Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
Student

Heather Cheeks

Date
10/25/15

Location HCGH

Faculty

Professor Sparhawk

N/A = Not
(*) Critical behavior
applicable
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
Outcome 1
SelfEval of
Evaluate the effectiveness of a plan of care using the nursing process to achieve patient
Eval
Student
outcomes.
S/N/U
S/N/U
Collects evidence related to assigned patient(s) from appropriate resources.
S
S
*Demonstrates accurate patient assessment skills.
S
S
S
Establishes nursing diagnoses based on patient assessment.
S
*Prioritizes patient care based on assessment.
S
S
Identifies measurable patient outcome based on nursing diagnosis.
S
S
Implements care according to established plan and desired outcomes.
Uses therapeutic communication techniques during nurse/patient interactions to facilitate
S
S
the nursing process.
*Identifies appropriate interventions based on assessment.
S
S
*Demonstrates knowledge of medications for assigned patients.
S
S
*Administers medication safely using six rights of medication administration.
S
S
*Implements appropriate infection control precautions.
S
S
Follows through with all patient care.
S
S
*Evaluates patient response to care and revises plan as needed.
S
S
Student Instructor
Outcome 2
SelfEval of
Assimilate into the profession of nursing with a commitment to lifelong learning and personal
Eval
Student
and professional growth.
S/N/U
S/N/U
Participates actively in all aspects of the clinical experience.
S
S
Discusses patients plan of care with instructor.
S
S
Demonstrates professional behavior and appearance.
S
S
Engages in self-reflection and communicates learning needs to instructor/preceptor.
S
S
Completes assignments as required and submits on time.
S
S
Organizes time efficiently.
S
S
Student Instructor
Outcome 3
SelfEval of
Provide culturally competent, holistic care using respectful and caring behaviors.
Eval
Student
S/N/U
S/N/U
Demonstrates caring behaviors with the ability to develop and maintain therapeutic relationships
S
with people from diverse backgrounds.
S
Considers patient values, cultural characteristics and religious differences when planning care.
S
S
Student Instructor
Outcome 4
SelfEval of
Collaborate with healthcare teams to provide patient-centered care.
Eval
Student
S/N/U
S/N/U
Identifies patient/family health education needs.
S
S
Implements patient and family education.
S
S
Seeks input from patient, instructor, peers, and healthcare team in the delivery of patient care.
S
S
*Updates instructor and healthcare team regarding changes in the patients condition.
S
S
*Identifies safety concerns and notifies instructor and appropriate healthcare team members.
S
S
Demonstrates initiative in assisting peers and healthcare team members in the clinical setting.
S
S
Demonstrates communication skills using SBAR.
S
S
S = Satisfactory

N = Needs Improvement

Approved 12/41/4. Revised 12/9/2014

U = Unsatisfactory

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation SUMMATIVE
Acts as an advocate for patients and families.
Outcome 5
Model a spirit of inquiry that supports evidenced-based practice.
Applies evidenced-based rationale that supports the patients plan of care.
Integrates knowledge from nursing and other disciplines to plan care.
Outcome 6
Practice within legal and ethical principles to deliver safe and competent care based on current
standards of practice.
Adheres to attendance policy.
*Demonstrates safe clinical practice.
*Provides nursing care based on the policies and procedures of the facility.
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act.
*Adheres to HIPAA guidelines regarding patient confidentiality.
*Provides care according to the ANA Nursing Scope and Standards of Practice.
*Demonstrates accountability and responsibility for own actions and attitudes.

S
Student
SelfEval
S/N/U
S
S
Student
SelfEval
S/N/U
S
S
S

S
Instructor
Eval of
Student
S/N/U
S
S
Instructor
Eval of
Student
S/N/U
S
S
S
S

S
S
S
S
S
S
S
Student Instructor
Outcome 7
SelfEval of
Research and communicate information through appropriate technology.
Eval
Student
S/N/U
S/N/U
Gathers data from the electronic medical record to provide patient care.
S
S
Uses electronic medical record to document patient care accurately and in a timely manner.
S
S
Student Learning Goals (List desired learning goals, and your plans to meet them, for the next weeks clinical
experience. Goals should be based on identified performance issues and the desire for new knowledge and
experiences.)
Overall I felt that I had a very good clinical experience at Howard County General Hospital. I truly felt that I learned a lot
and the staff was very helpful and cooperative. My instructor was willing to take the time to explain techniques and
concepts to me, and I felt comfortable coming to her to ask questions and for direction. I felt that I gained the most
experience with medication administration during this clinical rotation, which will help me immensely as I move forward
in the future. This was truly one of the best clinical experiences I have had.
Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
comments are necessary to clarify student performance**)
It has been a pleasure to watch Heather grow in her confidence and abilities. She has successfully managed
her time, completed assignments, and administer medications. She is compassionate and competent. She is
willing to help where needed and she is eager to learn. She was the quietest among her classmates but she
was the best in being a team player. I commend Heather on tackling new experiences, she may have been
nervous but she did not express it. She walked boldly. Continue on Heather, you will be a caring nurse who
calms and nurtures her patients. It has been a pleasure working with you!

Student Signature:

Heather Cheeks

Date:

10/25/15

Preceptor/Instructor
Signature:

Teresa Sparhawk MSN, RN

Date:

10/27/15

Approved 12/41/4. Revised 12/9/2014