Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Student Shalanei Streaker Date 10/20/15 Location HCGH 2S Faculty Lisa Balk
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 Self- Eval 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. S 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. N N
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. S S
Evaluates patient response to care and revises plan as needed. S S
Student Instructor
Outcome 2
Self- Eval 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 Self- Eval 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 Self- Eval 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. 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

Outcome 5 Student Instructor

Approved 12/4/14; Revised 4/12/2017
 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Self- Eval of
Provide nursing care based on scientific evidence. (SLO 4, GE 1) Eval Student
S/N/U S/N/U
Identifies evidenced-based rationale that supports the patient plan of care. S S
Integrates knowledge from nursing and other disciplines to plan care. S S
Student Instructor
Outcome 6
Self- Eval of
Plan nursing care based on legal and ethical principles and standards of practice. (SLO 6, GE
Eval Student
7)
S/N/U S/N/U
Adheres to attendance policy. S S
*Demonstrates safe clinical practice. S S
Provides nursing care based on the policies and procedures of the facility. S S
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse S S
Practice Act.
*Adheres to HIPAA guidelines regarding patient confidentiality. S S
*Provides care according to the ANA Nursing Scope and Standards of Practice. S S
*Demonstrates accountability and responsibility for own actions and attitudes. S S
Student Instructor
Outcome 7
Self- Eval of
Develop informatics skills using technology and electronic sources of health care information to
Eval Student
support clinical decisions, promote communication, and monitor care outcomes. (SLO 7, GE 4)
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 Reflection Looking back on the rotation:

How have you grown as a nurse? Please explain and use specific examples.
Over the past six week I personally believe I have grown an extra-ordinary amount as a nurse. I was able to learn a lot
about multiple things, such as how a thoracentesis is performed and I was able to connect class lecture and clinical
together, how to work a pyxis medication dispenser, and I was able to watch how blood is hung. I was able to remove
a Foley catheter, give a subcutaneous and intramuscular injection, I learned how to work an ice-man, give an IV
piggy back medication and hang fluids, give by mouth medication, how to manage my time, and most importantly I was
able to work on my communication skills. Over the course of the six weeks, I have become more comfortable in
administering medication, removing Foleys, setting up IV/IV meds and much more. These six weeks have gone quiet
well and has given me the ability to learn and grow as a nurse.

Do you have any continuing concerns about your performance? Please explain.
No, the only thing I hope for is to continue to connect clinical and lecture and to keep actively working on
communication skills.

Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are
necessary to clarify student performance**)

During this clinical rotation Shalanei has made a significant amount of progress. She has cared for two patients
simultaneously and done well with managing all patient care in a timely manner. She has demonstrated good
teamwork by helping other students and staff when she was available.
Shalanei has cared for a variety of patients with varied medical diagnosis including: UTI, pathological bone fracture
with neoplastic disease, pneumonia, hyponatremia, hip fracture and replacement, knee replacement, pelvic fracture,
and ankle fracture.
Shalanei is quiet and has taken constructive guidance well and worked to increase her communication with patients,
staff and her clinical instructor. She has made significant progress in this area and, as she mentioned above, will
continue to strive to communicate fully. While accompanying a patient to a procedure Shalanei was not very verbal but
comforted the patient by holding her hand throughout the procedure. This demonstrates a great amount of non-verbal
communication and also much compassion. I am confident that she will continue to comfort patients and use
therapeutic communication in the future.
Approved 12/4/14; Revised 4/12/2017
 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 Nursing Concepts 2
Student Clinical Performance Evaluation SUMMATIVE

Shalanei has performed multiple skills during this rotation including: basic patient ADL care, discontinuing a Foley
catheter, medication administration via a variety of routs including oral, SQ, IM, eye drops, and IV.
Shalanei has shown a desire to learn as much as possible and a willingness to improve.
She has successfully completed her second term clinical and I am confident that she is ready to progress to the next
level.

Student Signature: Date: 10/20/2015

Instructor Signature: Date: 10/24/15

Approved 12/4/14; Revised 4/12/2017