Carroll Community College

Division of STEM, Nursing and Allied Health

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

3/12/202
Student Emma d'Epagnier Date 0 Week # 4 Faculty Jenny Perry
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: S S
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: S S
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

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
WEEKLY Student Clinical Performance Evaluation

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
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)
What did you learn this week that has contributed to your growth as a nurse? Please explain.
This week my patient had a rare autoimmune disorder called diffuse scleroderma which causes the
tissues to thicken and become tough and decreases mobility; along with another condition called
autoimmune necrotizing myopathy where her immune system attacks her own body. I learned
about a medication called immune globulin which is formed from components of donated blood to
depress the patient's immune system and relieve her symptoms of immune response. This
medication has a specific protocol to follow regarding titration of the dosage and monitoring the
patients vital signs every 15 minutes upon initiation and every 1-2 hours following in case of any
anaphylactic reaction. My nurse had never administered this medication before and asked another
nurse for help to make sure he was doing it correctly. This showed me that there are always new
things you will come across in nursing and it is better to ask for help in order to provide safe care to
your patient.

Which objective did you accomplish this week? How did you do it?
This week I was able to balance taking care of two patients compared to one and see how to
prioritize patient care. Both of my patients had immediate needs that were important to take care of
in a timely manner, such as blood sugar monitoring and insulin injections for my diabetic patient and
the immune globulin medication for my autoimmune patient. I was able to do this by checking on my
patients on anything they need and asking my nurse what I could do to help.

Do you have any concerns about your performance? If so, what are your plans for improvement? Please explain.

I feel like I need to have more confidence in my own decisions for care for my patient. For example,
my diabetic patient's blood sugar was low and asked for some orange juice and graham crackers. I
checked his diet order to make sure it would be okay and determined it was, but still felt the need to
ask the nurse; I feel it is always better to double check in providing care but I think I need to trust
myself more at this point.

Faculty Comments/ Student Learning Goals (Goals must be established even if performance is satisfactory. If an item was i

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
WEEKLY Student Clinical Performance Evaluation

Faculty Comments:
Emma continues to do very well in clinical. She once again had a complex patient as well as taking care of another patient on top of
that. Emma was actually very busy most of the morning and we did not have a chance to catch up until midday. She was very
thorough in her assessment skills and continues to be thorough in her SBAR reports. Emma could not be more empathic and caring
to her patients. Her patient’s family and the bedside nurse both verbalized how great she was in the care of the patient. Emma
actually gave a bath for her scleroedema patient and this helped the patient feel better with her pain. Emma and I spoke about
prioritization and she did a great job in figuring out which patient she would see first. Her complex patient had a lot of things going
on (IE giving a difficult IV drug, monitoring the patient’s blood count, and maintaining tight glucose control) and she stated that this
patient was her priority.

Emma participated with her cultural assessment in post conference. She asked questions to her patient about their social
demographics, etc. Emma will give medications next week.

Student Signature: Emma d'Epagnier Date:3/12/2020

Instructor Signature: Jennifer L Perry Date: 3.12.20

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