Carroll C o m m u n i t y C o l l e g e

D e p a r t m e n t of Nursing
N U R S 2 4 2 - Nursing C o n c e p t s 4
S t l dent C l i n i c a l P e r f o r m a n c e E v a l u a t i o n - S U M M A T I V E

Student

D te

Cody Felisky

_
,. ,
S = Satisfactory
0

Faculty
Prof
Schroeder

Location C H C

N = Needs
|

U = Unsatisfactory

amicable

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n

c a

' behavior

lowing criteria will be given a remediation plan a n d m a y be p l a c e d on probation,

s m a y result in failure of the c o u r s e .
itical b e h a v i o r
- T w o n e e d s i m p r o v e m e n t s in a critical b e h a v i o r
ion-critical b e h a v i o r
-Four needs improvements
Instructor
Student
Outcome 1
E v a l of
SelfE v a l u a t e the e f f e c t i v e n e s s of a j Ian of c a r e u s i n g the nursing p r o c e s s to a c h i e v e patient
Eval
Student
outcomes.
S/N/U
S/N/U
S
S
C o l l e c t s e v i d e n c e related to a s s gned patient(s) from appropriate r e s o u r c e s .
* D e m o n s t r a t e s a c c u r a t e patient a s s e s s m e n t s k i l l s . H e a d to toe a s s e s s m e n t o b s e r v e d on a
S
S
patient. It w a s c o m p l e t e , a c c u r ; te, a n d o r g a n i z e d .
S t u d e n t s w h o m e e t a n y of the fc
F a i l u r e to p r o g r e s s in t h e s e a r e ;
- O n e u n s a t i s f a c t o r y g r a d e in a c
- T w o u n s a t i s f a c t o r y g r a d e s in a

E s t a b l i s h e s nursing d i a g n o s e s I a s e d on patient a s s e s s m e n t .
" P r i o r i t i z e s patient c a r e b a s e d c l as. s e s s m e n t . C o d y r e c o g n i z e s the n e e d for prioritization of
patient c a r e a n d a c t s appropriat ly.
Identifies m e a s u r a b l e patient 01 c o m e b a s e d on nursing d i a g n o s i s .
I m p l e m e n t s c a r e a c c o r d i n g to e t a b l i s h e d plan a n d d e s i r e d o u t c o m e s .
U s e s t h e r a p e u t i c c o m m u n i c ation t e c h n i q u e s during nurse/patient interactions to facilitate
the nursing p r o c e s s .
I d e n t i f i e s appropriate inten entions b a s e d on a s s e s s m e n t .
" D e m o n s t r a t e s k n o w l e d g e < f m e d i c a t i o n s for a s s i g n e d patients.
" A d m i n i s t e r s medication s a f e l y s i n g s i x rights of medication administration. Medication
administration w a s c o n s i s t e n t l y safe a n d C o d y w a s fully p r e p a r e d .
" I m p l e m e n t s appropriate inl :cti( )n control p r e c a u t i o n s .
F o l l o w s through with all pat jnt c a r e . E v i d e n t e v e r y w e e k a n d c o n f i r m e d by the patients
s h e c a r e d for.
" E v a l u a t e s patient r e s p o n s e to < a r e a n d r e v i s e s plan a s n e e d e d .
Outcome 2
A s s i m i l a t e into the p r o f e s s i o n o nur sing with a c o m m i t m e n t to lifelong learning a n d p e r s o n a l
a n d p r o f e s s i o n a l growth.
P a r t i c i p a t e s actively in all a s p e c :s o the c l i n i c a l e x p e r i e n c e . C o d y willing a c c e p t s the
opportunity for a n y learning e x p i jrie i c e w e e n c o u n t e r e d . C C U w a s a s p e c i a l e n c o u n t e r for
Cody.
D i s c u s s e s patient's plan of care with instructor. 1 w a s fully informed of C o d y ' s patient's
condition w h e n u n s t a b l e .
D e m o n s t r a t e s p r o f e s s i o n a l beh vior a n d a p p e a r a n c e . Neat a p p e a r a n c e , uniform c l e a n not
w r i n k l e d , hair up.
E n g a g e s in self-reflection a n d ct >mmunicates l e a r n i n g n e e d s to instructor/preceptor.
C o m p l e t e s a s s i g n m e n t s a s requ irec a n d s u b m i t s on time.

S
S

s
s

S
Student
SelfEval
S/N/U

Instructor
E v a l of
Student
S/N/U

O r g a n i z e s time efficiently.
Outcome 3
P r o v i d e culturally c o m p e t e n t , he listi ; c a r e u s i n g r e s p e c t f u l a n d c a r i n g b e h a v i o r s .
D e m o n s t r a t e s caring b e h a v i o r s with the ability to d e v e l o p a n d maintain t h e r a p e u t i c
relationships with people from c v e r s e b a c k g r o u n d s .
C o n s i d e r s patient v a l u e s , cultui; i\s a n d religious d i f f e r e n c e s w h e n planning c a r e .
Outcome 4
Approved 12/41/4. Revised 12/9/2014

11

S
S
S
S
S
S
S
Student
SelfEval
S/N/U
S
S
Student

S
S
S
S
S
Instructor
E v a l of
Student
S/N/U
S
S
Instructor

Carroll Community College

D e p a r t m e n t of Nursing
N U R S 2 4 2 - Nursing C o n c e p t s 4
StL ident C l i n i c a l P e r f o r m a n c e E v a l u a t i o n - S U M M A T I V E
C o l l a b o r a t e with h e a l t h c a r e tear IS t i provide patient-centered c a r e .

Identifies patient/family health e ucation n e e d s .

I m p l e m e n t s patient a n d family e lucation.
S e e k s input from patient, instruc :or, b e e r s , a n d h e a l t h c a r e t e a m in the delivery of patient c a r e .
" U p d a t e s instructor a n d h e a l t h c re t e a m regarding c h a n g e s in t h e patient's condition.
"Identifies s a f e t y c o n c e r n s a n d i otifies instructor a n d appropriate h e a l t h c a r e t e a m m e m b e r s .
D e m o n s t r a t e s initiative in a s s i s t ">9 Deers a n d h e a l t h c a r e t e a m m e m b e r s in the clinical setting.
D e m o n s t r a t e s c o m m u n i c a t i o n s (ills u s i n g S B A R .
A c t s a s a n a d v o c a t e for patients a n : f a m i l i e s .
Outcome 5
Model a spirit of inquiry that s u p )oii s e v i d e n c e d - b a s e d practice.
A p p l i e s e v i d e n c e d - b a s e d ration ile I hat s u p p o r t s the patient's plan of c a r e .
I n t e g r a t e s k n o w l e d g e from n u r s >g and other d i s c i p l i n e s to plan c a r e .
Outcome 6
P r a c t i c e within legal a n d ethical Drir c i p l e s to d e l i v e r s a f e a n d c o m p e t e n t c a r e b a s e d on c u r r e n t
s t a n d a r d s of practice.
A d h e r e s to a t t e n d a n c e policy. ( o d ' i w a s c o n s i s t e n t l y early to clinical a n d a l w a y s r e a d y for
report on time.
" D e m o n s t r a t e s s a f e clinical pra< tice
" P r o v i d e s nursing c a r e b a s e d o th ; policies a n d p r o c e d u r e s of the facility.
" M a i n t a i n s legal accountability f Jr n ursing p r a c t i c e in a c c o r d a n c e with t h e M a r y l a n d N u r s e
Practice Act.
" A d h e r e s to H I P A A g u i d e l i n e s r igarding patient confidentiality.
" P r o v i d e s c a r e a c c o r d i n g to the * \ N ^ N u r s i n g S c o p e a n d S t a n d a r d s of P r a c t i c e .
" D e m o n s t r a t e s accountability ai d responsibility for o w n a c t i o n s a n d attitudes.
Outcome 7
R e s e a r c h a n d c o m m u n i c a t e i n f : rmation through appropriate

technology.

G a t h e r s d a t a from the electronic m e d i c a l r e c o r d to provide patient c a r e .

U s e s electronic m e d i c a l record t o d o c u m e n t patient c a r e a c c u r a t e l y a n d in a timely m a n n e r .

SelfEval
S/N/U

E v a l of
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Instructor
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Student
SelfEval
S/N/U
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Student
SelfEval
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S
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SelfEval
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s
s
s
s

s
Instructor
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s
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E v a l of
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S t u d e n t L e a r n i n g G o a l s ( L i s t iies ired l e a r n i n g g o a l s , a n d y o u r p l a n s to m e e t t h e m , f o r t h e n e x t w e e k ' s c l i n i c a l

e x p e r i e n c e . G o a l s s h o u l d b e :>as 3d o n identified p e r f o r m a n c e i s s u e s a n d t h e d e s i r e f o r n e w k n o w l e d g e a n d
experiences.)
1 b e l i e v e that 1 h a v e m e t all ofmy g o a l s for t h e c l i n i c a l e x p e r i e n c e a n d h o p e to c o n t i n u e o n to m y p r a c t i c u m
w i t h all of t h e k n o w l e d g e I've acq u i r e d o v e r t h e p a s t 6 w e e k s a n d put it to g o o d u s e . Ive l e a r n e d a lot f r o m
b e i n g p l a c e d in different s i t u a tior i s s u c h a s b e i n g c h a r g e n u r s e for a d a y , f o l l o w i n g IV a c c e s s t e a m , a n d e v e n
s p e n d i n g time o n t h e C r i t i c a l s a i l i unit w h e r e 1 w a s a b l e to put w h a t i v e l e a r n e d o v e r t h e p a s t y e a r a n d a half to
u s e . 1 h a v e l e a r n e d a lot a n d p Ian o n c o n t i n u i n g that t r e n d .

P r e c e p t o r / I n s t r u c t o r c o m m e r t s / ! Student L e a r n i n g G o a l s : (**lf a n item w a s identified a s N o r U, narrative

c o m m e n t s a r e n e c e s s a r y to c aril ty s t u d e n t p e r f o r m a n c e * * )
Cody,
Y o u g a v e m e a c h a l l e n g e w h e r it c< j m e to a s s i g n m e n t s b e c a u s e y o u w e r e r e a d y for m o r e of a c h a l l e n g e e v e r y d a y .
Y o u r organizational skills a r e strone d u e to y o u r e x p e r i e n c e a n d your ability to critically think a problem through. Y o u
get it. It w a s a s m a r t plan to be wor king in the health c a r e field s o y o u could p r a c t i c e your skills with patient
c o m m u n i c a t i o n a n d c a r e . Y o u : >xhi )it strong c o m m u n i c a t i o n skills a n d put the patient at e a s e .
Approved 12/41/4. R e v i s e d 12/9/2014

Carroll C o m m u n i t y C o l l e g e
D e p a r t m e n t of Nursing
N U R S 2 4 2 - Nursing C o n c e p t s 4
Student Clinical Performance Evaluation - S U M M A T I V E

C o d y ' s e x p e r i e n c e s included e c u P C C (patient c a r e coordinator or c h a r g e n u r s e ) , a n d a critically ill patient with a

c h a l l e n g i n g d e c i s i o n a b o u t the e|hd c f life. T h e n u r s e w h o is k n o w n to be hard to i m p r e s s w a s s o glad to h a v e C o d y
c a r i n g for the patient with heart ailut e. S h e m a d e a point of telling m e how strong C o d y ' s s k i l l s w e r e . T h i s particular
patient w a s u n s t a b l e a n d C o d y monitored h e r V S frequently a n d c o m m u n i c a t e d e v e r y c h a n g e to the n u r s e
appropriately. It w a s good to kn o w w e h a d a n o t h e r " s e t of e y e ' s " on this patient a n d C o d y filled that role effectively.
S h e w a s respectful a n d support /e in her c a r e of the lady a s the patient m a d e s o m e tough e n d of life d e c i s i o n s . T h i s
patient w a s e n t h u s i a s t i c a l l y corr i l e p e n t a r y of C o d y ' s c a r e .
I feel that C o d y is r e a d y for a fu patient load. I s e e strong o r g a n i z a t i o n a l s k i l l s a n d c o m p a s s i o n a t e c a r e .
:

If I w o k e up after a n incident and s a w C o d y ' s f a c e I would feel s a f e in her c a r e .

I w i s h you the best a s y o u proce fed f o r w a r d . I s e e g r e a t potential in your n u r s i n g abilities C o d y . It w a s a p l e a s u r e to
h a v e you in clinical for this rotat <pn.

Student Signature:

Cody E. Felisky

Preceptor/Instructor
Signature:

J a n e Schroeder, MSN, R N 11/19/15

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

Date:

Date:

10/20/15