Taibah University ‫جامعة طيبة‬

Al-Madinah Al-Munawara ‫المدينة المنورة‬

Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬
College of Nursing ‫كلية التمريض‬
Medical Surgical Department ‫قسم الجراحة الطبية‬

CLINICAL EVALUATION CHECKLIST

EMERGENCY NURSING

Name of Student: _______________________________ Year / Clinical Group: ___________

Semester & School Year: _____________Inclusive Dates of Clinical Rotation: ___________________

Legend:
4 pts. Consistently Exceeds Expectations (Student displays at time a consistently high level of skills, abilities,
initiative, and productivity)
3 pts. Often Meet Expectations (Student displays a high level of skills, abilities, initiative, and productivity in some
areas, but not consistently)
2 pt. Meets Expectations (Student displays and maintains reliable level of performance but needs enhancement of
skills)
1 pt. Some Improvement Needed (Student displays inconsistency in the performance of the skills and frequently
falls below acceptable levels)

Learning Domains 4 3 2 1 Remarks

I. INTERPERSONAL SKILLS AND RESPONSIBILITY
1. Observe punctuality in reporting to duty
2. Project a professional image of a nurse.
3. Maintain good interpersonal relationship with
clients, colleagues and other members of the
institution
4. Respect the privacy, religious, cultural and ethnic
practices of the client and his/her family.
5. Adhere to policies, procedure, protocols in
prevention and control of infection.
II. COMMUNICATION, INFORMATION TECHNOLOGY,
NUMERICAL
1. Utilize proper channels of communication.
2. Accomplish accurate documentation in all matters
concerning client care based on standards of
nursing practice.
3. Inform client and significant others of relevant
information about the present condition.
4. Use appropriate technology to collect data, monitor
patient and provide client care.
III. PSYCHOMOTOR
1. Conduct emergency health assessment.
2. Perform infection control measures (hand washing,
gloving, use of mask and other universal infection
control measures applicable).
3. Assess and monitor vital signs.
4. Give/Administer medication safely.
5. Adhere to institutional guidelines on patients safety
6. Perform other nursing procedure as required
a.
b.
c.
d.
e.
7. Render nursing care consistent with the client’s bill of
rights.
Total Score: