Particulars 1 2 3 4 5

Assessment
History taking
Physical assessment
Nutritional assessment
Socio economic status
Physical environment of the family
Knowledge attitude and practice of the family
Community data collection
Identification of needs and family problem
Planning
prioritising the needs and the problem of the family
formulates nursing diagnosis
plan appropriate care
adequate preparation for home visit
plans appropriate health education
Implementation
Providing home care according to priorities
Skills in performing simple home procedure
Apply scientific principles
Maintenance of equipments
Give health teaching at community
Involves family members in the care
Recording and reporting
Evaluation
Evaluate the care provided
Modify the plan of care when required
Implement the modified plan of care
Total
For 100
Personal and professional behaviour
Groomed appropriately
Maintains punctuality
Dependable
Integrity
Emotional stability
Interpersonal relationship with health team members
Acceptance to the criticism and Corrections
Seek guidance and help from the nursing staff
May takes effective communication
Assumes responsibility for personal health
Total
For 100
Weightage Score

1
1.5
1
1
1
1
1.5
1.5

1
1
1
1
1

2
2
2
1
2
1.5
2

1
1
1

1
1
1
1.5
1
1
1
1
1
0.5
Particulars T Score
Assessment
History taking 3 3
Physical assessment 3 4.5
Nutritional assessment 3 3
Socio economic status 3 3
Physical environment of the family 3 3
Knowledge attitude and practice of the family 3 3
Community data collection 4 6
Identification of needs and family problem 3 4.5
Planning
prioritising the needs and the problem of the family 3 3
formulates nursing diagnosis 3 3
plan appropriate care 3 3
adequate preparation for home visit 3 3
plans appropriate health education 3 3
Implementation
Providing home care according to priorities 4 8
Skills in performing simple home procedure 2 4
Apply scientific principles 3 6
Maintenance of equipments 3 3
Give health teaching at community 3 6
Involves family members in the care 3 4.5
Recording and reporting 3 6
Evaluation
Evaluate the care provided 3 3
Modify the plan of care when required 3 3
Implement the modified plan of care 3 3
Total 91.5
For 100 61 Percentage
Personal and professional behaviour
Groomed appropriately 4 4
Maintains punctuality 4 4
Dependable 3 3
Integrity 3 4.5
Emotional stability 3 3
Interpersonal relationship with health team members 3 3
Acceptance to the criticism and Corrections 4 4
Seek guidance and help from the nursing staff 2 2
May takes effective communication 3 3
Assumes responsibility for personal health 3 1.5
Total 32
For 100 64 Percentage

Total 123.5
61.75