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  • Ward - Etool

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    Charmaine Manalo
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    This document contains a performance evaluation form for a nursing student on clinical rotation in a ward. The form evaluates the student's attitude, knowledge, and skills in various areas related to providing safe, quality nursing care including: taking vital signs, medication administration, following doctors' orders, patient education, documentation, communication, and collaboration. The student is rated on a scale of 1 to 5 in each area, with remarks from the clinical instructor. An overall performance rating and recommendation is also provided, with signatures from the student and instructor.

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    This document contains a performance evaluation form for a nursing student on clinical rotation in a ward. The form evaluates the student's attitude, knowledge, and skills in various areas related to providing safe, quality nursing care including: taking vital signs, medication administration, following doctors' orders, patient education, documentation, communication, and collaboration. The student is rated on a scale of 1 to 5 in each area, with remarks from the clinical instructor. An overall performance rating and recommendation is also provided, with signatures from the student and instructor.

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    127 views2 pages

    Ward - Etool

    Uploaded by

    Charmaine Manalo
    This document contains a performance evaluation form for a nursing student on clinical rotation in a ward. The form evaluates the student's attitude, knowledge, and skills in various areas related to providing safe, quality nursing care including: taking vital signs, medication administration, following doctors' orders, patient education, documentation, communication, and collaboration. The student is rated on a scale of 1 to 5 in each area, with remarks from the clinical instructor. An overall performance rating and recommendation is also provided, with signatures from the student and instructor.

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    © All Rights Reserved
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    of 2

    Lipa City Colleges

    College of Nursing

    Related Learning Experience Performance Evaluation


    Ward

    Name of Student: _____________________________________


    Year/Clinical group: ____________________________________
    School year: __________________________________________
    Term: _____ 1st Semester_____2nd Semester ______Summer_____
    Inclusive Dates of clinical Rotation: ________________________

    Legend: 5 – Highly Satisfactory


    4 - Very Satisfactory
    3 - satisfactory
    2 - Moderately Satisfactory
    1 - Unsatisfactory
    A. Attitude - 25%
    Score Remarks
    1. Punctual.
    2. Is neat and well groomed/wear appropriate attire
    3. Reports on duty with complete paraphernalia
    4. Exudes enthusiasm and initiative
    5. Is careful in the use of verbal and non-verbal language
    6. Fosters smooth relationships with other health team members
    7. Courteous to staff and other health team members
    8. Creative and resourceful
    9. sees to it that area of assignment is well arranged and maintained
    10.Maintains order and discipline
    Total rating ________
    B. Knowledge – 35%
    1. Examinations – 20%
    a. Pretest
    b. Postest
    c. Quizzes
    2. Other requirements (NCP, Drug Study, Case Study, Case Presentation,
    Individual Conferences) - 15%

    Total Rating ________


    C. Skills – 40%
    Legend: 4 Competent (student performs consistently in an effective and
    efficient manner
    3 Progress acceptable (performance is usually effective and efficient
    but not always
    2 Needs improvement (progress in performance is too slow to judge
    satisfactorily; task performance is not done properly for majority of
    the time)
    1 Progress unacceptable (no progress in performance has been
    demonstrated, and/or performance is consistently ineffective and
    inefficient)

    Score Remarks
    A. Safe and quality nursing care
    Utilizes the nursing process before doing any nursing intervention
    1.a. Obtains comprehensive client’s information by checking the
    clients record.
    1.b. Identifies the needs of the client before, during and after each
    procedure.
    1.c. Provides needed nursing intervention based on identified needs
    1.d. Monitors client’s responses to the procedure
    Provides appropriate bedside care according to professional standard
    Promotes safety and comfort of patient before, during and after each procedure.
    3.a. Provides physical comfort utilizing comfort devices/techniques.
    3.b.Positioning client based on the client’s level of consciousness
    3.c.Informs the client and explains the purpose of the procedure
    3.d.Observe proper implementation of the procedure based on
    principles
    3.e.Transports patient safely and appropriately based on proper body
    mechanics and SOP of the institution
    Takes patients vital signs according to principles and reports any untoward
    problem
    Gives patients medication based on what is written on the clients record observing
    the 10 rights in giving medication
    5.a. Assesses the clients ability to take the medication as prescribed
    which includes clients gag reflex, state of consciousness and
    presence of nausea and vomiting
    5.b. Wash hands before doing the procedure
    5.c. Arranges the medication tray and cups in the medication room or
    on
    the medication cart.
    5.d. Prepares the medication for one client at a time
    5.e. Gives the required medication
    5.f. Disposes soiled supplies according to institutional policy
    5.g. Makes relevant documentation
    6. Executes legal orders of the physician accurately and
    timely
    6.1. Verifies doctors order prior to the procedure
    6.2. Observes appropriateness of the order
    6.3. Exercises the degree of diligence before
    carrying it out
    7. Measures input and output accurately according to
    institutional policy
    B. Management of Resources and Environment
    1. Ensures availability, completeness and functionality of the equipments to be
    used.
    2. Observes institutional policies and protocols regarding each procedure.
    3. Observes proper handling of the equipments
    4. Observes proper disposal of waste based on institutional policy
    C. Health education
    1. Implements appropriate health education activities to client based on client
    needs
    D. Legal Responsibility
    1. Adheres to legal and institutional protocols regarding informed consent and
    other legal documents
    E. Ethico-moral Responsibility
    1. Respects the rights of the client.
    2. Accepts responsibility and accountability for own decisions and actions
    3. Maintains privacy and confidentiality of clients information.
    4. Adheres to the Code of Ethics for Nurses
    F. Quality Improvement
    1. Reports significant actual or potential observations seen in the area.
    2. Identifies and reports problems seen in the area.
    G. Records management
    1. Maintains legible, accurate and updated documentation of patients care on the
    clients record.
    2. Provides complete and accurate observations of clients response regarding the
    procedure.
    H. Communication
    1. Utilizes therapeutic communication skills with the patient, significant others and
    members of the health team
    2. Does nurses notes based on principles (Nursing Process)
    3. Utilizes proper channel of communication (through endorsement and reporting)
    I. Collaboration and teamwork
    1. Collaborates with other members of the health team to discuss things related to
    advancement and improvement of client care
    Total Rating __________
    Over-all Performance Rating______________%

    Recommendation:
    _________________________________________________________________________________
    _________________________________________________________________________________
    _________________________________________________________________________________
    _________________________________________________________________

    Conforme:
    _________________________________ ______________________________
    Signature of Student Signature of Clinical Instructor
    Over Printed Name Over Printed Name

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