Carroll Community College

Department of Nursing
NURS 140 – Nursing Concepts Two
SUMMATIVE Student Clinical Performance Evaluation
Student Gretchen Ruprecht Date 2/21/19 Week # 1 Faculty Tammy Keller
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
Instructor
Student Eval of
Outcome 1 Self-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 N
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
Instructor
Student Eval of
Outcome 2 Self-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-centered S
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
Instructor
Student Eval of
Outcome 3 Self-Eval Student
Provide patient-centered care with assistance (CO3) S/N/U S/N/U

16. *Implements appropriate infection control precautions S 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
SUMMATIVE Student Clinical Performance Evaluation
17. Provides culturally sensitive care with assistance S S
18. Documents patient care accurately with assistance S S
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 N/A N/A
23. Demonstrates caring behaviors S S
24. Uses SBAR to communicate patient status to instructor and healthcare team with S
assistance S

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 N
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
Instructor
Student Eval of
Outcome 4 Self-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

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
SUMMATIVE Student Clinical Performance Evaluation
Student Reflection (Thoroughly answer all questions)
How has this clinical rotation helped to define your role as a nurse? Please explain.

This rotation helped define my role as a nurse because there was more communication with patients parents
then experienced last semester. It was also different to experience patients being in the hospital for such an
extended amount of time.

Which objective did you accomplish during this rotation? How did you do it?

Participate in opportunities that promote professional growth (CO2). I found more comfortable speaking with my patients
this semester and making sure to be a part of every single part of the patients care. I felt I took initiative and asked
questions whenever I could.

What are your goals for your next clinical rotation?

Ask as many questions as I can and to continue to provide the best care I can give. Continue to gain comfort in
patients room and gaining more confidence.

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).

You did a great job taking care of your 2 month old with NG feeds this week. Unfortunately we didn’t have a
second week to continue learning how to care for pediatric patients with the language barrier and when parents
don’t always want us interrupting to provide care. You did a great job working with the nurse Emily and
communicating your needs with her. You appear confident and comfortable in the pediatric setting which is
great, and wanted to learn and see all the different patients which is a great quality. I would encourage you to
continue to work on assessments and identifying nursing priorities, although you were able to identify your
priority assessment for your patient. It is hard as a student and new graduate nurse to see the big picture and
critically think about what is going on with the patient, and you were on the right track- so keep up the
motivation you have and think about all of the systems involved with the patient and what is going on.
Otherwise great job in pediatric clinical and keep up the good work!

Student Signature: Gretchen Ruprecht Date: 2/21/19

Instructor Signature: Tammy Keller Date: 2/28/19

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