Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140/233
Student Clinical Performance Evaluation - Summative
Student: Jenny Clark Date (Term/Year): Spring 2014 Location: Frederick Memorial Hospital
Faculty: Theresa Breitenbach
S = Satisfactory
N = Needs Improvement
U = Unsatisfactory
(*) Denotes critical behaviors.
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 in non-critical behaviors
Integrating Concept: Context and Environment
Outcome 1: Identifies policies, procedures, safety concerns, patient characteristics, and
Student
teamwork within the organizational structure, with assistance. (PO/RNLG 2: Nursing Judgment,
Self-Eval
PO/RNLG 4: Spirit of Inquiry)
S/N/U
*Maintains ethical accountability for nursing practice in accordance with the ANA Code of Ethics.
S
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse Practice Act.
S
*Adheres to HIPAA guidelines regarding patient confidentiality.
S
Demonstrates the role of the nurse as patient advocate.
S
Integrating Concept: Knowledge and Science
Outcome 2: Identifies knowledge from nursing science and allied health disciplines to begin
Student
designing and implementing patient centered care for individuals, families, and communities, with Self-Eval
assistance. (PO/RNLG: 2 Nursing Judgment, PO/RNLG: 4 Spirit of Inquiry)
S/N/U
Collects evidence related to clinical practice from appropriate resources.
S
Integrates knowledge of evidence based theory from nursing and other disciplines to plan care.
S
Demonstrates accurate and holistic patient assessment skills.
S
Establishes appropriate nursing diagnoses based on patient assessment.
S
Determines patient specific etiology related to nursing diagnoses.
S
Determines patient specific signs and symptoms related to nursing diagnoses
S
Determines patient specific outcomes for nursing diagnoses.
S
Determines patient specific interventions for nursing diagnoses and outcome(s).
S
Implements care according to established plan and desired outcomes.
S
Evaluates patient response to care and revises plan as needed.
S
Integrating Concept: Personal and Professional Development
Outcome 3: Identifies the need for the lifelong process of learning nursing skills, values, and
behaviors, with assistance. (PO/RNLG: 3 Professional Identity, PO/RNLG: 4 Spirit of Inquiry)
Discusses patients plan of care with instructor.
Completes assignments as required and submits on time
Organizes time efficiently.
Demonstrates professional appearance and demeanor.
Engages in self-reflection and communicates learning needs to instructor.
Integrating Concept: Quality and Safety
Outcome 4: Identifies knowledge from nursing science and allied health disciplines to begin
providing competent care based on current standards of practice to minimize risk of harm to all
members of the health care system through system effectiveness and individual practice, with
assistance. (PO/RNLG: 1 Human Flourishing, PO/RNLG 2: Nursing Judgment, PO/RNLG 4: Spirit
of Inquiry)
*Provides safe care according to established standards of nursing practice.
Prioritizes patient care based on assessment.
Readily incorporates technology into clinical practice.
*Observes infection control precautions.
Demonstrates accountability and responsibility for own actions and attitudes.
*Demonstrates knowledge of medications for assigned patients.
*Administers medication safely using six rights of medication administration.
Integrating Concept: Relationship Centered Care
N140_N233 Clinical Eval 11/20/2015

Instructor
Eval of
Student

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

S/N/U
S
S
S
S
S
S
S
S
S
S

Student
Self-Eval

Instructor
Eval of
Student

S/N/U
S
S
S
S
S

S/N/U
S
S
S
S
S

Student
Self-Eval

Instructor
Eval of
Student

S/N/U
S
S
S
S
S
S
S

S/N/U
S
S
S
S
S
S
S

Student
Self-Eval

Instructor
Eval of

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140/233
Outcome 5: Recognizes that nursing is part of a collaborative interdisciplinary team which
provides holistic care to individual, family, community, and team relationships through the use of
therapeutic communication, with assistance. (PO/RNLG: 1 Human Flourishing, PO/RNLG: 3
Professional Identity)
Demonstrates ability to develop and maintain therapeutic relationships with diverse populations.
*Respects patients rights with regard to their dignity and human worth.
Identifies patient/family health education needs and implements patient teaching.
Documents patient care accurately and in a timely manner using the written or electronic health record.
Applies therapeutic communications skills.
Integrating Concept: Teamwork
Outcome 6: Recognizes the importance of effective communication and mutual respect when
working with all members of the health care team, with assistance. (PO/RNLG: 3 Professional
Identity)
Demonstrates initiative in assisting peers and health care team members in the clinical setting.
Seeks input from patient, instructor, peers, and healthcare team in the delivery of patient care.
*Updates instructor and healthcare team regarding changes in the patients condition in a timely manner.
Demonstrates professional communication skills using SBAR.
Participates actively in all aspects of the clinical experience.
Student Reflection- Looking back on the rotation:

Student

S/N/U
S
S
S
S
S

S/N/U
S
S
S
S
S

Student
Self-Eval

Instructor
Eval of
Student

S/N/U
S
S
S
S
S

S/N/U
S
S
S
S
S

How have you grown as a nurse? Please explain and use specific examples.
I learned a lot from the pediatric experience at Frederick. I honestly had no experience with children or babies and the exposure
alone helped my confidence exponentially. I now feel better about walking into my patients room and introducing myself to the
parents as well as the child. Our instructor, Theresa was able to teach me so much about infants that I didnt know. I learned
about various treatments of jaundice and the pathophysiology of babies who acquire jaundice. The entire experience was
extremely beneficial and I learned so much. This may actually be a field I could enjoy working in once I graduate.

Do you have any continuing concerns about your performance? Please explain.
I am still working on being confident when entering a room. This experience helped me learn the importance of that though. I
continue to learn from my mistakes in nursing and I feel that will be an ongoing process. Every day I learn a new way of
documenting or organizing myself thats a little bit different and it helps keep me on my toes.

Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are necessary to
clarify student performance**)
Jenny was eager to provide excellent care. Prior to her patient arriving on the unit, she completed a detailed research of the
diagnosis and treatment plan to prepare herself in caring for the infant, including expected labs and their rationale. She quickly
established a good rapport with the family to gain the history of the infant and then incorporated them into the care of the infant.
Her assessment was thorough, including the assessment of newborn reflexes. All vital signs and assessments were
immediately reported to myself and assigned nurse.
She actively sought out new learning opportunities, and completed as many nursing assessments as she could on the ER side
of the unit. She confidently performed the skills she was comfortable with, and asked for assistance if there was a new skill she
could provide.

N140_N233 Clinical Eval 11/20/2015

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140/233

Student Signature: Jenny Clark

Date: 3/30/14

Instructor Signature: Theresa Breitenbach, BSN, RNC

Date: 3/31/14

N140_N233 Clinical Eval 11/20/2015