Manila Adventist College

SCHOOL OF NURSING
DIALYSIS UNIT PERFORMANCE EVALUATION TOOL

Name of Student:_______________________________ Date:____________________

Evaluator:___________________________________ Signature:________________

Direction: Please check the column of the number which corresponds to the student’s
performance using the rating below.

4 – The student always performs the expected tasks/responsibilities and behaves above
the acceptable level, self-directed, needs very minimal guidance and supervision.
3 - The student frequently performs expected tasks/responsibilities and behaves within
the acceptable level; needs minimal guidance and supervision.
2 – The student seldom performs the expected tasks/responsibilities and behaves within
the acceptable level; needs moderate guidance and supervision.
1 – The student does not meet the expected level of performance and behavior required
for the responsibility despite counseling and supervision.
0 – The student totally does not meet the expected level of competency and needs
enormous change.

ASPECTS TO EVALUATE 4 3 2 1 0 REMARKS

Knowledge:
1. Has knowledge of the parts of the dialysis machine
and equipment used in the procedure prior to going
to duty
2. Easily understands information and instruction
presented by the supervising CI or DU personnel
3. Answers most of the questions raised regarding
the indications, complications and contraindications
of dialysis.
Skills:
1. Does a thorough assessment before the procedure
and gives preparatory nursing care competently.
2. Provides health teaching to client of what to
expect during and after the procedure
3. Performs basic skills with confidence and accuracy
4. Applies principles of aseptic technique
5. Assists and carefully observes the dialysis unit
nurse during the induction of the procedure
6. Able to provide appropriate nursing care to the
patient during the procedure
7. Provides holistic care taking into consideration not
only the patient’s physical needs but the emotional
and spiritual aspects as well
8. Monitors the client constantly and does
immediate referral for any untoward observation to
the DU charge nurse
9. Completes documentation precisely and on time
10. Examines and evaluates patient’s condition after
the procedure
Attitude:
1. Comes on time and presents self in an appropriate
uniform
2. Pays undivided attention to every instruction given

3. Shows eagerness to learn

4. Able to establish rapport with the clients and the
staff
5. Accepts criticism positively
6. Demonstrates caring attitude
7. Attends to patients needs urgently and politely
8. Helpful and respectful to co-students, CI and DU
staff
Fe Sarmiento ‘23

Total Score: ___________