Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 242 Nursing Concepts 4
Student Clinical Performance Evaluation
Student Yaneli Yero Mena
Date 10/28/16
CSE #
Faculty
Theresa
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
SelfEval of
Outcome 1
Eval
Student
Use the nursing process to optimize client health (CSLO1)
S/N/U
S/N/U
S
1. *Prioritizes patient care based on assessment
S
2. *Demonstrates accurate patient assessment skills
S
S
S
3. Analyzes and incorporates data from the patients medical record in the provision of
S
care
4. Uses patient assessment data to implement individualized plan of care
S
S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient
S
assessment
S
6. Establishes measurable patient outcomes based on nursing diagnosis
S
S
7. Establishes appropriate nursing interventions based on assessment
S
S
8. Evaluates patient response to care and revises plan as needed
S
S
Student Instructor
SelfEval of
Outcome 2
Eval
Student
Assimilate into the profession of nursing (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 patientS
centered 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
S
S
15. Completes assignments as required and submits on time
16. Demonstrates initiative in assisting peers and healthcare team members in the clinical
S
S
setting
Student Instructor
SelfEval of
Outcome 3
Eval
Student
Provide patient-centered care (CSLO3)
S/N/U
S/N/U
S
17. *Implements appropriate infection control precautions
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
S
S
24. Demonstrates caring behaviors
S
S
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
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 242 Nursing Concepts 4
Student Clinical Performance Evaluation
29.
30.
31.
32.
33.

members
Organizes time efficiently
Evaluate effectiveness of patient and family teaching and revises plan as needed
*Updates instructor and healthcare team regarding changes in the patients condition
*Provides nursing care based on the policies and procedures of the facility

*Provides nursing care in accordance with the Maryland Nurse Practice Act
34. *Adheres to HIPAA guidelines
35. *Provides care according to ANA Scope and Standards of Nursing Practice

Outcome 4
Engage in evidence based care (CSLO4)
36. Critiques current practice based on evidence

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

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

Student Reflection (Thoroughly answer all questions)

What did you learn this week that has contributed to your growth as a nurse? Please explain.
This week I learned how to straight catheter a patient to be able to get a urinalysis test. I also learned all the
pre-op checks need it before sending a patient to OR. I was also able to give meds using the six rights. I was
also able to collaborate and help with the rest of the team when need it.
Which objective did you accomplish this week? How did you do it?
Prioritizes patient care based on assessment was one of the objectives accomplished this week. I was able to
prioritize the VS and pre-op check to a Pt who was going to the OR at 10am. BP and HR were not WNL, which
I reported to the nurse, who was then able to report it to the Dr.
Do you have any concerns about your performance? If so, what are your plans for improvement?
Please explain.
No concerns now but looking forward for more skills to practice during this rotation.
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).
Yaneli provided competent and compassionate care this week. Her assessment skills were good and she
managed her time well. She maintained sterility while performing a straight catheterization for a urine
specimen. She was attentive and helpful to her classmates. I will continue to guide Neli in her practice,
exposing her to new opportunities as they arise. I will also instruct her to look at the whole picture of her
patient as she provides care.
Student Signature:

Yaneli yero mena

Date:10/28/16

Instructor Signature:

T. Sparhawk MSN, RN

Date: 11/1/16

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