EVALUATION FORMAT FOR OVERALL CLINICAL PERFORMANCE OF STAFF NURSES

Sl.No 1. 1.1. 1.2. 1.3. 1.4. 1.5. 1.6. 1.7. 1.8. 2. 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. 2.8. Items to be evaluated Always (2) Sometimes (1) Never (0)

PROFESSION AND PERSONAL Professional Autonomy Commitment to service Belief in the dignity and work of each person Emotional stability Self confidence Discipline Punctual Co-ordinates with co-workers NURSING CARE Assessment of the patient Identifies the needs of the patient Delivers high quality nursing care Skilled Considers patient as unique person Manages nursing care plan Able to plan and organize patient care Keeps up economy of time, material and energy while doing procedure 2.9. Have good communication skill 2.10. Accurate in maintaining records and reports 3. MANAGEMENT RESPONSIBILITIES 3.1. Leadership qualities 3.2. Planning and administration competency 3.3. Self awareness 3.4. Show quality of building human relations 3.5. Evaluation of activities 4. UPDATING KNOWLEDGE 4.1. Participate in ward teaching and conferences 4.2. Uses possible learning opportunities Good • 32, Average ± 24- 31, Satisfactory- 20-23, Poor < 20 Comment of Evaluator:

Signature of Staff Nurse: Date:

Signature of Evaluator

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