Arihant College of Nursing

Evaluation Performa for Case Study

Student’s Name:………………………………. Year…..………………….

Date…………………… Total Marks- 50 Scored marks………………………..

S.No Criteria Marks Alloted Marks

Obtained
1. Health Assessment Health history 4

Physical examination 4

Analysis of diagnostic 4
tests
2 Identification of the needs & health problems 3

3 Prioritization of the needs & health problems 3

4. Formulation of Nursing Diagnosis with 3

objectives
5 Plan for nursing intervention with rationale 5

6 Implementation 5

7 Evaluation Evaluation of Nursing 2

care
Family response outcome 2

Health Education 2

8. Comparatives Study 4
9. Students self Academic benefit 3
learning
Change in attitude 3
towards patient care
Innovations 3

Remarks:
1. Excellent - (36-50)
2. Good - (26-35)
3. Average - (16-25)
4. Poor - (1-15)

Signature of Clinical Supervisor