Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 133 Nursing Concepts 1
Student Clinical Performance Evaluation - SUMMATIVE

Faculty
Student Perside Epse Tatienou
Date 5/7/2015
CSE # LTC
Taylor
S = Satisfactory
N = Needs Improvement
U = Unsatisfactory
NA = 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
SelfEval of
Explain the use of the nursing process when creating a plan of care. (SLO 1, GE 3)
Eval
Student
S/N/U
S/N/U
S
Collects evidence related to assigned patients from appropriate resources.
S
S
Demonstrates accurate patient assessment skills.
S
Prioritizes patient care based on assessment.
S
S
Determines an individualized plan of care based on patient assessment.
Implements care according to established plan and desired outcomes.
Uses therapeutic communication skills during nurse/patient interactions to facilitate
the nursing process.
Follows through with all patient care.
Demonstrates knowledge of medications for assigned patients.
*Implements appropriate infection control precautions.
Outcome 2
Identify learning opportunities that promote personal and professional growth. (SLO 2, GE 5)
Participates actively in all clinical experiences.
Discusses patients plan of care with instructor.
Demonstrates professional behavior and appearance.
Engages in self-reflection and communicates learning needs to instructor.
Completes assignments as required and submits on time.
Organizes time efficiently
Outcome 3
Identify the importance of various cultural norms and belief systems in the delivery of holistic
healthcare to patients and their families. (SLO 3, GE 6)
Demonstrates caring behaviors with the ability to develop and maintain therapeutic relationships
with people from diverse backgrounds.
Considers patient values, cultural characteristics, and religious differences when planning care.
Outcome 4
Identify self as a member of the healthcare team. (SLO 4, GE 1)
Identifies patient and family health education needs.
Implements patient and family education.
Seeks input from patient, instructor, and healthcare team in the delivery of patient-centered care.
*Updates instructor and healthcare team regarding changes in the patients condition.
*Identifies safety concerns and notifies instructor and appropriate healthcare team members
Approved 12/4/14. Revised 12/10/2014; 01/2015

S
S
S
S
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
S
S
S
S

Student
SelfEval
S/N/U

Instructor
Eval of
Student
S/N/U

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

S
Instructor
Eval of
Student
S/N/U

S
S
S
S
S

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 133 Nursing Concepts 1
Student Clinical Performance Evaluation - SUMMATIVE
Demonstrates initiative in assisting peers and healthcare team members in the simulation setting.
Demonstrates communication skills using SBAR.
Acts as an advocate for patients and families.
Outcome 5
Explain the importance of scientific evidence to guide nursing practice. (SLO 5, GE 2)
Identifies evidence-based rationale that supports the patients plan of care.
Begins to use knowledge from nursing and other disciplines to plan care.
Outcome 6
Identify legal and ethical principles and professional standards of practice basic to the care of
patients and their families. (SLO 6, GE 7)
*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 ANA Scope and Standards of Nursing Practice.
*Demonstrates accountability and responsibility for own actions and attitudes.
Adheres to attendance policy
Outcome 7
Identify technology and electronic sources of health care information that supports clinical
decisions and promotes communication. (SLO 7, GE 4)
Gathers data from the electronic medical record to provide patient care.

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

Uses the electronic medical record to document patient care accurately and in a timely manner.

N/A

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
Instructor
Eval of
Student
S/N/U

NA
NA

Student Reflection (Thoroughly answer all questions)

What did you learn this week that has contributed to your growth as a nurse? Please explain.
I learned to assess a patient with amputated limb and I realized that having an amputated limb those not
automatically affect the strength of the remaining limb.
Did you accomplish the objectives you and the instructor set for this CSE? Please explain.
Yes, I was able to perform a full assessment of the patients that were assigned to me.
Do you have any concerns about your performance? Please explain. No
Student Learning Goals (List desired learning goals for the next clinical experience in N140. Goals should be based on
identified performance issues and the desire for new knowledge and experiences.)
My desire is to be able to plan and use my time efficiently.
Faculty Comments/ Student Learning Goals:
Student Signature:
Instructor
Signature:

Approved 12/4/14. Revised 12/10/2014; 01/2015

Perside Epse Tatienou

Date:

5/7/2015

Taylor

Date:

5/7/2015