Carroll Community College

Division of STEM, Nursing and Allied Health

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

Faculty
Student Sweta Kantesaria Date 05/10/2021 Week # Emily
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 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
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 S
17. Communicates appropriately with patient, family, healthcare team, and instructor S S
18. Explains the actions, side effects, and nursing implications of medications N/A N/A
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
Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical

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

(Meets) (Requires assistance) (Unable) applicable behavior

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.

I do not have any experience with kids whatsoever. This clinical experience helped me a lot to get comfortable with pediatric
patients. I also able to perform some of the skills I learn during skills lab like frequent IV sight assessment and face scale for pain
assessment.

How did you specifically meet the course goals for this course? Give detail for each. (Reminder, course goals are listed on the
evaluation here in blue).
I abled to apply my knowledge about milestone development that I learn in class during my assessments for pediatric patients. I
realize how much it is important to identify the milestones for the patient in head to toe assessment for pediatric patients in order
to determine stages of growth and development. I able to prioritize my care when patient was calm and abled to communicate
with patient’s family effectively.

What is the biggest take away you have from this clinical rotation and how will that affect your future practice?

My biggest take away from this clinical was how to understand the sign about patient’s nonverbal behavior and act on patient’s
needs accordingly. It is also important to involve patient’s parents in daily care and teach appropriate measures whenever
necessary. I able to corporate in my nursing care provided to my assign patient.

What are your goals for your next clinical rotation?

My next goal for the next clinical to manage my time and priorities for multiple assigned patients at a time. I also will be willing to
take care more than one patient at a time to practice how to meet patient needs and attain priority effectively.

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).

Sweta- Great job at clinical. I felt that you were willing to learn and were able to incorporate the learning into your priorities and
assessment skills. Continue to watch and learn about non-verbal communication as you continue throughout your career. Excellent
work.

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

Student Signature: Sweta kantesaria Date: 05/10/2021

Instructor Signature: Professor H. Date: 5/11/2021

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