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COLLEGE OF NUMBER PIMS ISLAMABAD

Clinical Practicum
Objective Form

Dated…………………………………………….…., Week………………………..…….,Unit:…………………
Sr. No Objectives Strategies Achieved Not Achieved Remarks
1 Attend the pre/conference
meeting with clinical instructor
2 Reach in ward at time
3 Introduce myself with nurse
4 Orientation given by in charge
5 Select the patient in ward
6 Introduce to patient
7 Build relation with patient
8 Assess and analyze the patient
9 Assess patient needs and provide
nursing care to patient
10 Formulate nursing Diagnosis
11 Make a nursing care plan
12 Implement NCP according to
diagnosis
13 Evaluate nursing intervention
14 Leave ward inform in charge
nurse
15 Attend post conference meetings

Preceptor sign,…………………………….. Faculty Sign…………………………………

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