SAINT LOUIS UNIVERSITY School of Nursing Baguio City 2600 Philippines

EVALUATION TOOL – CLINICAL PRACTICE

Hospital and Community
NAME: PERALTA, Keanu Year and Section: BSN4 C Group: 4
Agency/Hospital Clinical Areas: SLU HSH
Term: 1st Semester 2021-2022 / Short term________ Duty Dates: Aug 17-18; 22-25, 2021
LEGEND:
4 = competent (The student performs consistently in an effective and efficient manner; with minimal supervision)
3 = progress acceptable (performance is usually effective and efficient but not always; with moderate supervision )
2 = needs improvement (performance is unsatisfactory, task performance is not done properly most of the time; with close
supervision )
1 = performance unacceptable (performance is ineffective and inefficient always; with very close supervision)
STANDARDS
Nursing Core Competencies:_ 108__points SCORE REMARKS
A. Integration of relevant concepts in the practice of nursing.
1. Integrates relevant principles of social, physical, natural and health sciences 4
and humanities in a given health and nursing situation.
2. Applies relevant nursing concepts and actions holistically and 4
comprehensively.
B. Application of the Nursing Process
3. Assesses with the client (individual, family, population group, and/or 3
community), one’s health status/competence comprehensively
4. Formulates with the client a plan of care to address the health conditions, 4
needs, problems and issues based on priorities.
5. Implements appropriate and quality interventions with the client to address 4
the health needs, problems and issues.
6. Promotes safety, comfort and privacy of clients 4
7. Provides health education to targeted clientele using appropriate tools and 4
strategies
8. Evaluates with the client the health status/ competence/expected outcomes 3
9. Institutes appropriate corrective actions to prevent or minimize harm 4
C. Effective Communication
10. Ensures a working relationship with the client and/or support system based 4
on trust, respect and shared decision-making
11. Communicates clearly, briefly, accurately and promptly all relevant 4
information in an organized manner , both in oral and written form to members
of the health team
12. Establishes therapeutic communication with clients and significant others 4
D. Reporting and Documentation
13. Documents accurately client’s responses, nursing care services rendered and 4
outcomes
14. Ensures completeness, integrity, safety, accessibility and security of 4
information.
15. Adheres to protocol and principles of data privacy and confidentiality in 4
safekeeping and releasing of information.
E. Management and Leadership
16. Manages resources ( human, physical, financial, time) appropriately 3
17. Utilizes critical thinking in making decisions/solving problems related to 4
client care
F. Ethico-legal Practice
18. Adheres to the Code of Ethics for Nurses 4
19. Applies ethical reasoning and decision making process to address situations 4
of ethical distress and moral dilemma
20. Protects clients rights based on “Patient’s Bill of Rights and Obligations.” 4
 G. Collaboration and Coordination
21. Establishes collaborative relationship with colleagues and other 4
members of the health team
22. Implements strategies to enhance/support the capability of the client to 4
participate in decision making by the inter-professional team.
23.Maintains a harmonious and collegial relationship among members of the 4
health team
24. Promotes relevant health-related advocacies (health promotion/prevention, 4
DOH/WHO programs and health laws implementation, etc.)
H. Techno-intelligent care
25. Uses appropriate technology to perform safe and efficient nursing activities 4
I. Research and Evidence-based Nursing Practice
26. Implements research-based/evidence-based strategies, initiatives or 4
innovations
J. Responsible Citizenship
27. Provides culturally appropriate and sensitive nursing care 4

ATTITUDES: 30 points

1. PROFESSIONAL VALUES
1 2 3 4
Does not demonstrate caring Sometimes demonstrate caring Often demonstrate caring as Consistently demonstrate
as the core of nursing, love of as the core of nursing, love of the core of nursing, love of caring as the core of nursing,
God, love of country and God, love of country and love God, love of country and love of God, love of country
love of people; does not of people; displays altruism love of people; displays and love of people; displays
display altruism and respect and respect for human dignity altruism and respect for altruism and respect for
for human dignity, does not on some occasions; minimally human dignity most of the human dignity; projects the
project the positive projects the positive time; projects the positive positive professional image
professional image of a professional image of a professional image of a of a Filipino Nurse.
Filipino Nurse. Filipino Nurse. Filipino Nurse.
2. LIFELONG LEARNING
1 2 3 4
No evidence of self-directed Minimal evidence of self- Moderate evidence of self- Clear evidence of self-
learning; does not assume directed learning; directed learning; often directed learning; assume
responsibility for own personal sometimes assume assume responsibility for responsibility for own
development and improvement responsibility for own own personal development personal development and
of competence. personal development and improvement of improvement of
and improvement of competence. competence continuously.
competence.
3. COMPASSION AND SENSITIVITY
1 2 3 4
Grouchy, no charisma, dull, Moody, minimal response Good disposition, shows Outstanding compassion
hostile to fellow workers, very to the needs of client, less moderate compassion and and sensitivity, always
little response to physical/ compassionate, with poor sensitivity, often emphatic, exhibits empathy, very good
emotional needs of patients and rapport with client and good rapport with clients rapport with patients and
family, paranoid, fellow workers, sometimes and fellow workers, often family, charismatic,
unapproachable, “couldn’t care displays inappropriate displays appropriate consistently displays
less” attitude, inappropriate responses ( verbal and responses (verbal and non- appropriate responses
responses (verbal and non- non-verbal). verbal). (verbal and non-verbal).
verbal).

4. CHRISTIAN VALUES
1 2 3 4
No commitment, disrespectful, Minimal display of Moderate display Evident consistent display
self-centered, ungrateful, lacks commitment, respect, commitment, respect, of commitment, respect,
harmony, poor disposition, humility, gratitude, humility, gratitude, humility, gratitude,
projecting hopelessness, and not harmony, joyful harmony, joyful disposition, harmony, joyful disposition,
service-oriented; does not disposition; minimal instilling hope, and service- instilling hope, and service-
promotes justice, peace, and efforts to instill hope, oriented with some focus on oriented with focus on
integrity of creation. promotes justice, peace, preservation of life and preservation of life and
and integrity of creation; conservation of the conservation of the
involuntary service- environment; promotes environment; promotes
orientedness. justice, peace, and integrity justice, peace, and integrity
of creation. of creation.
5. INTELLECTUAL INTEGRITY AND HONESTY
1 2 3 4
Intellectually dishonest, Intellectually honest in Demonstrates intellectual Demonstrates intellectual
provides misleading information most situations; honesty and integrity; honesty even in difficult
meant to defend and protect occasionally withholds accepts mistakes and situations; readily accepts
self; does not readily accept information when limitations. mistakes and limitations &
mistakes and limitations. confronted; occasionally makes conscious effort to
fails to accept mistakes improve on time.
and limitations.
6. RELIABILITY AND RESPONSIBILITY
1 2 3 4
Irresponsible, unreliable; needs Usually prompt but Performs duties promptly; Performs duties promptly
repeated reminders of performs just enough to get often flexible and adaptable; and efficiently without
assignments; not flexible and by; often not flexible and dependable in performing being reminded; is
adaptable; does less than adaptable; usually responsibilities without resourceful and innovative;
prescribed work. dependable but sometimes being reminded. always flexible and
needs reminders of adaptable; takes initiative to
assignment. spend additional time.
7. COMPLETE PRESCRIBED UNIFORM AND PARAPHERNALIA
1 2
Incomplete prescribed uniform and paraphernalia (more Complete & neat prescribed uniform and
than 4 occasions); often untidy and non-functional paraphernalia; always with prepared functional
paraphernalia. equipment/paraphernalia; maintains them in neat order.
8. PUNCTUALITY AND ATTENDANCE
1 2
Late in attendance and submission of requirements. Punctual in attendance and submission of requirements.

9. PARTICIPATION IN GROUP ACTIVITIES

1 2
Does not participate in activities. Actively participates in activities; eager to share ideas and
learn from others.
SUMMARY:
Core Comp Score ( 108) 105 Core Competencies Score 55% 53
Attitude Score (30) 28 Attitude Score 10% 9
Written exams 15% 11
Requirements 20% 15
TOTAL ROTATION GRADE 88
CONFORME:
CI’s Signature: Student’s Signature:
Date: August 30, 2021 Date: August 31, 2021
STUDENT’S COMMENTS ON CLINICAL EXPOSURE:

It is a challenging experience that involves to maintain, promote and restore the health of patients while following the procedures of the
hospital. Working at a health care facility offers a chance for a student nurse to practice what we had learned in school.

Student’s Signature: ___________________________________