Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 233
Weekly/Summative Student Clinical Performance Evaluation Fall 2014

Student:

Jenny Clark

S = Satisfactory

N = Needs Improvement

Clinical Location: CHC-4W

U = Unsatisfactory

(*) Denotes critical behaviors

Students who fail to show progress through the semester will be given a remediation plan. Failure to progress may
result in in the student being placed on probation or failure of the course.
Outcome 1

Analyze the effectiveness of the plan of care using the nursing process (SLO 1,
GE 3)
Collects evidence related to clinical practice from appropriate resources.
*Demonstrates accurate patient assessment skills.
Integrates knowledge of evidence-based theory from nursing and other disciplines to plan care.
Determines an individualized plan of care based on patient assessment.
Establishes appropriate nursing diagnoses based on patient assessment.
*Prioritizes patient care based on assessment.
*Implements care according to established plan and desired outcomes.
*Evaluates patient response to care and revises plan as needed.
Outcome 2

Incorporate learning opportunities to promote professional growth (SLO 2, GE 5)

Participates actively in all aspects of the clinical experience.
Discusses patients plan of care with instructor.
Demonstrates professional appearance and demeanor.
Engages in self-reflection and communicates learning needs to instructor/preceptor.
Completes assignments as required and submits on time
Organizes time efficiently.
Outcome 3

Implement nursing care that considers the uniqueness of various cultures,

backgrounds, and belief systems (SLO 3, GE 6)
*Respects patients rights with regard to their dignity and human worth.
Demonstrates ability to develop and maintain therapeutic relationships with people from
diverse backgrounds.
Considers patient values, cultural characteristics and religious differences when planning care.
Demonstrates caring behaviors
Outcome 4

Contribute to multidisciplinary teams to provide patient-centered care (SLO 4, GE

1)
Identifies patient/family health education needs and implements patient teaching.
Documents patient care accurately and in a timely manner using the written or electronic health
record.
Applies therapeutic communications skills.
Demonstrates initiative in assisting peers and health care team members in the clinical setting.
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 in a
timely manner.
Demonstrates professional communication skills using SBAR.
Outcome 5

Implement nursing
care based on
scientific evidence.
(SLO 5, GE 2)
N242 Clinical Eval Approved: 8/28/2014

Student Self-Eval
S/N/U

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

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

S
S
S
Student
SelfEval
S/N/U
S

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

S
S
S
S

S
S
S
S

S
S

S
S

Instructor Eval of Student

S/N/U

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233
Weekly/Summative Student Clinical Performance Evaluation Fall 2014
Applies scientific rationale that supports a patients plan of care.
Integrates knowledge from nursing theory and other disciplines to plan care.
Outcome 6

Implement nursing care based on legal and ethical principles that reflect current
standards of practice. (SLO 6, GE 7)
*Maintains ethical accountability for nursing practice in accordance with the Code of Ethics.
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act.
*Adheres to HIPAA guidelines regarding patient confidentiality.
*Provides safe care according to ANA Standards of Nursing Practice.
*Implements appropriate infection control precautions.
*Identifies safety concerns and notifies instructor and appropriate healthcare team members
Demonstrates accountability and responsibility for own actions and attitudes.
*Demonstrates knowledge of medications for assigned patients.
*Administers medication safely using six rights of medication administration.
Outcome 7

Apply information management tools to monitor patient outcomes (SLO 7, GE 4)

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

Documents patient care accurately and in a timely manner using the written or electronic health
record.
Demonstrates competency with technologies and standardized practices that contribute to
safety and quality of care.

S
S
Instructor
Eval of
Student
S/N/U

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

S
S

Student comments: (areas of strength, areas for growth, ongoing goals)

I feel this week I was able to use my strengths in psych. I think Im very good at communication and I got a great
patient who was able to work with me very well. I think the experience taught me a lot more about the documentation
process which I dont usually see much of. I also learned what its like to have voluntary patients which was a much
different experience. I cant wait to see more next week and use a focused interaction to further my exposure to the
documentation process.

Clinical instructor comments:

You did well clinically. I have observed your attentiveness during your interactions. You are motivated in
doing well in clinical. You will continue to advance with you communication skills.

**If an item was identified as N or U, narrative comments are necessary to clarify student performance
Student Signature:
Preceptor/Instructor Signature:
N242 Clinical Eval Approved: 8/28/2014

Date:
Date:

11-16-=14

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233
Weekly/Summative Student Clinical Performance Evaluation Fall 2014
Carolyn Watson, MS, RN.

Almost Never Requires (<10% of the time)

Direction
Guidance
Monitoring
Support

Often requires (50% of the time)

Direction
Guidance
Monitoring
Support

Very often requires (75% of the time)

Direction
Guidance
Monitoring
Support

N242 Clinical Eval Approved: 8/28/2014

Satisfactory
Almost Always Exhibits (>90% of the time)
A focus on the client or system
Accuracy, safety & skillfulness
Assertiveness and initiative
Efficiency and organization
An eagerness to learn
Needs Improvement
Often Exhibits (50% of the time)
A focus on the client or system
Accuracy, safety & skillfulness
Assertiveness and initiative
Efficiency and organization
An eagerness to learn
Unsatisfactory
Occasionally Exhibits (25% of the time)
A focus on the client or system
Accuracy, safety & skillfulness
Assertiveness and initiative
Efficiency and organization
An eagerness to learn