Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140 – Nursing Concepts 2
SUMMATIVE Student Clinical Performance Evaluation

Student Date Week # Faculty

Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical
(Meets) (Requires assistance) (Unable) applicable 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
Instructor
Student Eval of
Course Goal 1 Self-Eval Student
Apply the nursing process when implementing a plan of care (PG1) S/N/U S/N/U
With assistance:
1. Prioritizes and completes daily nursing tasks S S
2. Completes assessments accurately S s
3. Uses EMR/MAR, patient charts, handoff report to provide care S S
4. *Establishes appropriate nursing priority list S S
5. Creates measurable patient outcomes S N
6. Establishes appropriate nursing interventions S S
7. Evaluates patient response to care and revises plan as needed S N
Instructor
Student Eval of
Course Goal 2 Self-Eval Student
Participate in opportunities that promote professional growth (PG2) S/N/U S/N/U
With assistance:
8. Adheres to dress code S S
9. Seeks input from patient, instructor, and healthcare team when providing care S S
10. *Demonstrates accountability and accepts responsibility for own actions and attitudes S S
11. Actively participates in all clinical experiences S S
12. Communicates learning needs to instructor S S
13. Completes assignments/evaluations as required S S
Instructor
Student Eval of
Course Goal 3 Self-Eval Student
Provide patient-centered care with assistance (PG3) S/N/U S/N/U
With assistance:
14. *Implements appropriate infection control precautions S S
15. Identifies client’s cultural needs S S
16. Accurately documents patient care NA N/A
17. Communicates appropriately with patient, family, healthcare team, and instructor S S
18. Explains the actions, side effects, and nursing implications of medications S S
19. *Administers medication using the six rights NA N/A
20. Demonstrates concern, compassion and empathy with patients S S
21. *Demonstrates physical and mental competence S S
22. *Notifies instructor and appropriate healthcare team members with safety concerns and changes S
in the patient’s condition S
23. Identifies patient and family health education needs S S
24. Provides nursing care in accordance with the Maryland Nurse Practice Act and the ANA Scope & S
Standards of Nursing Practice S
25. *Adheres to HIPAA guidelines S S
Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical
(Meets) (Requires assistance) (Unable) applicable behavior

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 – Nursing Concepts 2
SUMMATIVE Student Clinical Performance Evaluation

Instructor
Student Eval of
Course Goal 4 Self-Eval Student
Plan nursing care based on scientific evidence (PG4) S/N/U S/N/U
With assistance:
26. Justifies patient’s plan of care using appropriate resources 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 gave me a hands-on nursing experience with both a school age child and an infant. While there are many
similarities to care with adults, there are differences in the assessments, med admin, and very different communication techniques
required. The other big difference is the additional role you play with parents. Additionally, there were many challenging diagnoses
to learn about on this clinical rotation. For example, the 7-year old patient I was assigned had a cystic teratoma removed from her
uterus, and the infant had a subgaleal shunt along with many other complicated diagnoses. It was heartbreaking to know the baby
has had so much to overcome at such a young age.

Which objective did you accomplish during this rotation? How did you do it?
With my school-age patient, my biggest hurdle was to build rapport with her in order for her to allow me to do my assessments. I
got down at her eye-level to talk to her and asked her if she goes to school. Then I asked if she gets assignments for school and
explained that I was in school and that doing my assessments were my assignment. She allowed me to do my assessments after
that and our rapport grew from there. Another surprising lesson was how much I needed to also be there as a sounding board for
the mom and to help with the younger brother.
With my infant patient, I was able to complete a full head-to-toe assessment. His complicated diagnoses meant his assessment was
complex. While it is unfortunate that he was a “Code Blue”, it showed me how quickly an infant’s condition can change. I was able
to see how the nurse handled the stressful situation calmly and professionally.

What are your goals for your next clinical rotation?

I hope to take the learning that I have gained from my first two clinical rotations and apply it to the new learning experiences at my
next clinical rotations.

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).

Kelly,
You did an amazing job with your school age patient on the first week. I was pleased with your responds to the school age child and
will personally be using that when I do assessments for that population. The second week, you had a more complex baby and say a
code blue situation, it is a very intense situation and I am glad you handled it calmly. Practice the head to toe assessment in your
head and be able to talk it out without notes. You asked me great questions and had good participation with patients and our
group discussions. Remember to notify your nurse of any vital sign changes and to know the normal for each age group and be able
to report to the nurse so the nurse can assess the patient. Overall pleased with your performance, and I hope pediatrics didn’t
frighten you too much!

Student Signature: Kelly Rodier Date: 2/10/2020

Instructor Signature: Profesor Emily Habighorst Date: 02/11/2020

Definitions:
Coaching – Faculty guides student to define objectives, set goals, and develop action plans through collaboration in the decision-making process
Assistance – Student unable to perform task independently; needs some aid or minimal direction from faculty to complete tasks. Not autonomous but does not
require coaching.
Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020
Resource - Faculty serves as a facilitator but student is capable of completing self-directed tasks.