DE LA SALLE LIPA

COLLEGE OF NURSING
PERFORMANCE EVALUATION IN COMMUNITY
HEALTH NURSING
Name: Year / Section: Rating:
Hospital: Shift: Date of Exposure:

Rate the student’s performance by checking the appropriate box using the following criteria:
2.0 Competent (Performance is consistently done in effective and efficient means)
1.5 Satisfactory (Performance is usually effective and efficient but not always)
1.0 Developing (Progress in performance is too slow to judge satisfactorily; task
performance is not done properly for majority time)
0.5 Needs Improvement (No progress in performance has been demonstrated, and/or
performance is consistently inefficient and ineffective)

COMPETENCIES 2.0 1.5 1.0 0.5

I. VALUE-BASED
A. Safe and Quality Care of the Clients
1. Utilizes the nursing process in obtaining clients information.
2. Performs comprehensive and systematic nursing assessment by collecting pertinent
data using appropriate techniques and tools such as:
• Vital signs (Temp.,PR,RR,BP)
• Conducts physical examination
Checking of Fetal Heart Rate and Fundic Height
3. Applies and utilizes the standard of nursing practice in the community
settings.
4. Implements care of plan safely and effectively using evidence-based nursing
interventions.
• Verify Doctor’s Order
• Performs Leopold’s maneuver (as necessary)
• Monitor progress of labor/uterine contractions as to:
1. Frequency
2. Duration
3. Intensity
4. Internal
5.Promotes patient’s safety. Does necessary referrals as needed:
• Perform hygienic Care
• Assist the client to DR/OR according to plan of management
B. Ethical, Moral and Legal Practice
1. Respects the rights to privacy and confidentiality
2. Accepts responsibility and accountability for all decisions and actions
3. Respects the religious, cultural, and ethnic practices of the client.
4. Adheres to the Nursing Code of Ethics.
5. Protects and advocates client rights based on “Patient’s Bill of Rights and
Obligations”
C. Legal Responsibility
1. Checks individual and family record.
2. Documents all pertinent data correctly and completely.
3. Reports any abnormal findings in vital signs and other assessments
4. Evaluates and Reports pertinent data based on observations.
5. Observes and monitor client’s condition conscientiously.
II. KNOWLEDGE-BASED
A. Research
1. Identify researchable problem related to maternal care.
2. Proposed research study related to assigned case.
3. Discuss latest innovations on maternal and child care.
4. Discuss advances in the specifies field of nursing practice
5. Identify deviation and recommends corrective and preventive measures for
maternal and child practice
B. Continual Quality Improvement
1. Performs quality care that conform to nursing practice.
2. Identify deviation of practice from the standards.
3. Identify and participates in continual quality improvement activities
4. Assess and monitor maternal and child concerns.
5. Identify preventive measures for maternal and child practice
C. Health Education
1.Provides health instruction in promoting health and well being of both mother
and child
2. Responds to the questions of family regarding family health, immunization,
nutrition and other health related issues
3.Provide information on the importance of breastfeeding to the health and
development of the child
4. Provides information on different management and safety precautions in
relation to maternal and child care
5.Gives health teachings to mothers and family members regarding management
of different condition within the scope of nursing
III. OUTCOME ORIENTED
A. Communication
1. Communicates effectively with client and family plans through receptive
listening in non-judgmental approach and allowing time for responses.
2. Establishes working relationship with mother and newborn, significant others
and members of the health team.
3. Accepts criticism constructively by showing positive changes.

4. Interprets and validates clients or family body language and expression.

5. Spend time with the client or family to facilitate conversation that allows them
to express concerns.
B. Collaboration and Teamwork
1. Function effectively as a health team in the community.
2. Recognizes and maintain harmonious relationship among the members of the
health team with mutual respect and trust
3. Participates actively in client care management
C. Records Management
1. Documents accurately relevant data of maternal care
2. Document comprehensively outcome of care
3. Submit on time a comprehensive case study
IV. LEADERSHIP AND GOVERNANCE
A. Personal and Professional Development
1. Accepts criticism and recommendation.
2. Performs functions according to standards
3. Shows interest in work by voluntary willingness to perform assigned tasks
4. Observes punctuality and proper decorum
5. Wears neatly and completely the prescribed uniform and Grooming
B. Management of Resources and Environment
1. Maintains orderliness of the working area.
2. Observes policies, procedures and protocol in DR/ Lying in set up
3. Ensures a warm and a quiet environment
4. Adheres to policies, procedures, and protocols on prevention and control of
infection (segregation and proper disposal of waste)

KNOWLEDGE
Pre Test = Post Test =

Requirements: c/o of ONLINE

Group - 1 Case Study
Individual – 1 NCP (Lying In, Hospital)

COMMENTS: Strengths and Weakness

Attendance Record:

DATE TIME IN REMARKS

(Lates/Absences)

Student’s Signature CI’s Signature over Printed Name

Date: Date: ________________