CU-QMS-NURSING-0011

CAPITOL UNIVERSITY
COLLEGE OF NURSING

CLINICAL PERFORMANCE CHECKLIST FOR MEDICAL WARD

Name:______________________________ Period of Rotation:___________________

Level:______________________________ Rating:____________________________

I. KNOWLEDGE/COGNITIVE (40%) RATING

J.
1. Identifies significant assessment parameters, diagnostic exams and 4 3 2 1
laboratory findings pertinent to the patient’s condition.
2. Correlates significant clinical manifestations with the pathophysiology 4 3 2 1
of the disease condition.
3. Discusses nursing considerations in the care of clients undergoing 4 3 2 1
invasive diagnostic procedures and provide care when appropriate.
4. Formulates appropriate, relevant and realistic nursing care plan. 4 3 2 1
5. Identifies nursing diagnosis supported by appropriate assessment 4 3 2 1
parameters and prioritizes them accordingly.
6. Formulates specific, measurable and attainable nursing goals and objectives. 4 3 2 1
7. Identifies independent/interdependent nursing functions and discuss 4 3 2 1
comprehensively the rationale of such interventions.
8. Explains the indications of drugs and solutions used in patient care. 4 3 2 1
9. Anticipates discharge planning. 4 3 2 1
10. Evaluates and assesses the effectiveness of care rendered to patients. 4 3 2 1

II. SKILLS/PSYCHOMOTOR (40%)

1. Performs accurate physical assessment and obtain comprehensive 4 3 2 1
nursing history.
2. Implements plan utilizing appropriate and available resources. 4 3 2 1
6 3. Observes and assists other members of the health team during 4 3 2 1
7 invasive diagnostic procedures.
4. Performs independent and interdependent nursing functions 4 3 2 1
effectively and efficiently.
5. Records and reports significant data/observations about the patient’s 4 3 2 1
condition with promptness, accuracy, and conciseness.
6. Demonstrates nursing procedures skillfully (such as pulmophysiotherapy, 4 3 2 1
specimen collection, NGT feeding, exercises, positioning, O2 therapy,
hygiene measures, assisting with elimination, etc.)
7. Prepares, administers and documents medications given as ordered. 4 3 2 1
8 8. Records appropriately on flow sheets and narrative nurses’ notes. 4 3 2 1
9. Imparts effective health teachings to promote health and 4 3 2 1
prevent complications.
10. Organizes work and manages time effectively. 4 3 2 1

III. ATTITUDES/AFFECTIVE ( 20 %)
1. Abides with all institutional policies. 4 3 2 1
2. Accepts nursing service responsibilities with interest and 4 3 2 1
eagerness to work.
3. Allows considerable time to be with the patient and give 4 3 2 1
physical, emotional and spiritual support to patient and
significant others.
4. Accomplishes assigned task with competence, calmness, confidence, 4 3 2 1
compassion, initiative, resourcefulness and creativity.
5. Establishes professionalism with patients, co-students, 4 3 2 1
nurses and other health team members.
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STUDENT SIGNATURE ____________________________________
CLINICAL INSTRUCTOR’S SIGNATURE

Issue: 05 April 2006 Revision Code: 003