HEALTH TEACHING PLAN

Name of Patient:_______________ Age:_____ Gender: ___Room Number:__________

Date: ____________ Chief Complaints:____________________________
Diagnosis/Impression:______________________________________________________
Attending Physician: ________________________________________

Objectives: (at least 3)

1.
2.
3.

Learner’s Code:
Patient Spouse Father Mother Sitter Others:

Methods of Education:
Oral Discussion Demonstration Written Video Translator Group

Barriers to Learning:
Communication Difficulties Physical Impairment Cognitive Impairment None
Sensory Impairment Cultural/Religious Others/Complex: Language Emotional

Materials Needed
1.
2.
3.
General Health Teachings Specific Health Teachings

Performance Learner Code:

Verbalized Understanding Demonstrate Ability Reinforcement Recommended
Did not understand

Evaluation:

References: (at least 2)

Date/Time Performed:
 DISCHARGE PLAN

Name of Client:________________________ Age: ________ Gender: _____________

Religion: _______________
Diagnosis: __________________________________________________
Surgery if any:_________________________________________________________
Hospital: ____________________________ Room/Ward Bed No. _________________
Attending Physician/s: ____________________________________________________

A. OBJECTIVES
At the end of an hour of health education the client will be able to:
1.
2.
3.
4.
5.

B. METHODS
1. Medications
Name of Drug Dosage Route Curative Side Instructions
(Generic and Preparation Effects Effects
Trade Name) Frequency
Duration

2. Exercise/Activity and Home Environment

Types of activity that should not be allowed:

Type of Activity Allowed/To be continued:

Restrictions:
 Home Environmental Hazards:

3. Treatments/Therapies

4. Health Teaching/Education
Health Prevention/Promotion

5. OPD Visit
Clinic Appointment Schedule:
Follow-up Diagnostic or Laboratory Exam:
Referrals:
6. Diet
a. Prescribed Diet:

3- Day Sample Menu

Day 1 Day 2 Day 3

Breakfast

Lunch

Dinner

b. Diet Restrictions:

7. Spiritual Care and Psychological or Sexual Needs

Spiritual and Psychological Needs
( ) Spiritual Counseling
( ) Grief Work
( ) Anger Management
( ) Confession
( ) Family Therapy
( ) Reconciliation of Conflicted Relationships
( ) Supportive Counseling
( ) Join Church Organizations/Activities
( ) Prayer
( ) Meditation, Reflection, and Spiritual Devotion
( ) Religious Rituals
 ( ) Religious/Spiritual Materials

Sexual Needs
( ) Marriage Counseling
( ) Sex Therapy
( ) Sexual Violence
( ) Referral to Appropriate Agencies

C. DISCHARGE DETAILS
a. Date and Time of Discharge:
b. Accompanied by:
c. Mode of Transportation:
d. General Condition upon Discharge:

This discharge plan was explained to me by my student nurse and I have

understood it.

_____________________________
CLIENT/SIGNIFICANT OTHER
(Signature over Printed Name)

Instructed By: Approved By:

________________ ______________________
STUDENT NURSE CLINICAL INSTRUCTOR
(Signature over Printed Name) (Signature over Printed Name)
 NURSING CARE PLAN
Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
 ENDORSEMENT SHEET

Name: Date: ______________

Level: _____________ Group:_________ Area:_______________

Bed Number AM PM NOC

Patient’s Name:
Age:
Diagnosis/Impression/CC

Attending Physician/s

Vital Signs Temp= Temp=

CRT= CRT=
PR= PR=
BP= BP=
RR= RR=
Significant Findings upon
Assessment:

Meds due next shift & Hold,

NPO status, no stock

Diet

Ongoing IVF

IVF to follow

Intake: (oral, IV, OF, Meds in

large amount)
Output:

IV left

Nursing care rendered

Student Signature: ______________________

Clinical Instructor:
 TIME BUDGET

Time Activity Description

 CLINICAL EXPERIENCE REFLECTION JOURNAL

NAME:______________________________ Year:_________ Date:____________

LEARNING
OBJECTIVE(S) :_______________________________________________________________
_________________________________________________________________

DESCRIPTION OF EXPERIENCE(S)

1. Reflect on your feelings, attitudes and perceptions related to the clinical experiences. (AS
PRIMARY NURSE, MEDICINE NURSE, CHARGE NURSE, TEAM LEADER and
PRACTICING CI; ICU, ER, OR/DR NURSE, IN COMPLYING REQUIREMENTS &
INDIVIDUAL CONFERNCE).

2. Describe nursing interventions that you or others did.

3. Identify if any classroom theory /knowledge was helpful for this Clinical experience.

4. Analyze what you did well and what you could improve on.

5. Describe how this experience will affect how you handle a similar experience in the future.

Student Signature:

Clinical Instructor Comments:

Clinical Instructor Signature:

 ADVENTIST MEDICAL CENTER COLLEGE
San Miguel, Iligan City

SCHOOL OF NURSING
Related Learning Experience (Clinical)
1st Semester, AY 2022 – 2023

PRIMARY NURSE EVALUATION RUBRIC

Name _____________________________________________________ Section _________ Date __________________ Score _______

I. ASSESSMENT Demonstrated all Demonstrated 3 of the Demonstrated 2 of the Demonstrated 1 of

1. Assess clients in a timely and efficient manner. (4) assessment assessment activities assessment activities the assessment
2. Assess and report abnormal data and changes in client condition to the clinical instructor activities activities
3. Assess client’s learning needs as well as readiness for and barriers to learning
4. Identifies client’s priority problems and organizes work to meet those priorities

II. IMPLEMENTATION EXCELLENT VERY SATISFACTORY POOR

Complete and SATISFACTORY Missed three to four Missed five or more
Performance comprehensive Missed one to two steps of Primary nurse steps of Primary
steps of Primary nurse evaluation nurse evaluation
implementation evaluation
1. Comes to clinical mentally and physically prepared to provide safe and effective care
2. Gathers adequate, relevant information for decision making
of
Primary nurse
3. Uses correct techniques for physical assessment
evaluation
4. Performs task with minimal supervision
5. Performs nursing skills efficiently and competently
6. Demonstrates caring, compassionate behaviors towards clients and family
7. Calculates medications dosages and IV rates correctly. Follows correct procedures in preparing and
administering medications. Check 12 rights and client identifiers prior to medication administration.
8. Maintains a safe and environment for the patient (side rails, call light, etc.)
9. Protect clients, self and others from injury, infection and harm (e.g., universal precaution)
10. Use appropriate teaching and learning principles when implementing the health education Plan and
Discharge Plan
11. Establishes rapport to patients, family and members of the health team
12. Provides appropriate information to clients and families
13. Uses appropriate and respectful words and tone in verbal communications. Addresses superiors
appropriately (being courteous)
14. Adapts communication strategies based on client’s age, developmental level, disability, and culture
15. Utilizes channel of communication
16. Anticipate needs of the health care team in meeting client and agency needs
17. Applies conflict resolution and problem-solving skills as appropriate
18. Facilitates continuity of care within and across health care settings (endorses appropriately to ward
NOD)

Aftercare and Documentation

1. Ensures client’s ADLs are completed
2. Evaluates the effects of medications administered. Conducts drug study prior to drug administration
3. Updates on the new trends and issues in nursing

III. QUALITY OF PERFORMANCE EXCELLENT VERY SATISFACTORY POOR

Spontaneity (spontaneous in communication) Demonstrated all SATISFACTORY Demonstrated two Demonstrated 1
(4) qualities of Demonstrated 3 qualities of quality of
Articulation: diction and grammar performance qualities of performance performance
Mastery of the subject matter performance
Maintains a safe environment

IV. CONFIDENCE EXCELLENT VERY SATISFACTORY POOR

Performed entire SATISFACTORY Performed entire Not able to perform
procedure with Performed entire procedure with entire procedure
great confidence procedure with minimal confidence with confidence
moderate confidence
V. TIMING (AT LEAST 15 MINUTES) EXCELLENT VERY SATISFACTORY POOR
Performed entire SATISFACTORY Performed entire Performed the
procedure within Performed entire procedure with 10 entire procedure
the allotted time procedure with 5 minutes excess on the with 15 minutes or
minutes excess on the allotted time more excess of the
allotted time allotted time.

Perfect Score: 20 points

Range of Scores:
18 – 20 --------------------------------------- Excellent
16 – 17--------------------------------------- Very Satisfactory
14 – 15 --------------------------------------- Satisfactory
13 and below ------------------------------- Poor
Assessed by:

_______________________________
Name and Signature of RLE Instructor