Carroll Community College

Department of Nursing
NURS 140 – Nursing Concepts Two
SUMMATIVE Student Clinical Performance Evaluation
Student Annie Park Date 3/21/19 Week # 6 Faculty Lauren Craig
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
Self- Eval of
Outcome 1 Eval Student
Apply the nursing process when implementing a plan of care (CO1) S/N/U S/N/U
1. *Prioritizes patient care based on assessment with assistance S S
2. Demonstrates accurate patient assessment skills S S
3. Incorporates data from the patient’s medical record in the provision of care S S
4. Uses patient assessment data to develop individualized plan of care with assistance S S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient S
assessment with assistance S
6. Establishes measurable patient outcomes based on nursing diagnosis with assistance S S
7. Establishes appropriate nursing interventions based on assessment with assistance N N
8. Evaluates patient response to care and revises plan as needed with assistance S S
Student Instructor
Self- Eval of
Outcome 2 Eval Student
Participate in opportunities that promote professional growth (CO2) S/N/U S/N/U
9. Demonstrates professional behavior and appearance S S
10. Seeks input from patient, instructor, and healthcare team in the delivery of patient- S
centered care S
11. *Demonstrates accountability and accepts responsibility for own actions and attitudes S S
12. *Adheres to attendance policy S S
13. Participates actively in all clinical experiences S S
14. Engages in self-reflection and communicates learning needs to instructor S S
15. Completes assignments as required and submits on time S S
Student Instructor
Self- Eval of
Outcome 3 Eval Student
Provide patient-centered care with assistance (CO3) S/N/U S/N/U
16. *Implements appropriate infection control precautions S S
17. Provides culturally sensitive care with assistance S S
18. Documents patient care accurately with assistance S S
19. Uses therapeutic communication skills S S
20. Follows through with all patient care with assistance S S
21. Demonstrates knowledge of medications for assigned patients S S
22. *Administers medication safely using six rights of medication administration S S
23. Demonstrates caring behaviors S S
24. Uses SBAR to communicate patient status to instructor and healthcare team with S
assistance S
25. Acts as an advocate for patients and families with assistance S S
26. *Demonstrates physical and mental competence S S
27. *Identifies safety concerns and notifies instructor and appropriate healthcare team S S

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18; 1/13/19

 Carroll Community College
Department of Nursing
NURS 140 – Nursing Concepts Two
SUMMATIVE Student Clinical Performance Evaluation
members
28. Demonstrates time management techniques S S
29. Implements patient and family education S S
30. *Updates instructor and healthcare team regarding changes in the patient’s condition S S
31. *Provides nursing care based on the policies and procedures of the facility S S
32. *Provides nursing care in accordance with the Maryland Nurse Practice Act S S
33. *Adheres to HIPAA guidelines S S
34. *Provides care according to ANA Scope and Standards of Nursing Practice S S
Student Instructor
Self- Eval of
Outcome 4 Eval Student
Plan nursing care based on scientific evidence (CO4) S/N/U S/N/U
35. Justifies patient’s plan of care based on current evidence S S
Student Reflection (Thoroughly answer all questions)
How has this clinical rotation helped to define your role as a nurse? Please explain.

This clinical rotation helped me thinking more seriously to be a nurse. I have been improved patient
dealing skills and felt more comfortable than last semester. I have observed many new techniques
which my instructor or nurses explained well to me. It was fun and great clinical and got more
confident from this experience.

Which objective did you accomplish during this rotation? How did you do it?

Medication administration. I checked patients’ 2 identifications, made sure 6 Rights, and administered
to patients. It was nervous because I should not make any mistakes giving medications to the
patients.

What are your goals for your next clinical rotation?

Do not make any mistakes and arrange my time efficiently in the clinical rotation. If some
assessments are abnormal, should tell nurses or my instructor right away in order to correct and for
patient safety. Get more confident.

Faculty Comments/ Student Learning Goals (Goals must be established even if performance is satisfactory.
If an item was identified as N or U, narrative comments are necessary to clarify student performance along
with goals to improve performance).

Annie learned a lot this clinical rotation. She was able to experience as much as possible on the unit,
and ask questions to not only me but to the nurses on the unit as well. She has such a desire to learn
which will take her very far. She is hardworking on the unit, always checking on her patients, seeing

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18; 1/13/19

 Carroll Community College
Department of Nursing
NURS 140 – Nursing Concepts Two
SUMMATIVE Student Clinical Performance Evaluation
what she can do for others as well. She performs her assessments very thoroughly and timely.
She was nervous initially to do her assessments and also to give meds when it came time for it. She
is very careful and intentional when doing things. This is a successful trait that will keep you from
making mistakes.
She gave medications to her patients exercising the 6 rights and was able to identify what the
medications were for.
Her documenting improved as well throughout the rotation. Again Annie always asked appropriate
questions, In which you could tell she was trying to be the best she could be for her patients.
On the one occasion where she had an abnormal vital sign on a patient without letting me or the staff
know, it was explained to her that it is very crucial to alert someone. She understood and after that, if
even a temperature rose to a higher degree of normal, she would let me know. She is a very quick
learner.
Keep asking questions! It is so important that you know the answer to your questions, and to continue
with the desire to learn and constantly improve. No one is ever finished learning 😊
Believe in yourself, you know how to do assessments and you can perform them
confidently! Keep up the awesome work Annie.

Student Signature: Annie Park Date: 03/21/19

Instructor Signature: Lauren Craig Date: 3/22/19

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18; 1/13/19