COLLEGE OF NURSING

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CLINICAL EVALUATION FORM

BSc(N) – I Year

NAME OF STUDENT: ______________________COURSE & YEAR: ______________

CLINICAL TRAINING FROM: _____________________TO: _____________________

RATING SCALE
S.NO CRITERIA
1 2 3 4 5
1. Grooming
2. Punctuality
3. Leadership
4. Honesty
5. Sense of Responsibility
6. History Collection from Patient
7. Carrying Out Physical Examination
8. Stating Nursing Diagnosis
9. Writing Care Plan
10. Carrying Out Nursing Interventions
11. Technical Skills
12. Applying Scientific Knowledge
13. Critical Thinking Skills
14. Evaluation of Nursing Care Outcome
15. Documenting and Care
16. Communication
17. Professional Attitude
18. Inter Personal Relationship
19. Case Presentation
20. Incidental Health Teaching
TOTAL SCORE

REMARKS

SIGNATURE OF EVALUATOR