Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140t233

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Student Clinical Performance Evaluation - Summative

Date (Term/Year)$?vin0i4Location5'mrnrh AqlnrS FacultyA.:&il-y_g&IC&rL_

S = Satisfactory N = Needs lmprovement U = Unsatisfactory (*) Denotes critical behaviors.

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 improvemenfs in a critical behavior
- Two unsatisfactory grades in a non-critical behavior - Four needs j
in non-critical behaviors

Integrating Coneept:

and Ehviionment

OutG'ome I I ldentifires polidies, procedures-;

sifetyr,qqr.Crni, patint ettiiCiteristics, and

teamwork within the organizatio4alstructurq,with assistancer (PO/RNI-G Z:.Nursing Judgmint,
PO/RNLG 4: Spiritof tnquiru)
*Maintains
ethical accountabilitv for
in accordance with the ANA Code of Ethics.
"Maintains leoal accountabilitv for nu
in accordance with the
and Nurse Practice Act.
*Adheres
to HIPAA oui
confidentialit
Demonstrates the role of the nurse as
advocate.
lntegrating,,Gonceptr:. Knowledge and Science
outcomc2: ldbntifies knowledge ffom, nursing science and alliedhealttrloiteiplindsto:uegin,.: ' .'
designing and implementing pitient centerediare for individuals, families,
cornrnrniiies, with
"nd
asslstancG. ( POIRN l-G= 2, Nu rsi n s, J ud s menf, pO/R N I_G:,4 Soji, rT:of
Collects evidence related to clinical
from apt
resources.
lntegrates knowledqe of evidence based
ory from
and other disciplines to
Demonstrates accurate and holistic patient assessment skills.
Establishes apprqpriate nursing diagnoses based on patient aisessment.
Determines
related to n
Determines
and svmptoms related to
Determines
outcomes for n
Determines
interventions for
ino diaonoses and
lmplements care
to established plan and desired outcomes.
Evaluates

lnsliuctor
Eval of,l
Student,

SlN/U

lnstiuctor
rr

Eval of,

Student

.S/N'U

to care and revises plan as needed.

lntegrating Concept: Personal and Professionat Development

Outcome 3: ldentifies the need for the lifelong process of tearning nursing skills, values, and
behayioisi'withasgistalce..(PO/RNLGI,3 F/ofessional ldentity, pOnrule: * Siirit of
Discusses pati
of care with instructor.
ments as
red and submits on time
izes time efficientlv.

Eval'of

Student

SIN/U

.s

Demonstrates
and demeanor.
in self-reflection and communicates learninq needs to insiructon

lntegrating Concept: Quality and

outcome4:ldentifiesknowledgefro.mnursingscienceandalIiedhealthdisciplinestobegin
providing competent care based on.current standards of practice to.minimize'risk of harm to alt
members of the health care system through system effeciiveness and individual practice, wittr
assistance. (POIRNLG:1 Humai Ftourishing, PO/RNLG Z: Nursing Judgmeint, pbnn[O,t+l]qpmr
l
of lnouirvl
*Provides

safe care
to established standards of
Prioritizes patient care based on assessment.
into clinical
*Observes
infection control
Demonstrates accountabilitv and
for own actions and attitudes.
*Demonstrates
knowledqe of medications for
.Administers
medication safely usinq six
of medication adm inistration
N140_N233 Clinical Eval

1 1241201

lnstructor
Eval of
'Student,,
:

S/NIU