Glendale Career College – San Diego Campus

Associate of Science Degree in Nursing Program

Nursing Care Plan Grading Form
Student Name: Date:

Nursing Diagnosis: Course:

Column I: Data Organization & Collection
YES NO Comments
Subjective Data □ □
Objective Data □ □
Cluster/group data □ □
Column II: Nursing Diagnosis
YES NO
NANDA approved diagnosis □ □
“Related to” statement □ □
“As evidenced by” statement □ □
Specific to patient □ □
Column III: Expected Outcomes
Outcomes are:
YES NO
Reasonable □ □
Client centered □ □
Measurable □ □
Time frame stated □ □
Specific to patient □ □
Column IV: Interventions
Interventions reflect:
YES NO
Assessment of nursing diagnosis □ □ Assess
Specific interventions to meet outcome □ □ Do
Client/caregiver learning □ □ Teach
Assessment of client/caregiver learning □ □ Eval/encourage
Multidisciplinary team consultation □ □ Collaborate
Time Frame stated for each □ □
Text and page number cited □ □
Column V: Rationale:
YES NO
Congruent w/intervention □ □
Text and page number cited □ □
Column VI: Evaluation
YES NO
Outcome status stated □ □ Met/Not Met/Partially Met
Criteria of outcome stated □ □
Reassessment:
YES NO
Status of care plan stated □ □ Continue/Revise/Resolve
What do you plan to reassess □ □
Time frame for reassessment stated □ □
CORRECTED □ SATISFACTORY □ UNSATISFACTORY □
PH July2011