Mariano Marcos State University Document Code CHS-NURS-FRM-037

CHS - Department of Nursing

Revision No. 1 Page 1 of 2
Evaluation Tool for Nursing Care Plan Effectivity Date September 2019

EXCELLENT GOOD NEEDS IMPROVEMENT UNACCEPTABLE SCORE

PARAMETERS
4 3 2 1
a. Problem Priority problem is Priority problem is Priority problem is
identified: identified: identified:
• has 25% or less • has 50% or less • has more than 50%
Priority problem is identified with
corrections of the corrections of the corrections of the
accurate etiology and defining
etiology etiology etiology
characteristics include subjective
• lacks 25% or less • lacks 50% or less • lacks more than
and objective data.
information in the information in the 50% information in
defining defining the defining
characteristics characteristics characteristics
Inference miss
Inference include Inference miss important
Inference is simple, complete and important details with
b. Inference important details with details with 50% or less
accurate. more than 50%
25% or less corrections. corrections.
corrections.
Goal is specific, measurable,
Goal needs 25% or less Goal needs 50% or less Goal needs more than
c. Goal attainable, realistic and time
correction. correction. 50% correction.
bounded.
Interventions address the etiology • 25% or less of the • 50% or less of the • more than 50% of
and includes independent and interventions are interventions are the interventions
interdependent as well as missing missing are missing
d. Interventions
therapeutic, diagnostic and • 25% or less of the • 50% or less of the • more than 50% of
educative with appropriate rationale have few rationale have few the rationale have
rationale. corrections. corrections. few corrections.
Evaluation is based from the set Evaluation needs 25% or Evaluation needs 50% or Evaluation needs more
e. Evaluation
goals. less realignment. less realignment. than 50% realignment.

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to compliance to the Documented Information Procedure
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 Mariano Marcos State University Document Code CHS-NURS-FRM-037
CHS - Department of Nursing
Revision No. 1 Page 2 of 2
Evaluation Tool for Nursing Care Plan Effectivity Date September 2019

Name of Learner: _____________________________ ____________________________ DATE: ________ ______

TIME OF DUTY: RLE GROUP # ________ SECTION: ________ CONCEPT:

TOTAL GRADE
Inference Interventions
STUDENT CRITERIA Problem Goal Evaluation

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

CONVERSION TABLE Evaluated by:

Score Equivalent Grade Score Equivalent Grade
20 1.0 11 3.25
19 1.25 10 3.5 _____________________ ________________
18 1.5 9 3.75 Signature over printed name of C.I. / Date
17 1.75 8 4.0
16 2.0 7 4.25
15 2.25 6 4.5
14 2.5 5 4.75
13 2.75 4 & below 5.0
12 3.0

Disclaimer: Reproduction of this form is allowed subject

to compliance to the Documented Information Procedure
established by MMSU.