SREE GOKULAM NURSING COLLEGE,VENJARAMOODU

CLINICAL EVALUATION PERFORMA

MEDICAL SURGICAL NURSING
Name of the Student: Area:
SL CONTENT ALWAYS MOST SOMETIMES ALWAYS
No OF
TIME
A. Personality factors
1. Turn out in uniform in neat and
clean
2. Clean and well kempt
3. Interacts pleasantly with all
4. Alert and quick to act
5. Shoulders responsibility for ward
assignment

6. Punctual for clinical duty

B. Attitude
7. Takes correction well
8. Puts across points in an amicable
way
9. Submits assignments on time
10. Self directed in clinical condition
C. Knowledge and skill
11. Able to identify clinical condition
12. Aware of ward routine
13. Can correlate symptoms with
pathophysiology

14. Can explain the Action and side

effects of drugs

15. Aware of nursing responsibilities

while administering medications
16. Demonstrate skill in physical
examination
SL.No Content Always Most of the times Sometimes Rarely
17. Performs Procedure correctly
18. Applies scientific principles of
communication while
interacting with techniques
19. Follows medical and surgical
aseptic techniques
20. Identify patient problems
21. Prioritize the needs and
problems
22. Formulate nursing diagnosis
23. Implements care as planned
24. Evaluates care given
25. Documents accurately the care
given
TOTAL
Pen Picture

Signature of faculty
Signature of student

SCORE GRADE Grade Mark

90-100 A+ Always 4
80-89 A Most Of 3
The Times
70-79 B+
Sometimes 2
60-69 B
Rarely 1
50-59 C
Below 50 D