropriate healthcare team
members.
S
S
Student

Emily Crouse

Date

03/20/16

Location HCGH

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical (Practicum) Performance Evaluation SUMMATIVE
Demonstrates initiative in assisting peers and healthcare team members in the clinical setting.
Demonstrates communication skills using SBAR.
Acts as an advocate for patients and families.
Outcome 5
Model a spirit of inquiry that supports evidenced-based practice.
Applies evidenced-based rationale that supports the patients plan of care.
Integrates knowledge from nursing and other disciplines to plan care.
Outcome 6
Practice within legal and ethical principles to deliver safe and competent care based on current
standards of practice.
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.

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

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

S
S
S
S
S
S
S
S
Student Instructor
Outcome 7
SelfEval of
Research and communicate information through appropriate technology.
Eval
Student
S/N/U
S/N/U
Gathers data from the electronic medical record to provide patient care.
S
S
Uses electronic medical record to document patient care accurately and in a timely manner.
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.)
~Walking into this practicum experience was exciting and nerve racking because I was not with an instructor, but rather
with someone who I had never met. But I was so blessed to be placed with Taylor. I felt comfortable talking to her about
medications, care, and teaching of the patient. Taylor gave me the confidence to make decisions for my patients as well
as supporting me in my decisions. I was nervous to perform teaching independently, but Taylor was there to help me
feel comfortable and then offered constructive criticism to help me improve. I never once felt like a student because she
treated me like her peer. I learned so much about patient advocacy, nursing judgement and how to maintain composer
in times where everything was happening at once. She taught me how to prioritized and guided my thought process
regarding prioritizing within a maternal child unit. I was able to observe how she communicated with doctors, peers,
managers, supervisors, and techs. She was professional and prepared for every day at work. Taylor helped me to feel
comfortable with my decisions and helped to promote my independence. I am sincerely grateful for her willingness to
help further my education. I know it must have been weird to have someone follow her 24/7 on the job. I would strongly
recommend her as a preceptor and I sincerely hope that the student would treat her and the unit with the respect they
desire. She is knowledgeable and above all not afraid to ask someone when she did not know the answer. Taylor was
an awesome nurse and I would not hesitate in recommending her to any new mother who is on the unit.
Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
comments are necessary to clarify student performance**)
Emily was a pleasure to work with. She is always willing to help and volunteers her assistance in order to gain more
knowledge. She is caring and very thoughtful with the patients-always making them feel comfortable. Emily is not
scared to ask questions when she needs assistance, but also has the confidence to independently perform discharge
teaching and education to the mothers throughout their stay. She seemed to thoroughly enjoy the position and always
arrived early for the shift with a smile on her face. She demonstrated poise during stressful situations, appropriate with
prioritizing cares, diligent with medication administration, and grateful for any new set of knowledge or experience. She

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical (Practicum) Performance Evaluation SUMMATIVE
will make a great asset to any nursing team.

Student Signature:

Emily Crouse

Date:

03/20/16

Preceptor/Instructor Signature:

Taylor Kralowetz

Date:

3/20/16