Carroll Community College

Division of STEM, Nursing and Allied Health

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

Student Francine Ongbalindi Date 12/10/20 Week # 6 Faculty

Criteria: S = Satisfactory (Meets) N = Needs Improvement U = Unsatisfactory (Unable) NA = Not (*) Critical
(Requires assistance) 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
Analyze the effectiveness of the plan of care (PG1) S/N/U S/N/U
Using faculty as a resource:
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
Instructor
Student Eval of
Course Goal 2 Self-Eval Student
Seek opportunities that promote professional growth (PG2) S/N/U S/N/U
Using faculty as a resource:
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 faculty as resource (PG3) S/N/U S/N/U
Using faculty as a resource:
14. *Implements appropriate infection control precautions S S
15. Identifies client’s cultural needs S S
16. Accurately documents patient care S S
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 S S
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

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 233 – Nursing Concepts 3
SUMMATIVE Student Clinical Performance Evaluation

Criteria: S = Satisfactory (Meets) N = Needs Improvement U = Unsatisfactory (Unable) NA = Not (*) Critical
(Requires assistance) applicable behavior
Instructor
Student Eval of
Course Goal 4 Self-Eval Student
Implement nursing care based on scientific evidence (PG4) S/N/U S/N/U
Using faculty as a resource:
26. Incorporates evidence-based rationales that support the patient 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 is the best I have had so far, It helped me distinguish what my role and responsibilities are as far as taking care
of my patients.
It also clearly defined what my expectations were with each patient.

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

I got to see how things are done in a hospital setting, the pace at which they are done.
I also familiarize myself with the system and devices used on a daily basis.

What are your goals for your next clinical rotation?

For my next clinical rotation I want to get to do more patient care and acquire more experience which will help me down the line in
my nursing career.

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).

Great job this semester. I feel like your LPN experience has really helped make this rotation seamless for you. Continue to ask
excellent questions and try and understand and learn all that you can. I know this is a big swing from PSYCH but you definitely have
a knack for dealing with MED/SURG patients in terms of understanding the complexities of pathophysiology, medications and
interventions used for these types of patients.

Student Signature: Francine Ongbalindi Date: 12/10/20

Instructor Signature: Mark Perry Date: 12/10/202

Definitions:
Coaching – Faculty guides student to define objectives, set goals, and develop action plans through collaboration in the decision-making process
Assistance – Student unable to perform task independently; needs some aid or minimal direction from faculty to complete tasks. Not autonomous but does not
require coaching.
Resource - Faculty serves as a facilitator but student is capable of completing self-directed tasks.

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