Carroll Community College

Division of STEM, Nursing and Allied Health

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

Student Heather Winkler Date 10/1/2019 CSE # Faculty Professor Steinhice

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
Analyze the effectiveness of the plan of care (CSLO1) S/N/U S/N/U
1. *Prioritizes patient care based on assessment with faculty as a resource S S
2. *Demonstrates accurate patient assessment skills S S
3. Analyzes and incorporates data from the patient’s medical record in the provision of care S S
4. Uses patient assessment data to implement individualized plan of care with faculty as a S
resource S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient S
assessment with faculty as a resource S
6. Establishes measurable patient outcomes based on nursing diagnosis with faculty as a S
resource S
7. Establishes appropriate nursing interventions based on assessment with faculty as a S
resource S
8. Evaluates patient response to care and revises plan as needed with faculty as a resource S S
Student Instructor
Self- Eval of
Outcome 2 Eval Student
Seek opportunities that promote professional growth (CSLO2) 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 N
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
16. Demonstrates initiative in assisting peers and healthcare team members in the clinical setting S S
Student Instructor
Self- Eval of
Outcome 3 Eval Student
Provide patient-centered care with faculty as a resource (CSLO3) S/N/U S/N/U
17. *Implements appropriate infection control precautions S S
18. Provides culturally sensitive care S S
19. Documents patient care accurately S S
20. Uses therapeutic communication skills S S
21. Follows through with all patient care S S
22. Demonstrates knowledge of medications for assigned patients S S
23. *Administers medication safely using six rights of medication administration NA N/A
24. Demonstrates caring behaviors S S

Approved 12/4/14. Revised 12/10/2014; 01/2015

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

25. Uses SBAR effectively S S

26. Acts as an advocate for patients and families S S
27. *Demonstrates physical and mental competence S S
28. *Identifies safety concerns and notifies instructor and appropriate healthcare team S
members S
29. Demonstrates time management techniques S S
30. Implements patient and family education and evaluates effectiveness of teaching S S
31. *Updates instructor and healthcare team regarding changes in the patient’s condition S S
32. *Provides nursing care based on the policies and procedures of the facility S S
33. *Provides nursing care in accordance with the Maryland Nurse Practice Act S S
34. *Adheres to HIPAA guidelines S S
35. *Provides care according to ANA Scope and Standards of Nursing Practice S S
Student Instructor
Self- Eval of
Outcome 4 Eval Student
Implement nursing care based on scientific evidence (CSLO4) S/N/U S/N/U
36. Incorporates evidence-based rationale that supports the patient’s 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.
This clinical rotation has helped me to see how the psychiatric setting differs from the medical setting. Patients
on the psychiatric unit have different needs in this setting. While there may be somatic issues, the focus is on
their mental health and getting them resources to help them manage their symptoms when they are
discharged from the hospital.
Which objective did you accomplish during this rotation? How did you do it?
I was able to utilize critical thinking when participating in our post-conferences to discuss the unit and specific
concerns. I was able to practice therapeutic communication with patients I spoke with such as active listening
and asking open-ended questions to allow the patient to elaborate on details they might be willing to share.
What are your goals for your next clinical rotation?
My next clinical rotations include OB and acute care. My goal is to utilize what I’ve learned in the psychiatric
rotation and apply it to patients in those settings as well. Everyone’s mental health is important, and I hope to
be able to help them find ways to manage those needs while also attending to their somatic issues.

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).
Heather did an excellent job using therapeutic communication skills to gain patients trust and get them to open
up. She was comfortable on the unit and the patients could see this in her. She had no problems starting a
conversation with anyone.
Heather’s focused inter interaction was done very well. She was able to run the goals group on 9/30/2019
when asked by staff.
Heather received a N on #12 due to being late on 9/30/2019.
It was a pleasure having her in my clinical rotation.
Student Signature: Heather Winkler Date: 10/1/2019
Instructor Signature: Dorothy Steinhice RN, BSN Date: 10/2/2019

Approved 12/4/14. Revised 12/10/2014; 01/2015