MSU-Iligan Institute of Technology

COLLEGE OF NURSING
Level II AACUP Accredited

EVALUATION TOOL: CUS RUBRIC

UNACCEPTABLE SATISFACTORY EXCEPTIONAL

POINTS
(10) (15) (20)

PRESENTATION Vague portrayal of Lacking in one of the Clear presentation of roles in

Clear depiction of the roles. Lacking three (CUS) elements. depicting the situation:
situation and roles assertiveness in Addresses concerned a. courteously addresses
while demonstrating nursing role as the individual and introduces personnel being alerted
professional courtesy client’s advocate. self and his/her role in b. introduces self
Brash in conversation client care but needs c.clearly depicts assertiveness
improvement in concise as a nurse.
polite conversation Demonstrates effective self-
regulation. No demonstration
of defensive behaviour or
hyperarousal
I am Insufficient data to Patient is identified but Nurse provides information on
convince concerned pertinent data is patient’s:
CONCERNED personnel to incomplete. a. name
Pertinent and brief reconsider the Data concerning the b. status
information related to situation situations needs to be c. situation that needs
the situation, the Lacks description on better organized. rectification.
patient and his needs pertinent information Conveys urgency in the matter
in the situation on the client and the at hand
situation.
Unable to justify the
urgency of the
situation
I am Concern for client’s Presents limited Expresses how the situation
wellbeing and assessment data to makes you feel uncomfortable.
UNCOMFORTABLE evidence for unease support concern in the Provides pertinent information
Statement justifying in the matter is not situation.. on the specific urgent concern
concern towards the evident. such as relevant
situation laboratory/diagnostic test
results, medication or current
vital signs and why these have
aroused concern

This is a Lack of convincing There is some elaboration States or asks

SAFETY Issue evidence to” stop the
line”.
on why the situation
poses a threat to the
a. How the situation
compromises the client’s
Action requested to Poor evidence of safety of the client. safety or wellbeing.
ensure client safety agreement towards Lacks recommendation of b. informed suggestions on
resolution of the interventions needed for the alternatives for
problem the continuity of care continuity of care.
.
Seeks agreement and
resolution of problem.
Demonstrates excellent
conflict resolution skills
Total ___/80

Describe the specific situation or behavior; provide concrete data.

E—Express how the situation makes you feel/what your concerns are.
S—Suggest other alternatives and seek agreement.

C—Consequences should be stated in terms of impact on established team goals;

strive for consensus.

Assert a corrective action in a firm and respectful manner

 Make an opening.
 State the concern.
 State the problem (real or perceived).
 Offer a solution.
 Reach agreement on next steps.