MIZORAM COLLEGE OF NURSING

Format for Nursing Care Plan Evaluation

SUBJECT: MEDICAL SURGICAL NURSING

Name of Student:
Roll No. :
Area of Clinical Experience:

SI.No. Content Marks Marks Obtained

1 History Taking 4
2 Problems Identified 2
3 Formulation of nursing diagnosis 3
4 Planning of Care 4
5 Implementation & Evaluation 8
6 Health Teaching 2
7 Timely Submission 2
TOTAL 25

Comments:

Signature of Supervisor
 MIZORAM , COLLEGE OF NURSING
FORMAT FOR NURSING CASE PRESENTATION EVALUATION

Name of the student r

•
Roll No
Area

SINo Content Marks Marks

obtained
1 Knowledge about patient 05

2 Language, voice, fluency, clarity 02

3 Knowledge about disease 10

4 Relating patient to disease 05

5 A.V Aids 05

6 Group participation 03

7 Presentation of nursing management 08

8 Write up 10 ;

9 Timely presentation 02
Total 50

•
Comments:

Signature of student : Signature of Supervisor

• 'f
 MIZORAM COLLEGE OF NURSING
EVALUATION CRITERIA FOR SEMINAR

Name of the student: ----------------------- Roll No: -----------

Class: ---'- Topic: _
Subject: _

SIno Criteria Marks Marks

Obtained
I. Preparation of the classroom 2
2. Personal appearance ')
.)

3. Introduction of the topic 3

4. Language, voice, clarity, fluency 3
s. Mastery of the topic 10
6. Group participation 5
7. A.V.Aids 6
8. Conclusion 2
9. Time management 3
10. Bibliography 3
II. Write up 10
Total mark 50

Positive points Points to improve

.,

Signature of the student Signature of teacher

 MIZORAM COLLEGE OF NURSING
FORMAT FOR HEALTH TEACHING EVALUATION

Name of the student : .

Topic .
Scores 5=Excellent, 4=Very good, 3=Good, 2=Fair, I =Poor Total=I 00 Marks
SI No Particular } 2 3 4 5 Score
I Planning & organisation
a) Formulation of attainable objectives
b) Adequacy of content
c) Organisation of subject matters
d) Current knowledge related to subject matters
2 Presen ta tion
a) J nteresting
b) Voice clear & audible
c) Adequate explanation
d) Effective use of A.V. Aids
e) Group involvement
f) Time management
3 Personal qualities
a) Self confidence
b) Personal appearance
c) Language
d) Mannerism
e) Self awareness of strong & peak points
4 Feedback
a) Recapitulation
b) Effecti veness
c) Group response
5 Submit assignment on time
6 Bibliography
TOTAL MARKS OBTAINED
• 100 Marks will be converted into 25

Comments/ Remarks:

Signature of student: Signature of supervisor

 MIZORAM COLLEGE OF NURSING
Format for Drug Book Evaluation
SUBJECT: MEDICAL SURGICAL NURSING

Name of Student
Roll No.
Area of experience

SI.No. Particular Marks Marks obtained

1. Name of the drug 2

2. Dose, time & route 2

3. Action 3

4. Indication 3

5. Contra-indication 3

6. Side effects 3

7. Nursing Responsibilities 7
8. Timely submission 2
TOTAL 25

Signature of Students Signature of Supervisor

Date
•
Date
 MIZORAM COLLEGE OF NURSING
MIZORAM: FALKAWN
SUBJ: COMMUNITY HEALTH NURSING
CLINICAL EVALUATION PROFORMA
Name of the student: Year:

SINo Areas Urban Rural

A Knowledge and understanding about family
1 Studies family health record and collects significant & appropriate data
2 interprets significant data and able to formulate short & long term objective correctly
B Home visit
3 Prepare plans based on the-health needs of the family and identified goals
4 Plan and organized home visit effectively
5 Establishes rapport with the family and able to communicate
effectivelyand tactfully with different individual/groups
C Health assessment and observation
6 Conduct physical health assessment of family members
7 Identifies deviation from normal and set priorities in home care activities
8 Plans and implements home care based on preset goals and health needs
9 Carry out simple home procedures
D Nursing activities carried out
10 Follow scientific principles
11 Skillful & able to do modification according to situation & available resources
12 Allow involvement and participation of the family members
13 Interprete reports correctly & maintain records
14 Takes corrective action
E Health information/ Health Teaching
15 Uses every opportunity for incidental! planned teaching for individual & group
16 Follows appropriate teaching learning principles
F Post visit
17 Reports significant information
18 Completes records promply, precisely and accurately ..
G Professional qualities
..
19 Professional appearance-Wears clean, tidy uniform, well groomed .
20 Shows positive attitude towards criticism & suggestions
Total marks
Signature of student
Signature of Supervisor
Signature of Coordinator
Signature of Principal •
Total marks-l 00 Grading: Excellent-5, V good-4, Good-3, Fair-2, Poor-l