Sample Evaluative Tool
Sample Evaluative Tool
School of Nursing
87.19
STUDENT’S NAME: YEAR & SEC: Grade
AREA OF ASSIGNMENT: INCLUSIVE DATES: 0
CLINICAL INSTRUCTOR: SEMESTER: GROUP:
Responsibility 2 – Utilizes the Nursing Process in the Interdisciplinary Care of Clients that
Empowers the Clients and Promotes Safe Quality Care
COMPETENCY 5 4 3 2 1
Ensures a working relationship with the client and/or support system based on trust,
2.1 4
respect and shared decision making.
2.2 Assesses with the client (individual, family, population group, and /or community) 4
one’s health status/competence
2.3 Formulates with the client a plan of care to address the health conditions, needs, 4
problems and issues based on priorities.
2.4 Implements safe and quality interventions with the client to address the health needs, 4
problems and issues.
Provides health education using selected planning models to targeted clientele
2.5 4
(individuals, family, population group or community)
2.6 Evaluates with the client the health status/competence and/or process/expected 3
outcomes of nurse-client working relationship
2.7 Document client’s responses / nursing care services rendered and processes/outcomes 4
of the nurse client working relationship
Responsibility 3 – Maintains Complete, Accurate & Up-To-Date Recording & Reporting System
COMPETENCY 5 4 3 2 1
3.1 Ensure completeness, integrity , safety , accessibility & security of information 4
Adheres to protocol and principles of confidentiality in safekeeping and releasing of
3.2 4
records and other information.
3.3 Implements system of informatics to support the delivery of health care. 4
Responsibility 4 – Establishes Collaborative Relationship with Colleagues & Other Members of the
Team to Enhance Nursing & Other Health Care Services
COMPETENCY 5 4 3 2 1
4.1 Ensures intra-agency, inter-agency, multidisciplinary & sectoral collaboration in the 4
delivery of health care.
4.2 Implements strategies/approaches to enhance /support the capability of the client and 3
care providers to participate in decision making by the inter professional team.
A. COGNITIVE
1. Quizzes 95.00 x 10% = 9.50
2. Requirements
DAILY:
a. Uniform / Paraphernalia 100.00 x 10% = 10.00
b. Teaching Care Plan/ Structured Activity 95.00 x 15% = 14.25
c. Anecdotal Report/ARAS 92.00 x 10% = 9.20
Weekly:
d. Reading 92.00 x 10% = 9.20
e.Drug Study 90.00 x 10% = 9.00
f. IDB 91.00 x 15% = 13.65
g.Family Nursing Care Plan 89.00 x 10% = 8.90
h. Family Coping Index 89.00 x 10% = 8.90
i. MMDST/Physical Assessment 90.00 x 10% = 9.00
total for requirements (written) 92.10 x 20% = 18.42