COLLEGE OF ALLIED HEALTH SCIENCES

Nursing Department
Rizal Street, Iloilo City

PERFORMANCE RATING SCALE

General/Medical Ward Performance Evaluation Checklist

Code: GW/M

Name of Student: ____________________________________

Clinical Month: _____________________________________
Shift/Clinical Group: _________________________________
School Year: ________________________________________ Overall Rating
Inclusive Dates of Rotation: ___________________________

SELF- EARNED
CORE COMPETENCIES WT
EVALUATION POINTS
I. PATIENT CARE COMPETENCIES (50%)
A. Safe And Quality Nursing Care
Assesses the patient’s actual physical condition accurately. 2
Monitors the patient’s vital signs regularly, correctly and
2
accurately.
Performs head to toe assessment. 2
Identifies priority needs of the patient at the ward. 2
Formulates a nursing care plan which is mainly focused on
2
patient’s needs.
Provides needed intervention based on identified needs. 2
Demonstrates knowledge based on the health/illness status
2
of the clients.
Utilizes the nursing process as framework for the nursing
3
care to be performed based on the client’s needs.
Executes legal orders of the physician accurately and
2
timely.
Evaluates patient’s response to interventions. 2
Performs nursing skills efficiently and effectively
(e. g. suctioning, enema, catheterization, nebulization, 4
oxygen administration etc.).
Administers the prescribed medication observing the 10
3
rights.
Make wise decisions based on existing situation. 2
B. Communication
Maintains a therapeutic nurse-patient relationship by simply
introducing oneself properly and being attentive at all times 2
concerning patient needs.
Observes proper behavior when dealing with hospital
2
personnel, supervisors and group mates.
Utilizes proper channel of communication. 2
Observes complete and accurate endorsement procedures. 2
C. Collaboration
Collaborates planning of care with other members of the
2
health team.
Establishes a working relationship with the health team. 2
D. Health education
Listens attentively to patient and their family member’s
concern and able to answer their question within one’s 2
competence.
Provides the patient and their family the necessary
2
teachings concerning proper care and adjustments.
Implements appropriate health education activities to 2
patient based on needs assessment of the patient.
Accomplishes a discharge planning and provide discharge
2
instruction which is highly based on the institution’s policy.
II. EMPOWERING COMPETENCE (25%)
E. Ethico-moral Responsibilities
Respects the rights of the patients. 3
Considers the culture and religion of the patient on
2
rendering nursing care
Shows commitment, concern and dedication (punctuality,
3
adheres to policy, shows, pleasure in work.
F. Legal Responsibilities
Adheres to the legal and intuitional protocols regarding
2
informed consent and other legal documents.
G. Personal and Professional Development
Performs the function of a ward nurse in accordance with
2
professional standards.
Possesses positive attitude towards learning different
2
nursing procedures, skills and knowledge used in the ward.
Complies with the rules and regulations of the course
2
concerning uniform and paraphernalia.
Adheres to clinical requirements (e. g. case study, quizzes,
7
exams, attendance).
III. ENABLING COMPETENCE
H. Management Of Resources and
Environment
Ensures availability, completeness and functionality of ward
2
equipment.
Performs proper disinfection and sterilization techniques. 2
Observes ward policies, procedures, and protocols on
2
infection control.
Awareness of the institutional evacuation and location plan
1
for both fire and earthquake and other major emergencies
I. Records Management
Obtains comprehensive patient’s information by checking
2
complete accomplishment of the chart.
Maintains legible, accurate and updated documentation of
3
patient care in the chart.
Maintains complete and accurate nurse’s notes. 3
IV. ENHANCING COMPETENCIES (10%)
J. Research
Shares information about recent health innovation or
medical breakthrough to the group and to other members of 2
the health team
Provides medication updates. 1
Identifies researchable problems related to ward practices
1
and issues.
K. Quality Improvement
Reports significant actual and potential manifestations of
2
the client.
Reports positive and negative points in the ward. 1
Identifies and reports variances in sterility and other ward
1
activities.
Identifies deviation of practice from the standards. 1
Recommends corrective and preventive measures for the
1
identified deviations.
TOTAL 100 __________

REMARKS:
___________________________________________________________________________
___________________________________________________________________________

CLINICAL INSTRUCTOR: _________________________

CONFORME: Student’s Signature: _________________