University of San Jose Recoletos

College of Nursing
Head Nursing Program
Unit Case Load Profile
Room/Bed No.

Clinical Picture

Patient Classification

Prepared by:

Noted by:

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University of San Jose Recoletos

College of Nursing
Head Nursing Program
Logbook of Activities
Date:_____________

Shift:_______________

Time

Area of Assignment:___________________

Activities

Rationale

References (for the Rationale):

Prepared by:

Noted by:

____________________________

__________________________

University of San Jose Recoletos

College of Nursing
Medication List Form
Bed No.

Patients

Medication and Time to be given

Prepared by:

Submitted to:

_____________________________________
Head Nursing Student (Medication Nurse)

_____________________________
Supervising Clinical Instructor

University of San Jose Recoletos

College of Nursing
Head Nursing Program
Assignment Plan
Date:_____________ Shift:_____________ Area of Assignment:____________________
Head Nurse/Charge Nurse on Duty:________________________________________________
Staff Nurse on Duty:____________________________________________________________
Nurse Aid:____________________________________________________________________
Ancillary Personnel:____________________________________________________________
Clinical Instructor:______________________________________________________________
Student Nurses:_______________________________________________________________
Personnel

Prepared by:
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Activities

Time

Noted by:
__________________________

University of San Jose Recoletos

College of Nursing
Head Nursing Program
Teaching Plan
Student Nurse Facilitator:_____________________________
Activity:___________________________________________

Date & Venue:_____________

Subject Matter (Content and Scope):

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Value Theme:________________________________________________________________
References:
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Learning Objectives:
Cognitive:____________________________________________________________________
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Affective:_____________________________________________________________________
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Psychomotor:_________________________________________________________________
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Methodology:_________________________________________________________________
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Instructional Materials:
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Lesson Procedure:____________________________________________________________
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Prepared by:______________________________
Noted by:________________________________