24949119 Evaluation Tool in Nursing
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Transcript of 24949119 Evaluation Tool in Nursing
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University of Perpetual Help System-Las Pinas CampusLAS PINAS CITY
COLLEGE OF NURSING
CLINICAL PERFORMANCE AND EVALUATION CHECKLIST
Concept: Acute Biological Crisis
Area: EMERGENCY ROOM
Name: ________________________ Date: ________________
Year___ Section___ Group Number___ Rating: _______________
Direction: Put a check on the skills observed / performed, of not please include remarks on the space
provided.
Legend:
3 - Is at a very satisfactory level. Has thorough knowledge and understanding of the said case/topic.
Could do and plan intervention on his/her own.
2 - At satisfactory level. Has enough understanding to handle the case but needs Careful guidance.
1 - Needs to be reevaluated. Competency is at an unsatisfactory level and needs to be reoriented on
the subject/case at hand.
A. ASSESSMENT 10% Wt 3 2 1 Score Remarks
1. Assess different manifestations that are relatedto Acute Biological Crisis through the differentmethods used in physical and appropriate datagathering.
2
2. Performs physical examinations correctly andwith confidence.
2
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3. Identifies and differentiates between normal andabnormal findings in Acute Biological Cases.
2
4. Determines the significance of laboratory anddiagnostic findings to the emergent problems
2
5. Picks out critical and essential data in nursing
history relevant to the current situations.
2
Subtotal 10
A. PLANNING 4% Wt 3 2 1 Score Remarks
1. Knowledge in setting goals and prioritization ofpatients needs with Acute Biologic Crisis in theemergency room.
2
2. Identify changes in patients needs and nursingproblems as they occur and make necessaryadjustments in nursing measures.
2
Subtotal 4
A. INTERVENTIONS 15% Wt 3 2 1 Score Remarks
1. Assess the capability needed by the clientfor self-management in the emergency.
1
2. Ensures safety, comfort and privacy inrendering care of patients with acutebiologic crisis.
2
3. Provides necessary curative measures. 1
4. Provides immediaterestorative/rehabilitative measures duringtemporary stay in the ER.
1
5. Utilizes available physical andprofessional resources.
1
6. Makes referrals to appropriate healthprofessionals, as needed.
1
7. Shows commitment to the welfare of theclient.
1
8. Implements the plan of care jointly with
the client.
1
9. Performs nursing procedures/activities:9.1 with ease and confidence
1
9.2 correctly 1
9.3 systematically 1
9.4 practices bioethical principles in care 1
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9.5 provides after care 1
9.6 demonstrate situational flexibility andadaptability
1
Subtotal 15
A. EVALUATION 4% Wt 3 2 1 Score Remarks
1. Evaluates plan of care of client using theoutcome criteria and performs appropriatedocumentation and recording of changes in theclients evident status after the interventions.
1
2. Displays critical thinking in the analysis of thecurrent management being employed and
modifications that has to be done as needed.
1
3. Discusses with the appropriate health team results ofinterventions.
1
4. Accepts suggestions, constructive criticisms andemploy appropriate modifications in the plan ofcare.
1
Subtotal 4
Grand Total 100
________________________ _________________________
Students Signature Clinical Instructor Signature
University of Perpetual Help System-Las Pinas CampusLAS PINAS CITY
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COLLEGE OF NURSING
CLINICAL PERFORMANCE AND EVALUATION CHECKLIST
Area: OPERATING ROOM
Name: ____________________________ Date: _________________
Year___ Section___ Group Number___ Rating: _______________
Direction: Put a check on the skills observed / performed, of not please include remarks on the space
provided.
Legend:
3 - Is at a very satisfactory level. Has thorough knowledge and understanding of the said case/topic.
Could do and plan intervention on his/her own.
2 - At satisfactory level. Has enough understanding to handle the case but needs Careful guidance.
1 - Needs to be reevaluated. Competency is at an unsatisfactory level and needs to be reoriented on
the subject/case at hand.
A. ASSESSMENT 10% Wt 3 2 1 Score Remarks
1. Obtains and analyzes pertinent data concerningpatients condition.
2
2. Determines and categorizes clinical assessmentof the patient.
2
3. Interprets prudently the physicians order. 2
4. Checks and accomplishes pre-operativechecklist prior to surgical procedure.
2
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5. Assess patients physiological, psychologicaland patients emotional status.
2
Subtotal 10
A. PLANNING 4% Wt 3 2 1 Score Remarks
1. Formulates appropriate nursing diagnosis basedfrom thorough patients assessment.
1
2. Rationalizes principles of aseptic technique. 1
3. Checks functionality of the operating room /delivery room equipment such as suctionmachine, cautery and OR lights.
1
4. Prepares and selects surgical supplies
concerning the patients surgical procedure.
1
Subtotal 4
A. INTERVENTION 15% Wt 3 2 1 Score Remarks
Pre Operative Phase
1. Identifies patient and verifies procedure tobe done.
1
2. Secures consent. 1
3. Checks for clearances (cardio-pulmonaryclearance, pedia clearance), diagnosticprocedures.
1
Intra Operative Phase
1. Explains proper position for induction of
anesthesia and operation to be performed.
2
2. Demonstrate proper aseptic/antiseptictechnique, sterile drapings and handling ofinstruments.
2
3. Maintains sterility of the operating room andsterile field.
2
Post Operative Phase
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1. Monitors vital signs immediately after theoperation.
2
2. Evaluates patients recovery from anesthesia. 2
3. Discusses the emergency resuscitativedevices, equipment and emergency drugs in
the recovery room.
2
Subtotal 15
A. EVALUATION 4% Wt 3 2 1 Score Remarks
1. Evaluates plan care after applyingnecessary nursing interventions.
1
2. Discusses appropriate health teaching
(sterile wound care)
1
3. Performs proper documentation andother important details are needed.
1
4. Participates in activity during post-conference.
1
Subtotal 4
Grand Total 100
________________________ _________________________
Students Signature Clinical Instructor Signature
University of Perpetual Help System-Las Pinas CampusLAS PINAS CITY
COLLEGE OF NURSING
CLINICAL PERFORMANCE AND EVALUATION CHECKLIST
Concert: Staff Nursing
Area: GENERAL WARD
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Name: ____________________________ Date: _________________
Year___ Section___ Group Number___ Rating: _______________
Direction: Put a check on the skills observed / performed, of not please include remarks on the space
provided.
Legend:
3 - Is at a very satisfactory level. Has thorough knowledge and understanding of the said case/topic.
Could do and plan intervention on his/her own.
2 - At satisfactory level. Has enough understanding to handle the case but needs Careful guidance.
1 - Needs to be reevaluated. Competency is at an unsatisfactory level and needs to be reoriented on
the subject/case at hand.
A. KNOWLEDGE 3 2 1 REMARKS
1. Knowledge in gathering data
2. Knowledge of the different methods used in
physical assessment.
3. Adequate knowledge regarding normal values and
other laboratory results.
4. Identifies nursing problems of patient and its
cause.
5. Explains scientific principles behind patients
condition and management.
6. Knowledge in setting goals and prioritization of
patients needs.
7. Knows intervention to be given and the rationale.
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8. Knows the theories and rationale behind nursing
procedures being implemented.
9. Knows the principle of drug administration and its
action.
10. Knowledge on how to relate nursing
interventions to outcomes.
Subtotal:
B. SKILLS 3 2 1 Remarks
1. Checks, records and interprets accurately the
vital signs of assigned patients.
2. Ability to manipulate and care for the equipment.
3. Ability to collect specimens for the laboratory
examination.
4. Demonstrate skill in providing comprehensive
nursing care.
5. Performs nursing procedures with maximum
result with minimum time, effort and materials at
her/his level.
6. Implements nursing care according to priorities.
7. Provides health teaching for patient and his
family as manifested by good communication skill.
8. Coordinates with other members of the health
team with regards to patients condition.
9. Ability to transcribe doctors order.
10. Records accurately patients conditions and
nursing intervention.
Subtotal:
C. ATTITUDES AND VALUES 3 2 1 Remarks
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1. Punctuality and regular in attendance.
2. Professionalism in uniform.
3. Honesty and sincerity.
4. Resourcefulness and creativity.
5. Sense of responsibility.
6. Initiative, Diligence and Industry.
7. Tolerance and Patience.
8. Polite and Respectful to self and others.
9. Works harmoniously with others.
10. Aware and understands the needs and emotions
of others.
Subtotal:
_____________________ ________________________
Students Signature Clinical Instructor Signature
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University of Perpetual Help System-Las Pinas CampusLAS PINAS CITY
College of Nursing
Name: ____________________________________Date:___________________
Yr/Sec: ______________Group:___________ rating: __________________
Area: ____________________Clinical Instructor: __________________________
P E R F O R M A N C E E V A L U A T I O N T O O L
(STUDENT HEAD NURSE TO STUDENT NURSE)
NUMERICAL
RATINGQUANTITATIVE DESCRIPTION
5Outstanding Carries out expected tasks in a very consistent manner with
minimal guidance and supervision
4 VerySatisfactory
Carries out expected tasks in a consistent manner withminimal guidance and supervision
3Satisfactory Carries out expected tasks in a moderately consistent
manner with frequent guidance and supervision
2Needs
Improvement
Carries out expected tasks in a rarely consistent manner
with close guidance and supervision
1Unsatisfactory Does not carry out expected tasks even with close guidance
and supervision
PERFORMANCE RATING
I. ASSESSMENT / PLANNING
1.1 Establishes rapport with subordinates
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1.2 Able to involve patients in plan of care
1.3 Punctual and prompt in all activities
1.4 Able to maintain stability under pressure
1.5 Gathers data using interview, observation, records review andreports
1.6 Formulates appropriate nursing care plan
1.7 Wears complete prescribed RLE uniform
II. IMPLEMENTATION
a. Carries out assigned tasks based on the criteria of distribution of
assignments
b. Follows principles of time management
c. Equipped with required paraphernalia for RLE
d. Observes proper channels of communication
e. Carries out plan of care, including:
A. Bedside Care
B. Administration of medications
C. Administration of treatments (nebulization, IVF)
f. Shows initiative in performing tasks
g. Accomplishes delegated tasks within prescribed time frame
h. Provides psychological and spiritual support to patients
i. Accepts supervision and criticisms
j. Conducts appropriate health teachings
III. EVALUATION
1. Notifies immediate superior about untoward situations or conditions
related to patient care in the area
2. Make revisions in the plan of care as necessary
3. Evaluates Nursing Care rendered
V. ETHICOLEGAL CONSIDERATIONS
1. Demonstrates honesty at all times
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2. Conducts self in a tactful manner
3. Keeps confidential patient information
4. Observes the PNA Code of Ethics
5. Guided by RA 91736. Observes the 11 Core Competency Guidelines
REMARKS :
EVALUATED BY :
STUDENT HEAD NURSE
CONFORME BY :
STUDENT STAFF NURSE
NOTED BY:
CLINICAL INSTRUCTOR
University of Perpetual Help System-Las Pinas Campus
LAS PINAS CITYCollege of Nursing
ACTUAL SCORE x 100
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HEAD NURSE PERFORMANCE CHECKLIST
Name: ____________________________________Date:___________________
Yr/Sec: ______________Group:___________ rating: __________________
Area: ____________________ Clinical Instructor: __________________________
A. Knowledge 5 4 3 2 1
1. Applies as appropriate theory as a basis for decisionmaking in nursing practice.
2. Assesses staffs presenting symptoms to determinea nursing diagnosis and plan of action based on a
medical expertise and knowledge.3. Knowledge in communication, clarification andinterpretation of existing problems with staff andnursing responsibilities.
4. Inform the staff of the likely causes of errors defectsand waste.
5. Suggest in which risk, errors, quality of problemsmaybe reduce.
A. Attitude
1. Neat and well groomed. Adheres to dress code.
2. Punctual in reporting for duty
3. Complies with the code of ethics of the nursingprofession and upholds and implements schoolrules.
4. Assist in training staff in particular by setting a goodexample.
5. Promotion of professional responsibility,accountability and behavior.
A. Skills
1. Provide leadership in the assessment, planning,
implementation, and evaluation of comprehensiveschool health program.
2. Respond to the student/ staff medical emergencies.
3. Instruct subordinates in appropriate method andprocedure in providing care.
4. Initiate and facilitate any steps necessary to improvemethods, equipments, materials and condition in the
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work area for which they are responsible.
Equivalent: ______________ Rating: _______________
Point
scale
Grade Equivalent
5 85 Excellent Carries out expected behavior in a very consistent and
independent manner with less supervision and guidance.
4 82-84 Very
Satisfactory
Carries out expected behavior in a consistent and
independent manner that requires minimal supervision and
guidance.
3 79-81 Satisfactory Carries out expected behavior in rarely independent manner
requiring more supervision and guidance.
2 75-78 Fair Carries out expected behavior in rarely independent manner
requiring close supervision and guidance.
1 74 and
below
Needs
improvement
Carries out expected behavior under close supervision and
guidance.
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Name: _____________________ Area: ___________________________
Yr/sec./Group#:______________ Clinical Instructor: _________________
Scaling Interpretation
This evaluation is to determine and appraise the performance of the staff according to
their assign task. By writing the appropriate score in the proper column denoting the extent to
which the nurses performed these functions.
Criteria for Grading
15% Decorum Attendance-------------------------------------------
20% Requirements-----------------------------------------------------
25% Quiz-----------------------------------------------------------------
40% performance------------------------------------------------------
_____________
Total 100%
Prepared By:
ROMMEL JOHN A. ALAVAZO
BSNIV-(IV) Group 3A
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PERFORMANCE CHECKLIST
KNOWLEDGE 5 4 3 2 1
1. Gathers data appropriately and completely, then
validating it focusing function needing assistancesupport
2. Analyze and interpret collected data
3. Knows the correct way of doing physical
assessment.4. Gives attention and synthesize the significant
laboratory findings5. Knowledge in identifying nursing problems and
categorizing it according to the patients need.6. Knows the rationale behind every intervention
given for the care of the patient.7. Have knowledge in giving proper instruction for
medicine
a. classification
b. nursing responsibility
c. drugs and solution1. Explain or discuss the report clearly and able to
answer question correctly.2. Knowledge in preparation of patient for any
diagnostic procedure3. Knows how to formulate an accurate nursing care
plan for particular cases.
SKILLS 5 4 3 2 1
1. Ability to give and respond to the care needed by
the patient2. Perform procedure properly such as doing
physical assessment, taking VS, and giving
medication as ordered.
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3. Able to provide or assist patient in performance
of activities of daily living whenever needed.4. Always guided in precautionary and preventive
measure in providing care to the patient.5. Able to give health teachings clearly to the
patient.6. Communicate effectively in identifying the needs
of the patient.7. Properly handling an instance of emergency
situation.8. Implement Nursing care plan appropriately
9. Reassesses patient to determine whether a
remodification of care plan is necessary.10. Able to conduct discharged planning with the
patient, his family and significant others.
Legend:
5 Outstanding (85)
4 Very Satisfactory (83-84)
3 - Moderately satisfactory (81-82)
2 Minimally satisfactory (75-80)
1 Unsatisfactory (74 and below)