Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
Faculty
Prof
Schroeder
N = Needs
N/A = Not
S = Satisfactory
U = Unsatisfactory
(*) Critical behavior
Improvement
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. During this rotation a full head to toe
assessment was observed on a patient. You forgot the lower extremity assessment initially
when demonstrating the full assessment. As you completed the assessment, after my
S
S
prompting, it was obvious you had already assessed her extremities you just missed it when I
was observing. Try to relax Jenny, dont let performance anxiety get in your way.
Establishes nursing diagnoses based on patient assessment.
S
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
S
S
the nursing process.
*Identifies appropriate interventions based on assessment.
S
S
*Demonstrates knowledge of medications for assigned patients. Knowledgeable about
S
S
medications and able to put together critical thinking connections when questioned.
*Administers medication safely using six rights of medication administration. Prepared and
organized medication administration. Jenny got to practice documentation when a patient
S
S
refuses medication.
*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
Eval
Student
and professional growth.
S/N/U
S/N/U
Participates actively in all aspects of the clinical experience. Jenny willing accepts the
opportunity for any learning experience we encountered. Her background helps in the clinical
setting for she has certain organization skills already in place.
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
S
relationships with people from diverse backgrounds.
S
Considers patient values, cultural characteristics and religious differences when planning care.
S
S
Outcome 4
Student
Instructor
Collaborate with healthcare teams to provide patient-centered care.
SelfEval of
Student

Jenny Clark

Date
10/23/15

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

Location CHC IMC

Carroll Community College

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

Identifies patient/family health education needs. Since you were in touch with the patient and
making connections you were able to identify learning needs and take advantage of times to
implement patient teaching.
Implements patient and family education.
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.
*Identifies safety concerns and notifies instructor and appropriate healthcare team members.
Demonstrates initiative in assisting peers and healthcare team members in the clinical setting.
Demonstrates communication skills using SBAR.
Acts as an advocate for patients and families.
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. On time to clinical, ready for report at 0645.
*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.

Eval
S/N/U

Student
S/N/U

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

S
S
S
S
S
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
S
S
S
S
Student
Instructor
Outcome 7
SelfEval of
Research and communicate information through appropriate technology.
Eval
Student
S/N/U
S/N/U
Gathers data from the electronic medical record to provide patient care.
S
S
Uses electronic medical record to document patient care accurately and in a timely manner.
S
S
Student Learning Goals (List desired learning goals, and your plans to meet them, for the next weeks clinical
experience. Goals should be based on identified performance issues and the desire for new knowledge and
experiences.)
The last week of clinical I was able to spend a day in the Cath lab which was really interesting. Although I dont
think I would like to pursue this in my career, I was really interested to see what they do in the cath lab. I got to
see 3 cardiac caths including one that had a history of a CABG. The entire clinical experience these past six
weeks has vindicated my decision to become a nurse and really helped narrow my specialty. I have found
things I like and things I dont and I am even more open to trying new things in the future. I feel I learned to
become more confident as a nurse and I now understand more about the entire process. I cannot wait to move
on to my preceptorship and see more about psych nursing and broaden my horizons with that as well.

Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
comments are necessary to clarify student performance**)
Jenny,
I observed growth in your confidence and overall comfort level. I saw caring and genuine interest in your patients and
Approved 12/41/4. Revised 12/9/2014

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
this helped to build their trust in you. Your patients were consistently complimentary of your skills as a nurse. They see
great potential in you.
It seemed that you enjoyed the CCU and wound care experience more than the cardiac cath. lab. I am glad your clinical
skills were strong enough that you earned the privilege to visit the other units.
Continue to work on complete nursing assessments and thorough documentation.
I see great promise in your nursing skills Jenny. You show a genuine caring methodology.
It was my pleasure to have you in the clinical setting. You smile is readily visible which leads me to believe you really
enjoy nursing. You are pleasant and positive in your approach. This will help to open doors when communicating with
patients and team members.
I wish you the best as you continue on your path. Have a great practicum experience!

Student Signature:

Preceptor/Instructor
Signature:

Date:

Jane Schroeder, MSN, RN

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

Date:

11/1/2015