Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 133
Summative Student Clinical Performance Evaluation- Fall 2014
Student:

Tracey Graf

S =Satisfactory

N =Needs Improvement

U =Unsatisfactory

(*)Denotes critical behaviors

S =Satisfactory
N =Needs Improvement
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 improvements in a critical behavior
Two unsatisfactory grades in a non-critical behavior
- Four needs improvements in non-critical behaviors

Outcome 1
Explain the use of the nursing process when creating a plan of care. (SLO 1, GE 3)
Collects patient data related to clinical practice from appropriate resources.
Demonstrates accurate patient assessment skills.
Prioritizes patient care based on assessment.
Determines an individualized plan of care based on patient assessment.
Outcome 2
Identify learning opportunities that promote personal and professional growth. (SLO 2, GE 5)
Actively participates in clinical simulation.
Discusses patient's plan of care with instructor.
Engages in self-reflection and communicates learning needs to instructor.
Outcome 3
Identify the importance of various cultural norms and belief systems in the delivery of holistic
healthcare to patients and their families. (SLO 3, GE 6)
*Respects patients' rights with regard to their dignity and human worth.
Demonstrates ability to develop and maintain therapeutic relationships with people from diverse
backgrounds.
Considers patient values, cultural characteristics and religious differences when planning care.
Outcome 4
Identify self as a member of the healthcare team. (SLO 4, GE 1)
Demonstrates initiative in assisting peers and health care team members in the simulation setting.
Seeks input from patient, instructor, and peers in the delivery of patient-centered care.
Begins to identify resources that promote patient health, safety, and well-being.
Demonstrates beginning therapeutic communications skills.
Identifies patient health education needs and implements teaching.
Demonstrates professional communication skills using SBAR.
Outcome 5
Explain the importance of scientific evidence to guide nursing practice. (SLO 5, GE 2)
Identifies scientific rationale that supports a patient's plan of care.
N133 Clinical Eval Reviewed: 01/2013,
8/28/2014

Student
SelfEvaI
S/N/U

Instructor
Eval of
Student
S/N/U

s
s
s
s

s
s
s

s
s
s

s
s

Student
SelfEvaI
S/N/U

Student
SelfEvaI
S/N/U

s
s
Student
SelfEvaI
S/N/U

Instructor
Eval of
Student
S/N/U

Instructor
Eval of
Student
S/N/U

s
s
s

Instructor
Eval of
Student
S/N/U

s
s
s
s
s
s

s
s
s
s
s
s

Student
SelfEvaI
S/N/U

Instructor
Eval of
Student
S/N/U

Begins to integrate knowledge from nursing theory and other disciplines to plan care.
Outcome 6
Identify legal and ethical principles and professional standards of practice basic to the care of
patients and their families. (SLO 6, GE 7)
*Maintains ethical accountabilityfor nursinq practice in accordance with the Code of Ethics.
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act.
*Adheres to HIPAA guidelines regarding patient confidentiality.
*Provides safe care according to ANA Standards of Nursing Practice.
*Observes appropriate infection control precautions.
Identifies safety concerns and notifies instructor and appropriate healthcare team members
Demonstrates accountability and responsibility for own actions and attitudes.
Outcome 7
Use technological resources in the delivery of healthcare to patients.(SLO 7, GE 4)
Documents patient care accurately and in a timely manner using the written or electronic health
record.
Demonstrates competency with technologies and standardized practices that contribute to safety
and quality of care.

s
s
s
s
s
s
s

Student
SelfEvaI
S/N/U

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

s
s

Instructor
Eval of
Student
S/N/U

Instructor
Eval of
Student
S/N/U

s
s

Student Reflection; Looking back on the semester:

How have you grown as a nurse? Please explain and use specific examples.
Ihave become more comfortable with performing a head to toe assessment. Ihave practice each week in
assessment class and have learned why assessment is so important. With the help of my instructor I have
become more confident in my ability to determine and construct a nursing diagnosis. By this ability Iam
able to make connections with a concept map with the material that Ihave learned in lecture.By applying
what Ihave
learned throughout the course Iam hoping to bring to material with me to following semesters.
Do you have any continuing concerns about your performance? Please explain.
Iam nervous about starting clinicalnext semester. Iam worried that I will not be able to retain the information
that will be needed to prepare for that clinical day.Iam concerned that I will not know that answers to
questions that patients will ask me and how to respond to those answers. I understand that I will not know
everything but I still want to be confident" in my ability to perform important skills. With the help of my
instructors my hope is to be successfulin the semesters to come. It's ok to tell someone that you don't know
the answer, but you follow up with, "I'll find someone who does".
Student Learning Goals (List desired learning goals for the next clinical experience. Goals should be based on
identified performance issues and the desire for new knowledge and experiences.)
1) I will be able to carry all of the information that I have learned this semester to following semesters.
2) I will be able to recall information needed in preparation for that clinicalday.
3) I will be able to respond appropriately to clients and their families/support systems.
Faculty Comments/ Student Learning Goals (If an item was identified as Nor U, narrative comments are
necessary to clarify student performance) Tracey has grown in confidence over this term. She is able to think
through ideas and concepts, and connect the dots of theory and application. Her experience with patient care
is

evident in her level of comfort interacting with her patients. Ifeel confident that if Tracey continues to work
on her short and long term goals; she will be successful in terms to come.

Student Signature:

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Instructor Signature:

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Date:

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