October 6 University Faculty of Nursing

Pediatric Nursing Department

Pediatric Nursing
Surgical Clinical Area Evaluation Sheet
Student's Name:- -----------------------------------Group No: --------------------- Student's No: --------------------
Clinical duration: ----------- Days of Attendance: -------------------Days of absenteeism: --------------
Excuse: --------------------------Late: ------------------------------------------------------------------------------------------
Student's
Item Total marks Comments
marks
Maintain professional conduct:
1. Absenteeism
2
– Attending the clinical area on time.
2. Grooming
– Complete, tidy uniform, equipment and bring all clinical 1
sheets.
3. Communication
– Verbal and non-verbal communication with mother,
instructors, peers, nurses & doctors. 2
– Provide complete individualized teaching using proper
posters.
Total 5
Records documentation
1. Assessment sheet and growth chart 1
2. Nursing record and health teaching 2
3. Nursing care plan 2
Total 5
Knowledge
1- identify patient diagnosis 1
2- identify lab investigation 1
3- Medication 1
4- Growth measure 1
5- patient needs and problems 1
Total 5
Manual skills:
1. Measure vital signs 3
2. Provide quality nursing care.
– Provide hygienic care 2
– Provide accurate pre-operative care. 2
– Provide accurate post-operative care. 2
– Colostomy care 2
– Gastrostomy care 2
– Gastrostomy feeding 2
Total 15
Total 30

Student's signature:… ………………………….… Supervisor's Name: ………………………………

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