Philippine Rehabilitation Institute Foundation Inc College Of Nursing RLE LEADERSHIP AND MANAGEMENT ( HEAD NURSING ) ACHIEVEMENT EVALUTION

REPORT (HEAD NURSE TO STAFF NURSE) Area: Inclusive Date: Clinical Instructor: Name of Students Semester: Level: Sec/ Group: Remarks

Grades

Date: Submitted By:

Signature Over Printed Name

Philippine Rehabilitation Institute Foundation, Inc. College Of Nursing Daily TASK SHEET Name: Section/Group: Patients Name: Room/Bed #: Diagnosis: Attending Physician: Vital Signs: I & O: Diet: Activity: Contraption: IVFs: Procedure/ Laboratory Work Up: Medication: Area: Date:

Vital Signs: BP T P R

I: Oral = Parenteral = Output: Urine= Drainage: BM

PHILIPPINE REHABILITATION INSTITUTE FOUNDATION, INC. College of Nursing # 56 Banawe Street, Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Head Nurse to Student Staff Nurse) Name: Year/Section: Dates of Exposure: Clinical Area:

Group:

Direction: Rate the students on the following competencies using a 5-point scale as follows:

Rating 5 4 3

Quantitative Outstanding Very satisfactory Satisfactory

Needs Improvement

Unsatisfactory

Description Able to function independently and correctly observes principles Able to function with less supervision from the instructor ad observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing

I. 1. 2. 3. 4. 5. 6. 7. II. a. b.

Performance Assessment/ Planning Establishes rapport with patients Able to involve patients in plan of care Punctual and prompt in all activities Able to maintain stability under pressure Gathers data using interview, observation, records review and reports Formulates appropriate nursing care plan Wears complete prescribed RLE uniform Assessment/ Planning Carriers out assigned tasks based on the criteria of distribution of assignments Follows principles of time management

Rating

c. Equipped with the required paraphernalia for RLE d. Observes proper channels of communication e. Carriers out plan of care, including: Bedside care Administration of Medications Administration of treatment ( CPT, Nebulization, IVF ) f. Shows initiative in performing tasks g. Accomplishes delegated tasks within prescribed time frame h. Provides psychological and spiritual support to patients i. Accepts supervision and criticisms j. Conducts appropriate health teachings III. Evaluation a. Notifies immediate supervisor about untoward situations or conditions related to patient care in the area b. Makes revision in the plan of care as necessary c. Evaluates nursing care rendered IV. Ethico Considerations a. Demonstrates honesty at all times b. Conducts self in a tactful manner c. Keeps confidential information d. Observes the PNA Code of Ethics e. Guided by RA 9173 f. Observes the 11 Core Competency Guidelines

REMARKS:

EVALUATED BY: Student Staff Nurse CONFORME: Student Staff Nurse NOTED: Clinical Instructor Actual Score x 100 Total Score

PHILIPPINE REHABILITATION INSTITUTE FOUNDATION, INC. College of Nursing #56 Banawe Street, Quezon City RLE LEADERSHIP AND MANAGEMENT (HEAD NURSING) CLINICAL PERFORMANCE EVALUATION TOOL (Student Staff Nurse to Student Head Nurse)

Name: Year/ Section: Rating 5 4 Quantitative Outstanding

Group:

Date of Exposure: Clinical Area: Description Able to function independently and correctly Observes principles Able to function with less supervision from the instructor and observes principles theories of nursing most of the time Able to function but requires close supervision from the instructor and observes principles at theories of nursing sometimes Able to function but requires close supervision from the instructor and occasionally applies principles and theories of nursing Unable to function and has not applied nor observed underlying principles at theories of nursing

Very Satisfactory

Satisfactory

Needs Improvement

Unsatisfactory

Performance I.ESTABLISHMENT OF WORKING RELATIONSHIP 1. Establishes rapport with subordinates 2. Gains trust and confidence of subordinates 3. Able to mediate between subordinates and patients 4. Able to maintain stability under pressure II. ASSESSMENT/ PLANNING 1. Utilizes appropriate resources for ward assessment 2. Utilizes different techniques in gathering data ( interview, observation, records review, reports)

Rating

3. Gathers data on: Nursing service history Physical set up Organization chart Ongoing appraisal evaluation Ward rules and regulation at SOPS Channel of communication Records and Reports 4. Analyze data gathered based on scientific concepts and principles 5. Briefs students staff nurses on data gathered 6. Identifies and priorities problems based on data gathered according to the urgency of the availability of resources ( man power, materials, money/ budget) III. PROBLEM SOLVING PROCESS a. Involves the staff, other members of the health team and administrative units in identifying problems in the unit b. Generates suggestions and recommendations for the resolution of identifies problems c. Analyze the existence of the problem d. Identifies specific and appropriate strategies to attain objectives e. Develops alternative course of action f. Implements plan of action g. Sets criteria for evaluation using the different parameters of evaluation V. LEADERSHIP a. Conduct a pre conference with his/her staff to discuss the objectives and activities for the day, helps subordinates, formulate strategies in accomplishing assigned tasks, address questions pertaining to accomplishment of task b. Prepares and brief subordinates on the learning objectives for the day c. Distribute patient assignment evenly d. Delegates tasks to student staff nurse e. Prepares and brief subordinates on the daily plan activities f. Evaluates if the objective are met g. Come up with resolutions to address constraints h. Supervise his/her staff during procedures and other assigned tasks i. Coordinates and collaborates with other members of the health team and other administrative units in the attainment of objectives j. Evaluates performance of staff and the unit as a whole through the use of reports, records, observations, interviews, and conferences k. Troubleshoot as necessity arise l. Conducts post conference at the end of the shift, resolves issues and concerns and conducts debriefing as necessary m. Requires incident reports as necessary, keeps the clinical instructor informed and updated n. Utilizes the existing chain of command in implementing activities

REMARKS:

EVALUATED BY: Student staff Nurse CONFORME: Student Staff Nurse NOTED: Clinical Instructor

Actual Score x 100 Total Score

PHILIPPINE REHABILITATION INSTITUTE FOUNDATION, INC. College Of Nursing

Name: Hospital: DAILY REQUIREMENT CHECKLIST CRITERIA I.ATTENDANCE /Time of arrival II.PARAPHERNALIA PRI bag NANDA Book Drug Handbook ID/ Nameplate Complete Uniform Shoes Nursing Cap/ Undershirt Wrist Watch Notebook/ Ticklers Thermometer Oral Rectal Axilla BP Apparatus Stethoscope Canister w/ Dry cotton balls Cotton balls with alcohol Ballpen Red Black Green Pencil Eraser Ruler Micropore tape Tape measure Penlight with battery Face mask Bandage scissor Tourniquet Clean gloves Sterile gloves Soap

Section/Group: Date of Exposure:

Alcohol Betadine Tongue depressor Cotton buds Medicine tray Medicine cup Kidney basin Clip board Syringe 10 cc 5cc 3cc Tuberculin syringe Insulin syringe PATIENTS KIT Face towel Tooth brush Toothpaste Comb Nail cutter Soap Shampoo

Prepared By: Clinical Instructor: