OUR LADY OF FATIMA UNIVERSITY

Antipolo Campus
COLLEGE OF NURSING

RLE PERFORMANCE EVALUATION TOOL

Student Name: Dates of Exposure:

Group Number: Semester/Academic year:
Instructor: Hospital/Area/Concept:

Instruction: Rate the student using the following criteria after you have thoroughly evaluated his/her performance.
SCALE:
4 - Works competently and independently always
3 - Requires minimum guidance and supervision
2 - Requires close guidance and supervision most of the time
1 - Do not exhibit expected behavior even under supervision
NCMB418 RLE: CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS, ACUTELY ILL/ MULTI-ORGAN
PROBLEMS, HIGH ACUITY, AND EMERGENCY SITUATIONS
Focusing on the principles and techniques of nursing care management of sick clients in varied settings with life-
threatening conditions/ acutely ill/ multi-organ problems/ high acuity and emergency situations, acute and chronic
1 2 3 4
Providing First Contact Care (PC-FCC)
1. Ability to provide necessary health services appropriate to the urgency of the health
problem.
Providing Primary Comprehensive Care ( PC-COM)
2. The ability to provide a wide range of health services that meet common needs
across all life stages
Providing Continuing care
3. The ability to provide a sustained partnership with the patient or significant others
in the management of his/her condition
Coordinating care
4. The ability to transfer and share responsibility across disciplines and levels of care

Managing patient records

5. The ability to ensure coordination of care through accurate and timely integration of
medical records in the healthcare provider network
Promoting Health
6. The ability to identify describe and implement programs, policies and other health
promotion, interventions that are empowering, participatory, holistic, intersectoral,
equitable, sustainable, and multi strategic in nature.
Providing Public Health function
7. The ability to implement public health programs

No. of Make-up Duty

Date(s) of Tardiness

Date(s) of Absences

NCMB418 RLE: CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS… Page 1

 Maximum Possible Score 28 100% To compute:
Total Score =Score x 60 / Maximum Score + 40
e.g.
Final Clinical Grade
64 (score) x 60= 3840/64(score)= 60 + 40 =100

Comments:__________________________________________________________________________________________________

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Instructor Signature:___________________________________________

Student Signature:____________________________________________

Date:_______________________________________________________

Reviewed by:

NORBERT LEWIN F. SOLIVEN, LPT, MAN, RN

Clinical Coordinator
College of Nursing

Approved by:

EVANGELINE M. TERUEL, MAN, RN

Dean, College of Nursing
OLFU – Antipolo Campus

NCMB418 RLE: CARE OF CLIENTS WITH LIFE-THREATENING CONDITIONS… Page 2