Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE
Theresa
Breitenbach
S = Satisfactory
N = Needs Improvement U = Unsatisfactory
N/A = Not applicable (*) Critical behavior
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
Apply the nursing process when creating a plan of care. (SLO 1, GE 3)
Eval
Student
S/N/U
S/N/U
Collects evidence related to assigned patient(s) from appropriate resources.
s
S
Demonstrates accurate patient assessment skills.
n
S
Establishes appropriate nursing diagnoses based on collected evidence and patient assessment.
s
S
Prioritizes patient care based on assessment.
s
S
Identifies measurable patient outcome based on nursing diagnosis.
s
S
Implements care interventions according to established plan and desired outcomes.
Uses therapeutic communication techniques during nurse/patient interactions to facilitate
the nursing process.
s
S
Identify 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.
n
S
Student Instructor
Outcome 2
SelfEval of
Seek opportunities that promote personal and professional growth and a commitment to lifelong
Eval
Student
learning. (SLO 2, GE 5)
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.
s
S
Completes assignments as required and submits on time.
s
S
Organizes time efficiently.
s
S
Student Instructor
Outcome 3
SelfEval of
Plan holistic, culturally competent care for patients and families. (SLO 3, GE 6)
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.
s
S
Considers patient values, cultural characteristics and religious differences when planning care.
s
S
Student Instructor
Outcome 4
SelfEval of
Contribute to healthcare teams to provide patient-centered care. (SLO 4, GE 1)
Eval
Student
S/N/U
S/N/U
Identifies patient/family health education needs.
s
S
Implements patient and family education.
n
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
Student

Sarah LaCoss

Approved 12/4/14; Revised 2/25/2016

Date

2/19/15

Location

FMH

Faculty

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Outcome 5
Provide nursing care based on scientific evidence. (SLO 4, GE 1)
Identifies evidenced-based rationale that supports the patient plan of care.
Integrates knowledge from nursing and other disciplines to plan care.
Outcome 6
Plan nursing care based on legal and ethical principles and standards of practice. (SLO 6, GE
7)
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
Develop informatics skills using technology and electronic sources of health care information to
support clinical decisions, promote communication, and monitor care outcomes. (SLO 7, GE 4)
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
SelfEval
S/N/U
n
s
Student
SelfEval
S/N/U
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
Student
SelfEval
S/N/U
s
s

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

Student Reflection Looking back on the rotation:

How have you grown as a nurse? Please explain and use specific examples.
The pediatric clinical experience was extremely helpful in helping me grow as a nurse. It allowed me to
communicate with real patients and their families and work on my therapeutic communication skills. I was
also able to better my assessment skills and determine the aspects that I need to work on. In doing my
assessment the first time I completely forgot how to report my heart sounds, and lacked in my safety checks.
This experience allowed to me to see what I need to practice, without causing harm to my patient, since we
were being supervised and working alongside other nurses.
Do you have any continuing concerns about your performance? Please explain.
The only concern that I have about my performance is remembering all of the things to be looking for in the room and
with the patient when doing the assessment.
Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are
necessary to clarify student performance**)
Sarah came well prepared, recalling important assessment information that was discussed with Jodi the day before.
She interacted well with the patient and her family, utilizing them to gain a thorough history and how the child was
responding to therapy. She was able to use her resources to learn about a new medication in order to administer it
safely (IV antibiotic). She explained the medication to the parents and what side effects to look for. Sarah was very
involved in group discussions concerning the plan of care and rationale for it. Assessment skills will strengthen with
repeated exposure to patients. As the day progressed, Sarah was more relaxed and able to perform her
reassessments/focused assessments with more ease (anticipating an anxious toddler and how to use the family as a
distraction, keeping the toddler at ease).

Approved 12/4/14; Revised 2/25/2016

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Student Signature:
Instructor Signature:

Approved 12/4/14; Revised 2/25/2016

Sarah LaCoss

Date:

2/19/15

Theresa Breitenbach, RNC, BSN

Date:

2/19/15