Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 233 Nursing Concepts 3
Student Clinical Performance Evaluation SUMMATIVE
Student:

Tiffany Rhodes

S = Satisfactory

Date:

N = Needs Improvement

12/08/15

Location:

U = Unsatisfactory

UMMC

Faculty:

NA = Not applicable

Kelemen
(*) 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
Analyze the effectiveness of the plan of care using the nursing process (SLO 1, GE 3)
Eval
Student
S/N/U
S/N/U
Collects evidence related to clinical practice from appropriate resources.
S
s
*Demonstrates accurate patient assessment skills.
S
s
Establishes appropriate nursing diagnoses based on patient assessment.
S
s
*Prioritizes patient care based on assessment.
S
s
S
s
Identifies measurable patient outcome based on nursing diagnosis.
*Implements care according to established plan and desired outcomes.
S
s
Uses therapeutic communication techniques during nurse/patient interactions to facilitate
S
s
the nursing process.
S
s
Identify appropriate interventions based on assessment.
S
s
Demonstrates knowledge of medications for assigned patients.
S
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
*Evaluates patient response to care and revises plan as needed.
S
s
Student Instructor
Outcome 2
SelfEval of
Incorporate learning opportunities that promote personal and professional growth and a
Eval
Student
commitment to lifelong learning. (SLO 2, GE 5)
S/N/U
S/N/U
s
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
Student Instructor
Outcome 3
SelfEval of
Implement nursing care that considers the uniqueness of various cultures, backgrounds, and
Eval
Student
belief systems (SLO 3, GE 6)
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
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
s
Identifies patient and 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
Approved 12/4/14. Revised 12/9/2014

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233 Nursing Concepts 3
Student Clinical Performance Evaluation SUMMATIVE
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

s
s
s

S
S
S

Outcome 5
Provide nursing care based
on scientific evidence.
Student Self-Eval
(SLO 5, GE 2)
S/N/U
Identifies evidenced-based rationale that supports the patient plan of care.
Integrates knowledge from nursing and other disciplines to plan care.

Instructor Eval of Student

S/N/U
S
S
Student
Outcome 6
SelfImplement nursing care based on legal and ethical principles that reflect current standards of
Eval
practice. (SLO 6, GE 7)
S/N/U
Adheres to attendance policy
S
*Demonstrates safe clinical practice.
S
Provides nursing care based on the policies and procedures of the facility.
S
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act.
S
*Adheres to HIPAA guidelines regarding patient confidentiality.
S
*Provides care according to the ANA Nursing Scope and Standards of Practice.
S
*Demonstrates accountability and responsibility for own actions and attitudes.
S
Outcome 7
Student
Incorporate informatics skills using technology and electronic sources of health care
Selfinformation to support clinical decisions, promote communication, and monitor care outcomes.
Eval
(SLO 7, GE 4)
S/N/U
Gathers data from the electronic medical record to provide patient care.
S
Uses electronic medical record to document patient care accurately and in a timely manner.
S

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

Student Learning Goals (List desired learning goals, and your plans to meet them, for the next clinical
experience. Goals should be based on identified performance issues and the desire for new knowledge and
experiences.)
This rotation of clinicals has provided me with a wealth of knowledge as well as experience. I am forever
grateful for a faculty member that was more than willing to let us experience anything we were willing to do
within our scope of practice as well as share with us a small fraction of her knowledge. I have gained so much
confidence this semester with my skills as well as learn new skills. I feel confident in my ability to interpret a
telemetry strip as well and to truly understand what is happening to the heart with an irregular strip.

Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are
necessary to clarify student performance**)
Tiffany, you bring to clinical a great deal of positive energy and enthusiasm. You seek out every available experience,
ask great questions and take constructive feedback well. This rotation gave you numerous challenges that required
you to recall what you learned in classroom and apply it on a much higher level. Even when my questions were tough,
you worked through what you could and quickly picked up new information that I or the other nurses gave you. By the
end of the rotation, I feel you could work with NG tubes and chest tubes reasonably well, in addition to understanding
how to interpret telemetry and act on some of the findings. You also encourage your peers and establish great working
relationships with those around you. All great qualities of a nurse. Keep up the good work.

Student Signature:
Preceptor/Instructor Signature:
Approved 12/4/14. Revised 12/9/2014

Tiffany Rhodes

Date:
Date:

12/08/15

12/14/15

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233 Nursing Concepts 3
Student Clinical Performance Evaluation SUMMATIVE

Lisa Kelemen

Approved 12/4/14. Revised 12/9/2014