COLEGIO SAN AGUSTIN-BACOLOD

COLLEGE OF HEALTH AND ALLIED PROFESSIONS

P.O. Box 120, B.S. Aquino Drive,
Bacolod City, 6100 Philippines
Tel. No. (034) 434-2471/ (034) 434-7887
CSA-B Website: www.csab.edu.ph

NURSING PROGRAM

PERFORMANCE EVALUATION TOOL

TEAM NURSING EXPOSURE

Name of Student: _________________________________________________

CLINICAL COMPETENCIES STANDARD DESIRED 1st

RATING RLE
DATE
AREA
TOTAL No. HOURS/ EXPOSURE
LEVEL
SEMESTER
ACADEMIC YEAR
I. SAFE AND QUALITY NURSING CARE
1. Demonstrates knowledge based on the health/ illness status of the patients.
a. recognizes patients problem and interprets them to team. 1
b. Formulates an effective Nursing Care Plan with team members. 1
c. Identifies the health needs of the clients. 1
d. Explains the health status of the clients. 1
2. Provides sound decision making in the care of individuals/ families/
groups considering their beliefs and values
a. Identifies clients’ wellness potential and/ or health problems. 1
b. Gathers data related to the health condition. 1
c. Analyzes the data gathered. 1
d. Select appropriate action to manage the health problems of the clients. 1
e. Monitors the progress of the action of the team members. 1
3. Promotes safety and comfort of patients in the clinical Area
a. Evaluates effectiveness of care given by the team members. 1
b. Assess patients’ needs skillfully and establishes priority through frequent rounds. 1
c. Identifies age- specific safety and comfort measures in all aspects of client. 1
d. Identifies age- specific measures to ensure privacy in all aspect of client care 1

4. Sets priorities in nursing care based on clients’ need

a. Identifies the priority needs of clients 1
b. Direct team members in providing appropriate nursing care to clients 1
5. Formulates a plan of care in collaboration with clients and other members of the
health team.
a. Develop or update nursing care plan 1
b. Collaborates with other members of the health team. 1
c. States expected outcomes of nursing intervention maximizing clients’ 1
competence to the members of the team.
6. Implements planned nursing care to achieve identified outcomes
a. Carries out and identified changes in the doctor’s order. 1
b. Assist the doctor during rounds. 1
c. Interprets doctors order correctly. 1
d. Implements the doctors order accurately. 1
7. Evaluates progress toward expected outcomes
a. Monitors effectiveness of nursing interventions 1
b. Revises care plan based on expected outcomes 1
II. MANAGEMENT OR RESOURCES, ENVIRONMENT ANS EQUIPMENT
1. Organizes work load to facilitate timely patient care.
a. Identifies tasks or activities that need to be accomplished of the unit. 1
b. Makes patient assignment to each member of the team. 1
c. Delegates tasks and procedures to members of the team. 1
d. Finishes work assignment on time. 1
2. Utilizes financial resources to support client care.
a. Identifies the cost- effectiveness in the utilization of resources. 1
b. Develops budget considering existing resources for nursing care. 1
3. Establishes mechanism to ensure proper functioning of equipment.
a. Plans for preventive maintenance program of the unit. 1
b. Check proper functioning of equipment considering the 1
- Inted4ed use
- Cost benefit
- Infection control
- Safety
- Waste creation and disposal storage
c. Refers malfunctioning equipment to the appropriate unit. 1

4.Maintains a safe environment of the unit:

a. Complies with standards and safety codes prescribed by laws. 1
b. Adheres to policies, procedures, and protocols on prevention and control of 1
infection.
III. HEALTH EDUCATION
1.Develops health education plan based on assessed and anticipated needs of the
clients.
a. Formulates a comprehensive health education plan. 1
b. Involves the client, family and significant others and other resources in identifying 1
needs on behavior changes for wellness, healthy lifestyle or management of
health problems.
2. Develops information education materials appropriate to the level of clients 1
3. Monitors client and family responses to health education 1
IV. LEGAL RESPONSIBILITIES
1.Adheres to practices in accordance with nursing law and other relevant
legislation including contracts, informed consent.
a. Confirms information given by the doctor for informed consent 1
c. Secures waiver of responsibility for refusal to undergo treatment or procedure. 1
d. Check the completeness of informed consent and other legal forms. 1
2. Articulates the vision, mission of the institution where one belong 1
3. Acts in accordance with established norms of conduct of the institution/ 1
organization.
4. Accomplishes accurate documentation in all matters concerning client care in 1
accordance to the standards of nursing practice.
V. ETHICO-MORAL RESPONSIBILITY
1. Renders nursing care consistent with the client’s bill of rights (confidentiality of 1
information, privacy, etc.)
2. Accepts responsibility and accountability for own decisions and actions as a Team 1
Leader.
3. Adheres to the national and international code of ethics for nurses. 1
4. Reports unethical and immoral incidents to proper Authorities 1
VI. PERSONAL AND PROFESSIONAL DEVELOPMENT
1 Identifies own learning needs
a. Identifies one’s strengths, weaknesses/limitations 1
b. Determines personal and professional goals and aspiration. 1
2. Projects professional image of the nurse.
a. demonstrate good manners and right conduct at all times 1
b. dresses appropriately and well groomed 1
c. Punctual in reporting to duty 1
d. carries complete paraphernalia and requirements. 1
e. Behaves appropriately at all times. 1
3. Possesses positive attitude towards change and criticism
a. Listens to suggestions and recommendations 1
b. Tries new strategies and approaches 1
c. Adapts to changes willingly 1
4. Performs function according to professional standards
a. Assesses own performance against standard of practice 1
b. Sets attainable objectives to enhance nursing knowledge and skills 1
VII. QUALITY IMPROVEMENT
1. Identifies appropriate quality improvement methodologies for clinical problems. 1
2. Detects variation in specific parameters i.e. vital signs of the client from day to day 1
2. Solicit feedback from client and significant others regarding care rendered 1
3. Shares with the team relevant information regarding the clients condition and 1
significant changes in clients’ environment
4. Conduct nursing care conferences 1
5. Provides appropriate suggestions on corrective and preventive measures on clients 1
care.
6. Communicates with physicians and other health care personnel 1
VIII.RESEARCH
1. Gather relevant data using various research methodology. 1
2. Applies research findings in nursing practice. 1
3. Recommends practical solutions appropriate to the problem based on the 1
interpretation of significant findings.
IX. RECORDS MANAGEMENT
1. Maintains accurate and updated documentation of patient care.
a. Completes updated documentation of client care 1
b. Monitors and improves accuracy, completeness and reliability of relevant data 1
c. Makes record readily accessible to facilitate clients care. 1
2. Maintains integrity, safety, access and security of records. 1
3. Observes confidentiality and privacy of client’s records. 1
4. Maintains an organized system filing and keeping clients’ records in a designated 1
area.
5. Follows protocol in releasing records and other information. 1
X. COMMUNICATION
1. Establishes rapport with patients, significant others and members of the health 1
team.
2.Utilizes effective channels of communication relevant to client care management 1
XI. COLLABORATION AND TEAMWORK
1. Contributes to decision making regarding client’s needs and concerns 1
2. Participates actively in client care management including audit 1
2. Recommends appropriate intervention to improve client care 1
3. Respect the role of other members of the health team. 1
4. Maintain good interpersonal relationship with clients, colleagues, and other 1
members of the health team.
TOTAL SCORE 85

First Graded RLE : Academic Year __________ 1st Sem____ 2nd Sem____ Summer _____

_________________________________ __________________________________
Clinical Instructor’s Signature/Date Student’s signature/Date

GRADING SYSTEM:

WRITTEN REQUIREMENTS:
Specific objectives with narrative evaluation at the end of the week 5 points
Daily assignment sheet 30 points
Daily attendance with scheduled snacks/meals with reliever 25 points
Readings (2) with reaction - Leadership and Management 20 points
List of daily activities of a Team Leader 20 points
__________
100 points

100 points = Equivalent x 60%

TEAM CONFERENCE: 75 Points = Equivalent x 20%

PRE/POST TEST: Scores = Equivalent x 20%
________
100%
FINAL GRADE:
Written Requirements + Team Conference + Pre/Post Test x 50%
Performance Rating (PEC) Scores = Equivalent x 50%
______
RLE GRADE 100%