\ Carrol Community Geloge
Division of STEN, Nursing and A
. Deparment of Nursing
NURS 253 ~ Nursing Concepts 3
‘Student Cinical Performance Evaldation = SUMMATIVE.
Heath
student Monica Tenge vate: || te Location: Ulery recut: Walsh
'S=Satstaciny [N= Nends Improvement | U= Uneatatacory [NA
tape [() Creal haar
Falure o progress in these areas may result in alu ofthe course.
Two unsatisfactory grades in anon critcal behavior Four needs improvements
‘Suds who meet any ofthe folowing crtera wil Be given a remediation plan and may be placed on probation,
One unsatisfactory grade ina cial behavior Two needs improvements ina cial behavior
Outcome 1
‘Araya the efecvness ofthe plan of care using the nursing process (SLO 1, GE 3)
[Collects evidence rlaled to cinical pracios fom appropriate resourses
‘Student
‘sale
Eval
Instr
Evalol
‘Student
“Dernonstates accurate patient assessment skis
TEsiablshes sppropiste nursing dagnoses based on patent sssesarini
“Proniizes patent care bated on assessment
Tdentiies messurabe patent culcome based on nursing dlagnosls
“implements care according to esiabished plan and desired ovieomes
‘Uses therapeutic communication techniques during nurse/patient ntaracbonstoTecitale
{ne nursing process.
Identity appropiate infervenTone based on assessment
Demonstrates knowiedge of medicalios fr assigned palnis
"minal recent safely using sighs of meieston sdaavaTon <
“inpementsappoprate econ conta precauions
Fotows Oraugh wi al pale cae
“Evalsis pation respons to cve ond ess ano needed
Sleek neincor
oeeees Sete Evaar
IcoFora earn opportunities tha promote personel and otessienal growth and & aioe
ommivnent to tong ering. (SLO & GE 8) anne cee
arate acnay mal anpet of ie ical eparancn =k
“Disses patents plan ose win nstutor
Demonstatesprotesseral bee a appearance
Engages slefecton and commute earng nds nehucopracaror 2
Completes angers as fgued and subras on te.
One ane .
aed Scent | emer
Impement nang care tat conssers he uniqueness of varous cures, backarounds, ana SA: | Eval
Det syrbme (SLO GE) pea hoot
Demraates caring behavior wah he ay 1 devon and mala eapeS
‘elatonships wth paope rom diverse Backgrounds S[k
Considers tert ws, coral harectersie an eigaus cleorens when planing ee S.
Sion | acor
outcome 4 Ser | "Evalor
ont fo heattcare eas to rove patent centered care (S10 4, CE 1) Eva | Suen
smu | wu
dan pt nd Vr hel eaton ned 3
Implements patient and famfy education
‘Seeks input rom patient, nstucor, peers and healncare tear nthe delvery of patent care
“Updates insiuclor end hesthoare tesm regarding changes inthe patent's conction.
enifies safely concerns and notifies instucor and aporoprate healthcare team membars.
Demonstrates intalve in asising peers and healhare eam members in the dna sting
[Demonstrates communication skits using SEAR.
[Acts 26 an advocate for patens and families
‘Areva tie Ravens ‘20014
WnCarol Community College ‘
Dison of STEM, Nursing and Alled Heath .
Department of Nursing
NURS 233 ~ Nursing Concepts 3
‘Student Cinical Pecrmanee Evaluation ~ SUMMATWVE
] Student ituetor
‘Outcome §
Provide nursing care based on scienilc evidence. (SLO 5, GE2)
Tenis evidenced-based rafonale Tat supports the palin pln of cre
Integrates Knowisdge rom nursing and other discpines lo plan care.
‘Outeom:
|mplement nursing care based on legal and ethical principles that rofectcurent standards of
Practice. (S108, GET)
‘Aaheres to atentance poi
“Demonstrates safe cnical piace.
Provides nursing care based on the pois and posedures ofthe Toc
“Mainfans legal accountability for nursing practice in accordance withthe Maryiand Nurse
Practice Act 3 |S
"Aderes to HIPAA guides regarding patent contriaiy c
“Provides care arcording to he ANA Nursing Scope and Standards of PaCS,
Demonstrates countably end responsibly for own actions and aitudes u
“Outcome 7 Blader rstcior
Incorporate ifornats sls using echnology and electronic sources of heath care Sele Evalot
Information to support cirical decisions, promote communication, and mentor care outcomes. | Eval | Student
(SLO7, GE 4) = st SIN
(Gathers data fom the lacronic medical recerd to provide patent are pa
Uses elecironc medical record to document patent are accurately andi a tmely Manar
Student [Your plane To moat them, for dhe next clniaT
experience, Goals should be based on Identified performance lssues and the desire for new knowledge and
erperionees) yy dexcsriy goals, \apann: med adacnsleesip, rites tbebirel] Sig tad er
Crm belay eshbuak wquc Ota espace. quceetse lnsty Sob
ace te cb e16 ay Uctocts, CF he tpore my sia.
oncom err =a ‘an Item was Ideniified as Nor U, narrative comments are.
Bierce a fon ae Ren aCae ea
MUI (6 For OOH
adutacnon Rocher
IS Nace gd baer Sore Pec A enh AN es
anion opens 27 fg coe -
Precepinstructor Signature: [ cate: S| uly ’
Aomroms 24 Raves 1207014Carr Community College
Division of STEN, Nursing and Aled Health
Department of Nursing
NURS 253 - Nursing Concepts 3
‘Student Cinical Peformance Evaluation ~ Summative
suudene fy ate: +) lite Location: Upion _Facut
[[S=sSatstacony [N=Needs Improvement "[U= Unsatisfactory | NA=Notaprlcable | () Grtal bahavor
‘Slants who d nt mast nyo he follwing cea wilbe Given & emedaon pan and wil be paced on BOOSTS |
“Ore uneatitciony grade na cies! bahar -Tworneede provements na cit oeraver |
| ive unsatisfactory grades in snonatealbehnior “Four meee provements =annes
‘Student | instructor )
ae = ee
eles
Se eae
a
a
ern eee
Se :
implements care according i established plan and desed outcomes
‘Uses therepeutc communicaion techigues during nursofpatentmtaracona Yo aitale
{he nursing process,
deny aperopitaifervenians based on assessment. |
Demonstrates knowledge of medications for assigned pales
“Administes medication safely using six ighis of mediation sdminalon
bo |
“implements aprepriat econ cenvl precautions t
Flows tough wih a patent care 1 =
“Eralusis patent respons to care and revise lan se needed. — I
Outcome 2 ‘Sioaert | ier
|ncarporate leamiag opportunities that promote personal and professional growth and @ Pe
commiment to tfeong earning, (SLO2, GE) aa
Pariiplesscively nal atpecis of clnical epetenes
Discusses paiens plan of cre with insbucor
Demonstates professional behavior and appearance we
[Engages in seefecion and conmintcateslartng needs To insWucio/pecepi.
‘Complies essignmenis as fequred and submis on time. g
‘Organizes meetin =
‘Outcome 3 sant | Waar
Implement nursing cre tat consiers the uniqueness of various cuties, backgrounds, and $0 | Eval ot
[ beet eytems (St0 3,66) aa
| Deonera cag boiavar aie ay Gv and maa ape “
‘elationships with people from diverse backgrounds. S
Considers patent vaues cual characierscs and regious @erances when arng cae
‘Sudan | rebar
‘Outcome 4 ‘set. | “Evalot
Cnirbut io healticare teams to provide patient centered care (SLO 4, GE 1) Eval | Stucen
saw _| smu
Identifies paint and family Reaih edueaion needs.
[Implements patient and family education.
‘Seeks input fom patent, nsitucioy, pers, and Reaihcare team mn the delivery of patent care
(Pipi nso ecmce an gong chonosint iets io lates insucior and heathcare team regarding changes in the patent's condor.
*Idenifes safely concems and notifies instr and appropriate hesthcare learn rariber
‘Demonsiralesinliaive in essisiing peers and neattcare team members inthe clnielseting,
‘Demonsirates communication skits using SSAR,
‘Acs 6s an edvocate for patients ard families
Pood 144 Raves 1297014Caroll Communi Cotege
Division of STEN, Nursing ana Aiea Heath
Department of Wursing
NURS 233 ~ Nursing Concepts 3
‘Student Ciniel Performance Evaluation ~ Surmatve
f 7 "Suen ratueor
utom ‘set. | Enter
Provide uring care based on scientific evden, (SLO 5, GE 2) Evai_ | Stdert
fe = gnu _| ‘swu
saved aed SST at appr span pan of care
Trays inowiodge Fem nuning ana ee dspns fo lan car. &
eee Taser
Fiber rrsng care based on egal and cic peru that retactcurettandarasot | Sa | Evol
precise (SLO 6, GE 7) at
Milind sees pesnnnATTTENEEETEEEESEEERREREEESELE on, |
“Deranaals ste ccs pice 3
rags rye Eases ch the POE and rosedres of he Toc.
‘aia ya Scout er rng prac n accordance wid fhe Manyand Mure
Practice Act Ss
ahaa HIPAA gules epardng pao confer.
“Pravies cae boca ie ANA Norong Scope and Standards of PAGER. ¢
“Darna oceeuNaby end espensBil for own acon and aides.
Outcome 7 Sine | atuetor
fReoport fortis sil using technology and elconc sources of heath care et | Evaro!
| information to support clinical decisions, promote communication, and monitor care outcomes. Eval | Student
[iSt07, Ge) siu_| “SN
‘Savors asta tie Sri el read roids patent a. ¥
‘Uses slectonic medal eer eecumen paint care accally andin@ ely mater
‘Student Usaring Goals (st arin
tuperonce, Gone shuld be baved on Kentied peomance leues and the dei for new knowedge and
Siperonces) "
Bruns mow eerident them porbgenerny fred. pre asset
Fnupave thar prontg nest whee prwiding etcace and cea |
= 7 Si nedaa BO
Zo jecime mbes prolciertat adaee/ 09 |
aa co Sa Caan a eGo Sam
neceouary renter val aoe a 3 he paeitg aval
win Sse y en Ar duoc
win a 90 ae ae Gina dnt
[reget gate: V. Pls Bec ent
te He
one
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Preceptorinstuctor Sgn:
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powove 2414, Ravan 1982016Carrol Community Calege
Division of STEM. Nursing and Alled Heath
‘Department of Nursing
NURS 140 ~ Nursing Concepts 2
Student Cinical Perfomance Evaluation ~ SUMMATIVE
ssutentHonid Hongo vate 12/1/15 Location 5 doy Focuty 26S
‘Satisfactory | N= Needs Improvement | U= Unsatisfactory | N/A ="Not applicable | (") Critical behavior
‘Sludents wno meet any ofthe Tesowing cera wil be given a remedlalon plan and may be place on probation,
Falure to progress in these areas may resut in allure ofthe course
-One unsatisfactory grace in acicl behavior “Two needs improvements ina cecal behavior
Two unsasfocoyy grees ing nore! belt “Four needs ingrowernents
f ‘Student | sue
‘Outcome 1 ‘Sel | Evalof
‘Apply the nursing process when creating a plan of care. (SLO 1, GE 3) Eval | stusent
sn | SMU
‘Galcis evidence rated to absigned patina) Fam approprale resources
‘Demonsvals sccurae palit assessment sks,
Eslablshes appropriate nursing dagnoses based on colecied evidence and patent assessment =
roiizes patient care based on assessment #
8
=
a
s
etfs esse bet se Sie rma ogra
urs co Fives ssTdng sid ait Sane oucaes
ses irapute onrnncatonckties ut mrsoatoneacion ae
terror ase,
a Se as as aa ona
Sematas caege of ear sage palo
“Arne redsot S org al of nao sna
“ile appogrte econ Soria pears
Foto Bou we a poten re
‘Evaluates patient response to care and revises plan as needed, a
Saute Sa | ea
Srekopporunties tat root persona poesonal gown anéasaneinentioitsong | Sal | Eri
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sny | “SU
Paricipates acively al aspecs oT the cca experience
‘Discusses patient's plan of eare wih instructor.
‘Demnonsirates professional behavior and appearance, 1
Engages in saefiecion and communicates earring need Wo navuelor
‘Competes assignments as fequed and submis cn ime
‘Organizes time efficient t
‘Student | nai
Outcome 3 Evalof
Pian holst, culturally competent car for patents and tamil. (SLO 3, GE 6) Student
SIN
| Demonstaies cang behaviors wih the ably te develop and maintain erapeuiic elaionships
with people fom diverse backgrounds ist
Considers patient value, culural caracerisica and relgious Gfferences whan planning care |S”
‘Student | Tstucior
| Outcome 4 Sal. | Evalof
‘Contribute to healteare teams to provide patient-centered care. (SLO 4, GE 1) Eval | Student
smu | SN
[denies paienitamay Reath education needs
Tplements palent and family edcabon
‘Seeks input rom patent, nsrucior, peers, and healthcare eam in the dehy of paint care,
“Upeaies incor ag heatthcareleam regarding changes inthe pales condition
“Identifies safely concems and notes instuctor anc appropiate heatheare team meres
Demonsitses iisve assisting pers and neaicare lear members the circa sting
Demonsfaies communication skils using SBAR,
‘Acs as an advocate fer patients and fames,
Aone 2604 Ravin 12018Carrot Community Colege
Division of STEM, Nursing and Aled Heath
Department of Nursing
NURS ‘40-~ Nursing Concepts 2
‘Student Cinial Performance Evalusion ~ SUMMATIVE
‘Student | Tatustor
‘Outcome 5 ‘Sele | “Evalof
Provide nursing care based on scintic evidence, (SLO 4, GE 1) Eval | Student
| smiu_| “sruv)
Tenifesevidenced-based rational thal suppors the pater pan ofeare
Integrates knowledge fom nursing and othe dicipines fo pan cae,