Carroll Community College

NURS 233 – Nursing Concepts 3

Weekly Student Clinical Performance Evaluation

Student Catherine Nye Date Week 1 Faculty Donna Rohrbaugh, RN, BS

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
Analyze the effectiveness of the plan of care (CSLO1) S/N/U S/N/U
1. *Prioritizes patient care based on assessment with faculty as a resource S S
2. *Demonstrates accurate patient assessment skills S S
3. Analyzes and incorporates data from the patient’s medical record in the provision of care S S
4. Uses patient assessment data to implement individualized plan of care with faculty as a S
resource S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient S
assessment with faculty as a resource S
6. Establishes measurable patient outcomes based on nursing diagnosis with faculty as a S
resource S
7. Establishes appropriate nursing interventions based on assessment with faculty as a S
resource S
8. Evaluates patient response to care and revises plan as needed with faculty as a resource NA S
Student Instructor
Self- Eval of
Outcome 2 Eval Student
Seek opportunities that promote professional growth (CSLO2) 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
16. Demonstrates initiative in assisting peers and healthcare team members in the clinical setting S S
Student Instructor
Self- Eval of
Outcome 3 Eval Student
Provide patient-centered care with faculty as a resource (CSLO3) S/N/U S/N/U
17. *Implements appropriate infection control precautions S S
18. Provides culturally sensitive care S S
19. Documents patient care accurately S S
20. Uses therapeutic communication skills S S
21. Follows through with all patient care S S
22. Demonstrates knowledge of medications for assigned patients S S
23. *Administers medication safely using six rights of medication administration NA N/A
24. Demonstrates caring behaviors S S
25. Uses SBAR effectively S S
26. Acts as an advocate for patients and families S S
Approved 12/4/14. Revised 12/10/2014; 01/2015
 Carroll Community College
NURS 233 – Nursing Concepts 3
Weekly Student Clinical Performance Evaluation

27. *Demonstrates physical and mental competence S S

28. *Identifies safety concerns and notifies instructor and appropriate healthcare team S
members S
29. Demonstrates time management techniques S S
30. Implements patient and family education and evaluates effectiveness of teaching S S
31. *Updates instructor and healthcare team regarding changes in the patient’s condition S S
32. *Provides nursing care based on the policies and procedures of the facility S S
33. *Provides nursing care in accordance with the Maryland Nurse Practice Act S S
34. *Adheres to HIPAA guidelines S S
35. *Provides care according to ANA Scope and Standards of Nursing Practice S S
Student Instructor
Self- Eval of
Outcome 4 Eval Student
Implement nursing care based on scientific evidence (CSLO4) S/N/U S/N/U
36. Incorporates evidence-based rationale that supports the patient’s plan of care S S
Student Reflection (Thoroughly answer all questions)
What did you learn this week that has contributed to your growth as a nurse? Please explain.

I learned that the discharge process, teaching involved and filled out the paperwork with assistance from the primary nurse. I also
learned about post open heart precautions (sternal precautions) I was able to put ecg leads on by myself and restart monitor after
helping patient shower.

Which objective did you accomplish this week? How did you do it?

I was able to actively participate in all clinical care of my patient. Also, able to use therapeutic communication. I was able to do all my
patient’s ADL’s and carry out her plan of care because I had a very good primary nurse that let me do many skills. I also got to use
therapeutic communication, because I was able to spend a lot of time with my patient and just listening to her. I was able to build a
good patient nurse relationship.

Do you have any concerns about your performance? If so, what are your plans for improvement? Please explain.

There is always room for improvement, I would like to improve on understanding the ECG strips. I want to continue to practice SBAR so
I can give a flawless report and a good picture of my patient to the oncoming nurse.

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).

Successful week 1, learning the floor routine and where to find things. Basic information documented correctly
in computer. No medications were administered this week. Will plan to add a second patient next week.

Student Signature: Catherine nye Date:10/31/19

Instructor Signature: Date:

Approved 12/4/14. Revised 12/10/2014; 01/2015