STUDENT’S PERFORMANCE EVALUATION TOOL

SCALE:
4- Works competently and independently at all times
3- Requires minimum guidance and supervision
2- Requires frequent guidance and supervision
1- Requires frequent guidance and supervision most of the time
0- Do not exhibit expected behavior even under supervision
KNOWLEDGE (20%)
1. Applies their acquired knowledge, skills and attitude in 0 1 2 3 4
instituting comfort measures and other nursing measures
including drug administration and IV regulation and monitoring.
2. Identifies factors that may cause discomfort to patient and be
able to state the comfort measures to be provided.
3. Knows how to accurately compute for drug dosage depending on
the doctor’s order.
4. Effectively uses communication skills on establishing Nurse-
Patient relationship.

PERFORMANCE (20%)
1. Performs nursing procedures in providing comfort. 0 1 2 3 4
2. Administers medication appropriately and accurately.
3. Obtains comprehensive client information by checking the chart
for consent, medication, allergies, vital signs, history and
laboratory results and or diagnostic test.
4. Show efficiency in the performance of nursing procedures and
therapeutic like hygiene care, perilight therapy, perineal care,
proper positioning, assisting on physical examination, applying
drug administration, vital signs, I & O, IVF monitoring and proper
documentation and others.
5. Understands, interprets and carries out physician order
accurately.
6. Applies nursing procedures learned in Skills Laboratory like bed
making, IV therapy and others.
7. Uses proper recording system (e.g. making referrals, participating
during endorsements, etc.)
 8. Observes and performs other waste management procedures
according to hospital policy.
9. Uses effective communication skills during Nurse-Patient
interaction.
10. Provides correct information and summation during health
teaching
11. Listens attentively to client, client’s significant others, queries/
request and provides necessary feedback.
12. Spend time with the client to facilitate conversation that allows
client to express concern
13. Provide social, emotional, psychological and spiritual support.

PERSONALITY (30%)
0 1 2 3 4
1. Interpersonal relationship with patients, co-students, clinical
instructors, professional and non-professional hospital staff.
2. Demonstrates punctuality in reporting for duty.
3. Maintains personal appearance appropriate to the setting
4. Demonstrates punctuality in submitting requirements
5. Has complete paraphernalia ready for use anytime
6. Demonstrate sense of responsibility, Self-direction and ability to
follow instructions.
7. Applies bio-ethical principles and core values, religious, cultures
and ethnical practices of the client related to their treatment.
8. Maintains confidentiality of all client’s information related to
treatment
9. Maintains client privacy by preventing undue exposure
10. Updates oneself with the latest trends and development in
providing quality care.
11. Demonstrates good manner and right conduct at all times.

TO COMPUTE:

KNOWLEDGE: SCORE/16 X 100 X 20% 20

PERFORMANCE: SCORE/52 X 100 X 20% 20
PERSONALITY: SCORE/44 X 100 X 30% 30
REQUIREMENTS: SCORE/100 X 100 X 10% 10
EVALUATION: SCORE/# of Items X 100 X 20% 20_
TOTAL GRADES: 100

SUBMITTED BY:
___________________________________________________________ ________ _______________
(Signature over printed name of Clinical Instructor) Date

APPROVED BY:
__________________________________________________________
Melody M. Gatdula, RN, RM, LPT, MAN
Dean, College of Nursing Nueva Ecija Campus