Carroll Community College

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

Linda Chaffman
Date
3/17-18/16
Location
IMC Faculty
CHC
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.
S
S
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 the
S
S
nursing process.
*Identifies 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.
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 and
Eval
Student
professional growth.
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/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 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
Collaborate with healthcare teams to provide patient-centered care.
Eval
Student
S/N/U
S/N/U
Identifies patient/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
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
Approved 12/41/4. Revised 12/9/2014

Carroll Community College

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

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.
*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
Research and communicate information through appropriate technology.

Student
SelfEval
S/N/U
S
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

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 Reflection Looking back on the rotation:
How have you grown as a nurse? Please explain and use specific examples.
This rotation has showed me a wide variety of things. I have learned a lot and experienced a
lot. Getting the chance to experience other units such as CCU, wound care, and PACU. I was
able to take on 3 patients at a time while doing head to toe assessments and administering
medications safely. Learning how to organize and manage my time was a big help through
this rotation. There were COTS that were called and I was able to experience what they do in
those situations. This rotation has really helped me put things together as a whole from
medications, patient interaction, labs, etc. Being able to take on three patients has really
helped myself to get a taste of what to expect as a nurse when I am out in the field. I learned
a lot from my instructor in post conferences that we had that was very helpful. Experiencing
and seeing things like PICC lines being places, placing a Foley catheter, EKGS as well and
along with other daily tasks was an experience that helped in my skills and learning. What I
liked about this unit was that every patient just about was on the tele monitors. I was able to
get some practice with reading strips and looking at EKGS.
Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
comments are necessary to clarify student performance**)
Linda has shown tremendous progress throughout this clinical rotation. She started the rotation by taking
2 patients and being very unsure of her organization to being able to confidently and thoroughly care for
three patients as well as administering all three of the patients medications without error in a timely
manner and prioritized appropriately. Linda gained confidence and then began to challenge herself
clinically and dig deeper into her critical thinking skills.
Linda will be able to use her previous experiences and her learned experiences to thrive as a registered
nurse

Student Signature:
Approved 12/41/4. Revised 12/9/2014

Linda Chaffman

Date:

3/18/16

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
Alyson Taylor, BSN
Preceptor/Instructor Signature:

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

Date:

3/18/16