SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES

Nursing Department

PERFORMANCE RATING SCALE

General/Medical Ward Performance Evaluation Checklist

Name of Student: _____________________________________

Clinical Month: _______________________________________
Shift/Clinical Group: __________________________________
School Year: _________________________________________
Term: ______________________________________________ Overall Rating
Inclusive Dates of Clinical Rotation: _____________________

CORE COMPETENCIES WT. CLINICAL REMARKS

INSTRUCTORS’
EVALUATION
I. PATIENT CARE COMPETENCIES (50%)
A. Safe and Quality Nursing Care
Assesses the patient’s actual physical condition 2
accurately.
Monitors the patient’s vital signs regularly, correctly 2
and 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 2
focused on patient’s needs.
Provides needed intervention based on identified 2
needs.
Demonstrates knowledge based on the health/illness 2
status of the clients.
Utilizes the nursing process as framework for the 3
nursing 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 3
10 rights.
Makes wise decisions based on existing situation. 2
B. Communication
Maintains a therapeutic nurse-patient relationship by 2
simply introducing oneself properly and being attentive
at all times 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 2
procedures.
C. Collaboration and Teamwork
Collaborates planning of care with other members of 2
the health team.
Establishes a working relationship with the health team 2
D. Health Education
Listens attentively to patient and their family member’s 2
concern and able to answer their question within one’s
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 2
discharge instruction which is highly based on the
institution’s policy
 II. EMPOWERING COMPETENCIES (25%)
E. Ethico-moral Responsibilities
Respects the rights of the patient. 3
Considers the culture and religion of the patient on 2
rendering nursing care.
Shows commitment, concern and dedication 3
(punctuality, adheres to policy, shows pleasure in
work).
F. Legal Responsibilities
Adheres to the legal and institutional protocols 2
regarding informed consent and other legal
documents.
G. Personal and Professional Development
Performs the function of a ward nurse in accordance 2
with professional standards.
Possesses positive attitude towards learning different 3
nursing procedures, skills and knowledge used in the
ward.
Complies with the rules and regulations of the course 3
concerning uniform and paraphernalia.
Adheres to clinical requirements (e.g. case study, 7
quizzes, exams, attendance)
III. ENABLING COMPETENCIES (15%)
H. Management of Resources and Environment
Ensures availability, completeness and functionality of 2
ward equipments.
Performs proper disinfection and sterilization 2
techniques.
Observes ward policies, procedures, and protocols on 2
infection control.
Awareness of the institutional evacuation and location 1
plan for both fire and earthquake and other major
emergencies.
I. Records Management
Obtains comprehensive patient’s information by 2
checking complete accomplishment of the chart.
Maintains legible, accurate and updated 3
documentation of 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 2
medical breakthrough to the group and to other
members of the health team.
Provides medication updates 1
Identifies researchable problems related to ward 1
practices and issues
K. Quality Improvement
Reports significant actual and potential manifestations 2
of the client.
Reports positive and negative points in the ward. 1
Identifies and reports variances in sterility and other 1
ward activities.
Identifies deviation of practice from the standards. 1
Recommends corrective and preventive measures for 1
the identified deviations
TOTAL: 100 ______________

REMARKS:
____________________________________________________________________________________________
____________________________________________________________________

Clinical Instructor Name & Signature: ______________________________

Student’s Name & Signature: ___________________