Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 133 – Nursing Concepts 1
SUMMATIVE Student Clinical Performance Evaluation

Student Morgan Shade Date 11/19/2019 Week # 4 Faculty Carroll hospital

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
Use the components of the nursing process when creating a plan of care (CO1) S/N/U S/N/U
1. *Prioritizes patient care based on assessment with coaching S S
2. Demonstrates accurate patient assessment skills with coaching S S
3. Gathers data from the patient’s medical record to provide patient care S S
4. Uses patient assessment data to develop individualized plan of care with coaching S S
5. Establishes appropriate nursing priority list based on collected evidence and patient S
assessment with coaching S
6. Establishes measurable patient outcomes based on nursing priorities with coaching S S
7. Establishes appropriate nursing interventions based on assessment with coaching S S
8. Evaluates patient response to care and revises plan as needed with coaching S S
Student Instructor
Self- Eval of
Outcome 2 Eval Student
Develop an awareness of 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 coaching (CO3) S/N/U S/N/U
16. *Implements appropriate infection control precautions S S
17. Provides culturally sensitive care with coaching S S
18. Documents patient care accurately with coaching N/A NA
19. Uses beginning therapeutic communication skills S S
20. Follows through with all patient care with coaching S S
21. Verbalizes knowledge of medications for assigned patients S S
22. Demonstrates caring behaviors S S
23. Uses SBAR to communicate patient status to instructor with coaching S S
24. Identifies issues needing advocacy for assigned patients S S
25. *Demonstrates physical and mental competence S S
26. *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
 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 133 – Nursing Concepts 1
SUMMATIVE Student Clinical Performance Evaluation

members
27. Identifies ways to spend clinical time more efficiently S S
28. Identifies patient and family health education needs S S
29. *Updates instructor and healthcare team regarding changes in the patient’s condition S S
30. *Provides nursing care based on the policies and procedures of the facility S S
31. *Provides nursing care in accordance with the Maryland Nurse Practice Act S S
32. *Adheres to HIPAA guidelines S S
33. *Provides care according to ANA Scope and Standards of Nursing Practice S S
Student Instructor
Self- Eval of
Outcome 4 Eval Student
Explore the scientific evidence that supports the patient’s plan of care (CO4) S/N/U S/N/U
34. Identifies evidence-based rationale that supports the patient’s plan of care 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 better defined me as a nurse because it helped me begin to change my thinking from
a PCT standpoint to beginning to think like a nurse. I also think that this has helped me because there are a
variety of patients on the floor and they were all there for different reasons. I also got to incorporate all the
things that we learned in nursing concepts and bring them about and use them towards my plan of care as well
as asking questions and being questioned.
Which objective did you accomplish during this rotation? How did you do it?
I believe that I have successfully learned how to do a head to toe assessment with some fine tuning that needs
to be done. I have completed this task by attending my health assessment class as well as practicing on family
members to remember all the steps that go along with it. I have also followed the nurse when they go into the
room to do their assessment and learning as well as doing helps.
What are your goals for your next clinical rotation?
I would like to master my head to toe assessment, begin to pass meds and incorporating the 6 rights and 3
checks that go along with medication administration. I also plan on bringing all the new concepts learned in the
next term and add them into my knowledge and better attend to my patients.

Faculty Comments:
You did indeed begin the transition from PCT to student nurse and will continue in that growth until you
graduate. Then you never stop learning. You were generous in sharing your knowledge with your fellow
students- many of them implemented your suggestions. You already had a confident manner in approaching a
patient or family as well as staff.
You are also right to focus on your assessment- to recognize the abnormal by knowing the normal
You will not give meds in long term care or peds but it is crucial always to avoid med errors
The concept maps become a way to think like the nursing process and implement that in your care of patients.

Student Signature: Morgan Shade Date: 11/19/2019

Instructor Signature: Carol Palmer, RN, BSN, MA Date: 11252019

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