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This document contains a student evaluation form for a clinical rotation. It evaluates the student on interpersonal skills, communication/technology/numerical skills, and psychomotor skills. For each category, it rates the student on a scale of 1 to 4 on demonstrating consistently exceeds expectations, often meets expectations, meets expectations, or some improvement needed. The form is filled out by the evaluator with ratings and remarks for each criteria. It also includes spaces for the student and evaluator's name and date.

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ameeralahmadi075
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10 views2 pages

2

This document contains a student evaluation form for a clinical rotation. It evaluates the student on interpersonal skills, communication/technology/numerical skills, and psychomotor skills. For each category, it rates the student on a scale of 1 to 4 on demonstrating consistently exceeds expectations, often meets expectations, meets expectations, or some improvement needed. The form is filled out by the evaluator with ratings and remarks for each criteria. It also includes spaces for the student and evaluator's name and date.

Uploaded by

ameeralahmadi075
Copyright
© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
Download as docx, pdf, or txt
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Name of Student: Year / Clinical Group:

Semester & School Year: Inclusive Dates of Clinical Rotation:


Legend:
4 pts. Consistently Exceeds Expectations (Student displays at time a consistently high level of skills, abilities, initiative, and
productivity)
3 pts. Often Meet Expectations (Student displays a high level of skills, abilities, initiative, and productivity in some areas, but
not consistently)
2 pt. Meets Expectations (Student displays and maintains reliable level of performance but needs enhancement of skills)
1 pt. Some Improvement Needed (Student displays inconsistency in the performance of the skills and frequently falls below
acceptable levels)

Learning Domains 4 3 2 1 Remarks


I. Interpersonal Skills and Responsibility
1. Observe punctuality in reporting to duty
2. Project a professional image of a nurse.
3. Maintain good interpersonal relationship with clients, colleagues
and other members of the institution
4. Respect the privacy, religious, cultural and ethnic practices of the
client and his/her family.
5. Adhere to policies, procedure, protocols in prevention and
control of infection.
II. Communication, Information Technology, Numerical
1. Utilize proper channels of communication
2. Accomplish accurate documentation in all matters concerning
client care based on standards of nursing practice.
3. Inform client and significant others of relevant information about
the present condition.
III. PSYCHOMOTOR
1. Conduct comprehensive health assessment
2. Perform infection control measures (hand washing, gloving, use of
mask and other universal infection control measures as needed)
3. Provide bedside care
4. Assess and monitor vital signs
5. Measure intake and output
6. Give/Administer medication safely
7. Monitor intravenous therapy
8. Change linens as needed
9. Perform other nursing procedure as required
a.
b.
c.
d.
e.
10. Render nursing care consistent with the client’s bill of rights.
Total Score

Student: Evaluator:
Date: Date:

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