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Prediatric Ward Checklist

Prediatric Ward Checklist

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06/29/2014

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CU-QMS-NURSING-006
Capitol University
College of Nursing
CLINICAL PERFORMANCECHECKLIST FOR PEDIATRIC WARD
Name:__________________________________ Period of Rotation:_____________________
Level:__________________________________
Rating:_______________________________
I: KNOWLEDGE / COGNITIVE (40%)
RATING
1. Identify significant assessment limits, diagnostic examination
And laboratory findings pertinent to child\u2019s condition.
1
2
3
4
2. Identify child\u2019s growth and development
1
2
3
4
3. Correlates significant clinical manifestation with the
Pathophysiology of the disease condition.
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2
3
4
4. Identify common problem on different age group
And prioritize them accordingly
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2
3
4
5. Formulates appropriate, relevant & realistic nursing
Care plan
1
2
3
4

6. Formulates specific, measurable, attainable nursing,
goals and objectives and identifies independent /dependent
nursing function.

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3
4
7. Familiarized and explained the indication of drugs and solution
used in child\u2019s care
1
2
3
4
8. Describes the health benefits of breastfeeding and nutritional
options to the non-breastfeeding infant.
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2
3
4
9.Anticipates discharged planning.
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2
3
4
10. Evaluates and assess the effectiveness of care rendered.
1
2
3
4
II: SKILLS/ PSYCHOMOTOR (40%)
1. Conduct physical assessment on child general appearance
and obtain vital sign.
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2
3
4
2. Provide child needs during their acute, chronic and
life \u2013 threatening illness.
1
2
3
4
3. Observes and assist other member of the health team during
the intensive diagnostic procedure.
1
2
3
4
4. Records and reports significant data/observation about
the child\u2019s condition with promptness and accuracy.
1
2
3
4

5. Perform nursing procedures skillfully, (NGT feeding,
Pulmophysiotheraphy, 02 therapy, specimen collection,
Chest tapping and positioning.)

1
2
3
4
6. Prepares, administer & documents medicines
given as ordered.
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2
3
4
7. Provide practical and psychosocial support for the family
with high risk child.
1
2
3
4
8. Perform routine therapeutic intervention & maintain
Thermo-regulation.
1
2
3
4
9. Records appropriately on the flow sheets and narrative
nurse\u2019s notes
1
2
3
4
10. Organized work & manage time effectively & ensure
environmental safety.
1
2
3
4
III:
ATTITUDE /AFFECTIVE (20%)
1.Abides all institutional policies.
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4
2. Accept nursing service responsibilities with interest
and willingness to work
1
2
3
4

3. Allows considerable time to be with the patient and give
physical and emotional & spiritual support
to patient significant others.

1
2
3
4

4. Accomplishes assigned task with no competence, calmness,
confidence, compassion, initiative, resourcefulness
and creativity.

1
2
3
4
5. Establishes professionalism with patients, co-students, nurses
and other health team members.
1
2
3
4
_______________________________
STUDENT\u2019S SIGNATURE
______________________________
CLINICAL INSTRUCTOR
Issue: 05 April 2006
Revision Code : 003

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