CU-QMS-NURSING-0012

CAPITOL UNIVERSITY
RLE 2A
Clinical Performance Checklist for Hospital Exposure

Name: ___________________________Period of Rotation: ______________________Rating: ________

l. Knowledge/Cognitive ( 40 % ) RATING

1. State Accurately principles of medical asepsis and body mechanics 4 3 2 1

Applied to be bed making.
2. Identifies significant vital signs results pertinent to patient to patient 4 3 2 1
Condition.
3. Correlates significant vital signs results to the patient condition 4 3 2 1
4. Discuss actively the purposes, indications and scientific principles 4 3 2 1
rationale. Involved in TPR taking BP monitoring and I & O
measurement.
5. Identify the normal values of temperature, pulse rate, respiration 4 3 2 1
rate and blood pressure.
6. Explain the purposes and scientific principles/rationale involved 4 3 2 1
in performing hygiene and comfort measures.
7. Explain the principles of medical asepsis and its practical 4 3 2 1
application in patient care with emphasis on handwashing.
8. Identifies and explains general interventions for common signs & 4 3 2 1
symptoms (e.g. chest tapping, tepid sponge bath, Oresol preparation)
9. Discuss considerations and interventions in promoting patient’s 4 3 2 1
healthy nutritional status.
10. Evaluate the importance of referrals for any significant findings. 4 3 2 1

II. Skills/Psychomotor ( 40 % )
1. Demonstrates ability to correctly make a closed, open or occupied bed. 4 3 2 1
2. Performs accurate Vital Signs taking as: 4 3 2 1
a. Cleaning thermometer correctly before insertion
b. Lowering the thermometer reading
c. Reading the thermometer correctly at eye level
d. Leaving the thermometer at correct duration of time
e. Cleaning the thermometer before reading
f. Returning thermometer correctly to the receptacle
3. Performs accurately the BP reading as: 4 3 2 1
a. applies the BP cuff correctly
b. reads correctly the Bp
c. does correctly the after care of the BP apparatus
4. Performs correctly the P.R. and R.R. monitoring as: 4 3 2 1
a. positions patient properly while taking P.R. and R.R.
b. applies enough pressure to any artery for reading
c. determines accurately the P.R. and R.R.
5. Records vital signs and I and O appropriately on monitoring/ flow sheets 4 3 2 1
6. Reports significant vital signs and data/observations about patient’s 4 3 2 1
condition with promptness and accuracy
7. Demonstrates skillfully the correct techniques in providing comfort 4 3 2 1
measures and maintaining a clean, therapeutic environment.
8. Assists patient with elimination, taking into consideration privacy 4 3 2 1
appropriate technique for serving the bedpan or urinal and
providing perineal care. \
9. Demonstrates skillfully ability to perform several aspects of hygiene 4 3 2 1
including baths, back rubs, oral care & hair care.
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. Shows positive attitude towards role required in the area. 4 3 2 1
3. Resourceful, innovative, and allows considerable time to be with patient. 4 3 2 1
4. Self-directed, highly motivated 4 3 2 1
5. Establishes professionalism with patients, co-students and other health
team members. 4 3 2 1
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STUDENT’S SIGNATURE CLINICAL INSTRUCTOR’S SIGNATURE

Issue: 05 April 2006 Revision Code: 003