Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 133
Student Clinical Performance Evaluation - Weekly
Student: Jenny Clark

Date (Term/Year) 10/30/13 Fall/2013

CSE #4

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 coaching. (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
Identifies the need for patient advocacy.
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
coaching. (PO/RNLG: 2 Nursing Judgment, PO/RNLG: 4 Spirit of Inquiry)
S/N/U
Collects data from appropriate resources.
s
Begins to integrate knowledge from nursing theory and other disciplines to plan care.
s
Demonstrates holistic patient assessment skills.
s
Establishes appropriate nursing diagnoses based on patient data.
s
Identifies appropriate etiology and signs and symptoms related to priority nursing diagnoses.
s
Identifies appropriate short term outcomes for priority nursing diagnoses.
s
Identifies appropriate interventions for priority 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 coaching. (PO/RNLG: 3 Professional Identity, PO/RNLG: 4 Spirit of Inquiry)
Uses knowledge of cultural differences to plan and implement patient care.
Seeks out instructor to discuss patients plan of care.
Demonstrates caring and compassion towards patients.
Maintains a professional demeanor and attitude.
Follows program rules.
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
coaching. (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 and facility protocols.
Sets priorities and follows through with patient care.
Demonstrates beginning competency with technologies that contribute to safety.
*Observes infection control precautions.
Identifies safety concerns and notifies appropriate health team members.
Demonstrates accountability and responsibility for own actions.
Integrating Concept: Relationship Centered Care
Outcome 5: Recognizes that nursing is part of a collaborative interdisciplinary team which
N133 Clinical Eval 11/20/2015 Reviewed: 01/2013

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

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/N/U
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 133
provides holistic care to individual, family, community, and team relationships through the use of
therapeutic communication, with coaching. (PO/RNLG: 1 Human Flourishing, PO/RNLG: 3
Student
Professional Identity)
S/N/U
S/N/U
*Respects patients rights with regard to their dignity and human worth.
s
S
Identifies patient/family health education needs and implements patient teaching.
s
S
Documents patient care accurately and in a timely manner using the written or electronic health record.
s
S
Demonstrates beginning therapeutic communications skills.
s
S
Engages in self-reflection and communicates learning needs to instructor.
s
S
Integrating Concept: Teamwork
Instructor
Outcome 6: Recognizes the importance of effective communication and mutual respect when
Student
Eval of
working with all members of the health care team, with coaching. (PO/RNLG: 3 Professional
Self-Eval
Student
Identity)
S/N/U
S/N/U
Demonstrates initiative in assisting peers and health care team members in the clinical setting.
s
S
Seeks input from patient, instructor, peers, and healthcare team.
s
S
*Updates instructor and healthcare team regarding changes in the patients condition in a timely manner.
s
S
Demonstrates professional communication skills using SBAR.
s
N
Participates actively in post conferences.
s
S
Student Reflection
What did you learn this week that has contributed to your growth as a nurse? Please explain.
I learned therapeutic communication in practice. I had no lab results so I was forced to speak with the patient about the
possibilities of having cancer. I found this very beneficial as biopsies in real life will take time as well. I need to learn
how to talk about possibilities with patients awaiting diagnostic testing.
Did you accomplish the objectives you and the instructor set for this CSE? Please Explain.
I believe I did. I researched the patients culture thoroughly before attending the CSE and I was able to discuss it with
her in practice. I was also caring and spent more one on one time with her to show that I cared. I did not spend a lot of
time with other professionals but this was limited due to the CSE.
Do you have any concerns about your performance? Please explain.
I felt very good about my performance. I was hesitant to ask questions but only because my partner wasnt sure of the
answers. I feel like I learned a lot from it and Im very happy.

Student Learning Goals (List desired learning goals for the next clinical simulation experience. Goals should be based
on identified performance issues and the desire for new knowledge and experience).
Understand more psych issues
Communicate more with the pt
Assess pts willingness to communicate with me in return
Instructor Comments/Student Learning Goals
Jenny was very organized and proficient with her patient care. She introduced herself to the patient immediately upon entering
the room, checked the patients ID and removed any safety hazards. She assessed that the patient was in a great deal of pain
and came right out to inform of the patients c/o and began to prepare to give her the IM pain medication. She used the correct
technique in drawing up and administering the medication; carefully following the 6 rights.
She wrapped the ice pack she in a towel to help protect the patients skin. She also asked a fellow student for help in
changing the wet linens where the ice pack had leaked. She made sure the patient was comfortable and her leg was supported
when turned. She exhibited therapeutic communication skills by asking open ended questions, restating what the patient had
said, and asking appropriate questions. She spent time with the patient and allowed her time to verbalize her feelings. She
asked the patient about family support and suggested using Skype to communicate with her son that was recently deployed.
She focused her teaching plan on the patients medications and the possible side effects. She also discussed the different
diagnostic tests that the patient would be receiving. Her manner was unrushed and professional at all times.
Student Goals:
N133 Clinical Eval 11/20/2015 Reviewed: 01/2013

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 133

Continue to improve on organizational and time management skills

Continue to incorporate new skills and knowledge into the clinical setting
Continue to follow the Six Rights when administering medications
Continue to integrate Therapeutic Communication skills into your patient/family interactions
Be sure to Evaluate Plan of Care and Revise as needed
Be sure to identify and follow through with all assessed teaching needs

Student Signature:

Date:

Instructor Signature:

Date:

N133 Clinical Eval 11/20/2015 Reviewed: 01/2013