Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

Student Morgan Shade Date 10/22/2020 Week # 6 Faculty Mark Perry

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
Analyze the effectiveness of the plan of care (PG1) S/N/U S/N/U
Using faculty as a resource:
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 S S
7. Evaluates patient response to care and revises plan as needed S S
Instructor
Student Eval of
Course Goal 2 Self-Eval Student
Seek opportunities that promote professional growth (PG2) S/N/U S/N/U
Using faculty as a resource:
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 faculty as resource (PG3) S/N/U S/N/U
Using faculty as a resource:
14. *Implements appropriate infection control precautions S S
15. Identifies client’s cultural needs S S
16. Accurately documents patient care S S
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 S S
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 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

Instructor
Student Eval of
Course Goal 4 Self-Eval Student
Implement nursing care based on scientific evidence (PG4) S/N/U S/N/U
Using faculty as a resource:
26. Incorporates evidence-based rationales that support the patient 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 I was able to better define my role as a nurse by putting all the pieces together. This year I felt as though
everything began to make sense and I am thinking more like a nurse rather than a tech. When my clinical instructor was asking me
questions about my patients I felt as I was more readily able to answer the question properly and to the complete extent. This will
help me in my future practice because I will be better able to connect the dots when there is something, I am not sure about. This
will also help me be able to educate patients on their condition because the more I know the more I can tell the patient. I was also
able to pass medications this year that were in different routes such as IV ABX., PO, crushed in apple sauce and subQ injections.
Being able to successfully pass meds was a great accomplishment and made me feel slightly more comfortable in doing it. 
Which objective did you accomplish during this rotation? How did you do it?
This week I was able to accomplish watching another procedure. Unfortunately, I was not able to watch the complete procedure
due to the patient not being able to breathe laying down, so they had to place him on a non-rebreather and then the Bipap. I was
able to watch what was happening with him and how the nurses responded to the low O2 of the patient. I believe it is very
important to see "emergencies" that are not a complete emergency so I know how I should act and seeing what should be done in
certain situations. I was also able to see that they did not complete the cardiac Cath even with an increasing Trop. They did
perform an EKG on the patient to ensure he was "stable" to push him off until tomorrow and perform under general anesthesia.
Again, being able to watch the beginning stages of the procedure which turned into something else was important so I know how
to act, and I can educate future patients on what to expect. 
What are your goals for your next clinical rotation?
Next year I want to pass medications again successfully as well as connect the dots better. I also would like to see more procedures
that may be off the floor or at the bedside. I want to see more procedures so I can educate my patients about what they may
experience during it and to alleviate some anxiety. Next rotation I also want to master my head to toe assessment by memorizing
all of the steps because there are times that I have to go back and ask a question or look at the patient again. I want to master and
memorize the steps so I can begin to be more efficient in asking all the right questions when there is something abnormal with the
patient. 
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).

I am glad that this week you were able see a borderline decompensating/emergency happen with a patient. Remember this is
something that can happen one any floor, so just because you may be a med/surg nurse things happen.

Great job this semester. Honestly no issues with your clinical performance at all. Continue to ask questions and learn all that you
can. One thing I do want to commend you on is you always kept yourself busy and sought out learning opportunities when there
did seem to be any. This skill is going to take you places and help you grow leaps and bounds as a bedside nurse. There is always
more to learn!

Student Signature: Morgan Shade Date: 10/22/2020

Instructor Signature: Mark Perry Date: 10/22/2020

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 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

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