24949119 Evaluation Tool in Nursing

7/31/2019 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



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COLLEGE OF NURSING


Area: OPERATING ROOM

Name: ____________________________ Date: _________________



provided.

Legend:






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

________________________ _________________________



COLLEGE OF NURSING


Concert: Staff Nursing

Area: GENERAL WARD


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Name: ____________________________ Date: _________________



provided.

Legend:






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:

_____________________ ________________________



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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)

Documents

24949119 Evaluation Tool in Nursing