Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical (Practicum) Performance Evaluation SUMMATIVE
Student

April Brookhart

Date

Location: St.
Agnes

Faculty

Cindy Mitzman, RN
MSN

N/A = Not
(*) Critical behavior
applicable
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
Outcome 1
SelfEval of
Evaluate the effectiveness of a plan of care using the nursing process to achieve patient
Eval
Student
outcomes.
S/N/U
S/N/U
Collects evidence related to assigned patient(s) from appropriate resources.
S
S
*Demonstrates accurate patient assessment skills.
S
S
Establishes nursing diagnoses based on patient assessment.
S
S
*Prioritizes patient care based on assessment.
S
S
Identifies measurable patient outcome based on nursing diagnosis.
S
S
Implements care according to established plan and desired outcomes.
Uses therapeutic communication techniques during nurse/patient interactions to facilitate the
S
S
nursing process.
*Identifies appropriate interventions based on assessment.
S
S
*Demonstrates knowledge of medications for assigned patients.
S
S
*Administers medication safely using six rights of medication administration.
S
S
*Implements appropriate infection control precautions.
S
S
Follows through with all patient care.
S
S
*Evaluates patient response to care and revises plan as needed.
S
S
Student Instructor
Outcome 2
SelfEval of
Assimilate into the profession of nursing with a commitment to lifelong learning and personal and
Eval
Student
professional growth.
S/N/U
S/N/U
Participates actively in all aspects of the clinical experience.
S
S
Discusses patients plan of care with instructor. (preceptor)
S
S
Demonstrates professional behavior and appearance.
S
S
Engages in self-reflection and communicates learning needs to instructor/preceptor.
S
S
Completes assignments as required and submits on time.
S
S
Organizes time efficiently.
S
S
Student Instructor
Outcome 3
SelfEval of
Provide culturally competent, holistic care using respectful and caring behaviors.
Eval
Student
S/N/U
S/N/U
Demonstrates caring behaviors with the ability to develop and maintain therapeutic relationships
with people from diverse backgrounds.
S
S
Considers patient values, cultural characteristics and religious differences when planning care.
S
S
Student Instructor
Outcome 4
SelfEval of
Collaborate with healthcare teams to provide patient-centered re.
Eval
Student
S/N/U
S/N/U
Identifies patient/family health education needs.
S
S
Implements patient and family education.
S
S
Seeks input from patient, instructor, peers, and healthcare team in the delivery of patient care.
S
S
*Updates instructor (preceptor) and healthcare team regarding changes in the patients
condition.
S
S
*Identifies safety concerns and notifies instructor (preceptor) and appropriate healthcare team
members.
S
S
S = Satisfactory

N = Needs Improvement

U = Unsatisfactory

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical (Practicum) Performance Evaluation SUMMATIVE
Demonstrates initiative in assisting peers and healthcare team members in the clinical setting.
Demonstrates communication skills using SBAR.
Acts as an advocate for patients and families.
Outcome 5
Model a spirit of inquiry that supports evidenced-based practice.
Applies evidenced-based rationale that supports the patients plan of care.
Integrates knowledge from nursing and other disciplines to plan care.
Outcome 6
Practice within legal and ethical principles to deliver safe and competent care based on current
standards of practice.
Adheres to attendance policy.
*Demonstrates safe clinical practice.
*Provides nursing care based on the policies and procedures of the facility.
*Maintains legal accountability for nursing practice in accordance with the Maryland Nurse
Practice Act.
*Adheres to HIPAA guidelines regarding patient confidentiality.
*Provides care according to the ANA Nursing Scope and Standards of Practice.
*Demonstrates accountability and responsibility for own actions and attitudes.

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

S
S
S
Instructor
Eval of
Student
S/N/U
S
S
Instructor
Eval of
Student
S/N/U
S
S
S

S
SS
S
S
S
S
S
S
Student Instructor
Outcome 7
SelfEval of
Research and communicate information through appropriate technology.
Eval
Student
S/N/U
S/N/U
Gathers data from the electronic medical record to provide patient care.
S/N
S/N
Uses electronic medical record to document patient care accurately and in a timely manner.
N
N
Student Learning Goals (List desired learning goals, and your plans to meet them, for the next weeks clinical
experience. Goals should be based on identified performance issues and the desire for new knowledge and
experiences.)
During this clinical experience Ive learned so much. I feel like Ive really been able to gain accuracy and confidence in
my assessment skills. I provided safe and competent care throughout the practicum time. I also received the protocols
for any drips we were administering and made sure I understood the correct way to titrate, the goal for the patient, and
other pertinent information. The only thing I was not able to accomplish was documenting due to the fact I received login
information after my last day of practicum. While I believe documentation is a very important part of my future role as a
nurse I also feel that out of all of the objectives its the least critical because each documentation system is different at
every hospital. However, I was able to look at labs and other patient information on the electronic system with my
preceptor and I made sure to take note of everything that I thought I would document on my patient report sheets.

Carroll Community College

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical (Practicum) Performance Evaluation SUMMATIVE
Preceptor/Instructor comments/ Student Learning Goals: (**If an item was identified as N or U, narrative
comments are necessary to clarify student performance**)
It was a pleasure to be Aprils preceptor. April has really improved throughout the time that I worked with her.
April was willing to look for new learning situations and was very helpful on the floor. She asked the
appropriate questions pertaining to her patients and their disease process. I see one problem with the system
and that is not allowing the students to document in the patients chart. But April made up for that loss. She
would take down detailed notes on her patients so that she would be able to participate in reporting off to the
oncoming nurse. Thank you for allowing me to help in Aprils education.

Student Signature:

April Brookhart

Date:

Cynthia Mitzman, MSN, RN

Date:

3/7/2016
3/14/2016

Preceptor/Instructor Signature: