PERFORMANCE EVALUATION TOOL

Safe and Quality Nursing Care

1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Management of Resources and
Environment
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Health Education
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Legal Responsibility
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Ethico-Moral Responsibility
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Personal and Professional Development
1 1.0
2 1.0
 3 1.0
4 1.0
5 1.0
Quality Improvement
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Research
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Records Management
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Communication
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Collaboration and Teamwork
1 1.0
2 1.0
 3 1.0
4 1.0
5 1.0

Prepared by:
ZIA MAEVE CALDOZA
Student Nurse

Noted by:
DON LEOFREJIM JONE ANTIVO, RN
Supervising Clinical Instructor

DAN MICHAEL APARICIO SARABIA, RN

Clinical Instructor

Section: Level 1 - N15

Subject/Topic: Anatomy and Physiology – Skeletal System
Clinical Instructor: Manilyn A. Busia, RN, LPT

Excellent Very Good Fair Poor

Good
I. Personal Characteristics 34 7

II. Knowledge of Topics and Clarity 27 14

of Presentation
III. Management and Organization 30 11

IV. Interest and Stimulation 30 11

V. Rapport 30 11

Prepared By:

ZIA MAEVE CALDOZA, SN

Practice Clinical Instructor

Noted By:

MANILYN A. BUSIA, RN, LPT

Clinical instructor

DON LEOFREJIM JONE ANTIVO, RN

Supervising Clinical Instructor

PCI EVALUATION RESULTS

Practicing Clinical Instructor: Cheryl Moana Marie Fedelis
Level IV CHN Group 2 – Batch 4

PERFORMANCE EVALUATION TOOL

Safety and Quality Nursing Care Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Management of Resources and Environment Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Health Education Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Legal Responsibility Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Ethico-moral Responsibility Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Personal and Professional Development Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Quality Improvement Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Research Total of Students Rating
1 1.0
 2 1.0
3 1.0
4 1.0
5 1.0
Records Management Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Communication Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
Collaboration and Teamwork Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.0
TOTAL 1.0

Prepared by:

CHERYL MOANA MARIE FEDELIS

Student Nurse

Noted by:

DON LEOFREJIM JONE ANTIVO, RN MARIA CORAZON GALLENTES, RN

Supervising Clinical Instructor Clinical Instructor

Section: Level 1 - N19

Topic: Anatomy and Physiology of Muscular System
Clinical Instructor: Arman-Emm Escatron, RN, MAN

EVALUATION RESULTS

LECTURE DEMONSTRATION EVALUATION TOOL

RATE 5 4 3 2 1
Number of Students:
Personal Characteristics 25 0 0 0 0
Knowledge of Topics and Clarity of Presentation 25 0 0 0 0
Management and Organization 25 0 0 0 0
Interest and Stimulation 25 0 0 0 0
Rapport 25 0 0 0 0
Present: 25 Absent: 2

Evaluation:
During the lecture demonstration, the instructor exhibited a high level of expertise and
professionalism, effectively conveying the subject matter while establishing a strong rapport with the
audience. Their presentation was engaging and interactive, ensuring that all aspects of the lesson were
thoroughly discussed. Additionally, the instructor's confidence, knowledge, and passion for the
subject were evident, making for an amazing and articulate delivery that left students feeling
encouraged and inspired.

Prepared by:

CHERYL MOANA MARIE FEDELIS, SN

Practicing Clinical Instructor

Noted by:

ARMAN-EMM C. ESCATRON, RN, MAN

Clinical Instructor

DON LEOFREJIM JONE ANTIVO, RN

Supervising Clinical Instructor

PRACTICE CLINICAL INSTRUCTOR STUDENTS PERFORMANCE EVALUATION

PCI name: Jean L. De Vera Level IV
CHN Group 2 – Batch 4

Safe and Quality Nursing Care Total of Students Rating

1 1.0
2 1.0
3 1.1
4 1.0
5 1.0
Management of Resources and Environment Total of Students Rating
1 1.1
2 1.0
3 1.0
4 1.1
5 1.0
Health Education Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.0
5 1.1
Legal Responsibility Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.2
5 1.0
Ethico-moral Responsibility Total of Students Rating
1 1.0
2 1.0
3 1.3
4 1.0
5 1.0
Personal and Professional Development Total of Students Rating
1 1.0
2 1.0
3 1.1
4 1.2
5 1.0
Quality Improvement Total of Students Rating
1 1.0
2 1.0
3 1.3
4 1.0
5 1.0
Research Total of Students Rating
 1 1.0
2 1.0
3 1.0
4 1.0
5 1.1
Records and Management Total of Students Rating
1 1.0
2 1.0
3 1.0
4 1.2
5 1.0
Communication Total of Students Rating
1 1.0
2 1.2
3 1.0
4 1.0
5 1.0
Collaboration and Teamwork Total of Students Rating
1 1.1
2 1.0
3 1.0
4 1.0
5 1.0

Prepared by:

JEAN L. DE VERA
Student Nurse

Noted by:

Brenston V. Castanos, RN

Supervising Clinical Instructor

DON LEOFREJIM JONE ANTIVO, RN

Supervising Clinical Instructor

LECTURE DEMONSTRATION STUDENTS EVALUATION

Section: Level 1 - N19

Subject/Topic: Human Anatomy

No. of Students: 27
Rate: 5 4 3 2 1

Personal 27
Characteristics

Knowledge of 27
Topics & Clarity
Presentation

Management and 27
Organization

Interest and 27
Stimulation

Rapport 27

Prepared by:

JEAN L. DE VERA
Student Nurse

Noted by:

ARMAN-EMM C. ESCATRON, RN, MAN

Supervising Clinical Instructor

DON LEOFREJIM JONE ANTIVO, RN

Supervising Clinical Instructor