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CAPITOL UNIVERSITY
RLE 2A
Clinical Performance Checklist for Hospital Exposure
l. Knowledge/Cognitive ( 40 % ) RATING
II. Skills/Psychomotor ( 40 % )
1. Demonstrates ability to correctly make a closed, open or occupied bed. 4 3 2 1
2. Performs accurate Vital Signs taking as: 4 3 2 1
a. Cleaning thermometer correctly before insertion
b. Lowering the thermometer reading
c. Reading the thermometer correctly at eye level
d. Leaving the thermometer at correct duration of time
e. Cleaning the thermometer before reading
f. Returning thermometer correctly to the receptacle
3. Performs accurately the BP reading as: 4 3 2 1
a. applies the BP cuff correctly
b. reads correctly the Bp
c. does correctly the after care of the BP apparatus
4. Performs correctly the P.R. and R.R. monitoring as: 4 3 2 1
a. positions patient properly while taking P.R. and R.R.
b. applies enough pressure to any artery for reading
c. determines accurately the P.R. and R.R.
5. Records vital signs and I and O appropriately on monitoring/ flow sheets 4 3 2 1
6. Reports significant vital signs and data/observations about patient’s 4 3 2 1
condition with promptness and accuracy
7. Demonstrates skillfully the correct techniques in providing comfort 4 3 2 1
measures and maintaining a clean, therapeutic environment.
8. Assists patient with elimination, taking into consideration privacy 4 3 2 1
appropriate technique for serving the bedpan or urinal and
providing perineal care. \
9. Demonstrates skillfully ability to perform several aspects of hygiene 4 3 2 1
including baths, back rubs, oral care & hair care.
10. Organizes work and manages time effectively. 4 3 2 1
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STUDENT’S SIGNATURE CLINICAL INSTRUCTOR’S SIGNATURE