CU-QMS-NURSING-006

Capitol University
College of Nursing CLINICAL PERFORMANCECHECKLIST FOR PEDIATRIC WARD Name: __________________________________ Level: __________________________________ Period of Rotation: _____________________ Rating: _______________________________ RATING 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4

I: KNOWLEDGE / COGNITIVE (40%) 1. Identify significant assessment limits, diagnostic examination And laboratory findings pertinent to child’s condition. 2. Identify child’s growth and development 3. Correlates significant clinical manifestation with the Pathophysiology of the disease condition. 4. Identify common problem on different age group And prioritize them accordingly 5. Formulates appropriate, relevant & realistic nursing Care plan 6. Formulates specific, measurable, attainable nursing, goals and objectives and identifies independent /dependent nursing function. 7. Familiarized and explained the indication of drugs and solution used in child’s care 8. Describes the health benefits of breastfeeding and nutritional options to the non-breastfeeding infant.

9. Anticipates discharged planning.
10. Evaluates and assess the effectiveness of care rendered. II: SKILLS/ PSYCHOMOTOR (40%) 1. Conduct physical assessment on child general appearance and obtain vital sign. 2. Provide child needs during their acute, chronic and life – threatening illness. 3. Observes and assist other member of the health team during the intensive diagnostic procedure. 4. Records and reports significant data/observation about the child’s condition with promptness and accuracy. 5. Perform nursing procedures skillfully, (NGT feeding, Pulmophysiotheraphy, 02 therapy, specimen collection, Chest tapping and positioning.) 6. Prepares, administer & documents medicines given as ordered. 7. Provide practical and psychosocial support for the family with high risk child. 8. Perform routine therapeutic intervention & maintain Thermo-regulation. 9. Records appropriately on the flow sheets and narrative nurse’s notes 10. Organized work & manage time effectively & ensure environmental safety. III: ATTITUDE /AFFECTIVE (20%)

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1. Abides all institutional policies.
2. 3. 4. 5. Accept nursing service responsibilities with interest and willingness to work Allows considerable time to be with the patient and give physical and emotional & spiritual support to patient significant others. Accomplishes assigned task with no competence, calmness, confidence, compassion, initiative, resourcefulness and creativity. 1 Establishes professionalism with patients, co-students, nurses and other health team members.

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STUDENT’S SIGNATURE
______________________________ CLINICAL INSTRUCTOR

Issue: 05 April 2006

Revision Code : 003

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