Carroll Community College

Department of Nursing
NURS 140 – Nursing Concepts Two
SUMMATIVE Student Clinical Performance Evaluation
Student Nakia Williams Date 3/21/2019 Week # Faculty Northwest
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 S S
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.
Clinical rotation helped me to integrate skills and knowledge that was taught in lecture into the clinical setting
and to have a better understanding of the objectives taught.

Which objective did you accomplish during this rotation? How did you do it?
The objective that I completed was perfusion. My patient had orthopedic surgery of the left knee and the way
that perfusion was used was by providing the patient with VTE to prevent venous thromboembolism which she
is at risk for due to surgery.

What are your goals for your next clinical rotation?

To have more confidence in myself and my skills.

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).

Nakia really did an excellent job this rotation. She is constantly asking appropriate questions, and trying to
understand more and more about each patient. She performs very thorough assessments and notices if
something is abnormal and then speaks to me or the nurse about it. One specific strength that Nakia has is
that she consistently builds great rapport with her patients. She is very personable when communicating with
them and you can tell that the patient feels very comfortable with her around. That is a skill that will take you
far, keep up the awesome work with that.
Documenting her assessments is another skill Nakia learned this rotation. By the end, she could navigate
quickly without needing much help at all.
When it comes to giving report at the end of the day, Nakia is very detailed and you can tell that throughout the
day she really tries to learn her patient through and through. Excellent report giving skills.
She is safe at giving medications, exercising the 6 rights of administration.
Keep up the amazing work, have confidence in yourself and keep asking questions!

Student Signature: Nakia Williams Date: 3/21/19

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18; 1/13/19

Instructor Signature:
Carroll Community College
Department of Nursing
NURS 140 – Nursing Concepts Two
SUMMATIVE Student Clinical Performance Evaluation
Lauren Craig Date: 3/22/19

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