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Carroll Community College

Department of Nursing
NURS 140 – Nursing Concepts Two
Weekly Student Clinical Performance Evaluation

Date
04.17 Faculty
Student Nakia Williams .19 Week # Palmer
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
Apply the nursing process when implementing a plan of care (CO1) S/N/U S/N/U
1. *Prioritizes patient care based on assessment with assistance S S
2. Demonstrates accurate patient assessment skills S S
3. Incorporates data from the patient’s medical record in the provision of care S S
4. Uses patient assessment data to develop individualized plan of care with assistance S S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient S
assessment with assistance S
6. Establishes measurable patient outcomes based on nursing diagnosis with assistance S S
7. Establishes appropriate nursing interventions based on assessment with assistance S S
8. Evaluates patient response to care and revises plan as needed with assistance S S
Student Instructor
Self- Eval of
Outcome 2 Eval Student
Participate in 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 assistance (CO3) S/N/U S/N/U
16. *Implements appropriate infection control precautions S S
17. Provides culturally sensitive care with assistance S S
18. Documents patient care accurately with assistance S n/a
19. Uses therapeutic communication skills S S
20. Follows through with all patient care with assistance S S
21. Demonstrates knowledge of medications for assigned patients S S
22. *Administers medication safely using six rights of medication administration S n/a
23. Demonstrates caring behaviors S S
24. Uses SBAR to communicate patient status to instructor and healthcare team with s
assistance S
Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18; 1/13/19
Carroll Community College
Department of Nursing
NURS 140 – Nursing Concepts Two
Weekly Student Clinical Performance Evaluation

25. Acts as an advocate for patients and families with assistance S S


26. *Demonstrates physical and mental competence S S
27. *Identifies safety concerns and notifies instructor and appropriate healthcare team S
members S
28. Demonstrates time management techniques S S
29. Implements patient and family education S S
30. *Updates instructor and healthcare team regarding changes in the patient’s condition S S
31. *Provides nursing care based on the policies and procedures of the facility S S
32. *Provides nursing care in accordance with the Maryland Nurse Practice Act S S
33. *Adheres to HIPAA guidelines S S
34. *Provides care according to ANA Scope and Standards of Nursing Practice S S
Student Instructor
Self- Eval of
Outcome 4 Eval Student
Plan nursing care based on scientific evidence (CO4) S/N/U S/N/U
35. Justifies patient’s plan of care based on current evidence s s
Student Reflection (Thoroughly answer all questions)
What did you learn this week that has contributed to your growth as a nurse? Please explain.
It helped me to perform basic care with being comfortable to deal with the elderly population

Which objective did you accomplish this week? How did you do it?
Skin integrity, assess the pt’s skin daily

Do you have any concerns about your performance? If so, what are your plans for improvement?
Please explain. To make sure that I am wearing the correct shoes before coming to clinical

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).

Nakia, I have taken the liberty of completing your form- using your answers from the scanned document- onto
this form that can be sent by email
You will receive 16/16 points for your presentation on sleep disorders. I am so glad this made a personal
difference for you.
I appreciated your honesty and willingness to jump right in at the clinical site. I hope you can see the geriatric
population are complex medically, and while skin is certainly important, there are many additional health risks
and priorities to be concerned about. You had a nice demeanor with your residents and also added to our
group discussions.
In terms of readiness for clinical (and eventually you “real job” as a RN), try to get yourself in the habit of
everything laid out and ready to go the night/ period of time before you will report. I am sure you likely did this
in your other professional positions. Being ready to go and not having to be concerned about the routine things
such as your uniform will enable you to focus on the care of your patients. Just reduces the burden of
preparing yourself along with whatever else you must do to get out the door.

Student Signature: Nakia Williams Date:04/17/19


Instructor Signature: Carol Palmer Date: 04/25/19

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18; 1/13/19