URDANETA CITY UNIVERSITY

(formerly City Colleges of Urdaneta)

San Vicente West, Urdaneta City, Philippines-2428 Paste Picture
Telefax No.: 075-568-7612 here!!
Email Address: info@ucu.edu.ph

COLLEGE OF NURSING

EVALUATION OF RELATED LEARNING EXPERIENCE

Name: _______________________________________ Date of Experience: _____________

Year & Section: _________________ Area: _________________________

I. SKILLS (40%)

A. SKILLS EVALUATION (20%)

1. Is able to identify and meet overt and covert patient’s needs
2. Establishes activities in a given workload
3. Carries activities in a systematic workload
4. Is able to analyze situations and decides for appropriate nursing measures before
resorting to medical interventions
5. Takes necessary precautions in carrying our doctor’s order and nursing procedure
6. Carries out nursing care with gentleness
7. Substitutes for what is lacking and make use of what is available
8. Understands and applies principles as basis for procedures and nursing actions
9. Charts neatly, legibly, correctly and systematically
10. Communications clearly with patient family
Total Score:

B. REQUIREMENTS (20%)
(NCP, journal readings, drug study, case study, case presentation, etc.)
Total Grade: _______

II. KNOWLEDGE (40%)

A. KNOWLEDGE EVALUATION (20%)

1. Integrates and strives to increase her knowledge on patient care
2. Creates alternative nursing actions if one fails
3. Makes an analytic comparison of theoretical knowledge with those observed in the
clinical situation of the patient
4. Observes and reports any significant symptom or changes in the patient’s condition
5. Makes accurate informative and pertinent report and records
Total Score:
B. EXAMINATIONS (20%)
(Quizzes, evaluation examination)
Total Grade: _______

III. ATTITUDE (20%)

A. PERSONAL APPEARANCE (5%)

1. Maintains good health and vitality
2. Reports to duty with the required attire
3. Appears well groomed and maintains good poise while on duty
Total Score:

B. PROFESSIONAL ASSETS (5%)

1. Has a reasonable control of emotions
2. Maintains good interpersonal relationships
3. Accomplishes workload given to a designated time
4. Accepts suggestions and criticisms graciously and shows effort to overcome
shortcomings and liabilities
5. Shows leadership ability
Total Score:

C. ATTENDANCE (10%)
1. Always comes on or before the time
2. Never been absent
3. Always brings with him/her required paraphernalia
Total Score:

SUMMARY OF GRADES:

I. SKILLS: ____________
II. KNOWLEDGE ____________
III. ATTITUDE ____________

FINAL GRADE: ___________

CONFORME:

_____________________________ ___________________________
SIGNATURE OF STUDENT CLINICAL INSTRUCTOR
(Sign above printed name) (Sign above printed name)