Palawan Polytechnic College, Inc.

Department of Nursing

EVALUATION TOOL – CLINICAL PRACTICE (level 2 to 4)

Hospital and Community
NAME: Year & Section: Group:
Clinical area: Semester: Summer:
Disciplinary Problem:
INC Requirements: Absences: Days  Excused  Unexcused
Tardiness : Minutes
LEGEND:
4 = competent (The student performs consistently in an effective & efficient manner)
3 = progress acceptable (Performance is usually effective & efficient but not always)
2 = needs improvement (Progress in performance is too slow to judge satisfactorily. Task perform 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 & inefficient)
STANDARDS SCORE REMARKS
NURSING PROCESS 76%
1. Reports prepared about the case.
2. Obtains comprehensive, yet concise patient history.
3. Conducts physical assessment quickly, thoroughly and precisely.
4. Exhibits updated knowledge pertinent to case.
5. Identifies overt/covert problems and classify them according to actual, potential or
possible problems.
6. Communicates effectively with client, family, and co-workers.
7. Courses of actions are feasible and appropriate.
8. Courses of actions are congruent with the culture of the client and the work setting.
9. Monitor’s patients progress (both positive and negative)
10. Performs therapeutics interventions correctly.
11. Teaches patient and family relevant information.
12. Prioritizes and organizes work activities to maximize time, effort and supplies.
13. Uses correct techniques in performing nursing procedures.
14. Involves client and family in patient care.
15. Reports relevant data promptly.
16. Charts comprehensively, concisely and accurately.
17. Evaluates results of interventions objectively and accurately.
18. Identifies factors which led to evaluation results.
19. Makes modifications/adaptations in the plan as needed.
SUBTOTAL
ATTITUDES 34%
1. SENSITIVITY AND CONCERN
1 2 3 4
Grouchy, no charisma, dull, Moody, minimal response to the Good disposition, shows Outstanding concern and
hostile to fellow workers, very needs of client, less caring, with moderate concern and sensitivity, exhibits empathy, very
little response to poor rapport with client and sensitivity, often emphatic, good rapport with patients and
physical/emotional needs of fellow workers. good rapport with client and family, charismatic.
patients and family, paranoid, fellow workers.
unapproachable, “couldn’t care
less” attitude.
2. COOPERATION AND HELPFULLNESS
1 2 3 4
No “Bayanihan” spirit, unwilling Oftentimes reluctant to accept Willing to accept, share of Very helpful to fellow workers,
to accept, share of responsibility, responsibility. responsibility. obliging, willing to accept, share
difficult to work with. of responsibility, quick to extent
help.
3. PROFESSIONAL AND PUBLIC RELATION
1 2 3 4
Intriguer, manipulator, Often self-centered, shows Acceptable concern for people Well-liked, tactful and
discourteous, disliked, tactless, minimal concern for others and and authority. considerate, respectful of rights
and inconsiderate, disrespectful authority. of others, wins confidence of
of rights of others, rude to others.
people even to superiors, smug
attitude.
4. INTELLECTUAL INTEGRITY
1 2 3 4
1
Intellectually dishonest, provides Intellectually honest in most Demonstrate intellectual Demonstrate intellectual honesty
misleading information meant to situations; occasionally withholds honesty and integrity; accepts even in difficult situations;
defend and protect self; does information when confronted; limitations. accepts limitation & makes
not accept limitation. occasionally fails to accept conscious effort to improve on
limitations. time.
5. MORAL/ETHICAL VALUES
1 2 3 4
Known to engage in Demonstrate occasional lapses in Practices are ethical and Highly ethical and morally
unethical/immoral practices, maintaining ethical and moral morally consistent with upright; provide excellent
inconsistent with norms and uprightness. accepted norms. example to peers and
practice. subordinates.
6. RELIABILITY AND RESPONSIBILITY
1 2 3 4
Irresponsible, unreliable; needs Usually prompt but performs just Performs duties promptly and Performs duties promptly and
repeated reminders of enough to get by; usually efficiently without being efficiently without being
assignments; does less than dependable but sometimes reminded. reminded; is resourceful and
prescribed work. needs reminders of assignment. innovative; takes initiative to
spend additional time.
7. COMPLETE PRESCRIBED UNIFORM
1 2 3 4
Often incomplete prescribed Occasionally with incomplete Complete and neat prescribed Complete & neat prescribed
uniform and paraphernalia prescribed uniform and uniform and paraphernalia. uniform and paraphernalia;
(more than 4 occasions) often paraphernalia (1-3) occasions. always with prepared functional
untidy and non-functional Sometimes with non-functional equipment / paraphernalia;
paraphernalia. paraphernalia. maintains them in neat order.
8. PUNCTIONALITY AND ATTENDANCE
1 2 3
Often late in attendance and submission of Occasionally reports for duty late (5-15 Punctual in attendance and submission of
requirements. mins) 1-2x during the rotation, sometimes 1 requirements.
day late in the submission of requirement (1-
2) occasions.
9. PARTICIPATION IN GROUP ACTIVITIES
1 2 3
Does not participate in activities Participates in group activities when called Actively participates in activities; eager to
to do so. share ideas and learn from others.

FOR HOSPITAL FOR COMMUNITY/HEALTH CENTER

Nursing process score Nursing process score
Attitude score Attitude score
TOTAL SCORE TOTAL SCORE
Nursing process = Total score x 80% Nursing process = Total score x 70%
& Attitude Perfect score & Attitude Perfect score
SUMMARY: SUMMARY:
I. Nsg Process & Attitude 80% I. Nsg Process & Attitude 70%
II. Written exams 10% III. Written exams 20%
IV. Requirements 10% V. Requirements 10%
TOTAL 100% TOTAL 100%
C.I’s Signature: C.I’s Signature:
Date: Date:
CONFORME: CONFORME:
Date: Date:
STUDENT COMMENTS :

Student’s Signature: ____________________________

Date: ____________________________

Mpulao 11-19-17