Carroll Community College

Division of STEM, Nursing and Allied Health

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

Perside Epse
Tatienou

S = Satisfactory

Date
:

N = Needs Improvement

5/11/2016

Location:

U = Unsatisfactory

St Agnes

Faculty
:

NA = Not applicable

Linaya Prior
(*) 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
S
Collects evidence related to clinical practice from appropriate resources.
S
*Demonstrates accurate patient assessment skills.
Establishes appropriate nursing diagnoses based on patient assessment.
*Prioritizes patient care based on assessment.
Identifies measurable patient outcome based on nursing diagnosis.
*Implements care according to established plan and desired outcomes.
Uses therapeutic communication techniques during nurse/patient interactions to facilitate
the nursing process.
Identify appropriate interventions based on assessment.
Demonstrates knowledge of medications for assigned patients.
*Administers medication safely using six rights of medication administration.
*Implements appropriate infection control precautions
Follows through with all patient care
*Evaluates patient response to care and revises plan as needed.
Outcome 2
Incorporate learning opportunities that promote personal and professional growth and a
commitment to lifelong learning. (SLO 2, GE 5)
Participates actively in all aspects of the clinical experience.
Discusses patients plan of care with instructor.
Demonstrates professional behavior and appearance.
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)
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
Contribute to healthcare teams to provide patient-centered care (SLO 4, GE 1)
Identifies patient and family health education needs.
Implements patient and family education.
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.
*Identifies safety concerns and notifies instructor and appropriate healthcare team members.
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
Approved 12/4/14. Revised 12/9/2014

S
S
S
S
S

S
S
S
S
S

S
S
S
S
S
S
Student
SelfEval
S/N/U
S
S
S
S
S
S
StudSen
t SelfEval
S/N/U

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

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

Carroll Community College

Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233 Nursing Concepts 3
Student Clinical Performance Evaluation SUMMATIVE
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.)
My Goals for next clinical rotation is to use my time effectively and be more organized as I provide care for my
patients.
I am glad because I learned a lot during clinical rotation. I was able to apply what we were taught as I took
care of my patients. The big thing I am taking out of this experience is to assess my patients first and never
go by what the monitor (equipment) says.
Faculty Comments/ Student Learning Goals (**If an item was identified as N or U, narrative comments are
necessary to clarify student performance**)
That is a very important thing to learn and I am glad to hear you are taking that with you from this experience.
Throughout this experience you had thorough assessment skills. This lead you to identify appropriate
nursing diagnoses and interventions. If you were confused or unsure you were not afraid to ask questions.
This is a great quality and never be afraid to ask questions. Asking questions prevents a lot of mistakes in
nursing. Whenever I gave you feedback you used the feedback to improve the following week. You were
successful in giving medications by multiple routes. Each week you had knowledge of your medications and
were aware of critical assessments necessary before administration. At times you even picked up on things
with medications that the primary nurse had not thought of and you advocated for the patient. Continue to
advocate for your patients because this will lead to improvements in patient outcomes. Great job and good
luck in your future!
Student Signature:

Perside Epse Tatienou

Date:

5/11/2016

Preceptor/Instructor Signature:

Linaya Prior

Date:

5/11/2016

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