Mindanao State University

Iligan Institute of Technology

COLLEGE OF NURSING

CLINICAL PERFORMANCE AND EVALUATION CHECKLIST

February 27-29, 2017
8:00 AM- 4:00 PM

Direction: Put a check on the skills observed / performed.

Legend:

5- Outstanding
4- Very Satisfactory
3- Moderately Satisfactory
2- Minimally Satisfactory
1- Unsatisfactory

A. KNOWLEDGE 5 4 3 2 1
Knowledge of the different methods used in physical
assessment.
Identifies nursing problems of patient and its cause.
Knowledge in setting goals and prioritization of patients
needs.
Knows intervention to be given and the rationale.
Knows the theories and rationale behind nursing procedures
being implemented.

B. SKILLS 5 4 3 2 1
Checks, records and interprets accurately the vital signs of
assigned patients.
Implements nursing care according to priorities.
Provides health teaching for patient.
Coordinates with other members of the health team with
regards to patients condition.
Records accurately patients condition and nursing
intervention.

C. ATTITUDES AND VALUES 5 4 3 2 1

Punctuality and regular in attendance.
Professionalism in uniform.
Sense of responsibility.
Polite and Respectful to self and others.
Aware and understands the needs and emotions of others.

Comments:
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