SAINT LOUIS UNIVERSITY

School of Nursing
Baguio City 2600
Philippines
EVALUATION TOOL – CLINICAL PRACTICE
Hospital and Community
NAME: VILLAMIN, AZIZAH ANNE C. Year and Section: 4G Group: 3
Agency/Hospital Clinical Areas: SLU - SHS, MEDCCU
Term: ________Semester
2nd 20___-20____
21 22 / Short term________ Duty Dates:March 7 - 9, 2022
LEGEND:
4 = competent (The student performs consistently in an effective and efficient manner; with
minimal supervision)
3 = progress acceptable (performance is usually effective and efficient but not always; with
moderate supervision )
2 = needs improvement (performance is unsatisfactory, task performance is not done properly
most of the time; with close
supervision )
1 = performance unacceptable (performance is ineffective and inefficient always; with very close
supervision)
STANDARDS
Nursing Core Competencies:_ 108__points SCORE REMARKS
A. Integration of relevant concepts in the practice of
nursing.
1. Integrates relevant principles of social, physical, natural and
health sciences and humanities in a given health and nursing 3
situation.
2. Applies relevant nursing concepts and actions holistically
2
and comprehensively.
B. Application of the Nursing Process
3. Assesses with the client (individual, family, population
group, and/or community), one’s health status/competence 2
comprehensively
4. Formulates with the client a plan of care to address the
health conditions, needs, problems and issues based on 2
priorities.
5. Implements appropriate and quality interventions with the
client to address the health needs, problems and issues. 3
6. Promotes safety, comfort and privacy of clients 4
7. Provides health education to targeted clientele using
appropriate tools and strategies 3
8. Evaluates with the client the health status/
2
competence/expected outcomes
9. Institutes appropriate corrective actions to prevent or
minimize harm 4
C. Effective Communication
10. Ensures a working relationship with the client and/or
support system based on trust, respect and shared decision- 4
making
11. Communicates clearly, briefly, accurately and promptly all
relevant information in an organized manner , both in oral and 4
written form to members of the health team
12. Establishes therapeutic communication with clients and
4
significant others
D. Reporting and Documentation
13. Documents accurately client’s responses, nursing care 3
services rendered and outcomes
14. Ensures completeness, integrity, safety, accessibility and
4
security of information.
15. Adheres to protocol and principles of data privacy and
confidentiality in safekeeping and releasing of information. 4
E. Management and Leadership
 16. Manages resources ( human, physical, financial, time) 2
appropriately
17. Utilizes critical thinking in making decisions/solving
2
problems related to client care
F. Ethico-legal Practice
18. Adheres to the Code of Ethics for Nurses 4
19. Applies ethical reasoning and decision making process to 4
address situations of ethical distress and moral dilemma
20. Protects clients rights based on “Patient’s Bill of Rights and 4
Obligations.”

G. Collaboration and Coordination

21. Establishes collaborative relationship with colleagues and
other 3
members of the health team
22. Implements strategies to enhance/support the capability of
the client to participate in decision making by the inter- 3
professional team.
23.Maintains a harmonious and collegial relationship among
4
members of the health team
24. Promotes relevant health-related advocacies (health
promotion/prevention, DOH/WHO programs and health laws 2
implementation, etc.)
H. Techno-intelligent care
25. Uses appropriate technology to perform safe and efficient 2
nursing activities
I. Research and Evidence-based Nursing Practice
26. Implements research-based/evidence-based strategies, 3
initiatives or innovations
J. Responsible Citizenship
27. Provides culturally appropriate and sensitive nursing care 4

ATTITUDES: 30 points

1.PROFESSIONAL VALUES
1 2 3 4
Does not demonstrate Sometimes demonstrate Often demonstrate Consistently
caring as the core of caring as the core of caring as the core of demonstrate caring as
nursing, love of God, nursing, love of God, nursing, love of God, the core of nursing,
love of country and love of country and love love of country and love of God, love of
love of people; does of people; displays love of people; country and love of
not display altruism altruism and respect for displays altruism and people; displays
and respect for human human dignity on some respect for human altruism and respect
dignity, does not occasions; minimally dignity most of the for human dignity;
project the positive projects the positive time; projects the projects the positive
professional image of professional image of a positive professional professional image of
a Filipino Nurse. Filipino Nurse. image of a Filipino a Filipino Nurse.
Nurse.
2. LIFELONG LEARNING
1 2 3 4
No evidence of self- Minimal evidence of Moderate evidence of Clear evidence of self-
directed learning; does self-directed learning; self-directed learning; directed learning;
not assume responsibility sometimes assume often assume assume responsibility
for own personal responsibility for own responsibility for own for own personal
development and personal personal development development and
improvement of development and and improvement of improvement of
competence.
3. COMPASSION AND SENSITIVITY
1 2
Grouchy, no charisma,
dull, hostile to fellow
workers, very little
response to physical/
emotional needs of
patients and family,
paranoid,
unapproachable,
“couldn’t care less”
attitude, inappropriate
responses (verbal and
non-verbal).
improvement of competence. competence
competence. continuously.
3 4
Moody, minimal Good disposition, Outstanding
response to the shows moderate compassion and
needs of client, less compassion and sensitivity, always
compassionate, with sensitivity, often exhibits empathy, very
poor rapport with emphatic, good good rapport with
client and fellow rapport with clients patients and family,
workers, sometimes and fellow workers, charismatic,
displays often displays consistently displays
inappropriate appropriate responses appropriate responses
responses ( verbal (verbal and non- (verbal and non-
and non-verbal). verbal). verbal).

4. CHRISTIAN VALUES
1 2 3 4
No commitment, Minimal display of Moderate display Evident consistent
disrespectful, commitment, commitment, respect, display
self-centered, ungrateful, respect, humility, gratitude, of commitment,
lacks humility, gratitude, harmony, joyful respect,
harmony, poor harmony, joyful disposition, instilling humility, gratitude,
disposition, disposition; minimal hope, and service- harmony, joyful
projecting hopelessness, efforts to instill hope, oriented with some disposition,
and not promotes justice, focus on preservation instilling hope, and
service-oriented; does not peace, of life and service-
promotes justice, peace, and integrity of conservation of the oriented with focus on
and creation; environment; preservation of life and
integrity of creation. involuntary service- promotes justice, conservation of the
orientedness. peace, and integrity of environment;
creation. promotes
justice, peace, and
integrity
of creation.

5. INTELLECTUAL INTEGRITY AND HONESTY

1 2 3 4
Intellectually dishonest, Intellectually honest Demonstrates Demonstrates
provides misleading in most situations; intellectual honesty intellectual honesty
information meant to occasionally and integrity; accepts even in difficult
defend and protect self; withholds information mistakes and situations; readily
does not readily accept when confronted; limitations. accepts mistakes and
mistakes and limitations. occasionally fails to limitations & makes
accept mistakes and conscious effort to
limitations. improve on time.

6. RELIABILITY AND RESPONSIBILITY

1 2 3 4
Irresponsible, unreliable; Usually prompt but Performs duties Performs duties
needs repeated performs just enough promptly; often promptly and
reminders of to get by; often not flexible and adaptable; efficiently without
assignments; not flexible flexible and dependable in being reminded; is
and adaptable; does less adaptable; usually performing resourceful and
than prescribed work. dependable but responsibilities without innovative; always
sometimes needs being reminded. flexible and adaptable;
reminders of takes initiative to
assignment. spend additional time.
7. COMPLETE PRESCRIBED UNIFORM AND PARAPHERNALIA
1 2
Incomplete prescribed uniform and Complete & neat prescribed uniform and
paraphernalia (more than 4 occasions); often paraphernalia; always with prepared
untidy and non-functional paraphernalia. functional equipment/paraphernalia;
maintains them in neat order.
8. PUNCTUALITY AND ATTENDANCE
1 2
Late in attendance and submission of Punctual in attendance and submission of
requirements. requirements.

9. PARTICIPATION IN GROUP ACTIVITIES

1 2
Does not participate in activities. Actively participates in activities; eager to
share ideas and learn from others.
SUMMARY:

Core Comp Score Core Competencies Score 55%

( 108)
Attitude Score (30) Attitude Score 10%
Written exams 15%
Requirements 20%
TOTAL ROTATION GRADE
CONFORME:
CI’s Signature: Student’s Signature:
Date: Date:
STUDENT’S COMMENTS ON CLINICAL EXPOSURE:
It was a rotation filled with learning and skills as we maximized our shift in the MEDCCU which enabled me to
communicate and perform assessment on my assigned patient effectively. Also, I was able to prepare all of the due
medications and administer them with the supervision of my Clinical Instructor on time.

Student’s Signature: ___________________________________