Canoll Canrmunity College

Oivision of STEM, Nursing and Allied Health

Oepartment ol Nursing
NURS 233 * Nursing Concepts 3
Student Clinical Performance EvEluation - SUMMATIVE

Student: "{*** f.it-*,tqar{

Date:

Location:

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{4N

S=Satisfactory [N=Needslmprovement lU=Unsatisfactory INA.Notapplicable l1'lCriticatbehavior

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 oredes in a non-critical behavior -Four needs improvements
$tudent lnstruct$r
Outcoms I
$elF
Eval of
Analyze lhe effectiveness of the plan af care using tha nursing process (SLO 1, GE 3)
Eval
Studant
Collects evidence related to clinical practice from appropriate rasoufces,
'Oemonstrates accurate patient assessment skills.
Establishes applqplqte nursing diagnoses based on patient asspssmsnt.
*Prioritizes patienl
care based on assessmenl
ldentifies measurable patient outcome based on nursinq diaqnosis.
*lmplements
care accordinq to established plan and desired outcomes.
Uses therapeutic communication techniques during nurset'patient interactions to facilitate
the nursinq proces$,
ldentify appropriate interventions based on assessmnt.
,Demonstrates knowledge of medications for assiqned patients.
"Administers rnedication safely usino six riqhts of medication administretion.
'lmplements appropriate infection control precautions
Follows through with all patient care
lEltrlqates patiant response to care q4d revises plan as needed

Outcoma

lncorporate learining opportunities that promole personal and professional growth and a
cornmibnent to lifelong learning. {SLO 2, GE E)
Padicipates actjvely in all aspecls of the clinical experience.
q,scussqq pg!ag11($ plan of care with instructor.
Demonstrates protessional behavior and appeerance.
Engages in self-reflection and comrnunicates learning needs to instructo*preceptoi
Cornpleles assig!!|lgltC,as required and submiis on time.
Orgeni?es time efiicientlL

Outcoma 3
lmplement nursing care that considers the uniqueness ol various cultures, backgrounds, and
belief systems (SL0 3, cE 6)
Demonstrates caring behaviors with ttre ability to develop and maintain iheir,autic
relationships with people from diverse backqrounds.
-qglSdeE patien! yqL es, cultural characterislics and religious differences when nlannina care"

0utcomo 4

S/NIU

S
S

{.4

i>

i3

i)

*
*

ldantifies pqlie1tlnd tamily health education needs

lmplements patient and fumily education
$eeks input lrgrn patient, igqlructsr, peeF, and healthcare tearn
'Updates instructor and healthcare te-qElegarding changes in the paiienit conOition
*ldentilies
safety conQ.emq_and_r,otifies instructor and appropriiie hialthcareieam mem5ersl
Semolslrales injtiative in assisting pears qnd healthcare team memUers in tfre;ifnicrEeiiinq
Qemoqglralqs com munication skills u sin g S BAR,
ActF as an advsqate for patients and families

in@

Student
Self-

lnstructor

Eval
S/NIU

Studeni
S/N/U

Eval of

S
S

$
$

t:.

Student
Self-

lnstructor
Eval of
Student

Eval
S/N/U

s/N/lJ

s
s

$tudent

lnstructor
Eval of
Student

Self-

Contribute to healthcare teams to provide patient-centered care (SLO 4, GE 1)

Approved 1?J{/14 Revi$ed 1ASAA14

S/NIU

Eval
SINIU

SIN/U

S
S

fi

It

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Cansil CommunitY Cotlege

Division sf STEM, Nursing and Allied l-lealth
Oepartment of Nursing
NUR$ ?33 - N*rsing ConcePts 3
Student Clinical Perforrnance Hvaluation * $lJMMp\TiVE

Outeoma $
Provide nursing eare based on sciEniific evidenea.

(slo

5, Gs 2)

Eval

$tudent
S/Nru

lntesrates i-nowielqe from nursing and other disciplines tg plQn*are,

Student

Outcome 6

lmplement nursing cara basad on legaland athicat PrinelPles that reflect current standards of
practica. (SLO 6, SE 7)

Eual of

Eval

Student

slNll",

on the polieies an{procedure$ of

the-fgcility.

-.".=.-:

inlccordance with the Maryland Nurse

Practice Act
'ndneies to HIFA'A quidelines regarding
=Frovile$ care aocoiOind to the ANA Nursing $cope and Standards alB@ctice.
responqibllitv fsr own actio ns-gng a'!!.lt{!85.

"

outcomo ?

lncorporate infonnatics skills using technclogy and electronic ssurces af health care
infurmation to support clinlcal decisions, promotts csmrnunication, and monitsr care oulcerne$,
{SLO 7 GE 4}
Gathers data fiom tfre elactronic medical record lo provide patienl care-

ffis.diod0c.nnentpatientcarsaccuratelyandinatimelymannef"

cl}!l.t!

il

S
"

lnstructor

$elf-

Adheres to attendance Policy

*Demonstrates safe clinical practice,

ffi

lnstructor
Eval of

S/N/U

G6iilfies evldenced-based ralionale that support$ the patient plan olqaIg

ffi

Student
Self-

c
c

$tudent

lnstruetor

.fe[-

Ev*l sf

Eval

Str*cl*nt

SINIU

$INIU

is,andyourplanetorrrogtthem,farthenextcllnleal

axperlence" GoaT* shouli ba bs*Ed an ldantified per{orman** iseuss and the desira lor new knewledg* and
exporlencas.)
t grew toward my goal of becoming a compeienl Nurse through this experiene*. I re alize tle nccd tc organize rny tirne efficiently.

I assisieJ carricd multiplcs oieverything she belicved she rvould need in order lo d*liver care; it savcd hcr irom having
to make mulriplc trips rvhcn **mrthing went a*ry (and things did go awry). I wilnessed on* of my pelients wi*rdrawing frcm
alcohol; aware olthe symptorns snd tie kxowledgc she was no longer being sccred on the CWAS assessment form' I aclually hae*
fur
a tough time distinguis"hing some of her sepsis signs ond symptoms t?om ETOH withdraw sigrs anrl symptoms. I advoeated
on. if *y patient who be ttved a newly piescribed mcdieine, fndoaetbccine, was sausing his troubles. He told nre he had a friend
bring his medicine to him fiom home beiause he fek it rvas &e cause, lrul no one w8* lislening to hinr about the medicine. I
Iistried to hirn, researched his suspected rnedieine, and lound thnt c,ne sfthe side eflbets ofthat drug was thr$mbs*ytopenis. I
was able io reaeh rny psrient aboui his newly diagnose diabetss mellitus. I taught 5l$ r:f Hlper- l"llpoglycemig possible .
cornplications of nlrt, anrl lhe imporlance oig*tting an Eiiucation by using his referal to Tire Diabelic Center of tlr* hr:spitai" I rv*s
enlightened Bs to the importanre nf gctti:rg pstients who arc n*rvly diognr:sed with diabet*s to use avnila*:l* resources lur
eduiorion. If a potienl does not use Ge referrats when they are ne wly diagnosed some opiions ar* no longer avaiiable to then'r. I
rryimessed *re process of plasmapheresis in the Oialysis Csnter of the hospital, noting the similaritiss to a blor:d transfusion. I
wilnessed an esophagogastroduodenosc*py (EOD) snd a eoi*tloscapy. I was tl:ere ltorn consent fcrm tc rec*very' i was
enlighrened to tt. n,ising process by the team ofthree nursis: a.nesthetist, physicians assistant, the prac*dure"s nurse, and the
room nur$e, It ias exeellent to see how smoothiy the tesm rvorkerJ logether during the proced*res. I gained insight as to
what ttre nurres were responsible for before, during, and sfier tirese proe*dures. I also rvi{*essed rvhat rny patient went through
before, during, ond after her exsminqtions, I will carry sonrs more eompassion fsrwerd as a result of my pttie nt's e xperience'
Communicarkn is my strong suit. Yeers os a journalist has 6iven me the ahility to get inlbrmation ftom & pe$ofi' rvhen I have a
need fbr it. One tirne howe"er I had e patienr wtro could not c*mmunicate a[ all. $he cultivated in rne n degree of aelvoeacy for my
patients I had not even considered. I i,.as also gr*unded to th* thougllt illend of lile considerations and thal {he future might hold
me responsible for the enlighrenment ofla family mernber of a patient, to change the ir code ststus io DNR/ n)'il. One of my clients
was a venythnch/peg patieit; through care ofthis cli*nt and the teaclringl my prolessor I was enlighten*d about how ts provide
competent care, whal complicalioni !o look for, and how lo assess and rern*dy lhose coxrplications. I witnesscd some func{ions *f
inreidisciplinnry care: rhe iole olrespiratory th*rapy, the rsle ofthr charge nurse in coordinating a thoracentesis procedure rvith
Radiology, Fulmonologr, Respiratory Th*rapy, and thc clicnt$ Nume, and lhe role of the bedside Hemodialysis Nurse" i leamed
alout thi'DKa prorocii and rvitnessed how it was impleme nted. Through the treatmtnl ol DKA my reachings of K+ serum levels
in a patient under an acidstic stille were solid!.
On"c nurse

...i.ry

Appravsd

12v4r'1d.

R6vis6d 12lgl2014

Canoll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURSrSS - Nursing Concepts 3
Student Clinical Performance Evaluation - SUMMATIVE
client's nursing nolc stated, the patient was combative, taking "swings" at nurses and pulling on his tuiling, the ngrsing
intervention was to placc a mitlen on one of his hands, ln the early moming his vital signs were elevated and he was sleeping.
Laler in the morning he awoke his vitol signs had become wnl and he was no longer combative. i educated the patient ar to why he
had a mitten put on his hand and removed it. He rvas very pleasant and cooperative during my time of my care. I was raugit thi
process of getting 0 patient a referral for social services, dietary, etc. As 0 rvhole, this was an enormous leaming experienie ior rne.

necsssery to clarlfy studsnt performance.")

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$tudent Signature:

Approved I ?J4l'l{. Revised 12$nA1

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