Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 140 – Nursing Concepts 2
SUMMATIVE Student Clinical Performance Evaluation

Student Erika Zawistowski Date 02/28/2020 Week # Faculty Professor Taylor

Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical
(Meets) (Requires assistance) (Unable) applicable 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
Course Goal 1 Self-Eval Student
Apply the nursing process when implementing a plan of care (PG1) S/N/U S/N/U
With assistance:
1. Prioritizes and completes daily nursing tasks S S
2. Completes assessments accurately S S
3. Uses EMR/MAR, patient charts, handoff report to provide care S S
4. *Establishes appropriate nursing priority list S S
5. Creates measurable patient outcomes S S
6. Establishes appropriate nursing interventions S S
7. Evaluates patient response to care and revises plan as needed S s
Instructor
Student Eval of
Course Goal 2 Self-Eval Student
Participate in opportunities that promote professional growth (PG2) S/N/U S/N/U
With assistance:
8. Adheres to dress code S S
9. Seeks input from patient, instructor, and healthcare team when providing care S S
10. *Demonstrates accountability and accepts responsibility for own actions and attitudes S S
11. Actively participates in all clinical experiences S S
12. Communicates learning needs to instructor S S
13. Completes assignments/evaluations as required S s
Instructor
Student Eval of
Course Goal 3 Self-Eval Student
Provide patient-centered care with assistance (PG3) S/N/U S/N/U
With assistance:
14. *Implements appropriate infection control precautions S S
15. Identifies client’s cultural needs S s
16. Accurately documents patient care S na
17. Communicates appropriately with patient, family, healthcare team, and instructor S S
18. Explains the actions, side effects, and nursing implications of medications S S
19. *Administers medication using the six rights n/a Na
20. Demonstrates concern, compassion and empathy with patients S S
21. *Demonstrates physical and mental competence S S
22. *Notifies instructor and appropriate healthcare team members with safety concerns and changes S
in the patient’s condition S
23. Identifies patient and family health education needs S S
24. Provides nursing care in accordance with the Maryland Nurse Practice Act and the ANA Scope & S
Standards of Nursing Practice S
25. *Adheres to HIPAA guidelines S S
Criteria: S = Satisfactory N = Needs Improvement U = Unsatisfactory NA = Not (*) Critical
(Meets) (Requires assistance) (Unable) applicable behavior

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 – Nursing Concepts 2
SUMMATIVE Student Clinical Performance Evaluation

Instructor
Student Eval of
Course Goal 4 Self-Eval Student
Plan nursing care based on scientific evidence (PG4) S/N/U S/N/U
With assistance:
26. Justifies patient’s plan of care using appropriate resources s
S
Student Reflection (Thoroughly answer all questions)
How has this clinical rotation helped to define your role as a nurse? Please explain.
I absolutely loved this experience. I got to see a side of long term care that I had honestly never seen before. This experience
helped me to realize just how much information I like to know in my own nursing style. Knowing that the GNA’s and CMA’s did a lot
of the work that I thought the nurse would want to see helped me realize just how hands on I would like to be with my patients as
a nurse. I think it is vital to make sure that if a patient has wounds that they are addressed at least once a day to ensure there are
no changes. Here at Levindale I did not see that. I was also more aware of how important it is to try and know as much as you can
about your patients. While at Levindale, I made sure to report changes to the nurses that I noticed, as well as things that could be
done to help the patient’s situation. I also was more assertive in my delegation role, which is something I strived for last semester
in my acute care clinical. Professor Taylor is an incredible instructor that challenges you every day to make an improvement from
the last, and I feel I have definitely learned and reshaped my thinking because of her. Thank for the compliment as well as for the
well thought out reflection. I will let you know if there has been any progress on SLP eval for your patient and lifting of the NPO
status.
Which objective did you accomplish during this rotation? How did you do it?
During this rotation I learned to care for patients in a different way. I learned to gather more information that would help me
redefine a patients care plan. In discussion with my clinical instructor and the nurse I was able to aide in trying to help my patient
off of an NPO status. The patients that I cared for in this rotation did not see their nurses as much as in an acute care setting which
is how I was able to decide that more information needed to be gathered. With the help of my clinical instructor I was able to learn
the value of getting to know your patient in depth to better support them. Your patient was certainly one that didn’t see a lot of
staff members and though people were talking about her mental status and whether or not her hospice status was really
appropriate no one seemed to be connecting the dots to do anything about it….including the hospice team.
What are your goals for your next clinical rotation?
For my next rotation I will be in pediatrics. I will definitely take this experience with me to help me better understand my patients
needs and how to formulate good reports, and care plans. Each individual patient is so different and it is imperative to get to know
them to ensure their needs and goals are being met. My biggest goal is learning more of how to formulate a complete care plan on
how to better serve my patient. I would also like to see the difference in dealing with mostly elderly to pediatric level. I usually tell
students that the elderly patient and the peds patient actually have a lot in common…depending on the age of the peds patient.
Their family is often harder to care for than the patient. The patient has varying amount of teeth, cognition, communication,
continence and capability to understand/comply with what you want to do for them. Kids are sometimes cuter…but that also
depends on your perspective.
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).
I like your goal regarding formulation of a plan of care, but I will tell you that what you come to think of as a plan of care will vary a
lot from setting to setting. For instance, in my post-partum world, I might leave report with one plan and within the first hour of
my day have completely revised what I’m doing for several of my patients because patients sometimes move through a unit so
quickly…it’s like aiming at a moving target.
However, knowing of your interest in Burn trauma and Oncology, creating/updating/communicating and optimizing a care plan are
really important and can be very complex – physically and emotionally. So, yes…great goal.
Student Signature: Erika Zawistowski Date: 02/28/2020
Instructor Signature: Henrietta Taylor, MS RN Date: 3/2/2020

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020

 Carroll Community College
Division of STEM, Nursing and Allied Health
Department of Nursing
NURS 140 – Nursing Concepts 2
SUMMATIVE Student Clinical Performance Evaluation

Approved 12/4/14. Revised 12/10/2014; 01/2015; 3/16/18, 1/2020