Carroll Community College

Division of STEM, Nursing and Allied Health

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

Student Melody Voland Date 11/23/21 Week # 1 Faculty Dr. Schlaerth

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 N NA
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
in the patient’s condition S 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 &
Standards of Nursing Practice S 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.

For this clinical rotation, I realized that obstetrics is a completely individual, specialized field of nursing with many different
concerns than other areas of work. Not only are you caring for certain patients pre and post operation, but you are also caring for
newborn babies. I think this obstetrics clinical brings many nursing care considerations together in one unit.

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).
1- I, with the help of my nurse, made assessments to our patient who had delivered via a c-section and intervened according
to the assessments made. For example, when assessing pain, the patient complained and therefore, we administered the
PRN pain medication.
2- I was able to bath a newborn baby for the first time, and I learned a lot about the proper technique and will feel more
comfortable to do this on my own in the future.
3- With the help of Dr. Schlaerth, I was able to write and discuss my nursing priorities for my patient, make SMART goals for
her, and evaluate the effectiveness of my interventions.
4- I was able to encourage my patient to ambulate and void after assessing the lochia and fundal height of the patients’
uterus. Without this data, ambulation would not have been encouraged.

What is the biggest take away you have from this clinical rotation and how will that affect your future practice?
From this rotation, I learned that the human body is really a wonderful functioning unit and the ability of a woman to give birth and
then be still able to continue living normally is incredible to me.

What are your goals for your next clinical rotation?

For my next clinical rotation, I would like to practice administering medications and I would love the opportunity to see a vaginal
and c-section birth.

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).

It was such a pleasure to have you in clinical, Melody. I agree with your personal reflection and assessment. You had a very active
clinical day, and were able to witness and participate in a lot of direct patient care. Based on your assessment you set appropriate
SMART outcomes and implemented nursing actions to achieve those goals. When asked Socratic questions you were able to
accurately answer and explain why you came to that decision. You were able to make the connections between the patients and
their labs, presentation, or EFM strips. I wish you the best of luck in your future!

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

Student Signature: Melody Voland Date: 11/23/21

Instructor Signature: Date: 12/16/2021

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