EASHWARI BAI COLLEGE OF NURSING

CLINICAL EVALUATION PERFORMA

OBSTETRICS AND GYNAECOLOGY NURSING-I

AREA: ANTENATAL WARD MAXIMUM MARKS:

NAME OF THE STUDENT: YEAR/COURSE: FIRST MSC (N)

PROCEDURE: Antenatal Assessment DATE:

S.N CRITERIA 1 2 3 4
O
I KNOWLEDGE, SKILL & APPLICATION

1. Demonstrates sound scientific knowledge &

understanding in his/her dealings with patient and
family.
2. Demonstrates ability & skill in history taking of the
mother antenatal history

3. Demonstrates skill in antenatal assessment

4. Demonstrates skill in identifying the needs &

problems of antenatal mothers
5. Demonstrates ability to analyze & plan care for
antenatal mothers

6. Demonstrate ability to implement the planned care to

antenatal mothers

7. Demonstrate ability in preparing patients for surgical

intervention if necessary

8. Able to perform & assist in diagnostics and treatment

modalities.

9. Demonstrate skill in intrauterine fetal monitoring

10. Makes relevant observations & record & reports them

promptly & effectively

11. Identifies risk factors & manages emergency situation

effectively & promptly

12. Works independently & makes prompt, relevant

decisions in all situations.
13. Able to carry out health talks & incidental health
teachings effectively.
 14. Demonstrates sound knowledge of drugs used safely
during antenatal period

15. Able to establish therapeutic relationship with the

patient & family.

II PERSONALITY ASPECTS

16. Personal grooming & turn-out in uniform

17. Patient, keen & effective listener

18. Courteous, tactful & considerate in all her dealings

with colleagues, seniors, staff, patients & their family

19. Expresses ideas, concepts concisely

20. Enthusiastic & interested , takes interest in clinical

settings

21 Follows instructions & exhibits positive behavioral

change whenever required

22. Displays emotional maturity in clinical settings

23. Practice economy in relation of time & effort,

material.

24. Demonstrates evidence of self-learning by additional

reading current literature

Special comments of Clinical Supervisor: 1.______________2.________________

Response of the Student: 1.________________2.______________________

Signature of Clinical Supervisor

Signature of Student

Signature and Seal of Principal