MSU-Iligan Institute of Technology

COLLEGE OF NURSING
PERFORMANCE EVALUATION TOOL FOR RETURN DEMONSTRATIONS
STUDENT: _Jalova, Jana Patricia P.______________________________________ Date: January 16, 2021
PROCEDURE: Nursing Care During Labor________________________________________________________
I. SKILLS WORKBOOK
GRADING CRITERIA GRADE 30% REMARKS
100 Complete; all steps are rationalized correctly with in-depth concept-base discussion
91-99 Complete; steps are rationalized appropriately but lacks in-depth explanation
81-89 Incomplete; some steps are not rationalized properly with missing information
71-79 Incomplete; only 50% of the steps are rationalized properly
61-69 Insufficient; only 50% of the steps are rationalized with insufficient explanation
51-60 Highly insufficient; only 25% are rationalized
50 No written information at all

II.  RETURN DEMONSTRATION

RATING TOTAL REMARKS
CRITERIA
5 4 3 2 1 20 points
KNOWLEDGE            
Specify content and objectives (oral)            
Completeness of principles with correct rationale 40%              
Resourcefulness              
Ability to answer questions            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 20 points
SKILLS            
Organization and technique            
Workmanship and safety precaution 40%              
Ability to use time, supplies, and effort              
Handling of equipment            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 25 points
ATTITUDE            
Punctuality: Reports for return demonstration on time            
Submission of requirements on time            
Reliability 10%              
Intellectual Integrity: Demonstrates intellectual integrity and
           
honesty
Good relationship with peers and attitude towards procedure            
SUM
CRITERIA TOTAL
REMARKS
LEARNING REFLECTIONS 5 points
10%
Reflection of the activity  
SUM  
Score (70 points)  
Average Grade
70%
Grading Criteria
5 Student is able to perform the procedure with mastery and accuracy.
4 Student is able to perform in a precise manner but unable to rationalize the procedure.
3 Student is able to execute with appropriate rationalization but in the wrong order.
2 Student is able to perform in an incorrect sequence, present an inappropriate rationalization and displays limited skill in execution.
1 Student is unable to perform at all.
Total Score: ________
________________________________________ ________________________________________
STUDENT/SIGNATURE CLINICAL INSTRUCTOR/SIGNATURE
 MSU-Iligan Institute of Technology
COLLEGE OF NURSING
PERFORMANCE EVALUATION TOOL FOR RETURN DEMONSTRATIONS
STUDENT: Jalova, Jana Patricia P _______________________________________ Date: January 16, 2021
PROCEDURE: ________Partograph Use_________________________________________________________________
I. SKILLS WORKBOOK
GRADING CRITERIA GRADE 30% REMARKS
100 Complete; all steps are rationalized correctly with in-depth concept-base discussion
91-99 Complete; steps are rationalized appropriately but lacks in-depth explanation
81-89 Incomplete; some steps are not rationalized properly with missing information
71-79 Incomplete; only 50% of the steps are rationalized properly
61-69 Insufficient; only 50% of the steps are rationalized with insufficient explanation
51-60 Highly insufficient; only 25% are rationalized
50 No written information at all

II.  RETURN DEMONSTRATION

RATING TOTAL REMARKS
CRITERIA
5 4 3 2 1 20 points
KNOWLEDGE            
Specify content and objectives (oral)            
Completeness of principles with correct rationale 40%              
Resourcefulness              
Ability to answer questions            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 20 points
SKILLS            
Organization and technique            
Workmanship and safety precaution 40%              
Ability to use time, supplies, and effort              
Handling of equipment            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 25 points
ATTITUDE            
Punctuality: Reports for return demonstration on time            
Submission of requirements on time            
Reliability 10%              
Intellectual Integrity: Demonstrates intellectual integrity and
           
honesty
Good relationship with peers and attitude towards procedure            
SUM
CRITERIA TOTAL
REMARKS
LEARNING REFLECTIONS 5 points
10%
Reflection of the activity  
SUM  
Score (70 points)  
Average Grade
70%
Grading Criteria
5 Student is able to perform the procedure with mastery and accuracy.
4 Student is able to perform in a precise manner but unable to rationalize the procedure.
3 Student is able to execute with appropriate rationalization but in the wrong order.
2 Student is able to perform in an incorrect sequence, present an inappropriate rationalization and displays limited skill in execution.
1 Student is unable to perform at all.
Total Score: ________
________________________________________ ________________________________________
STUDENT/SIGNATURE CLINICAL INSTRUCTOR/SIGNATURE
 MSU-Iligan Institute of Technology
COLLEGE OF NURSING
PERFORMANCE EVALUATION TOOL FOR RETURN DEMONSTRATIONS
STUDENT: _ Jalova, Jana Patricia P._____________________________________________ Date: January 16, 2021
PROCEDURE: ______Administering Ophthalmic Medications_____________________________________________
I. SKILLS WORKBOOK
GRADING CRITERIA GRADE 30% REMARKS
100 Complete; all steps are rationalized correctly with in-depth concept-base discussion
91-99 Complete; steps are rationalized appropriately but lacks in-depth explanation
81-89 Incomplete; some steps are not rationalized properly with missing information
71-79 Incomplete; only 50% of the steps are rationalized properly
61-69 Insufficient; only 50% of the steps are rationalized with insufficient explanation
51-60 Highly insufficient; only 25% are rationalized
50 No written information at all

II.  RETURN DEMONSTRATION

RATING TOTAL REMARKS
CRITERIA
5 4 3 2 1 20 points
KNOWLEDGE            
Specify content and objectives (oral)            
Completeness of principles with correct rationale 40%              
Resourcefulness              
Ability to answer questions            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 20 points
SKILLS            
Organization and technique            
Workmanship and safety precaution 40%              
Ability to use time, supplies, and effort              
Handling of equipment            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 25 points
ATTITUDE            
Punctuality: Reports for return demonstration on time            
Submission of requirements on time            
Reliability 10%              
Intellectual Integrity: Demonstrates intellectual integrity and
           
honesty
Good relationship with peers and attitude towards procedure            
SUM
CRITERIA TOTAL
REMARKS
LEARNING REFLECTIONS 5 points
10%
Reflection of the activity  
SUM  
Score (70 points)  
Average Grade
70%
Grading Criteria
5 Student is able to perform the procedure with mastery and accuracy.
4 Student is able to perform in a precise manner but unable to rationalize the procedure.
3 Student is able to execute with appropriate rationalization but in the wrong order.
2 Student is able to perform in an incorrect sequence, present an inappropriate rationalization and displays limited skill in execution.
1 Student is unable to perform at all.
Total Score: ________
________________________________________ ________________________________________
STUDENT/SIGNATURE CLINICAL INSTRUCTOR/SIGNATURE
 MSU-Iligan Institute of Technology
COLLEGE OF NURSING
PERFORMANCE EVALUATION TOOL FOR RETURN DEMONSTRATIONS
STUDENT: _______ Jalova, Jana Patricia P __________________________________________ Date: January 16, 2021
PROCEDURE: _____________Administering Oral Medications________________________________________________________
I. SKILLS WORKBOOK
GRADING CRITERIA GRADE 30% REMARKS
100 Complete; all steps are rationalized correctly with in-depth concept-base discussion
91-99 Complete; steps are rationalized appropriately but lacks in-depth explanation
81-89 Incomplete; some steps are not rationalized properly with missing information
71-79 Incomplete; only 50% of the steps are rationalized properly
61-69 Insufficient; only 50% of the steps are rationalized with insufficient explanation
51-60 Highly insufficient; only 25% are rationalized
50 No written information at all

II.  RETURN DEMONSTRATION

RATING TOTAL
CRITERIA
5 4 3 2 1 20 points
KNOWLEDGE            
Specify content and objectives (oral)            
Completeness of principles with correct rationale 40%              
Resourcefulness              
Ability to answer questions            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 20 points
SKILLS            
Organization and technique            
Workmanship and safety precaution 40%              
Ability to use time, supplies, and effort              
Handling of equipment            
SUM  
 
RATING TOTAL
CRITERIA
5 4 3 2 1 25 points
ATTITUDE            
Punctuality: Reports for return demonstration on time            
Submission of requirements on time            
Reliability 10%              
Intellectual Integrity: Demonstrates intellectual integrity and
           
honesty
Good relationship with peers and attitude towards procedure            
SUM
CRITERIA TOTAL
REMARKS
LEARNING REFLECTIONS 5 points
10%
Reflection of the activity  
SUM  
Score (70 points)  
Average Grade
70%
Grading Criteria
5 Student is able to perform the procedure with mastery and accuracy.
4 Student is able to perform in a precise manner but unable to rationalize the procedure.
3 Student is able to execute with appropriate rationalization but in the wrong order.
2 Student is able to perform in an incorrect sequence, present an inappropriate rationalization and displays limited skill in execution.
 1 Student is unable to perform at all.

Total Score: ________

________________________________________ ________________________________________
STUDENT/SIGNATURE CLINICAL INSTRUCTOR/SIGNATURE

MSU-Iligan Institute of Technology

COLLEGE OF NURSING
PERFORMANCE EVALUATION TOOL FOR RETURN DEMONSTRATIONS
STUDENT: __________ Jalova, Jana Patricia P _____________________________________ Date: January 16, 2021
PROCEDURE: ______________MMDST________________________________________________________
I. SKILLS WORKBOOK
GRADING CRITERIA GRADE 30% REMARKS
100 Complete; all steps are rationalized correctly with in-depth concept-base discussion
91-99 Complete; steps are rationalized appropriately but lacks in-depth explanation
81-89 Incomplete; some steps are not rationalized properly with missing information
71-79 Incomplete; only 50% of the steps are rationalized properly
61-69 Insufficient; only 50% of the steps are rationalized with insufficient explanation
51-60 Highly insufficient; only 25% are rationalized
50 No written information at all

II.  RETURN DEMONSTRATION

RATING TOTAL
CRITERIA
5 4 3 2 1 20 points
KNOWLEDGE            
Specify content and objectives (oral)            
Completeness of principles with correct rationale 40%              
Resourcefulness              
Ability to answer questions            
SUM  
 
RATING TOTAL
CRITERIA REMARKS
5 4 3 2 1 20 points
SKILLS            
Organization and technique            
Workmanship and safety precaution 40%              
Ability to use time, supplies, and effort              
Handling of equipment            
SUM  
 
RATING TOTAL
CRITERIA
5 4 3 2 1 25 points
ATTITUDE            
Punctuality: Reports for return demonstration on time            
Submission of requirements on time            
Reliability 10%              
Intellectual Integrity: Demonstrates intellectual integrity and
           
honesty
Good relationship with peers and attitude towards procedure            
SUM
CRITERIA TOTAL
REMARKS
LEARNING REFLECTIONS 5 points
10%
Reflection of the activity  
SUM  
Score (70 points)  
Average Grade
70%
Grading Criteria
5 Student is able to perform the procedure with mastery and accuracy.
4 Student is able to perform in a precise manner but unable to rationalize the procedure.
3 Student is able to execute with appropriate rationalization but in the wrong order.
2 Student is able to perform in an incorrect sequence, present an inappropriate rationalization and displays limited skill in execution.
1 Student is unable to perform at all.

Total Score: ________

________________________________________ ________________________________________
STUDENT/SIGNATURE CLINICAL INSTRUCTOR/SIGNATURE