Carroll Community College

Department of Nursing
NURS 140 – Nursing Concepts Two
SUMMATIVE Student Clinical Performance Evaluation

Student Margaret Snyder Date 2/27/19 Week # 1-2 Faculty Tammy K/Alexandra G
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 N N
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 N S
22. *Administers medication safely using six rights of medication administration NA N/A
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

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
27. *Identifies safety concerns and notifies instructor and appropriate healthcare team S
members S
28. Demonstrates time management techniques S S
29. Implements patient and family education N N
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 has helped me define my role as a nurse by witnessing in real time how nurses prioritize
and balance patient care, charting, assessments, and medications all within the shift by order of importance.
Understanding how to use clinical judgement and realizing nothing is black and white in nursing has helped to
apply what we learn in concepts lecture to patients and processes on the floor.

Which objective did you accomplish during this rotation? How did you do it?
I accomplished several objectives during this clinical, one in particular I feel I accomplished was performing
specific assessments appropriate to the patients diagnosis. We learn how to do the various systems
assessments but applying them to real patient to determine what assessments they need is crucial as well. We
had a patient with a brain tumor do performed a thorough neurological assessment as well as a GI
assessment for his constipation, while additionally performing respiratory and cardiac assessments, these
were less related to his diagnosis and less likely to result in crucial changes.

What are your goals for your next clinical rotation?

My goals for the next clinical rotation will be to prioritize my education more and put myself in positions to
learn, ask more questions and try to see more assessments, procedures, and processes to expand my
knowledge as much as possible and take advantage of this learning environment. In addition, I would also like
to work with becoming more comfortable with patients and parents and be confident and comfortable in my
role as a student nurse and act confidently within my scope of practice.
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).

Maggie had a great pediatric clinical experience. It was evident she had passion in caring for children and confidence in
her skills. Her documentation on the computer was excellent and timely as well. I am glad you saw how the nurses
prioritize and organize their day and assess the patient by systems which is important in all ages but especially in
pediatrics. The policy where I worked was to perform a head to toe assessment each shift and then only the system
affected every 4 hours, so this is where you identify what your priority systems are and how you would assess them. You
were able to start gtube feeds independently and helped care for twin brothers to allow the mom to rest for a while, which
is so important in pediatric nursing- caring for the whole family. Great job this rotation and good luck in future clinical
experiences this semester.
Student Signature: Maggie Snyder Date: 3/6/19
Instructor Signature: Tammy Keller Date: 3/11/19
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

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