Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
Student

Chrissy Hall

Date1020-15

LocationCHC

Faculty

Schroeder

N/A = Not
(*) 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. Head to toe assessment observed on a
S
S
patient. It was complete, accurate, and organized.
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. Easy and up beat communication with her patients.
*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
Eval
Student
and 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.
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. . Chrissys patients consistently compliment her care
S
and tell me they think she will make a fine nurse.
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 care.
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 and healthcare team regarding changes in the patients condition.
S
S
*Identifies safety concerns and notifies instructor and appropriate healthcare team members.
S
S
S = Satisfactory

N = Needs Improvement

Approved 12/41/4. Revised 12/9/2014

U = Unsatisfactory

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical 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.)
I feel this clinical rotation was a great learning experience. I have learned about how to manage multiple pts. I
was able to see how different RNs did things differently and I can take some from each of them into my career
as an RN. I was able to visit both the Pre-op and PACU as well as the Cath lab, I enjoyed seeing how different
areas of the hospital worked. I know after this clinical rotation I have grown as a nurse. I feel better about my
ability to prioritize as well as manage my time.
I think that all of my patients appreciated me and the care I provided. Many of them expressed that to my
instructor. When I was in the PACU I was able to show them a trick I had learned along the way in my career, a
post-op 7.5 hour surgical pt came into PACU with his wedding ring still on his hand, his hand was very swollen
and his finger was red and around the ring was starting to cut into his finger. I showed them the trick with using
the suture to wrap the finger very tight and I was able to get the ring off. So the pt. was happy because he
didnt loose his ring or his finger. I delivered it to his wife, she too was very greatful!

Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
comments are necessary to clarify student performance**)
Chrissy,
I observed growth in your interactive skills, prioritization, and organization of care for multiple patients during the clinical
rotation at CHC.
Chrissy you look fresh and clean in your appearance that portrays a professional demeanor. It was nice to see you
smiling every day.
On week 2 you were placed on probation. After that incident you were mindful of your position as a nursing student.
Approved 12/41/4. Revised 12/9/2014

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
The probation continues but for this clinical rotation you have corrected the identified behavior. Keep on working on the
right balance between reigning the Chrissy in and letting her out. I am glad you did not feel the need to change your
style of nursing. I happened to think you are a positive presence with your patients and their families. For example our
lovely lady who returned to your care during the clinical rotation. She was battling cancer. They all wanted to see you
to thank you for your caring attitude and skillful nursing care.
I see great strengths in you Chrissy. Work in opening up your vision as you have done during this rotation. Practice
those diplomatic communication skills.
I wish you the best in the next step toward obtaining your goal of becoming a registered nurse.

Student Signature:
Preceptor/Instructor
Signature:

Approved 12/41/4. Revised 12/9/2014

Date:
Jane Schroeder, MSN, RN 11/1/15
Date: