Carroll Community College

Division of STEM, Nursing and Allied Health

Department of Nursing
NURS 233 - Nursing Concepts 3
Student Clinical Summative Evaluation

Date
'1011711
Faculty:
Student albot 6 csE # Winchester
S = Satisfactory I N = Needs lmprovement I U = Unsatisfactory I NR= Notapplicable (*) Critical rehavior
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 qrades in a non-critical behavior -Four needs imorovements
Student lnstructor
self- , Eva[ of
'Eval Student
Analyze the effectiveness of the,plan of care (eSLOl ) S/NIU S/NiU
1.
*Prioritizes patient
care based on assessment with facultv as a resource S i)
2. *Demonstrates accurate oatient assessment skills
S S
3. Analyzes and incorporates data from the patient's medical record in the provision of care 5 S
4. Uses patient assessment data to implement individualized plan of care with faculty as a S
resource S
5. Establishes appropriate nursing diagnoses based on collected evidence and patient S
assessment with faculty as a resource S
6. Establishes measurable patient outcomes based on nursing diagnosis with faculty as a S
resource S
7. Establishes appropriate nursing interventions based on assessment with faculty as a S
b resource S
7 8. Evaluates patient response to care and revises plan as needed with faculty as a resource S S
Student lnstructor:
$slf:,' EVal. of
Outcome 2 Eval Student
Seek opportunities that promote professional qrowth (CSLO2) S/N/U S/N/U
9. Demonstrates professional behavior and appearance S
10. Seeks input from patient, instructor, and healthcare team in the delivery of patient- S
centered care S
11. *Demonstrates accountabilitv and accepts responsibilitv for own actions and attitudes S D
12. "Adheres to attendance oolicv S S
'13. Participates actively in all clinical experiences S S
14. Enqaoes in self-reflection and communicates learnino needs to instructor S S
15. Completes assiqnments as required and submits on time S S
16. Demonstrates initiative in assisting peers and healthcare team members in the clinical settino S S
Student lnstructor
Self-: Eval of
Outcome 3 EvaJ, Student
Provide patient-centered care with facultv as a,resource (CSLO3) S/N/U S/N/U
7. *lmplements appropriate infection control precautions
1 S
S
18. Provides culturallv sensitive care S S
19. Documents patient care accurately S S
20. Uses therapeutic communication skills S S
b 21. Follows throuqh with all oatient care S S
Y 22. Demonstrates knowledge of medications for assiqned patients S S

Approved 1 21 41 1 4. Revised 121 1 01201 4; 01 12015