NAME OF STUDENT: ________________________________ YEAR: _______________________________

SUBJECT: _____________________________________________ PROFESSOR: __________________________

KEY PERFORMANCE INDICATOR

DIRECTION: RATE THE FOLLOWING NURSING PROCEDURES BASED ON YOUR CLINICAL EXPERIENCE

VERY GOOD

GOOD

FAIR

BAD

VERY BAD

You can also indicate if the following procedure/s was/were not yet performed.

Score Score
Taking vital signs Oral gastric tube insertion
Transferring patient Cleaning enema
Bed making Wound dressing
NGT insertion Collecting sputum
NGT feeding Collecting urine specimen
Chest Physiotherapy (CPT) Collecting stool specimen
Hair Shampoo Diaper change
Indwelling Catheterization (Male) Obtaining capillary blood glucose
Indwelling Catheterization (F) Bandaging
Fleet Enema Blood Transfusion
Intradermal Injection Withdrawing from ampule
Intramuscular Injection Withdrawing from vial
Subcutaneous Injection Changing occupied bed
 Score Score

IV Cannulation Applying nasal cannula

Oral Suctioning
Endotracheal Suctioning
Foot care
Perineal-genital care
Oral care
Intravenous Injection
Applying face mask
Ophthalmic Instillation
Ear installation
Oral medication
Hand washing
Changing unoccupied bed