Carroll Community College

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

Faculty
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
S
Establishes nursing diagnoses based on patient assessment.
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.
N
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.
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
S
with people from diverse backgrounds.
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
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 12/41/4. Revised 12/9/2014

Date

Location

Carroll Community College

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

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.
Outcome 7
Research and communicate information through appropriate technology.
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 Reflection Looking back on the rotation:

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
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

How have you grown as a nurse? Please explain and use specific examples.
I have grown as a nurse by expanding my time management skills. By having 3 patients I have been able to see
what it is like in the nursing world to prioritize and apply critical thinking skills. I have also been able to witness
the role of a dialysis, charge, and OR nurse. By being able to witness these role I now have a better
understanding of these nursing roles which I have not been able to experience in the past. This rotation has
shown me how much I have grown as a nursing student over the years.

Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
comments are necessary to clarify student performance**)
Kerri is a natural in the clinical setting. It has been a pleasure working with her. She will be a great asset in the
nursing profession. I encourage Kerri to continue her studies. She will make a good leader in the future. She is
professional, knowledgeable and able to complete assignments and tasks on time. She is a willing helper and
she is open to new learning experiences. Best wishes Kerri!

Student Signature:

Kerri Burda

Date:

3/19/16

Preceptor/Instructor Signature:

Teresa Sparhawk MSN, RN

Date:

3/24/16

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