Carroll Community College

Division of STEM, Nursing and Allied Health

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

Student Amanda Ceresa Date 2/14/2020 Week # 1 Faculty Prof. Steinhice

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 S
6. Establishes appropriate nursing interventions SS S
7. Evaluates patient response to care and revises plan as needed S
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 S 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 N 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
WEEKLY 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)
What did you learn this week that has contributed to your growth as a nurse? Please explain.
I LEARNED ABOUT EQUIPMENT AND MEDS THAT I HAVE NEVER USED/SEEN BEFORE. I ALSO LEARNED THIS WEEK ABOUT CIWA
PROTOCOL AND HOW ALCOHOL WITHDRAWL AFFECTS A PERSONS BODY SYSTEMS.
Which objective did you accomplish this week? How did you do it?
I WAS ABLE TO SPEND MORE TIME WITH MY PATIENT IN ORDER TO BETTER UNDERSTAND HER PLAN OF CARE, AND WAS ABLE TO
HAVE A MORE HANDS-ON APPROACH IN HELPING PLAN FOR HER CARE ALONG SIDE THE PRIMARY NURSE. AFTER HAVING A LAB
ON SUCTION AND NG TUBES, I WAS ABLE TO SEE THOSE DEVICES IN USE AND HAVE A BETTER UNDERSTANDING OF HOW THEY
WORK.
Do you have any concerns about your performance? If so, what are your plans for improvement? Please explain.
I THOUGHT THAT MY PERFORMANCE THIS WEEK WAS ACCEPTABLE. I UTILIZED MY TIME WISELY LOOKING UP MEDS AND
INFORMATION ABOUT MY PATIENT THAT WOULD HELP ME UNDERSTAND HER DIAGNOSIS BETTER. I WAS ALSO ABLE TO HELP
OTHER PATIENTS ON THE FLOOR WITH TASKS THAT BECAUSE OF THE NURSES DEMAND WITH OTHER PATIENTS, WOULD HAVE
HAD TO WAIT ON.

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).

Amanda had a good first week. She was willing to help out wherever was needed on the unit. She had time to learn the computer
system so that next week when she has to document, she will know it better. She communicated well with the patient, primary
nurse and me. She was able to spend time with her patient getting to know them. She was able to discuss her safety observation at
mid-day conference.
Keep up the good work!!

Student Signature: Amanda Ceresa Date: 02-14-2020

Instructor Signature: Dorothy Steinhice BSN, RN Date: 2/15/2020

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.
Resource - Faculty serves as a facilitator but student is capable of completing self-directed tasks.

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