JAGANNATH GUPTA INSTITUTE OF NURSING SCIENCES

Clinical Evaluation Format

Name of the student: Clinical field:

Experience started: Experience ended:

Total marks: 100 : Marks obtained:

Sl Criteria Poor Average Good Very Excellent

no Good
1 2 3 4 5
I Objective:
Evidence of ability in planning
comprehensive patient care based on
assessment of patient need:

1. Make Nursing assessment (Head to Toe

assessment / pain assessment / system wise /
psychosocial / spiritual)

2. Identify the patient problem by considering

patient as a whole.
3. Recognize the nature of illness
4. Plan and organizes daily work priority wise
5. Consider economy of time, material and
energy.
6. Use knowledge of available resources.
II
Objective II:
Evidence of ability to implement
appropriate nursing interventions based on
Scientific Principles and concepts of
Nursing Care.

7. Explains the nursing action before

implementation.

8. Knowledge in carrying out the treatment.

9. Provide problem based Nursing care.

10. Applies scientific principles – that justify

nursing action.
11.
Carries out Nursing procedure effectively

12. Taking care of the equipment

13. Taking care of the patient’s unit

III Objective III

Evidence of teaching skill in patient
situation:

14. Identify the learning need of the patient and

the families.

15. Teach according to the level of

understanding of the patient and the
families.
IV Objective :IV
Evidence of recording and reporting
information essential for the continuity of
care.

Complete charts, Reports and record of

16. patient’s conditions and Nursing action
accurately.

Receives / reports pertinent information

17.
when reporting on and off duty

Objective: V
V
Evidence of behavioral aspects

18.
Collaborate with other team member as
needed
19.
Professional behavior & Punctuality.
20.
Emotional stability.

Signature of the evaluator Signature of the students

Remarks :
JAGANNATH GUPTA INSTITUTE OF NURSING SCIENCES

Evaluation format for Health Talk

NAME : :
 DATE

TOPIC : Total Marks : 25

Total
Sl.No. Criteria Marks Marks obtained
1 Organization of the presentation 4  
2 Depth and understanding 5  
Arrangement of the unit /
3 classroom 1  
4 Appearance 1  
5 Confidence level 1  
6 Voice and tone 2  
7 Communication skill 5  
8 Handling question 2  
9 Use of A V aids 2  
10 Time 2  

REMARKS :

Signature of the evaluator Signature of the students