MANILA TYTANA COLLEGES MANILA DOCTORS COLLEGE OF NURSING EVALUATION CHECKLIST GROWTH AND DEVELOPMENT Name of Student:_______________________ Area

a of Assignment: Tondo Elementary School Date of Exposure: ______________________ Clinical instructor: ______________________
ROTATION GRADE

Directions: Please rate the students level of competency on each expected skill using the scale provided 2 DONE INDEPENDENTLY (Student demonstrates excellent skills, exhibits competency independently) 1 DONE WITH ASSISTANCE (Student demonstrates fair strength in demonstrating skills with close supervision) 0 NOT DONE (Student did not exhibit competency. Needs improvement)

BEHAVIOR/ COMPETENCY

SCORE 1 0

N/A

REMARKS

Safe and Quality Nursing Care/ Communication/ Collaboration and Teamwork/ Health Education I. Before the Test 1. The child can see and reach test materials easily 2. Explains the purpose of MMDST 3. Explains that the child is not expected to perform everything asked of him 4. Calculates age of a child after asking parents the childs birth date. 5. Before drawing age line, identifies if the child is born prematurely 6. Draws the age line correctly 7. Indicates the date test was administered at top of age line Safe and Quality Nursing Care/ Communication/ Collaboration and Teamwork During the Test Assures cooperation of child by: 8. Gives child a chance to become used to the examiner 9. Starts each sector of test with items the child could pass 10. Tells child what to do rather than asking 11. Clears table of materials which are not being used 12. Asks leading questions when asking parents report(e.g. suggest answer) 13. Praises the child ONLY when he correctly performed an item 14. Asks the parent if the behavior of child typical of his usual behavior 15. Gives enough items (at least 3 passes and 3 failures in each sector) Safe and Quality Nursing Care/ Communication/ Collaboration and Teamwork/ Records Management After the test 16. Shades right end of bar to emphasize delays 17. Indicates delays only on those items failed which were completely to the left of age line 18. Interprets test performance correctly Page 1 of 2

BEHAVIOR/ COMPETENCY

SCORE 1 0

N/A

REMARKS

19. Writes observations on back of form TOTAL ***Based on the MMDST Manual, Second Edition, 1999,UP Manila College of Nursing, pp.81-82 COMPUTATION OF GRADE: 1. Get the sum of all points for the entire procedure. 2. Use the formula below to get the final grade for this particular competency checklist. Formula: RAW SCORE PERFECT SCORE X 60 + 40 = FINAL GRADE

________________________________ Signature over printed name Student Date: __________________

_______________________________ Signature over printed name Clinical Instructor Date: __________________

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